Citation Nr: 0702718 Decision Date: 01/30/07 Archive Date: 02/06/07 DOCKET NO. 05-11 203 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Buffalo, New York THE ISSUES 1. Entitlement to service connection for posttraumatic stress disorder. 2. Entitlement to an increased (compensable) rating for residuals of a fourth metacarpal fracture of the right hand. 3. Entitlement to service connection for migraine headache. 4. Whether new and material evidence has been received to reopen the previously denied claim of entitlement to service connection for residuals of an eye injury, claimed as blurred vision. REPRESENTATION Appellant represented by: New York State Division of Veterans' Affairs ATTORNEY FOR THE BOARD Ambler T. Jackson, Associate Counsel INTRODUCTION The veteran had active duty service from December 1980 to July 1984. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2004 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Buffalo New York. The veteran was notified of the decision in August 2004. In July 2004, the RO denied the claim of entitlement to service connection for posttraumatic stress disorder (PTSD), entitlement to service connection for residuals of an eye injury, claimed as blurred vision, and entitlement to service connection for migraine headache. The RO denied the claim of entitlement to an increased rating for residuals of a fourth metacarpal fracture of the right hand and continued the noncompensable rating, effective from November 1995. The RO also determined that new and material evidence had not been submitted to reopen the previously denied claim of entitlement to service connection for dental trauma. This claim, however, was withdrawn when the veteran's accredited representative submitted a correspondence in February 2005, which indicated that the veteran desired to withdraw the claim. As for the veteran's claim that he is entitled to service connection for blurred vision, a review of the record shows that the veteran apparently relates his complaints of blurred vision to the in-service eye injury during his period of service in June 1982. Note that in May 1996, the RO denied the claim of entitlement to service connection for an eye injury because, in essence, the evidence did not show that the veteran's vision was impaired. He was also notified of the decision in May 1996, he did not file a timely Notice of Disagreement (NOD), and the decision became final. By correspondence dated in February 2003, the veteran claimed entitlement to service connection for blurred vision and put in parenthesis, the word "eyes." The Board finds that the claim of blurred vision is related to the eye injury for which the veteran previously claimed entitlement to service connection. Accordingly, the veteran essentially claims entitlement to service connection for residuals of an eye injury, claimed as blurred vision. As this claim was adjudicated in May 1996 and is final, the Board construes the February 2003 correspondence as a claim to reopen the previously denied claim. The issue of entitlement to service connection for PTSD and the issue of whether new and material evidence has been received to reopen the previously denied claim of entitlement to service connection for residuals of an eye injury, claimed as blurred vision is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The service medical records show that the veteran complained of headaches in connection with a June 1982 fall during his period of service. 2. The record shows that there is no evidence of a chronic headache disability at the time of the veteran's separation from service and no evidence of continuity of symptoms associated with the in-service complaints of headaches. 3. The post-service medical record includes a current diagnosis of migraine headache; however, the record does not include evidence of a medical opinion which tends to link the current diagnosis of migraine headache to the veteran's period of service, to include the June 1982 head injury. 4. The service-connected residuals which are attributable to the fourth metacarpal fracture of the right hand are manifested by subjective complaints of pain and numbness. 5. The severity of the service-connected residuals which are attributable to the fourth metacarpal fracture of the right hand does not approximate amputation of the ring finger. CONCLUSIONS OF LAW 1. Migraine headache were not incurred in active military service. 38 U.S.C.A. §§ 1110 1112, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.303 (2006). 2. The criteria for entitlement to an increased (compensable) rating for the service-connected residuals of a fourth metacarpal fracture of the right hand have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5227 (in effect prior to August 26, 2002, and thereafter). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Preliminary Matters Before addressing the merits of the veteran's claim on appeal, the Board is required to ensure that the VA's "duty to notify" and "duty to assist" obligations have been satisfied. See 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2006). The VA is required to assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. The VA is required to notify a claimant and the claimant's representative, if any, of any information, and any medical or lay evidence, not previously provided to the Secretary that is necessary to substantiate the claim. As part of the notice, the VA is to specifically inform the claimant and the claimant's representative, if any, of which portion, if any, of the evidence is to be provided by the claimant and which part, if any, the VA will attempt to obtain on behalf of the claimant. In addition, the VA must also request that the claimant provide any evidence in the claimant's possession that pertains to the claim. The Board notes that the United States Court of Appeals for Veteran's Claims (the Court) has held that the plain language of 38 U.S.C.A. § 5103(a) requires that notice to a claimant be provided "at the time" of, or "immediately after," the VA's receipt of a complete or substantially complete application for VA-administered benefits. See Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). As it pertains to the veteran's claim for an increased rating, this was accomplished by information provided in the June 2003 notice letter. More recently, the Court found that in cases for service connection, the VA must notify the claimant that, should service connection be awarded, a disability rating and an effective date for the award of benefits will be assigned. See Dingess v. Nicholson, 19 Vet. App. 473 (2006). The timing notification requirements listed in 38 C.F.R. § 3.159 should include all downstream issues of the claim. (i.e., the initial-disability-rating and effective-date elements of a service-connection claim). See Dingess. In the present appeal, although the veteran has not been provided notice of the type of evidence necessary to establish a disability rating or an effective date for the disabilities on appeal, the Board finds that there is no prejudice to the veteran in proceeding with the issuance of a final decision. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993) (where the Board addresses a question that has not been addressed by the agency of original jurisdiction, the Board must consider whether the appellant has been prejudiced thereby). As explained below, the Board has determined that entitlement to service connection for migraine headache and entitlement to an increased (compensable) rating for the service-connected residuals of a fourth metacarpal fracture of the right hand is not warranted. Consequently, no disability rating and/or effective date will be assigned; therefore, while the veteran was not notified of the evidence pertinent to this element, there is no possibility of any prejudice to him. In March 2004, the veteran was provided with a notice letter which informed him of the information and evidence necessary to substantiate a claim for service connection. In June 2003, the RO provided the veteran with a notice letter pertaining to the claim of entitlement to an increased rating for residuals of a fourth metacarpal fracture. The Board initially concludes that, collectively, the discussions contained in the June 2003 and March 2004 notice letters complied with VA's duty to notify the veteran. For example, he was notified of the evidence that is necessary to substantiate claims for service connection and he was notified that VA required additional evidence to process the claim of entitlement to an increased rating for residuals of a right fourth metacarpal fracture; he was informed of the evidence that VA received in connection with the claim; he was informed of where to send the information and how to contact VA if he had questions or needed assistance. The veteran was also informed of the efforts that VA would make to assist him in obtaining evidence necessary to substantiate the claims. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). He was also told, in essence, to submit all evidence he had in his possession that was relevant to the claims. A review of the record shows that the veteran had knowledge of the evidence necessary to substantiate the claim for an increased rating. The veteran submitted numerous VA outpatient medical treatment records which include complaints of the right hand and wrist, and his statement submitted in support of the claim indicates that he continued to receive treatment for the right hand, thereby acknowledging that it was helpful to his claim to submit evidence showing the current level of severity of the residuals of the right fourth metacarpal fracture. Any error in the adequacy of the notice provided to the veteran is not shown to have any effect on the case, or to cause injury to the veteran. Any assistance that VA would provide to the veteran with respect to VA's duty to notify would not further substantiate the veteran's claims. 38 U.S.C.A. § 5103A(a)(2); 38 C.F.R. § 3.159(d). As such, the Board concludes that any such harmless error does not prohibit consideration of the appeal on the merits. See ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998); Miles v. Mississippi Queen, 753 F.2d 1349, 1352 (5th Cir. 1985). The record also reflects that the veteran's service medical records, service personnel records, VA examination report, and VA outpatient medical treatment records have been obtained and associated with the claims file. The veteran has not identified any other obtainable medical records or evidence pertinent to the claims. The Board is similarly unaware of any outstanding obtainable evidence. Therefore, the Board is satisfied that the VA has complied with the duty to assist requirements. II. Analysis Entitlement to Service Connection for Migraine Headaches The veteran maintains that he is entitled to service connection for migraine headaches. He asserts that his current diagnosis of migraine headaches is related to an in- service head injury. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. See 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2006). In order to establish service connection for the claimed disorder, the following must be present: medical evidence of a current disability; medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the disease identity is established, there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned. See 38 C.F.R. § 3.303(b) (2006). When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. Id. A lay person is competent to testify only as to observable symptoms. See Falzone v. Brown, 8 Vet. App. 398, 403 (1995). A lay person is not, however, competent to provide evidence that the observable symptoms are manifestations of chronic pathology or diagnosed disability, unless such a relationship is one which a lay person's observations is competent. See Savage v. Gober, 10 Vet. App. at 495-97. Service connection may be also granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. See 38 C.F.R. § 3.303(d) (2006). The service medical records show that the veteran injured his head after he tripped and fell. Upon receiving treatment in connection with the fall, the veteran complained of headaches. The September 1980 service enlistment examination report was essentially normal. The contemporaneous report of medical history does not indicate that he had any problems associated with headaches. The June 1982 chronological record of medical care states that the veteran tripped and fell on his face and complained of a headache and pain. It is noted that the veteran may have been slightly intoxicated. He apparently loss consciousness and then regained consciousness when "he was awakened by a friend." The July 1984 separation examination report reveals a normal neurologic examination and the report does not include any complaints, findings, or a history of treatment for migraine headaches. The post-service medical record shows that the veteran is currently diagnosed as having migraine headaches. These records, however, do not include a medical opinion which tends to establish a relationship between the current diagnosis of migraine headaches and the veteran's period of service, to include the June 1982 head injury. The first VA outpatient treatment records associated with the claims file are dated in 1995. These medical records do not include a diagnosis of migraine headaches. The additional VA outpatient treatment records have dates which begin in 2001. The VA outpatient treatment records, dated in May 2004, state that the veteran has a three to four year history of migraine headache, status-post head injury. The records states that the veteran was hit in the head with "an iron ball." There are no reports of an in-service head injury associated with the diagnosis. (See VA outpatient medical treatment records, dated on July 2001 to November 2004). In view of the foregoing, the Board concludes that the requirements for entitlement to service connection for migraine headaches are not met. The Board initially finds that while the service medical records show in-service complaints of headaches, the evidence does not show that these complaints were chronic. On service separation examination, there was no mention of the veteran continuing to experience headaches. Note that in cases where a condition noted in service is not shown to be chronic, as is the situation in the instant appeal, continuity of symptomatology is required. See 38 C.F.R. § 3.303(b). In the veteran's case, there is no evidence of continuity of symptomatology. The Board determines that the complaints of the headaches during his period of service were acute and transitory and that there is no evidence of continuity of the in-service complaints of headaches after the veteran's period of service. For example, the complaints and diagnosis of migraine headache was shown many years after the veteran's separation from service. (See VA medical outpatient treatment records, dated in 1995, and the VA outpatient medical treatment records, dated from July 2001 to February 2005). As for the existence of competent medical evidence which relates the current diagnosis of migraine headache to the veteran's period of service, to include the June 1982 in- service head injury, the post-service medical record does not include such evidence. The postservice medical records appear to suggest that the diagnosis of migraine headaches is associated with a postservice injury. Thus, in the absence of competent medical evidence which tends to establish a relationship between the current diagnosis of migraine headache and the veteran's period of service, service connection is not warranted. The Board has considered the veteran's assertions that the current diagnosis of migraine headache is related to his period of service. The veteran is certainly competent to describe his own symptoms. See Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Heuer v. Brown, 7 Vet. App. 379, 384 (1995). However, as a layperson without the appropriate medical training and expertise, he is not competent to render a probative opinion on a medical matter, such as whether there is a