93 Decision Citation: BVA 93-05034

 Y93 

                 BOARD OF VETERANS' APPEALS
                   WASHINGTON, D.C. 20420

DOCKET NO.  90-01 741       )    DATE
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                         THE ISSUES

1.  Entitlement to service connection for an organic brain
disorder.

2.  Entitlement to service connection for a psychiatric
disorder.

3.  Entitlement to service connection for headaches.

4.  Entitlement to service connection for an eye disorder.

5.  Entitlement to service connection for chronic
obstructive pulmonary disease.

6.  Entitlement to service connection for residuals of an
injury to the back and right hip, including arthritis.

7.  Entitlement to service connection for syncope.

8.  Entitlement to service connection for defective hearing
in the left ear.

9.  Entitlement to service connection for hallux valgus of
the right foot with hammertoes.

10. Entitlement to service connection for a heart disorder.

11.  Entitlement to an increased rating for retinal
detachment of the left eye, currently evaluated as
20 percent disabling.

12.  Entitlement to an increased rating for thrombophlebitis
of the right leg, currently evaluated as 10 percent
disabling.

13.  Entitlement to a compensable rating for residuals of
pulmonary emboli.

14.  Entitlement to a total rating based on individual
unemployability due to service-connected disabilities.

15.  Entitlement to a temporary total rating based on a
hospitalization at a VA facility from August 31 to
September 7, 1986.

                       REPRESENTATION

Appellant represented by:  Disabled American Veterans

               WITNESSES AT HEARINGS ON APPEAL

The veteran and his wife

                   ATTORNEY FOR THE BOARD

R. L. Shaw, Counsel
                        INTRODUCTION

The veteran had active military service from April 1975 to
January 1977 and from August 1977 through May 31, 1980.
(See further discussion of service dates below).

This matter is before the Board of Veterans' Appeals (the
Board) on appeal in part from a November 1986 rating
decision by the Cleveland, Ohio, Regional Office (RO) of the
Veterans Administration (now Department of Veterans Affairs)
(both VA).  A communication dated October 30, 1987, was
accepted by the RO as a notice of disagreement with ratings
assigned for thrombophlebitis of the right leg and pulmonary
embolism.  A statement of the case on these matters was
issued on February 19, 1988.  A substantive appeal (VA
Form 1-9) was received on October 13, 1988.  The appeal also
arises in part from a December 1988 rating decision by the
VA Regional Office in Huntington, West Virginia (hereinafter
RO), which denied service connection or increased ratings
for a number of additional disabilities.  A notice of
disagreement with these determinations was received on
January 17, 1989.  A supplemental statement of the case was
issued on March 1, 1989.  A hearing was held at the RO on
March 8, 1989; by a decision dated August 4, 1989, the
hearing officer confirmed and continued the denials.  A
supplemental statement of the case was issued on January 5,
1990.  A hearing was held before the Board on November 7,
1990, in Washington, D.C.

On December 27, 1990, the Board remanded the appeal in order
for the veteran to undergo a period of hospitalization for
extensive testing by a number of specialists to obtain
current information concerning the disabilities at issue.
It was also requested that additional treatment records be
obtained and that the question of entitlement to service
connection for headaches be adjudicated under the provisions
of law relating to finality of prior adjudication.
Examinations were performed on various dates in January,
February and March 1991.  By a rating decision of April 8,
1991, the prior adverse determinations were confirmed and
continued.  A supplemental statement of the case was issued
on April 17, 1991.  The case was received by the Board on
July 1, 1991, and the appeal was redocketed on July 8,
1991.  The veteran is currently represented on appeal by the
Disabled American Veterans; before October 1991, he was
represented by the Veterans of Foreign Wars of the United
States.

Included among the issues developed and certified for review
as part of this appeal is that of entitlement to service
connection for a psychiatric disorder.  However, it is clear
from the medical record that the veteran's current
psychiatric problems stem in large part from organic
pathology of the brain, the etiology of which is in
dispute.  Consequently, the issue of entitlement to service
connection for organic brain disease is inextricably
intertwined with the issue of entitlement to service
connection for a functional psychiatric disorder and must be
addressed herein.  Payne v. Derwinski, 1 Vet.App. 85
(1990).

Also included among the certified issues is that of
entitlement to a rating higher than 40 percent for right
footdrop due to pes cavus.  The veteran has indicated on
appeal that he does not disagree with the 40 percent rating
but does dispute the effective date (February 24, 1988)
assigned for it.  Consequently, the increased rating issue
has been dropped.  The issue of entitlement to an effective
date earlier than February 24, 1988, has not been developed
for appeal and is referred to the RO for appropriate
action.  The veteran has also disputed the effective date of
December 17, 1987, assigned for a 20 percent rating for a
detached retina of the left eye.  The issue of entitlement
to an earlier effective date for this rating is also
referred to the RO.  In his presentation on behalf of the
veteran, the representative of the Disabled American
Veterans has raised the additional issue of entitlement to
service connection for tinnitus on the basis of acoustic
trauma during service.  This issue is likewise referred to
the RO for appropriate action.

             CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends that a diagnosis of anxiety reaction
was reported during service in September 1979 and that the
same disorder was diagnosed during a VA hospitalization in
June 1988.  He asserts that the disorder was also shown on a
psychological assessment in September 1988 and that an
adjustment disorder with anxiety was noted during a
hospitalization at the Roane General Hospital in August
1989.  He maintains that the current psychiatric disability,
diagnosed as some form of organic pathology, cannot be
disassociated from the preceding anxiety reaction.
Specifically, he maintains that as a result of clots thrown
by the thrombophlebitis in the right lower extremity and
resulting pulmonary emboli, he had a number of "strokes"
which resulted in the current neurological impairment.  He
claims that the anxiety disorder matured into a dysthymic
disorder and eventually into multi-infarct dementia.  He
argues that service connection for any current organic brain
pathology should be recognized as service connected on a
secondary basis pursuant to 38 C.F.R. § 3.310(a) (1992).

With respect to headaches, the veteran contends that he
began to experience head pain during service after an injury
sustained in a fall from a tank at Fort Knox, Kentucky, and
that the headaches were documented on various occasions
during service.  He argues that headaches have been
regularly reported by both VA and private physicians since
separation and that a diagnosis of post concussion headaches
was reported at a VA examination in June 1980.

With respect to the eyes, the veteran argues that the
records dated from June 1980 to November 1982 show diplopia,
cataracts, esotropia and chorioretinitis due to
cauterization of the retinas.  He maintains that although
surgery for detached retina in the right eye was performed
before service, he continued to have problems with visual
acuity during service and had worse vision at separation
than at entrance.  He argues that retinal detachment in the
left eye during service, for which service connection has
been granted, resulted in undue strain on the right eye
which contributed to further impairment of visual acuity in
that eye and that service connection for the right eye
should be granted under 38 C.F.R. § 3.310(a) (1992).

With respect to chronic obstructive pulmonary disease, the
veteran argues that bronchitis was noted during service on
two occasions in 1979 and by a VA physician in February
1988.  He claims that examinations in service in 1978 and
1979 showed symptoms of shortness of breath as well as sinus
and chest congestion.  He states that post service medical
records have shown chronic obstructive pulmonary disease
since October 1986.  Alternatively, he notes that in
February 1981 a VA physician suggested that the disorder may
be the result of pulmonary embolism.

With respect to the back and hip, the veteran contends that
the fall from a tank in service resulted in an injury to
both areas and ultimately caused the onset of arthritis.  He
maintains that treatment for pain in the low and middle back
was shown in service on two occasions in May 1979 and that
clinical assessments of back strain were made.

With respect to syncope, the veteran contends that he has
recurrent episodes of blackouts and dizziness as a result of
the various disorders he claims are caused by the
service-connected thrombophlebitis.

With respect to his hearing, the veteran contends that an
April 1977 audiogram showed a hearing loss in the
conversational ranges of both ears.  He states that a mixed
hearing loss shown at a VA examination in August 1988
represents an increase in hearing deficit from the hearing
loss shown in service in 1977.  He claims that there has
been no intercurrent cause of the hearing loss since
service.  He attributes the loss of hearing to duty as an
offset pressman in service and to acoustic trauma from a
hand grenade explosion during basic training.

With respect to the right foot, the veteran contends that he
has hallux valgus with hammertoes which had its onset during
military service.  He claims that the disorder was noted in
March 1977 on an X-ray report which showed an old ununited
fracture of the phalanx of the fifth digit.  He states that
hammertoes were noted in April 1979.  He maintains that the
hallux valgus with hammertoes is the result of the foot
disability for which service connection has been granted.

The veteran contends that he currently has a heart disorder
which had its onset as the result of pulmonary emboli
originating in the service-connected thrombophlebitis of the
right leg.

With respect to the rating for residuals of retinal
detachment of the left eye, the veteran argues that an
increased rating should have been assigned based on a visual
field chart dated in February 1981.

The veteran contends that an increased rating should be
assigned for recurrent pulmonary emboli which have resulted
from an injury to the right foot in service and subsequent
thrombophlebitis in the right leg.  He argues that as a
result of the emboli there have been frequent episodes of
dyspnea on exertion and chest pain.  He claims that while
the chest pain has decreased with nitroglycerin, pain in the
arm with numbness in the fingers and arms remains.

The veteran contends that he is unemployable as the result
of his disabilities.  He contends further that a temporary
total rating should be assigned under 38 C.F.R. § 4.30
(1992) based on a period of hospitalization at a VA facility
in August and September 1986.

                    DECISION OF THE BOARD

In accordance with the provisions of 38 U.S.C.A. § 7104
(West 1991), following review of all evidence and material
of record in the claims file, and for the reasons and bases
hereinafter set forth, it is the decision of the Board that
service connection for headaches is warranted based on clear
and unmistakable error in a rating decision of July 1981 and
that a preponderance of the evidence supports the claim for
service connection for hallux valgus of the right foot with
hammertoes.