medical relationship between a current disability and service. See Bostain v. West, 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997) (a layman is generally not capable of opining on matters requiring medical knowledge). In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. at 53-56 (1990). Thus, the claim is denied. Entitlement to an Increased (Compensable)Rating for Residuals of Right Fourth Metacarpal Fracture By rating decision, dated in May 1996, the RO awarded service connection for residuals of a fourth metacarpal fracture of the right hand and assigned a noncompensable rating, effective November 1995. In February 2003, the veteran claimed entitlement to an increased rating for residuals of a fourth metacarpal fracture of the right hand. The veteran essentially maintains that he is entitled to a compensable rating for residuals of a right fourth metacarpal fracture of the right hand. He maintains that he has received continuous treatment for the disability. Disability evaluations are determined by comparing a veteran's present symptomatology with criteria set forth in the VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. See 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular Diagnostic Code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. See 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. See 38 C.F.R. § 4.3 (2006). The veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The veteran's service-connected residuals of a right fourth metacarpal fracture are evaluated under 38 C.F.R. § 4.71a, Diagnostic Code 5227, Ankylosis of the Little Finger or Ring Finger. The veteran's fourth finger is the ring finger. The RO received the veteran's correspondence indicating that he requested an increased (compensable) rating for residuals of the right metacarpal fracture in June 2002. During the pendency of the appeal, VA revised Diagnostic Codes 5216- 5230, which pertain to ankylosis and limitation of motion of fingers. See 67 Fed. Reg. 48784-48787 (July 26, 2002). The revisions became effective August 26, 2002. Under DC 5227 (effective prior to August 26, 2002) a noncompensable rating is warranted for ankylosis of the ring finger. The note following DC 5227 indicates that extremely unfavorable ankylosis of the ring finger would be rated as amputation under Diagnostic Code 5155. Under 38 C.F.R. § 4.71a, DC 5227 (effective August 26, 2002), a noncompensable rating is assigned for favorable or unfavorable ankylosis of the ring finger (of the major or minor hand). The Note associated with these criteria states that the evaluator should also consider whether evaluation as amputation is warranted and whether additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand. Under 38 C.F.R. § 4.71a, Diagnostic Code 5155, a 10 percent rating is warranted for amputation at the proximal interphalangeal joint or proximal thereto (either hand), without metacarpal resection. With metacarpal resection (more than 1/2 of that bone lost), a 20 percent rating is warranted (either hand). Thus, the current manifestations do not more nearly approximate the criteria for a 20 percent rating. Note that the veteran is entitled to the application of the version of the regulation that is more favorable to him from the effective date of the new criteria, but only the former criteria are to be applied for the period prior to the effective date of the new criteria. Kuzma; VAOPGCPREC 3- 2000. The evidence received in connection with the veteran's claim shows that he has subjective complaints of pain, numbness; he also complained of difficulty grasping objects. There is no evidence of fracture, subluxation, or dislocation. (See the VA outpatient medical treatment records, dated from July 2001 to July 2002; the September 2003 VA X-ray Report; and VA outpatient medical treatment records, dated from June 2003 to December 2003). The veteran underwent VA examination in February 2004. The February 2004 examination report states that the veteran writes with his right hand. The examiner reviewed the medical records and stated that in approximately 1996 the veteran began to experience pain in the right hand which also traveled to the right arm and shoulder. It is noted that the veteran has a history which is significant for carpal tunnel syndrome and that the veteran also complained of numbness and tingling of the right hand in connection with carpal tunnel syndrome. The examiner also reported that the veteran complained of weakness in the right hand and dropping items out of the right hand. A physical examination was performed. The examination was essentially normal; the veteran's grip was equal in all fingers of the right hand, he had normal flexion to touch the transverse crease of the hand, he was able to touch the thumb with the tip of all fingers without hesitation, he was able to move all joints of the right hand. The examiner expressly stated that he saw no deformity in the use of the right hand. It is noted that the veteran wears a splint because of a carpal tunnel problem. The impression was that the veteran has a stress fracture of the right fourth metacarpal with no X-ray at the time of the fracture and that there is no deformity shown on the X-ray dated in September 2003. In conclusion, the examiner noted that the veteran has symptoms of carpal tunnel syndrome, but that the veteran claims that the whole hand is numb in the morning and that the numbness travels up the arm and to the neck. The examiner also stated that there was no evidence of atrophy of the muscles. He notes that the veteran stated many symptoms; however, he (the examiner) was unable to find any physical changes that he could comment on. The examiner stated that he did not find any residuals from the fracture of the fourth metacarpal on palpation or on X-ray. The examiner also stated that "it is not at all likely that the stress fracture in 1984 is the cause of the symptoms which he now complains of." An April 2004 VA electromyography (EMG) report states that the veteran continued to complain of pain and numbness in the hand, and that he continued to experience dropping objects. As for the history of the veteran's disability, it is noted that he was provided a cast which extended up to the veteran's elbow when he injured the right hand during his period of service and that he now has numbness in the fourth finger. A motor conduction study, sensory nerve test, and a quantitative EMG were performed. The examiner stated that the veteran has a right ulnar neuropathy due to compression and/or entrapment of the right elbow and a secondary compression or entrapment of the sensory branch of the right distal ulnar nerve distal to the canal of the Guyon. The examiner did not relate these findings to the right fourth metacarpal fracture. The May 2004 VA orthopedic note states that the veteran continued to complain of numbness and tingling of the right arm and that he experienced these symptoms intermittently for two or three years. The veteran reported that he also dropped objects. The note states that the veteran was seen by a neurologist in April 2004 and essentially reiterates the findings of the April 2004 EMG report. The VA outpatient medical treatment records, dated through February 2005, shows diagnoses for carpal tunnel syndrome and right ulnar neuropathy. The veteran was offered a release of the ulnar nerve at the wrist and elbow. These records do not, however, reveal evidence of ankylosis or recommended amputation of the right fourth finger or right hand. In view of the forgoing, the Board concludes that the evidence does not show that the residuals attributable to the service-connected fourth metacarpal fracture of the right hand meet the criteria for a compensable rating under any applicable Diagnostic Code. The RO evaluated the residuals of the right fourth metacarpal fracture of the right hand under 38 C.F.R. § 4.71a, Diagnostic Code 5227. Applying the symptoms noted above to the applicable rating criteria, the Board finds that there is no basis for assigning a compensable rating under Diagnostic Code 5227 (ankylosis of the ring or little finger). Essentially, this Diagnostic Code does not provide for a compensable rating, regardless of severity. Moreover, the evidence does not show that the veteran has ankylosis of the right finger or right hand. Applying the Note associated with Diagnostic Code 5227, the Board finds that evaluation as amputation is not warranted, as there is no deformity of the right fourth finger/hand/wrist. The record shows that there is no impairment which has been associated with the service- connected residual fracture. A VA examiner has specifically stated that the symptoms that the veteran complained of are not related to the fracture of the right ring finger. As to whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand, the Board finds that the evidence reveals normal motion of the fingers of the right hand. (See VA examination report, dated in February 2004). The evidence also reveals that there is interference with the overall function of the veteran's right hand; however, the evidence demonstrates that this interference is related to carpal tunnel syndrome, a disability for which the veteran is not service-connected. Accordingly, a compensable rating is not warranted under the provisions of the Note associated with Diagnostic Code 5227. With respect to the possibility of entitlement to a compensable evaluation under 38 C.F.R. §§ 4.40 and 4.45, the Board has also considered whether an increased (compensable) evaluation could be assigned on the basis of functional loss due to the veteran's subjective complaints of pain. DeLuca v. Brown, 8 Vet. App. 202, 204-206 (1995). The Board finds that there is insufficient evidence of objective pain on motion, or any other functional loss, to warrant a compensable rating. In this regard, the evidence fails to show that he has residuals from the fracture which are analogous to amputation of the right ring finger. The Board therefore concludes that the evidence does not show that there is functional loss due to pain to warrant a compensable rating. See 38 C.F.R. §§ 4.40, 4.45; DeLuca. Extraschedular Rating The Board considered the assignment of an extraschedular rating under 38 C.F.R. § 3.321(b)(1); however, the evidence of record does not demonstrate that the service-connected residuals of the right fourth metacarpal fracture result in marked interference with earning capacity or employment beyond the interference that is contemplated by the assigned evaluation, or that the disability has necessitated frequent periods of hospitalization. See 38 C.F.R. § 3.321(b)(1) (2003); Bagwell v. Brown, 9 Vet. App. 337, 338-339 (1996). Conclusion In view of the foregoing, the Board concludes that the evidence received in connection with the claim of entitlement to an increased (compensable) rating for residuals of the right fourth metacarpal fracture of the right hand does not meet the criteria for a compensable rating. In reaching this conclusion, the Board finds that the preponderance of the evidence is against the claim of entitlement for an increased rating. 