It is the further decision of the Board that a preponderance
of the evidence is against the claims for service connection
for an organic brain disorder, a psychiatric disorder, a
heart disorder, chronic obstructive pulmonary disease,
residuals of an injury to the back and right hip (including
arthritis), an eye disorder, syncope, or defective hearing
in the left ear.  It is the further decision of the Board
that a preponderance of the evidence is against the claims
for increased ratings for retinal detachment of the left eye
and thrombophlebitis of the right leg and for a compensable
rating for residuals of pulmonary embolism.  It is the
further decision of the Board that a preponderance of the
evidence is against the claims for a total rating based on
individual unemployability due to service-connected
disabilities and a temporary total rating based on
hospitalization at a VA facility from August 31 to
September 7, 1986.

                      FINDINGS OF FACT

1.  The evidence required for proper adjudication of the
issues on appeal has been obtained to the extent possible.

2.  An organic brain disorder was not manifest during active
military service or within one year after separation from
either period of service.

3.  Service connection is in effect for residuals of an
injury to the right foot, with pes cavus and drop foot,
rated 40 percent disabling; defective vision of the left eye
due to retinal detachment, rated 20 percent disabling;
thrombophlebitis of the right leg, rated 10 percent
disabling; and pulmonary embolism, rated noncompensable.

4.  An organic brain disorder was not caused by and is not
shown to be related to military service or to a
service-connected disability.

5.  A chronic functional psychiatric disorder was not
manifest during active military service; any current
functional psychopathology is not shown to have been caused
by or related to military service or to a service-connected
disability.

6.  The veteran has chronic headaches which unequivocally
had their onset during active military service.

7.  Service connection for headaches was denied by a rating
decision of July 1981; that decision was not adequately
supported by the evidence then of record.

8.  The veteran was discharged from military service as a
result of severe congenital or developmental refractive
errors of both eyes.

9.  A preservice surgical repair of a detached retina of the
right eye was performed in 1970; no subsequent retinal
detachment has been documented and residuals of the surgery
did not increase in severity during service.

10.  No acquired pathology of either eye, including
diplopia, cataracts, chorioretinitis or esotropia is shown
to have been manifest during active service or to have been
caused by or related to service connected residuals of a
detached retina of the left eye.

11.  Chronic obstructive pulmonary disease was not manifest
in service or until several years after separation and is
not shown to have been caused by or related to a
service-connected disability.

12.  A chronic back or hip disability was not demonstrated
during service or until many years after separation;
arthritis of the back or hips was not demonstrated during
service or within one year after separation.

13.  A disorder manifested by syncope was not manifest
during service or until a number of years after separation
and is not shown to be caused by or related to military
service or to a service-connected disability.

14.  Defective hearing in the left ear was not documented
during service or until a number of years after separation.

15.  Hallux valgus and hammertoes of the right foot are foot
deformities probably caused by residuals of an injury to the
right foot during active service.

16.  A heart disorder was not manifest in service or until
several years after separation and is not shown to have been
caused by or to be related to a service-connected disability.

17.  Corrected visual acuity in the left eye is reported
variously as 20/60 or 20/70; the average concentric
contraction of the visual field of the left eye is 12.6
degrees.

18.  Thrombophlebitis of the right lower extremity is
manifested by recurrent episodes of tenderness and pain;
persistent swelling, discoloration, pigmentation, and
cyanosis are not documented in the available record.

19.  The veteran has experienced recurrent pulmonary emboli
originating in thrombophlebitis of the right lower
extremity, most recently in August 1989; the current record
is insufficient to describe the nature and severity of
current disability attributable to the emboli.

20.  The veteran completed three years of college and has
occupational experience as an offset pressman, security
guard and manager; he was last employed in July 1987.

21.  The veteran is manifestly unemployable at the present
time due to multiple disabilities; his service-connected
disabilities alone are not shown to result in unemployability.

22.  The veteran was hospitalized at a VA facility from
August 31 through September 7, 1986, for treatment of
disability which included service-connected pulmonary
emboli; no surgery was performed and no joint was
immobilized.

23.  Except with respect to the issue of entitlement to
service connection for an organic brain disease, the issues
on appeal are not so complex or controversial as to require
referral for an opinion by an independent medical expert.

24.  There are no exceptional or unusual circumstances in
this case which would have warranted referral of the issues
of entitlement to increased ratings for retinal detachment
of the left eye and thrombophlebitis of the right leg and
entitlement to a compensable rating for pulmonary emboli to
the Director of the VA Compensation and Pension Service.

                     CONCLUSIONS OF LAW

1.  An organic brain disorder was not incurred in or
aggravated by active military service, may not be presumed
to have been incurred in active military service, and is not
proximately due to or the result of a service-connected
disability.  38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131,
1137, 5107(a), 7104 (West 1991); 38 C.F.R. §§ 3.307, 3.309,
3.310(a) (1992).

2.  A chronic functional psychiatric disorder was not
incurred in or aggravated by active military service, and
the veteran does not have a chronic functional psychiatric
disorder which is proximately due to or the result of
service-connected disability.  38 U.S.C.A. §§ 1110, 1131,
5107(a), 7104 (West 1991); 38 C.F.R. §§ 3.303(b), 3.310(a)
(1992).

3.  The rating decision of July 1981 which denied service
connection for headaches involved clear and unmistakable
error and is not final; headaches were incurred in peacetime
service.  38 U.S.C.A. §§ 1131, 5107(a), 7104 (West 1991);
38 C.F.R. §§ 3.105, 3.303(b) (1992).

4.  Preservice residuals of surgical repair of a retinal
detachment of the right eye did not increase in severity
during service.  38 U.S.C.A. §§ 1110, 1131, 1153, 5107(a),
7104 (West 1991); 38 C.F.R. § 3.306 (1992).

5.  The veteran does not have other chronic acquired eye
disorder (apart from the service-connected left eye impaired
vision secondary to retinal detachment) as a result of
disease or injury incurred in or aggravated by active
military service or which is proximately due to or the
result of service-connected disability.  38 U.S.C.A.
§§ 1110, 1131, 5107(a), 7104 (West 1991); 38 C.F.R.
§ 3.310(a) (1992).

6.  Chronic obstructive pulmonary disease was not incurred
in or aggravated by active military service and is not
proximately due to or the result of service-connected
disability.  38 U.S.C.A. §§ 1110, 1131, 5107(a), 7104 (West
1991); 38 C.F.R. § 3.310(a) (1992).

7.  Residuals of an injury to the back and right hip were
not incurred in or aggravated by active military service and
arthritis of the back and hip may not be presumed to have
been incurred in service.  38 U.S.C.A. §§ 1101, 1110, 1112,
1113, 1131, 1137, 5107(a), 7104 (West 1991); 38 C.F.R.
§§ 3.307, 3.309 (1992).

8.  Syncope was not incurred in or aggravated by active
military service and the veteran does not have a chronic
disorder manifested by syncope which is proximately due to
or the result of service-connected disability.  38 U.S.C.A.
§§ 1110, 1131, 5107(a), 7104 (West 1991); 38 C.F.R.
§ 3.310(a) (1992).

9.  Defective hearing in the left ear was not incurred in or
aggravated by active military service and sensorineural
defective hearing in that ear may not be presumed to have
been incurred in such service.  38 U.S.C.A. §§ 1101, 1110,
1112, 1113, 1131, 1137, 5107(a), 7104 (West 1991); 38 C.F.R.
§§ 3.307, 3.309, 3.385 (1992).

10.  Hallux valgus and hammertoes are proximately due and
the result of service-connected residuals of an injury to
the right foot, currently rated as drop foot.  38 U.S.C.A.
§§ 5107(a), 7104 (West 1991); 38 C.F.R. § 3.310(a) (1992).

11.  A chronic heart disorder was not incurred in or
aggravated by active military service, may not be presumed
to have been incurred in active military service, and is not
proximately due to or the result of a service-connected
disability.  38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131,
1137, 5107(a), 7104 (West 1991); 38 C.F.R. §§ 3.307, 3.309,
3.310(a) (1992).

12.  The criteria for a rating higher than 20 percent for
impaired vision due to retinal detachment of the right eye
are not met.  38 U.S.C.A. §§ 1155, 5107(a), 7104 (West 1991);
38 C.F.R. Part 4, Codes 6008, 6080 (1992).

13.  The criteria for a rating higher than 10 percent for
thrombophlebitis of the right leg are not met.  38 U.S.C.A.
§§ 1155, 5107(a), 7104 (West 1991); 38 C.F.R. Part 4, Code
7121 (1992).

14.  The criteria for a compensable rating for pulmonary
emboli are not met.  38 U.S.C.A. §§ 1155, 5107(a), 7104
(West 1991); 38 C.F.R. Part 4, Code 6810 (1992).

15.  The criteria for a total rating based on individual
unemployability are not met.  38 U.S.C.A. §§ 1155, 5107(a),
7104 (West 1991); 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16
(1992).

16.  The criteria for a temporary total rating based on
hospitalization at a VA facility from August 31 through
September 7, 1986, are not met.  38 U.S.C.A. §§ 5107(a),
7104 (West 1991); 38 C.F.R. §§ 4.29, 4.30 (1992).

17.  Referral of this appeal for additional opinions from
independent medical experts is not warranted.  38 U.S.C.A.
§§ 7109, 7104 (West 1991); 38 C.F.R. § 20.901 (1992).

18.  The failure of the RO to consider or to document its
consideration of the question of the referral of the issues
of entitlement to increased ratings for retinal detachment
of the left eye and thrombophlebitis of the right leg and
entitlement to a compensable rating for pulmonary emboli is
harmless error.  38 C.F.R. § 20.1102 (1992).

       REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

                      I.  Service Dates

The date of separation from the veteran's second period of
active service is shown on the DD Form 214 as April 22,
1980.  However, the file contains documents showing that in
February 1986 the Department of the Army Board for Correction
of Military Records (BCMR) nullified this discharge date and
revised the records to show that the veteran remained on
active duty through May 31, 1980, that he was placed on the
Temporary Disability Retired List (TDRL) as of that date
with disability rated 30 percent disabling, and that he was
honorably discharged from the Army with severance pay on
November 22, 1982.  (In a prior decision of September 1980,
the BCMR held that the veteran's release from the earlier
period of active duty on October 20, 1976, was void and that
he remained on active duty until January 20, 1977, when he
was returned to the Army Reserve.)

The veteran contends that since his revised discharge did
not become effective until November 22, 1982, when he was
discharged from the TDRL, he is entitled to service
connection for disabilities documented before that date.
However, the military service requirements which must be
satisfied to establish entitlement to VA benefits are
defined not in the law governing military discharges (see
Title 10 of the United States Code Annotated (U.S.C.A.)) but
in the law governing VA operations (Title 38 of the
U.S.C.A.).  Under the applicable provisions of Title 38,
service connection is granted for disability due to disease
or injury incurred in or aggravated by "active military,
naval or air service."  38 U.S.C.A. §§ 1110 (wartime), 1131
(peacetime) (West 1991).  The term "active military, naval,
or air service" includes active duty and active duty for
training.  38 U.S.C.A. § 101(24) (West 1991).  Neither
Title 38 nor its implementing VA regulations includes time
spent on the TDRL as "active military, naval or air service"
for service connection purposes.  38 C.F.R. § 3.6(a)(b)(c)
(1992).  Consequently, the fact that the veteran is now, as
a result of the action of the BCMR, deemed to have been
"discharged" from the TDRL and military service on
November 22, 1982, is irrelevant to his VA claim.  For
purposes of the present determinations, the last day
countable as active duty is May 31, 1980.

                        II.  Analysis

                             A.

The Board finds preliminarily that the claims raised by the
veteran are well grounded within the meaning of 38 U.S.C.A.
§ 5107(a) (1992).  That is, each is "a plausible claim, one
which is meritorious on its own or capable of
substantiation."  Murphy v. Derwinski, 1 Vet.App. 78 (1990).

The volume of the record in this case, the number of issues,
and the number and intensity of the contentions advanced by
the claimant combine to make this appeal unusually complex
and difficult to adjudicate in accordance with the stringent
requirements imposed by the United States Court of Veterans
Appeals (the Court) with respect to development of the
evidence and articulation of adequate justifications for the
determinations reached.  Mindful of the difficulty of
fulfilling its obligations, the Board remanded the claim to
the RO for procurement of comprehensive information
concerning the veteran's current medical status.  Upon the
return of the file, the Board referred the claim for an
independent medical opinion with respect to the etiology of
organic brain syndrome, an issue for which there was
adequate clinical data available but inadequate medical
authority in the record.

Notwithstanding the efforts to develop the record to its
fullest, the Board must acknowledge that the studies
performed pursuant to the remand are not adequate in every
respect.  The veteran was not hospitalized in accordance
with our instructions, and the studies were conducted in a
piecemeal fashion.  Proper evaluation of the veteran's
current status should of necessity have included
examinations by specialists in respiratory and peripheral
vascular diseases, and the current status of the
thrombophlebitis and the residuals of pulmonary emboli
should have been specifically commented upon.  The
inadequacy of the studies was noted by the representative in
the presentation received by the Board on November 8, 1991.
The Board would ordinarily remand the claim for the
additional studies.  However, the veteran indicated in a
substantive appeal form, submitted in April 1991, that he
would not submit for any further tests.  Without his
complete cooperation, further attempts to develop the record
would be fruitless.  The veteran is advised that if at any
future time he should change his mind and indicate a
willingness to appear for further examinations, the
additional studies which could potentially support his claim
may be scheduled.  In the meantime, the Board has no choice
but to conclude that the statutory duty to assist has been
satisfied.  38 U.S.C.A. § 5107(a) (West 1991).  In this
regard we note that, although the representative has
requested that an independent medical opinion be obtained
with respect to each of the issues on appeal, the Board
finds that such a study was required only with respect to
the organic brain disorder issue.

                  B.  Organic Brain Disease

The veteran was evaluated at a VA hospital in May 1985 for
complaints of progressive numbness of the hands and neck,
scapular pain, poor balance and head pain of about four
weeks' duration accompanied by transient visual obscuration.
A CT scan showed unusual calcifications with irregularities
of the globe.  The diagnoses were spastic paraparesis of
undetermined etiology and rule out multiple sclerosis.
Subsequent VA and private medical records have shown a
progressively debilitating neurological disorder manifested
by cognitive difficulties and motor and sensory impairments,
the etiology of which is not certain (see discussion below).

It is not disputed that the neurological symptomatology was
not manifest until approximately May 1985, when the veteran
was admitted to the hospital for evaluation.  It is neither
shown nor contended that the disability was manifest during
either period of active duty or within one year after
separation from either period.  Therefore, a grant of
service connection on the basis of direct incurrence in
service is precluded.  38 U.S.C.A. §§ 1110, 1131 (West
1991).  Nor may service connection be granted under the
provisions of law by which certain statutorily enumerated
disabilities, including organic neurologic diseases, may be
presumed to have been incurred in service if shown to be
manifest to a degree of 10 percent or more within one year
after separation.  38 U.S.C.A. §§ 1101, 1112, 1113, 1137
(West 1991); 38 C.F.R. §§ 3.307, 3.309 (1992).

The dispute on appeal involves the etiology of the
neurologic disorder.  The law permits the granting of
service connection for disability which is proximately due
to or the result of service-connected disability.  38 C.F.R.
§§ 3.310(a) (1992).  In this regard, the veteran contends
that he has suffered multiple "strokes" as the result of
pulmonary emboli originating in thrombophlebitis of the
right leg following an injury to the right lower extremity
in service.  A long history of multiple deep vein thrombi
and pulmonary emboli is well documented and is recognized as
service connected.  Specifically, service connection is in
effect for right drop foot secondary to injury, with pes
cavus, rated 40 percent disabling since February 1988; for
thrombophlebitis of the right leg, rated 10 percent
disabling since April 1983; and for pulmonary embolism,
rated noncompensable since June 1980.

In the absence of evidence in the record as to the cause of
the neurologic disability, and in recognition of the fact
that the Board may not exercise its own independent medical
judgment in evaluating the record, Colvin v. Derwinski,
1 Vet.App. 171 (1991), the Board remanded the case in
December 1990 for comprehensive studies by multiple
examiners.  A psychiatrist examined the veteran in February
1991 and concluded that he had a profound organic brain
deficit which was "presumably on the basis of cardiovascular
problem, probably related to thrombophlebitis and pulmonary
emboli."  The diagnosis on Axis I was multi-infarct
dementia.  Noting that the etiology was unclear and that the
disorder was "perhaps" related to the long history of
thrombophlebitis and pulmonary emboli, he recommended that a
neurologic workup and magnetic resonance imaging scan be
performed for clarification.  A neurologist who examined the
veteran in March 1991 found a "probable" residual of
cerebral contusion and "possible" right cerebral infarction
in 1988.  He noted a "possible" additional functional
component to the disability.  No magnetic resonance imaging
scan (MRI) has been performed.

In a further attempt to obtain the necessary clarification,
the Board referred the claim to an independent medical
expert associated with a medical school and received a
lengthy opinion, dated August 31, 1992, in response to
several questions posed.  The reply is quoted verbatim and
in its entirety:

           I am replying to your request for an
         independent medical expert opinion on
         this patient.  I have reviewed all of the
         medical records that were sent to me.  I
         will briefly record the salient features
         that I have extracted from these records.

           He is a tall man with long fingers and
         a high myope.  In 1970, at the age of 15,
         he developed a retinal detachment in the
         right eye, and at that stage was noted to
         give a poor history, and to have various
         inconsistencies in the history.  No
         comment about his intellect was made at
         that stage however.  He underwent a
         surgical procedure.  Neurological
         examination at that stage was apparently
         normal.

           I understand that he was in active
         military service from April of 1975 to
         October of 1976, and August of 1977
         through May, 1980, having been initially
         discharged for impaired visual acuity
         secondary to a further detachment of the
         retina.  I believe that he has also had
         surgical correction of a retinal
         detachment on the left.

           In September, 1976, he apparently fell
         from a tank and suffered an inversion
         sprain of the right ankle without
         fracture.  He subsequently complained
         that he had injured his head in the same
         accident, though the records at that time
         give no indication of such an injury.
         Later medical records comment that the
         patient complained of having lacerated
         his head at that stage, and one medical
         record records a healed scar in the
         frontal region.  One record at a later
         period comments that he suffered from one
         episode of concussion, though the date of
         this is not stated.

           In November, 1976, he developed the
         first of multiple episodes of deep vein
         thrombosis in the right leg, together
         with recurrent episodes of pulmonary
         embolism.

           On the admission of 11/27/76 to
         Southwestern General Hospital, with one
         of the episodes of pulmonary embolism,
         there was a comment that he had not
         suffered fainting episodes, and
         neurologic examination was normal.  There
         was deformity of the right foot.  More
         details are not provided.

           In 1985, there is a VA in-patient
         evaluation dictated by Dr. Agrawal when
         the patient was 30 years old.  He
         complained of progressive numbness of the
         hands, pain in the neck, poor balance,
         and head pain of 4 week's duration.
         There was no comment of a speech
         disorder.  The reflexes were excessively
         brisk, and the plantar responses were
         extensor; the abdominal reflexes were
         present.  Sensation showed a diminished
         pin prick over the fingers.  He had the
         ability to walk heel-to-toe.
         Consideration was given to a diagnosis of
         multiple sclerosis.  He had a CT scan of
         the head that showed "unusual
         calcification with irregularities of the
         globe".  The patient did not return to
         have a myelogram and CSF examination.

           The patient was admitted to Elyria
         Memorial Hospital on 7/15/87 for a
         syncopal episode.  He complained of
         recurrence of chest pain and pain in the
         right lower extremities.  There was pes
         cavus deformity of the right foot,
         tenderness of the right calf, but no
         increase in temperature or swelling.  A
         CT scan of the brain was negative.
         Neurological examination was said to be
         "not remarkable".

           On 9/28/88, he was evaluated for
         psychological purposes; his verbal IQ was
         recorded at 73, performance IQ at 70, and
         full-scale IQ at 70.  His memory quota
         was 70.  It was felt that he was
         attempting to perform in all of the
         tests.  He was noted to have both visual
         and hearing problems.

           On 1/23/89, he was evaluated by Cathy
         Comerci, D.O.  He complained of
         difficulty with hearing and vision, and a
         worsening speech impediment, as well as
         memory loss.  He had evidence of a marked
         valgus deformity of the right ankle, with
         the foot plantar flexed to 40 [degrees]
         and inability to dorsiflex actively or
         passively.  There were diminished
         reflexes in the lower extremity on the
         right, and normal reflexes elsewhere.
         There was diminished strength of
         dorsiflexion on the right foot.

           On 6/12/89, he was examined by Lee
         Pratt,M. D., a neurologist.  The patient
         recorded a fall from a tank with a
         concussional head injury and scalp
         laceration in 1976 with hospitalization
         at a local Fort Knox Hospital for
         4-5 days.

           Neurological examination revealed a
         dull patient, with marked dysarthria.
         Reflexes in the upper limbs were brisk
         and symmetrical, and those in the lower
         limbs were hypoactive and symmetrical.
         No Babinski signs were noted.  There was
         marked decreased vibration and
         appreciation of light touch and pin prick
         sensation, mainly in the right lower
         extremity, while the left lower extremity
         appeared normal.  There was marked pes
         cavus deformity on the right lower
         extremity, tremulousness of the
         outstretched hands, mild dysmetria when
         doing cerebellar testing.  The patient
         was unable to stand without assistance.
         He could not walk without using a crutch
         and his leg brace.  He could not stand up
         from the sitting position without
         assistance.

           He was admitted to Roane General
         Hospital on 8/24/89 because of weakness
         of the left side.  He complained of pain
         in his chest and left neck with
         headache.  His speech impediment had
         worsened.  He is recorded as having a
         right foot drop, motor strength of 2/5 in
         the left arm.  He had a spinal tap which
         showed a protein of 76 mg% and no cells.
         He had a CT scan of the head without
         contrast that showed no abnormality.

           In 1991, audiometric evaluation showed
         mild to moderate sensory neural hearing
         loss in both ears.

           On March 20, 1991, he was seen by
         Dr. LaPoint.  He was recorded as being
         dysphonic and dysarthric with reduced
         movements of the left side of the face,
         and the left upper limb was maintained in
         extension with flexion of the IP joints.
         There was major gait disturbance with
         stiffness of both lower limbs and the
         need for support on a half crutch.  There
         was moderate tremor of the right upper
         limb without weakness.  There was
         proximal weakness of the lower limbs,
         together with weakness of dorsiflexion of
         the ankles, worse on the right.  The
         right upper limb reflexes were increased,
         and the remainder was sluggish.  There
         was an extensive plantar response on the
         left.

         Response to Questions:

         1)  What is the proper diagnosis of the
         organic pathology of the veteran's brain?

           It is not possible to give a clear
         diagnosis from the information provided.
         He appears to have a progressive
         degenerative disorder of the brain,
         without abnormality on the CT scan.  I
         believe that the abnormality of the globe
         is likely to be a post-surgical
         calcification related to the operations
         for retinal detachment.  The brain itself
         appears to be normal on repeated
         CT scans.  This makes it more
         likely that he had a degenerative brain
         disorder.  It does not appear that this
         is due in any way to recurrent strokes
         that might have been due to paradoxical
         embolus from the deep vein thrombosis of
         his right leg.

           He gives a history of brain injury
         though none of this is recorded in the
         chart.  Nevertheless, the progressive
         nature of the neurological deterioration
         is not that which is seen in any patient
         who has had a mild concussive head injury.

         2)  What is the etiology of this disorder?

           It is impossible to provide a clear
         answer.  This patient could have a
         condition such as multiple sclerosis, or
         a degenerative brain disease such as a
         spinocerebellar degeneration.

         3)  Is the evidence of records sufficient
         to justify in the mind of a fair and
         impartial individual a conclusion that
         the organic brain pathology is
         proximately due to or the result of
         thrombophlebitis of the right lower
         extremity or recurrent pulmonary emboli?

           It appears from the records of
         competent physicians that this patient
         does have a progressive organic brain
         disease.  It is quite likely that his
         initial intellectual level was low, but
         he does appear to have developed
         progressive organic disease superimposed
         upon this.  I do not believe there is any
         support from the medical records that I
         have received that this patient's organic
         brain pathology is in any way due to the
         thrombophlebitis of the right lower
         extremity or recurrent pulmonary emboli.
         It seems more likely that he has a
         degenerative brain disease
         completely unrelated to any intercurrent
         event, which would have happened whether
         or not he had suffered any head injury,
         pulmonary embolus, deep vein thrombosis,
         or similar intercurrent event.

The Board of Veterans' Appeals is obligated to make a
determination with respect to the credibility and probative
value of the evidence in the record.  Gilbert v. Derwinski,
1 Vet.App. 49 (1990).  The present panel finds that, of the
opinions of record with regard to the etiology of the
neurologic disorder, that of the independent medical expert
has the greatest probative value.  While the independent
medical expert does not offer an unequivocal opinion as to
the cause of the neurological deterioration, the crucial
finding reported is that the disorder cannot be attributed
to the emboli or to head trauma.  Unlike the other opinions,
it adequately explains the basis for the conclusions.  The
conflicting medical opinions suggesting a causal connection
between the service-connected pathology and the organic
brain disease do not cite either medical authority or
clinical findings in the record as the basis for this
conclusion and must, therefore, be regarded as conjectural.
The Board accepts the opinion of the independent medical
expert as the basis for the decision reached in this
appeal.  We would also note that the veteran has submitted
absolutely no evidence to substantiate the allegation that
the organic brain disease is a maturation of a preexisting
neurosis, but the point is moot given the action below with
respect to the claim for service connection for psychiatric
disease.

The Board finds that the evidence relevant to the question
of whether the organic brain disease is proximately due to
or the result of a service-connected disability is not in
relative equipoise and that a preponderance of the evidence
is in fact against the claim.  38 U.S.C.A. § 5107(b) (West
1991); 38 C.F.R. § 3.310(a) (1992).

                  C.  Psychiatric Disorder

The veteran claims that, in addition to the organic brain
disease, he has a psychiatric disorder that had its onset in
service and was documented in service medical records.
Service medical records contain an entry dated in September
1979 in which a clinical impression of anxiety reaction was
noted.  The veteran was referred for a psychiatric
evaluation in October 1979; it was noted that he had
multiple complaints, many of which were somatic.  A
provisional diagnosis of inadequacy feelings was made.
After service, the earliest reference to psychiatric
complaints is found in VA outpatient treatment records dated
from May to October 1987.  In an entry dated May 29, 1987,
he complained of increased nervousness, depression, and
guilt.  A history of heavy drinking was noted, though he
requested help for his drinking.  The diagnosis on Axis I
was adjustment disorder with mixed emotional features;
alcohol abuse, unspecified; questionable dysthymic disorder,
rule out major depression.  The diagnosis on Axis II was
personality disorder.  When seen on June 29, 1987, his
complaints included short temper, distrust of his wife's
fidelity, anxiety, depressed mood, restless sleep and
decreased appetite.  He attributed problems of stress to
financial problems, three lawsuits, distrust of his wife's
infidelity, problems with a detached right retina, and
problems with an adopted son.  A 7- to 14-day
hospitalization in 1985 for questionable anxiety after
losing a restaurant business was noted.  He was referred for
individual psychotherapy.  Moderate anxiety neurosis was
diagnosed during a VA hospitalization in June 1988.  A
dysthymic disorder was diagnosed in September 1988 by a
private psychologist, J. Ledwell, Ph.D.

The post service diagnoses cited above include anxiety
neurosis, dysthymic disorder, adjustment disorder with mixed
emotional features, and a personality disorder.  To the
extent that the veteran's symptoms are the result of a
personality disorder, the granting of service connection is
precluded by law.  38 C.F.R. § 3.303(c) (1992).  The common
denominator among the records containing the remaining
diagnoses is that the symptoms represent a response to
various stressful life circumstances, only one of which is
physical disability.  The statement from Dr. Ledwell
describes the symptoms in relation to various disabilities,
including eye problems, hearing deficits, pulmonary emboli
and psychological problems, but even this statement stops
short of attributing the dysthymic disorder directly to the
specific disorders for which service connection has been
granted.  Furthermore, the probative value of the statement
is decreased by the fact that, in contradiction of a wealth
of other information in the record, Dr. Ledwell found that
testing for organic brain damage was negative.  When
subsequently examined by an examiner for VA purposes in
February 1991, no functional psychiatric symptomatology was
present.  The diagnosis was multi-infarct dementia, and none
of the above-mentioned disorders was clinically identified.
Neither an anxiety disorder nor a dysthymic disorder was
reported to be present.  The Board therefore finds that a
preponderance of the evidence precludes a finding that the
veteran currently has a psychiatric disorder for which
service connection can be granted.

                        D.  Headaches

The veteran's original claim for service connection for
post-traumatic headaches was denied by a rating board
decision of July 1981 on the grounds that neither a head
injury in service nor chronic headache disorder had been
documented.  The veteran did not appeal.  Under the law, an
unappealed determination is final and is not subject to
revision on the same factual basis in the absence of clear
and unmistakable error therein.  38 U.S.C.A. § 7104 (West
1991).  However if the evidence establishes clear and
unmistakable error, the prior decision will be reversed or
amended.  38 C.F.R. § 3.105(a) (1992).

The evidence considered by the rating board in its decision
of July 1981 consisted of service medical records, the
reports of VA examinations in March 1977, June 1980 and
February 1981, the reports of two private physicians
(L. J. Singerman, M.D., May 1980, June 1980;
B. B. Braunstein, December 1980), reports of
hospitalizations at private facilities in August 1970,
November 1976 to January 1977, and May 1980, and the
transcript of a hearing held in February 1981.

Service medical records contain an entry dated February 27,
1978, which refers to "very bad headaches" together with
other symptoms attributed to a "flu virus."  On a report of
medical history form dated October 3, 1979, the veteran
checked the box indicating "frequent or severe headaches"
and reported having received an injury to the head and foot
in 1976.  In April 1980 he complained of headaches and of a
problem with the left eye.  Examination was negative.  In
his May 1980 statement, Dr. Singerman referred to a
diagnosis of migraines associated with "ocular syndromes."
At a VA examination in June 1980 he complained of having had
headaches ever since the injury in service in September
1976; he indicated that they were currently infrequent and
occurred about once per year.  The headaches were located in
the right temple and radiated to the neck and lasted for two
days.  The diagnosis was residuals of post concussion
headaches."

Despite the absence of actual treatment records showing the
severity of the injury to the head in service, the foregoing
evidence is sufficient to describe a pattern of persistent
headaches during the period from 1976 to at least June 1980,
at which time a VA examination indicated the presence of a
headache disorder.  The entries are sufficient to give
credibility to the veteran's contentions that headaches had
been present and recurring.  The evidence is conflicting as
to the etiology of the headaches in that although the
neurologist in June 1980 attributed them to a concussion,
there is other evidence attributing them to eye pathology.
But regardless of the etiology, the evidence is adequate to
establish chronicity.  The failure of the rating board to
make a finding of chronicity was therefore clearly and
unmistakably erroneous, and the prior denial was not final.
The evidence pertaining to the period since July 1981 shows
continuation of headaches.  The veteran in his substantive
appeal referred to VA notations of headaches on various
dates from May 1983 through June 1988, of which only the
entry dated February 19, 1983, is in the current record.
Nevertheless, at a VA examination in August 1988, the
veteran reported having had a headache "every day since
1976," and severe headaches were reported by Dr. Ledwell in
September 1988.  The fact that subsequent VA neurological
examinations were negative for headaches is not particularly
probative, considering the severity of the veteran's other
multiple disorders.

The Board finds that the rating decision of July 1981 is not
final inasmuch as it involves clear and unmistakable error
and that a preponderance of the evidence of record supports
the granting of service connection for headaches.

                      E.  Eye Disorder

Service connection was granted by a rating decision of
September 1980 for retinal detachment of the left eye.  A
10 percent rating was initially assigned but was reduced to
noncompensable from November 1, 1980.  A 20 percent rating
has been in effect since December 1987.  The issue presently
before the Board is whether the veteran is entitled to
service connection for pathology of the right eye and for
additional pathology of the left eye, the nature of which is
discussed below.  With respect to the right eye, we note
that service connection for residuals of a detachment of the
right eye was denied by a rating decision of September 1980,
which was not appealed, but that evidence added to the
record since September 1980 satisfies the requirements for
recognition as new and material evidence within the meaning
of 38 U.S.C.A. § 5108 (West 1991) and 38 C.F.R. § 3.156(a)
(1992) such as to warrant a reopening of the claim with
respect to the right eye.  Colvin v. Derwinski, 1 Vet.App.
171 (1991); Smith v. Derwinski, 1 Vet.App. 178 (1991)

A report from the Southwest General Hospital shows that in
August 1970 the veteran was hospitalized for surgical
correction of a retinal detachment of the right eye, the
date of onset of which was not shown.  There was a vague
history of trauma.  Bilateral myopia was noted.  Medical
records from the first period of service show no defect of
either eye other than impairment of refraction requiring
9.75 diopters of correction on the right and 8.25 on the
left.  Records from the second period of active service show
that in February 1978 the right retinal detachment repair
was found to have produced a good surgical result.  In April
1980, a medical board found that as a result of severe
bilateral myopia requiring greater than 8 diopters for
correction, the veteran failed to meet induction standards
but met retention standards for military service.  The
disorder was found to have preexisted service.  The veteran
was separated from service on the basis of eye disability.
On April 24, 1980, a scleral buckling procedure to correct a
detached retina of the left eye was performed by a private
physician.  As previously noted, the veteran's service
records were subsequently amended to reflect that he was on
active duty at the time of this surgery and service
connection for residuals of the procedure has been granted.

The disability which resulted in discharge from military
service consisted of severe refractive error of both eyes,
diagnosed as myopia.  Under the law, refractive errors of
the eyes are regarded as congenital or development defects
for which service connection cannot be granted.  38 C.F.R.
§ 3.303(c) (1992).  Consequently, a worsening of the degree
of visual impairment due to refractive error during service
would not establish aggravation; in any case, such
worsening, though claimed by the veteran, is not documented
in service medical records.  The corrected visual acuity in
the right eye was 20/30 minus 4 on June 6, 1980, shortly
after separation; this was slightly better than the
corrected visual acuity of 20/40 reported in March 1974 for
purposes of his initial enlistment.

The veteran contends that the record shows evidence of
chorioretinitis in the right eye.  In this regard, we note
that plaques of chorioretinitis due to cauterization were
noted in the right eye on a VA examination of September
1983.  Subsequent examinations have also noted these
chorioretinitis plaques, but no active chorioretinitis has
been documented at any time.  Chronic active chorioretinitis
having its onset during active service would indeed be
recognizable as a superimposed disability in the right eye,
but the current evidence does not demonstrate such
pathology.  The chorioretinitis plaques are not shown to
have had their onset during active military service.  The
record does not show an increase in severity of the
preservice surgery residuals beyond natural progression of
the disorder.  Aggravation of the preservice disability is
not demonstrated.  38 U.S.C.A. § 1153 (West 1991); 38 C.F.R.
§ 3.306 (1992).

The veteran also contends that he has additional pathology
of the eyes related to service, including esotropia,
cataracts, and diplopia.  The earliest reference to
complaints of diplopia in the present record is found in a
VA outpatient treatment entry dated September 13, 1982.
Another such complaint was noted on November 22, 1982.
Subsequent records have shown periodic references to
diplopia.  Esotropia was first documented in a December 1987
statement from a private physician and has been reported on
VA eye examinations in May 1987 and February 1991.  Neither
is shown to have been manifest during service.  There are no
clinical records on file which attribute either diplopia or
esotropia to the service-connected detached retina repair in
the left eye.  At the VA examination of May 1989, diplopia
was attributed to extraocular motion problems which were
possibly related to one or several vascular strokes causing
crossed eyes (esotropia).  The examiner noted on the report
of visual fields testing that there was full motility of
both eyes but that there was esotropia from paresis.  The
diplopia was attributed to multiple cerebral vascular
accidents.

The veteran likewise has cataracts of post service onset.
No cataracts were seen on special VA eye examinations in
June 1980, February 1981, or September 1983.  Small
bilateral cataracts were seen at the examination of May 1989
in both eyes.  There is no support in the medical record for
the veteran's contentions that the onset of cataracts was
related to the retinal detachment in the right eye or that
the retinal detachment in the left eye placed undue strain
on the right eye.  38 C.F.R. § 3.310(a) (1992).

The Board finds that a preponderance of the evidence is
against the claim for service connection for a disorder of
either eye.

          F.  Chronic Obstructive Pulmonary Disease

The record shows chronic obstructive pulmonary disease of
moderate to marked degree.  The disputed matters involve the
point of onset of the disorder and its relation to the
service-connected disorders.

The earliest evidence concerning the veteran's respiratory
status is found in the report of an August 1970 admission to
the Southwest General Hospital, where it was reported that
he had had some asthma as a child between the ages of 2
and 10 for which he was hospitalized about five times but
that he had had no trouble with the disorder since the age
of 10 and was able to run and play without wheezing or
shortness of breath.

Service medical records show that the veteran was seen on
September 5, 1978, at a pulmonary clinic in connection with
a physical profile after two pulmonary emboli.  He
complained of increased shortness of breath after running
1 mile and having to breathe deeply after climbing a flight
of stairs.  He complained of chest pain which was made worse
by deep breathing; he claimed that he had been told that
this was related to scarring due to previous "injury."
Examination was negative.  In May 1979 he complained of
being short of breath since November 1976, when he had a
pulmonary embolism.  Examination was normal, including chest
X-ray.  In September 1979 he was seen for central chest pain
and difficulty breathing.  The chest was clear to percussion
and auscultation.  Service medical record entries received
directly from the veteran himself dated in September 1979
show a diagnosis of bronchitis.  A physical profile was
issued in September 1979 because of "bronchitis chronic."
On a report of medical history dated October 3, 1979, the
veteran checked the box indicating a history of shortness of
breath.

While the bronchitis noted in September 1979 was
characterized on the profile report as chronic, the finding
of chronicity may be legitimately questioned.  The word
bronchitis was used on only one other occasion in available
records, again in 1979.  It did not include a description of
manifestations sufficient to identify a disorder properly
diagnosable as bronchitis, but even if the diagnosis of
bronchitis was correct, the abnormality was not shown to
have been present over a period of time and thus may equally
well be designated as acute.  When the fact of chronicity in
service is not adequately supported, a showing of continuity
after discharge is required to support the claim.  38 C.F.R.
§ 3.303(b) (1992).  Post service records do not show
episodes of recurrent bronchitis or contain any findings
suggesting that the earlier bronchitis may have been a
factor in the post service development of chronic
obstructive pulmonary disease.  The veteran has cited a
number of specific entries over the years when shortness of
breath was documented, but these appear to have been
symptoms associated with treatment for pulmonary emboli
rather than chronic obstructive pulmonary disease.

The veteran contends that his chronic obstructive pulmonary
disease is secondary to pulmonary emboli.  During the period
since the initial diagnosis of chronic obstructive pulmonary
disease, the veteran has undergone numerous workups at both
private and VA facilities (the Elyria Memorial Hospital in
July 1987, the Roane Hospital in November 1988, August 1989
and March 1991, and a VA hospital in June 1988).  He has
undergone VA compensation examinations in August 1989 and
February 1991.  The reports of these studies are negative
for any indication whatsoever that the onset of the disorder
has been attributed by medical personnel to deep vein
thrombophlebitis or consequent pulmonary emboli.  The only
evidence suggesting an etiology of any kind consists of
reports from the Roane Hospital in November 1988, which
contained a diagnosis of "COPD smoking" and August 1989,
which cited a past history of COPD secondary to smoking.

The preponderance of the evidence of record precludes a
finding that chronic obstructive pulmonary disorder had its
onset during service or is related to respiratory
symptomatology during service.  A preponderance of the
evidence likewise is against a finding that the onset of
chronic obstructive pulmonary disease is a consequence of a
service-connected disability.  38 C.F.R. § 3.310(a) (1992).

  G.  Injury to the Back and Right Hip, Including Arthritis

The veteran claims that he injured his back and right hip in
the same fall from a tank as that which caused injuries to
the right foot and head.  The sole historical reference to
that injury in available service medical records (in the
medical history report of October 1979) contained no
reference to injury to the back or right hip.  On a VA
examination in March 1977, between the two periods of active
service, the veteran complained that his back hurt most of
the time but did not refer to a specific injury.  No
examination findings or diagnoses regarding the back were
recorded.  During the second period of service the veteran
was seen in April 1979 for complaints of intermittent low
back pain as well as midback pain.  A clinical assessment of
back strain was noted.  In May 1979 it was noted that he
still had back pain.  The clinical assessment at that time
was mild back strain.

On the medical history report of October 1979 the veteran
specifically denied recurrent back pain and bone, joint or
other deformity.  Postservice medical records show that at a
VA examination in August 1988, X-rays showed degenerative
changes of the cervical, thoracic and lumbosacral spine
segments with mild degenerative joint disease of both hips.

Despite the occurrence of a low back strain in 1979, the
subsequent medical evidence shows no continuity of back
symptomatology between 1979 and August 1988.  Consequently,
continuity of symptomatology is not shown.  38 C.F.R.
§ 3.303(b) (1992).  Arthritis is one of the disorders
enumerated in the statute as eligible for presumptive
service connection, but arthritis was not documented before
June 1988.  38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West
1991); 38 C.F.R. §§ 3.307, 3.309 (1992).  While the veteran
claims to have had back problems continuously since service,
no complaints or defects regarding the back were documented
in medical reports between 1979 and 1988.  Likewise, there
is no basis in the record for attributing the ultimate onset
of degenerative joint disease and arthritis to the reported
fall from a tank during service.

The Board finds that a preponderance of the evidence
precludes a finding that the veteran has residuals of any
injury to the back sustained in service or that the current
degenerative joint disease with arthritis is related to
service.

                         H.  Syncope

The veteran contends that he experiences dizziness and
blackouts and that the first such incident occurred during
active military service when he was stepping out of a car,
shortly after he sustained a head injury in service.

Service medical records, as noted above, contain no reports
describing the actual injury to the head or treatment for
it; the only reference to the incident is found in a medical
history form dated in October 1979.  The same medical
history report indicates that the veteran checked "yes" in
the box for "dizziness or fainting spells," though no
additional information was provided, and no clinical records
of fainting or dizzy spells in service are of record.  The
earliest post service reference to such symptomatology is
found in the report of a hospitalization in July 1987 at the
Elyria Memorial Hospital, where the veteran was admitted
after passing out.  It was noted that before passing out he
experienced chest pains and dyspnea and had pain in the
right lower extremity.  Examination, including skull X-ray,
chest X-ray, lung scan and CT scan of the brain, was
negative.  He was discharged the day after admission with a
diagnosis of syncope, probably vasomotor in origin.

Subsequent records show that the veteran was seen at the
Roane Hospital in November 1988 primarily for pulmonary
emboli, and that he had had "syncopal-type feelings"
accompanied by chest pain at the time of admission.  His
blood pressure was slightly low and sublingual nitroglycerin
helped significantly.  On a VA examination of June 1989, he
related that he had been hospitalized in service for a brief
syncopal episode and that some abnormality had been noted on
a CT scan.  There was no current diagnosis of syncope.  On a
general VA medical examination in March 1991 he reported
passing-out spells which occurred upon standing up and
usually lasted 2 to 3 minutes.  A diagnosis of syncope of
unknown cause was reported.

The lack of documentation of episodes of syncope during
service or for many years after service precludes a finding
that the veteran has a chronic syncope disorder of service
onset.  Even if we were to concede that a fainting spell did
occur in 1976 in the manner claimed by the veteran,
continuity of symptomatology after that episode is not
documented.  The evidence is not specific as to the cause of
the fainting episodes first documented in the post service
record in July 1987.  In the absence of a documented
etiology, the record is insufficient to support a finding
that the veteran has a chronic syncope disorder which is
caused by or proximately due to a service-connected
disability.  38 C.F.R. § 3.310(a) (1992).  Furthermore, as
should be clear from other portions of this decision, to the
extent that the syncopal episodes may be related to either
cardiovascular or neurological disease, the actions taken
herein with respect to those disabilities likewise precludes
a grant of secondary service connection.

                    I.  Defective Hearing

Service connection may be granted for impairment of hearing
at the frequencies of 500, 1,000, 2,000, 3,000 and
4,000 Hertz, as measured by pure tone and speech recognition
criteria.  However, hearing status shall not be considered
service connected when the thresholds for the above
frequencies are all less than 40 decibels; the thresholds
for at least three of these frequencies are 25 decibels or
less; and speech recognition scores using the Maryland CNC
Test are 94 percent or better.  38 C.F.R. § 3.385, effective
on and after May 3, 1990.  Although these regulatory
criteria did not become effective until May 3, 1990, a VA
adjudication manual in effect for many years previously
contains a substantially equivalent standard.  See VA
Manual M21-1, § 50.07.

VA audiograms dated in August 1988 and February 1991 show
that at the present time the veteran has a hearing loss in
each ear which satisfies the regulatory criteria as service
connectable defective hearing.  The issue, therefore,
involves the time of onset of this hearing impairment.
According to the available record, electronic testing of
hearing acuity was performed on three occasions before
August 1988.  On examination for enlistment in March 1974,
the pure tone hearing thresholds were 10 decibels or less in
each ear at each frequency tested from 500 to 6,000 Hertz.
On examination for separation in June 1976, there were pure
tone thresholds in the right ear of 35 decibels at 500 and
1,000 Hertz and of 15 decibels at 4,000 Hertz.  The
thresholds in the left ear were 15, 15, and 5, respectively,
at these frequencies.  On a medical history report dated in
September 1979 the veteran checked off the box indicating
that he had a prior history of hearing loss.  He was
currently working as an offset pressman.  On August 2, 1979,
the pure tone thresholds were 25 decibels in the right ear
at 1,000 Hertz and 15 decibels or lower at all other
frequencies tested for that ear.  In the left ear, a
threshold of 35 decibels was reported at 500 Hertz; the
thresholds at the other frequencies were 15 decibels or
lower.

Although it is arguable that the test results of June 1976
showed defective hearing in the right ear under the M21-1
standard since three or more thresholds of 25 or lower were
not recorded, the test results on August 2, 1979, were
indicative of a greater level of hearing acuity and were
within the manual standard.  The hearing loss arguably shown
in the right ear in June 1976 must be regarded as temporary,
given the subsequent improvement (we say arguably because
the test scores for that date are not complete; no
thresholds were reported at 2,000 or 3,000 Hertz).
Consequently, the veteran is not shown to have had defective
hearing of the requisite degree until 1988.  The
representative referred in his presentation of November 8,
1991, to an audiogram dated in April 1977, but no such
audiogram is of record; it appears that he was instead
referring to the audiogram of August 2, 1979, which showed
normal hearing.  The evidence does not support the
allegation that the hearing loss reported many years after
his separation is related to work as a pressman during
service or to an explosion in basic training; in any case,
that explosion is not documented in the record.

The Board finds that a preponderance of the evidence of
record precludes a finding that defective hearing was
manifest during service or that sensorineural defective
hearing was manifest to a degree of 10 percent within one
year after separation.  38 U.S.C.A. §§ 1101, 1110, 1112,
1113, 1131, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309
(1992).

     J.  Hallux Valgus of the Right Foot with Hammertoes

By a rating decision of July 1981, service connection was
granted for residuals of an injury to the right foot with
pes cavus; a 10 percent rating was assigned under Diagnostic
Code 5278 from April 23, 1980.  The rating was later raised
to 20 percent from May 27, 1986.  In a decision dated
August 4, 1989, a VA hearing officer raised the rating to
40 percent under Diagnostic Code 5167 on the basis that
current evidence showed a drop foot on the right.  The
effective date of the 40 percent rating was initially
assigned as October 26, 1988, later revised to February 24,
1988.

The current grant of service connection for the right foot
is limited to residuals of an injury to the foot with pes
cavus.  The service records show that the veteran was
referred for an orthopedic evaluation in September 1976
after he twisted his right ankle the night before.  There
was marked swelling laterally with ecchymosis and
tenderness.  X-ray examination showed no fracture.  The
clinical assessment was moderate strain of the right ankle.
In September 1978 he complained of right ankle pain on
running and an X-ray showed a bone fragment in the distal
medial malleolus due to old injury with possible necrosis.
He was referred to a podiatry clinic, at which time a
history of a severe inversion sprain of the right ankle was
noted.  X-rays showed a unilateral high arch of the right
foot with many loose bodies of the medial ankle.  The
clinical assessment was unilateral cavus foot with ankle
pain secondary to loose body and chronic sprain.

Post service medical records show that at a VA examination
of May 1986 there was a high cavus arch of the right foot
with moderate clawing of the toes.  The ankle was stable.
X-rays showed a rather severe valgus deformity of the 1st,
2nd, 3rd and 4th digits with medial angulation resulting in
a broad right foot.  A right footdrop was noted in a VA
outpatient entry dated in February 1988.  The veteran
underwent a VA orthopedic examination in May 1989.  A varus
deformity was noted, as was a calcaneal valgus deformity and
pes cavus with dropped metatarsal heads.  There was a club
toe deformity secondary to flexion contracture of the toes.
The diagnoses were calcaneal valgus and cavus deformity of
the right foot, footdrop deformity secondary to peroneal
nerve palsy, plateau deformity, and callous deformity
beneath the head of the 1st and 5th metatarsal bones as a
result of cavus deformity and dropped metatarsal heads.

A sequential review of the foregoing medical records
discloses progressively worsening deformity of the bones of
the right foot during the period since the initial injury to
the foot in 1976.  The RO has justified the denial of the
claim for hallux valgus and hammertoes on the basis that
neither deformity was manifest during service, but this
rationale, though factually accurate, does not dispose of
all of the legal grounds by which the claim must be
considered.  Service connection may also be granted for
disability which is proximately due to or the result of
service-connected disability.  38 C.F.R. § 3.310(a) (1992).
The available medical reports do not identify any basis in
the record for disassociating the hallux valgus and
hammertoes from the other foot deformities for which service
connection had already been granted.  To the contrary, it
appears that the hallux valgus and hammertoes are the result
of deformity of the metatarsals which resulted in the cavus
deformity and dropped metatarsal heads.

Accordingly, we find that the evidence of record, with
particular consideration of the report of the VA orthopedic
examination of May 1989, supports the granting of secondary
service connection for both hallux valgus and hammertoes.

                     K.  Heart Disorder

The record includes reports from the Roane General Hospital
beginning in November 1988 showing that the veteran's
symptoms included anginal chest pain which responded to
nitroglycerin.  Atherosclerotic heart disease was
diagnosed.  Subsequent medical records from both VA and
private facilities are replete with references to
well-documented atherosclerotic cardiovascular disease.
Consequently, as with chronic obstructive pulmonary disease,
the question remaining is when the disorder had its onset.
Atherosclerotic heart disease is eligible for presumptive
service connection under the law.  38 U.S.C.A. §§ 1112,
1113, 1137; 38 C.F.R. §§ 3.307, 3.309 (West 1991).

Service medical records contain various references to chest
pain and shortness of breath associated with pulmonary
emboli (a more complete description of the symptoms due to
pulmonary emboli is found in Subsection M of this
decision).  In September 1978 the veteran related that he
had a history of a "heart attack" and two "strokes."  He
gave a similar history in September 1979, the examiner noted
that the history was "variable and nonconfirmed."
Examination and treatment records from both periods of
active service are otherwise negative for references to
heart abnormality.  After service, the veteran received
thorough hospital workups at private facilities (St. John
and West Shore Hospital, September and October 1986; Elyria
Memorial Hospital, July 1987, including a normal
echocardiogram) and VA hospitals (May 1985 and August to
September 1986) for various complaints, but no heart defect
was reported.  The negative findings on these evaluations
provide compelling evidence that no cardiovascular disease
was present until a number of years after separation from
service.  The record thus provides no basis for the granting
of either direct or presumptive service connection.

The veteran bases his appeal in part on the contention that
the onset of heart disease is the result of recurrent
pulmonary emboli for which service connection has been
granted.  The evidence of record, however, which includes
the reports of numerous hospitalizations and examinations,
provides no medical support for this allegation.  There is
no medical document which intimates the presence of a
connection between the two disabilities.  The veteran's own
lay opinion that his current disability is due to service or
to a service-connected disability is insufficient to support
the claim.  Espiritu v. Derwinski, 2 Vet.App. 492 (1992).
Consequently, a preponderance of the evidence is against a
finding that the veteran has a heart disorder which is
proximately due to or the result of a service-connected
disability.  38 C.F.R. § 3.310(a) (1992).

   L.  Increased Rating for Retinal Detachment of Left Eye

The only eye disability for which service connection is in
effect consists of residuals of the left retinal detachment
which was surgically repaired in April 1980.  A 10 percent
rating was assigned for that disability from June 1, 1980,
under Code 6008, which provides ratings of 10 percent to
100 percent for detachment of the retina on the basis of
resulting impairment of visual acuity or visual field loss,
pain, rest requirements, or episodic incapacity.  An
additional 10 percent is combined during the continuance of
active pathology.  Ten percent is the minimum evaluation
during active pathology.  38 C.F.R. Part 4, Code 6008 (1992).

The veteran was examined by a private optometrist,
J. Selario, O.D., on December 16, 1987.  It was indicated
that there was extensive myopic stretching of both eyes by
funduscopic examination.  Alternating esotropia was noted.
Corrected visual acuity was 20/30 in each eye.  The
diagnoses for each eye were extreme myopia, astigmatism,
esotropia and cataracts.  On measurements of visual fields,
the concentric contraction in the left eye was to no less
than 25 degrees at any of the meridians.

The veteran underwent another eye examination by a private
examiner in November 1988.  He complained that his vision
was poor with his present glasses.  Corrected visual acuity
was 20/70 minus on the left and 20/50 on the right.  The
visual fields on the left were constricted to no less than
20 degrees at any meridian.  Very high myopic astigmatism
was diagnosed.

The veteran underwent a VA examination in May 1989.  He
complained of flashes of light in the left eye.  Slit lamp
examination showed buckling and enlarged vessels in both
eyes.  The corrected vision was 20/50 minus 1 in the left
eye with 14 diopters of correction and 20/60 plus 3 in the
right eye with 10.5 diopters of correction.  The extent of
concentric contraction was less than 5 degrees at the
meridians from 135 to 225 degrees in the left eye.

The rating was raised from 10 percent to 20 percent by a
rating decision of October 1989 and was made effective from
December 16, 1987, the date of the examination by a private
examiner.  The rating was assigned under Diagnostic
Code 6080, which provides a 20 percent rating for unilateral
concentric contraction of the visual field to 15 degrees but
not to 5 degrees.  Under this code, a 30 percent rating may
be assigned for concentric contraction to 5 degrees.  It is
clear that the visual field constriction reported in
December 1987 and November 1988 did not support a rating
higher than 20 percent under this code.  The visual fields
examination of May 1989 showed more concentric contraction
than that reported on the two prior occasions but the
average concentric contraction at the eight principal
meridians was 12.6 degrees.  In the absence of contraction
to 5 degrees or less, no rating higher than 20 percent may
be assigned for unilateral involvement.

The veteran's potential entitlement to a rating higher than
10 percent must also be considered under the codes pertaining
to impairment of central visual acuity.  The corrected visual
acuity in the veteran's left eye was reported as 20/30 in
December 1987, 20/70 minus in November 1988, 20/50 minus 1
in May 1989 and 20/60 in February 1991.  The visual acuity
of the right eye is also severely impaired, but since
service connection is not in effect for that eye, the visual
defect on the right may not be considered; for purposes of
application of the VA rating criteria, the vision in that
eye must be deemed to be 20/40 or better.  Diagnostic
Code 6079 provides that when corrected visual acuity is
20/70 in one eye and 20/40 in the other eye, a rating of no
more than 10 percent is warranted.  In order for the veteran
to receive a rating higher than the current 20 percent based
on unilateral central visual acuity impairment, his vision
would have to be 10/200, in which case the rating would be
30 percent.  This degree of impairment is not present.

The veteran's claim must also be considered under the rules
regarding extraschedular evaluations.  Under 38 C.F.R.
§ 3.321(b)(1) (1992), an extraschedular evaluation
commensurate with the average impairment of earning capacity
due to the service-connected disability may be assigned if
the case presents an exceptional or unusual disability
picture, with such related factors as marked interference
with employment or frequent periods of hospitalization, as
to render impractical the application of the regular
schedular standards.  In this case, the veteran's visual
problems are worsened substantially by diverse
nonservice-connected pathology of both eyes.  Even with this
added pathology, he was considered by the VA examiner in
February 1991 to be "holding on very well indeed" and to be
in no need of active treatment.  In these circumstances, no
basis for an extraschedular rating is shown.  Likewise, the
disability picture does not more nearly approximate that
required for the next higher rating of 30 percent.
38 C.F.R. § 4.7 (1992).

            L.  Thrombophlebitis of the Right Leg

Thrombophlebitis of the right leg was first documented in
records from the Southwest General Hospital dated in
November and December 1976, where the veteran was admitted
after the acute onset of chest pain and difficulty
breathing.  A pulmonary embolus of the left lung was also
noted.  He was readmitted in January 1977 for a recurrence
of symptoms.  Minimal leg soreness was evident but a
venogram showed no thrombosis this time.  Records from the
second period of service show that the veteran continued to
have complaints involving the right side of the ankle.  In
November 1977 he was referred to a pulmonary clinic because
of chest pain.  It was noted that he had been taking
anticoagulation since the prior hospitalizations.  It was
determined in December 1977 that no further treatment was
warranted and that no duty limitation was required because
of deep vein thrombosis.  In September 1978 he was again
seen at a pulmonary clinic.  He complained of shortness of
breath after running 1 mile and of having to breathe deeply
after climbing stairs.  He was seen for further complaints
of this nature in May 1979.

Postservice medical evidence shows that chronic
thrombophlebitis was diagnosed on a VA examination of June
1980.  Tenderness of the calf was noted, but deep
circulation was okay.  The veteran was admitted to a VA
hospital in February 1985 for possible pulmonary embolism.
No thrombophlebitis was noted at that time.  No redness,
swollen vessels or calf tenderness were reported on a VA
examination in August 1988.  Deep vein thrombosis of the
right leg and thigh was documented during a VA
hospitalization in June 1988 with deep cordlike veins
palpable.  There was mild warmth and early phlebitis.  A
private physician, C. Comerci, D.O., reported that Doppler
studies in October 1988 had been negative for deep vein
thrombosis.  Records from the Roane General Hospital
describing admissions in November 1988, August 1989 and
March 1991 are of record.  Deep vein thrombosis with
resulting pulmonary emboli to the bilateral apical and left
lateral lung areas were diagnosed.  The symptoms in August
1989 also included right leg pain which was like what he had
when he had a blood clot.  Anticoagulation was given.  The
diagnoses included chronic deep vein thrombosis with history
of pulmonary embolism.  At the time of admission in March
1991 the veteran's complaints included right leg pain.

The veteran underwent multiple studies at a VA facility in
February and March 1991 pursuant to the Board remand.  On
the general medical examination it was noted that there was
"evidence of chronic thrombophlebitis."  The diagnoses on
orthopedic examination included history of multiple episodes
of thrombophlebitis in the right lower extremity.  No
specific findings were reported.  At the VA examination of
May 1989, the orthopedic examiner noted tenderness over the
right ankle joint.  The neurological examiner noted that the
right lower extremity was warm into the thigh and that there
was normal hair growth.

Service connection was granted for thrombophlebitis by a
rating decision of July 1981; a noncompensable rating was
assigned.  A compensable rating of 10 percent was
subsequently assigned from April 6, 1983, under Code 7121.
Under that code, a 10 percent rating is provided for
unilateral thrombophlebitis manifested by "persistent
moderate swelling of leg not markedly increased on standing
or walking."  The next higher rating of 30 percent is
assigned when there is "persistent swelling of leg or thigh,
increased on standing or walking 1 or 2 hours, readily
relieved by recumbency...moderate discoloration,
pigmentation or cyanosis."  38 C.F.R. Part 4, Code 7121
(1992).

The record shows that active thrombophlebitis required
hospitalization in June 1988, November 1988, and August 1989
and that symptoms suggestive of thrombophlebitis were
manifest during the hospitalization of March 1991.
Anticoagulation on these occasions has been successful in
relieving the symptoms.  The record contains scant
information concerning the status of the disorder during the
intervals between the hospitalizations.  The orthopedic
examiner who saw the veteran in May 1989 noted tenderness
over the right ankle joint and a neurologist indicated that
the lower extremity was warm to touch.  A Doppler study in
October 1988 was negative for deep vein thrombosis.  The VA
examiner of March 1991 noted "evidence of chronic
thrombophlebitis" but did not indicate what that evidence
was.  The record does not show the specific symptoms
required for a 30 percent rating, including persistent
swelling, discoloration, pigmentation or cyanosis.

The paucity of examination findings concerning the current
status of the disorder highlights the need for a current
examination.  Ordinarily the Board would remand the claim
again for a detailed peripheral vascular examination in
accordance with the requirement imposed by the United States
Court of Veterans Appeals that such development be performed
when the record before the Board is clearly inadequate.
Littke v. Derwinski, 1 Vet.App. 90 (1990).  However, since
the veteran has indicated that he has no intention of
submitting to further tests, the Board has no choice but to
decide the claim on the basis of the evidence already of
record.  Without further information, the fact that several
hospitalizations have been required since 1988 is not
sufficient in and of itself, in the context of all of the
evidence of record, to justify the assignment of an increase
on either a schedular or extraschedular basis.  38 C.F.R.
§ 3.321(b)(1) (1992).  Consequently, the Board finds that a
preponderance of the evidence is against the claim for an
increased rating for thrombophlebitis.

                   M.  Pulmonary Embolism

Service connection for pulmonary embolism as disability
secondary to thrombophlebitis was granted by a rating
decision of November 1986.  A noncompensable rating was
assigned by analogy to serofibrinous pleurisy under
Code 6899-6810.  Under Code 6810, chronic fibrous pleurisy
following lobar pneumonia and other acute diseases of the
lungs or pleural cavity, without empyema, is considered a
nondisabling condition, except that a 10 percent rating may
be assigned for "diaphragmatic pleurisy, pain in chest,
obliteration of costophrenic angles, tenting of diaphragm."
38 C.F.R. Part 4, Code 6810 (1992).  A 10 percent rating is
also assignable under Code 6811 for moderate purulent
pleurisy (empyema) when there is some embarrassment of
respiratory function.  A 30 percent rating is assignable for
moderately severe disability, with residual marked dyspnea
or cardiac embarrassment on moderate exertion.  38 C.F.R.
Part 4, Code 6811 (1992).

The veteran experienced confirmed pulmonary emboli in
November 1976, January 1977, August 1986, November 1988 and
August 1989, as previously reported.  A description of the
symptoms resulting from pulmonary emboli is found in the
reports of hospitalizations at the Roane Hospital in
November 1988 and August 1989, the dates of the two most
recent emboli.  In November 1988 the veteran was admitted
with leg pain of one week's duration followed by left lower
sternal border "pop" which caused severe pain in the left
chest and arm.  A Doppler study showed venous insufficiency
but no clot.  The chest pain responded to sublingual
nitroglycerin.  It was noted that morphine also helped but
that it was "difficult to distinguish what caused what."  He
was discharged several days later with numerous diagnoses,
including pulmonary emboli, angina, chronic obstructive
pulmonary disease.  A lung scan showed pulmonary emboli in
the left upper lobe and lateral lung fields and right upper
lobe.  The August 1989 admission was likewise prompted by
pain in the chest; there was radiation to the left neck.
The chest pain decreased with nitroglycerin but the arm pain
remained.  He claimed that his face, neck and arm had
swelled up.  He had also had right leg pain which had waxed
and waned, anticoagulation was started.  In March 1991 the
symptoms at admission consisted primarily of dyspnea with
right-sided chest pain accompanied by pain in the right
medial thigh.  A profusion scan showed a low probability of
pulmonary embolism.  During the hospitalization the veteran
stated that the pain was in the sternal area with deep
breathing.  Breath sounds were diminished in the left lung
fields.

The veteran cites the chest pain and dyspnea on exertion as
the disability which he believes entitles him to a
compensable rating for pulmonary emboli.  At face value, the
symptoms recorded during the hospitalizations for actual
emboli appear to be significantly disabling.  The veteran
claims that he has exertional dyspnea and chest pain even
between the episodes of acute emboli, and his testimony in
this regard must be considered as relevant evidence.
Nevertheless, the record demonstrates unequivocally that the
veteran's debilitated medical status is due in part to a
number of disorders which can produce the symptoms cited,
including atherosclerotic heart disease and chronic
obstructive pulmonary disease.  Even the veteran's treating
physician was not certain what caused what.  It is clear
that, to sort out the tangle of overlapping symptoms,
further clinical examination will be needed and medical
opinions based on those studies will be critical.  Little
can be done in the meantime to adjudicate the claim
further.  Any compensable schedular or extraschedular rating
assigned for pulmonary emboli must reflect an objective
application of the criteria to the evidence of record
following adequate development.  Since the veteran is
currently unwilling to report for the requisite studies, the
Board has no choice but to deny the claim.

     N. Total Rating Based on Individual Unemployability

A claim for a total rating based on individual
unemployability was received in October 1987.  The veteran
reported that he had completed three years of college and
had received vocational training as a mason in 1984 and
1985.  He reported occupational experience as a security
guard, manager, and offset pressman.  He had last worked
full time in July 1987, when he became too disabled to work.

A total disability rating for compensation may be assigned
where the service-connected disabilities are less than
100 percent disabling when it is found that such
disabilities are sufficient to produce unemployability
without regard to advancing age.  The veteran in this case
does not satisfy the schedular requirements for an award
based on individual unemployability in that he does not have
a single service-connected disability ratable at 60 percent
or more, or two or more disabilities (one of which is
ratable at 40 percent or higher) combining to 70 percent or
more.  38 C.F.R. § 4.16(b) (1992).  We note in this regard
that, while headaches and hallux valgus with hammertoes have
not yet been rated by the RO, the outcome of the appeal will
turn on the question of employability.  In any case, it is
not likely, based on the present record, that the veteran
will meet the schedular requirements even after these
disabilities are rated.

The record clearly establishes that the veteran is
manifestly incapable of pursuing substantially gainful
employment at the present time.  However, the disorders
productive of the most severe disablement, particularly the
organic brain disease, heart disease, and chronic
obstructive pulmonary disease, are not service-connected.
The service-connected disorders, which affect the left
eye, right lower extremity and vascular system, did not
preclude employment by the veteran during the first several
years after separation.  As explained herein, the extent of
increased disability due to the recurrences of
thrombophlebitis and pulmonary emboli at the present time
cannot be determined from the available record.  Until the
necessary studies can be completed, the Board must find that
a preponderance of the evidence is against the claim for a
total rating based on individual employability.

     O.  Temporary Total Rating Based on Hospitalization
    at a VA Facility from August 31 to September 7, 1986.

The veteran was admitted to a VA hospital on August 31,
1986, after the onset of sharp right-sided chest pain which
was preceded by leg and back pain following a fall the week
before.  The chest pain increased with inspiration and cough
and did not radiate.  The chest was exquisitely tender over
the lower left rib cage and the pain was accompanied by
shortness of breath.  An electrocardiogram showed no
evidence of ischemic disease.  A VQ scan showed a high
probability of pulmonary embolus.  Anticoagulants were
given.  The veteran was discharged on September 7, 1986,
with a diagnosis of pulmonary embolism.

VA regulations permit the assignment of a total rating for a
period of 1, 2 or 3 months following hospital discharge if
the hospital treatment for a service-connected disability
resulted in surgery necessitating post hospital
convalescence, surgery with severe postoperative residuals
shown at hospital discharge, or immobilization by cast,
without surgery, of one or more major joints.  Since the
veteran did not undergo surgery during this hospitalization
and did not have a joint immobilized by a cast, there is no
basis for the assignment of a total rating under this
section.  38 C.F.R. § 4.30, as in effect before March 1,
1989.

The law also permits the assignment of a temporary total
rating based on hospitalization when it is established that
a service-connected disability has required hospital
treatment for a period in excess of 21 days or hospital
observation for a period in excess of 21 days.  38 C.F.R.
§ 4.29 (1992).  In this case, the hospitalization in
question lasted a total of eight days only.

                            ORDER

Service connection for headaches is granted.

Service connection for hallux valgus of the right foot with
hammertoes is granted.

Service connection for an organic brain disorder, chronic
obstructive pulmonary disease, a psychiatric disorder, an
eye disorder (separate from residuals of retinal detachment
of the left eye), residuals of an injury to the back and hip
with arthritis, syncope, defective hearing in the left ear,
and a heart disorder is denied.

Increased ratings for retinal detachment of the left eye,
thrombophlebitis of the right leg, and pulmonary emboli are
denied.

A total rating based on individual unemployability and a
temporary total rating based on hospitalization at a VA
facility from August 31 to September 7, 1986, are denied.


                 BOARD OF VETERANS' APPEALS
                   WASHINGTON, D.C. 20420

     STEPHEN L. WILKINS                 U. H. ANG, M.D.

                       DANIEL J. STEIN

NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. § 7266 (West
1991), a decision of the Board of Veterans' Appeals granting
less than the complete benefit, or benefits, sought on
appeal is appealable to the United States Court of Veterans
Appeals within 120 days from the date of mailing of notice
of the decision, provided that a Notice of Disagreement
concerning an issue which was before the Board was filed
with the agency of original jurisdiction on or after
November 18, 1988.  Veterans' Judicial Review Act, Pub. L.
No. 100-687, § 402 (1988).  The date which appears on the
face of this decision constitutes the date of mailing and
the copy of this decision which you have received is your
notice of the action taken on your appeal by the Board of
Veterans' Appeals.