38 U.S.C.A. § 1110 (West 2002). As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application in the instant case. See generally Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Thus, the claim is denied. ORDER Entitlement to service connection for migraine headache is denied. Entitlement to an increased (compensable) rating for residuals of a fourth metacarpal fracture of the right hand is denied. REMAND a. Posttraumatic Stress Disorder Additional development with respect to verifying the veteran's claimed in-service stressor(s) is necessary before the Board can adjudicate the claim. In June 2002, VA received the veteran's claim of entitlement to service connection for posttraumatic stress disorder (PTSD). As for the in-service stressor information, the veteran maintains that he was stationed on board the United States (USS) John F. Kennedy (JFK) during his period of service and that on April 14, 1983 the Marine Barracks in Lebanon were attacked by a terrorist group. In connection with the attacks, he maintains that there were 271 casualties and that his duties included receiving the casualties that were transported to the USS JFK, some of which, he asserts, were dead. Essentially, he argues that he has unpleasant thoughts about the event and continues to have dreams about people crying and dying as a result of the attack. (See the veteran's June 2003 PTSD Questionnaire Form). The service personnel records reveal that the veteran served on board the USS JFK. The Enlisted Performance Record shows that the veteran was stationed on the USS JFK from April 21, 1983 to July 31, 1984. Deck logs are not associated with the service personnel records. These records do not indicate whether in fact the USS JFK actually participated in receiving casualties of the attack or that the veteran specifically participated in receiving casualties. Records pertaining to the role of the USS JFK, if any, in the casualties of the 1983 attack in Lebanon are relevant to the veteran's claimed stressor(s). The post-service medical record includes evidence showing that the veteran is diagnosed as having PTSD. In August 2003, after an evaluation of the veteran at a VA Behavioral Health Clinic, the initial diagnostic impression was PTSD, non-combat type. Additional VA outpatient medical treatment records also report a current diagnosis of PTSD. (See VA outpatient medical treatment records, dated from July 2001 to February 2005). The RO undertook development action to verify the veteran's claimed in-service stressor(s). In July 2004, D. Schoenle at the RO in Buffalo, New York emailed the webmaster at a department associated with the USS JFK (CV 67) and placed the following in the subject line, "verification of participation of an event /location of a ship." D. Schoenle stated that the veteran reported that on April 14, 1983, the Marine Barracks in Lebanon were bombed and that the veteran was required to assist the medical staff with casualty care and transportation of the dead. The question of whether the USS JFK operated as an overflow for mass casualties was asked. In response to the inquiry from D. Schoenle, internet-print- outs pertaining to the USS JFK were submitted. The internet records from the American Israel Public Affairs Committee (AIPAC) show that a van filled with explosives was driven into the U.S. Embassy in Lebanon on April 18, 1983 and that a bombed truck slammed into the US Marine Barracks in Lebanon on October 23, 1983. Mr. Schoenle was also advised to contact other agencies to verify the veteran's claimed stressor(S). He contacted the Navy Historical Center. A July 2004 email correspondence from K. Hurst, Historian, at the Naval Historical Center, states that the USS JFK was located at the port of Norfolk, Virginia. On October 23, 1983, the USS JFK was a carrier en route to the Mediterranean. In April 1984, the USS JFK was located at the port of Naples, Italy. As stated, the veteran's service personnel records show that he was on board the USS JFK from April 21, 1983 to July 31, 1984. Apparently, the attack in Lebanon occurred during the veteran's period of service. Accordingly, there is a question of whether the veteran participated in recovering casualties, and whether the USS JFK operated as an overflow for casualties after the attack at the Marine Barracks in Lebanon. In view of the foregoing, on remand, contact the National Archives and Records Administration (NARA) and the United States (U.S.) Army and Joint Services Records Research Center (JSRRC) and request the deck logs for the USS JFK during the veteran's period of service. Obtaining the ship's command history would also be helpful in verifying the veteran's claimed in-service stressor(s). b. Whether New and Material Evidence has been Submitted to Reopen the Claim of Entitlement to Service Connection for Residuals of an Eye Injury, Claimed as Blurred Vision Additional development with respect to the inadequate notice provided to the veteran is necessary before the Board can determine whether new and material evidence has been submitted to reopen the previously denied claim for service connection. The Board notes that by rating decision, dated in May 1996, the RO denied the claim of entitlement to service connection for an eye injury, noting that the veteran sustained a fall and trauma when he hit face, resulting in minor abrasions superiorly and laterally to the right eye, during his period of service in June 1982. The RO essentially denied the claim because the veteran's vision was not impaired. He was properly notified of the decision in May 1996, he did not file a timely Notice of Disagreement (NOD), and the decision became final. As for the notice provided to the veteran, there are two notice letters of record. Neither of these letters satisfies the notice requirements for new and material evidence claims. (See VA notice letters, dated in June 2003 and May 2004). Recent development in case law states that VA is obligated to provide a claimant with notice of what constitutes new and material evidence to reopen a service-connection claim, to look at the bases for the denial in the prior decision, and to respond with a notice letter that describes what evidence would be necessary to substantiate that element or elements required to establish service connection which were found insufficient in the previous denial. See Kent v. Nicholson, 20 Vet. App. 1 (2006). Consequently, the question of what constitutes material evidence to reopen a claim for service connection depends on the basis on which the prior claim was denied. A review of the notice letters of record shows that the veteran was not provided with information that describes what evidence would be necessary to substantiate that element or elements required to establish service connection which were found insufficient in the previous denial. See Kent. On remand, provide the veteran with such notice. In Dingess v. Nicholson 19 Vet. App. 473 (2006), the United States Court of Appeals for Veterans Claims (Court) held that upon receipt of an application for a service-connection claim, VA must inform the veteran that a disability rating and an effective date for the award of benefits will be assigned if service connection is granted. A review of the record shows that the veteran was not provided with notice of the type of evidence that is necessary to establish a disability rating and an effective date in the event that the veteran's claim of entitlement to service connection for PTSD is granted or that the previously decided claim for service connection is reopened and granted. Given the foregoing, the Board finds that the requirements set forth in Dingess have not been met. On remand, provide the veteran with such notice. In view of the foregoing, on remand, in addition to requesting additional information as it pertains to verifying the veteran' s claimed in-service stressor(s), provide the veteran with the proper notice as required by 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159 and which is consistent with the provisions of the decision in Kent and the provisions of the decision in Dingess. Accordingly, the case is REMANDED for the following action: 1. Please send the veteran a notice letter which is consistent with 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b)(1). The notice letter must describe the information and evidence not of record that is necessary to substantiate the claim to reopen the finally decided service connection claim. The notice letter should inform the veteran about the information and evidence that VA will seek to provide; the information and evidence the veteran is expected to provide; and the notice letter should request or tell the veteran to provide any evidence in the veteran's possession that pertains to the claim. To satisfy the notice requirements for finally decided service connection claim, the notice letter must state the bases for the final decision and describe what evidence would be necessary to substantiate that element or elements required to establish service connection that were deficient in the final decision. The veteran should also be informed that material evidence consists of a competent medical opinion which links a current diagnosis of an eye disability (blurred vision) to his period of service. See Kent v. Nicholson, 20 Vet. App. 1 (2006). 2. Contact the National Archives and Records Administration (NARA), the United States (U.S.) Army Joint Services Records Research Center (JSRRC), and any other appropriate agency and request the ship's deck logs and command histories for the USS JFK during the veteran's period of service for the period from April 21, 1983 to July 31, 1984. 3. The RO should readjudicate the claims and verify that the requested development has been accomplished in a manner that is consistent with this Remand, and if the benefits sought on appeal remain denied, the appellant should be provided with a Supplemental Statement of the Case (SSOC). The SSOC must contain notice of all relevant actions taken on the claim for benefits, to include a summary of the evidence and applicable law and regulations considered pertinent to the issue on appeal. The appropriate period of time should be allowed for response. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2005). ______________________________________________ K. Osborne Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs