Citation Nr: 0000436 Decision Date: 01/06/00 Archive Date: 01/11/00 DOCKET NO. 97-10 312A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Baltimore, Maryland THE ISSUES 1. Entitlement to service connection for peripheral neuropathy as secondary to a head injury. 2. Entitlement to an increased evaluation for anxiety, currently rated as 10 percent disabling. 3. Whether new and material evidence has been submitted to reopen the claims of entitlement to service connection for a lung disability and a skin disability as secondary to exposure to herbicides. 4. Entitlement to service connection for a disability of the jaw. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD D. Odlum, Associate Counsel INTRODUCTION The veteran had active military service from July 1962 to September 1970. This matter is before the Board of Veterans' Appeals (Board) on appeal from rating decisions from the Baltimore, Maryland Department of Veterans Affairs (VA) Regional Office (RO). The veteran is currently service-connected for conjunctivitis (10 percent), anxiety (10 percent), callosities (noncompensable), scars on the right knee and head (noncompensable), and scars on both heels (noncompensable). He is also receiving nonservice-connected pension benefits for left brachial plexus neuropathy (60 percent), maxillary sinusitis (noncompensable), a lung disorder (noncompensable), crural intertrigo (noncompensable), and a tingling sensation in the right leg and foot (noncompensable). The Board notes the presence of two old pending claims which appear to have never been specifically adjudicated by the RO. In April 1972, the veteran referred to having been attacked while in the service, sustaining, in pertinent part, a laceration to the head. He reported that he had shaking and impaired dexterity in his hands, and indicated, at least in part, that this shaking was due to his head injury, as well as nervousness. In August 1972, the veteran more specifically indicated that he suffered a head injury while in the service. He then referred to a VA treatment report that diagnosed him with cerebral dysrhythmia. The report he referred to is a December 1971 VA examination report in which examiner diagnosed cerebral dysrhythmia "with other C & S damage related to concussion." He testified at the September 1999 hearing to sustaining a head injury in service. As this issue has been neither procedurally developed nor certified for appellate review, the Board is referring it to the RO for initial consideration and appropriate action. Godfrey v. Brown, 7 Vet. App. 398 (1995). The veteran also raised a claim of service connection for dental trauma in February 1981. As this issue has been neither procedurally developed nor certified for appellate review, the Board is referring it to the RO for initial consideration and appropriate action. Id. More recently, the veteran submitted a statement contending that he was entitled to a clothing allowance. As this issue has been neither procedurally developed nor certified for appellate review, the Board is referring it to the RO for initial consideration and appropriate action. Id. The issues of service connection for a disability of the jaw and entitlement to an increased rating for anxiety are addressed in the remand portion of this decision. FINDINGS OF FACT 1. The claim of entitlement to service connection for peripheral neuropathy as secondary to a head injury is not supported by cognizable evidence showing that the claim is plausible or capable of substantiation. 2. The RO denied entitlement to service connection for a skin disorder and a lung disorder as secondary to exposure to herbicides when it issued an unappealed rating decision in May 1981. 3. The RO denied reopening the claim of entitlement to service connection for a lung disability as secondary to exposure to herbicides when it issued an unappealed rating decision in March 1994. 4. The evidence submitted since the final unappealed May 1981 and March 1994 determinations bears directly and substantially upon the issues at hand, is neither duplicative nor cumulative, and is so significant that it must be considered in order to fairly decide the merits of the claims. 5. The claims of entitlement to service connection for a lung disability and a skin disability as secondary to exposure to herbicides are not supported by cognizable evidence showing that the claims are plausible or capable of substantiation. CONCLUSIONS OF LAW 1. The claim of entitlement to service connection for peripheral neuropathy as secondary to a head injury is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. Evidence received since the final determination in May 1981 wherein the RO denied entitlement to service connection for a skin disability as secondary to exposure to herbicides is new and material, and the veteran's claim for this benefit is reopened. 38 U.S.C.A. §§ 5108, 7105(c) (West 1991); 38 C.F.R. §§ 3.104(a), 3.156(a), 20.1103 (1999). 3. Evidence received since the final determination in March 1994 wherein the RO denied reopening the claim of entitlement to service connection for a lung disability as secondary to exposure to herbicides is new and material, and the veteran's claim for this benefit is reopened. 38 U.S.C.A. §§ 5108, 7105(c); 38 C.F.R. §§ 3.104(a), 3.156(a), 20.1103. 4. The claims of entitlement to service connection for a lung disability and a skin disability as secondary to exposure to herbicides are not well grounded. 38 U.S.C.A. § 5107(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service connection for peripheral neuropathy as secondary to a head injury Factual Background The veteran's service medical records show no documentation of a diagnosis of peripheral neuropathy. Entrance examination indicated that his neurological condition was normal. Hand shaking and sweats were noted in March 1965. It was noted that he was reporting nervousness and that previous thyroid testing had been normal. A history of abundant sweating of the feet was noted in April 1967. A November 1967 physical examination indicated that his neurological condition was normal. He denied a history of a head injury, leg cramps, lameness, neuritis, and paralysis. Leg cramps, occurring after standing for a long period of time, were reported in April 1968. A dental treatment note dated April 1968 indicated that the veteran had sustained a traumatic injury to the duct of the left parotid gland. Excessive "hyperdrosis" of the feet was again noted in January 1970. Neurological evaluation on separation examination was indicated as being normal. In general, there is no documentation of a diagnosis or treatment of peripheral neuropathy in the service records. On VA examination in February 1971 the veteran reported that, while in Vietnam, the Vietcong had overrun the area he was in and that he got "bashed" in the forehead but that he did not know how. No diagnosis or specific complaint of peripheral neuropathy was documented. In May 1971 the veteran was admitted to the Perry Point VA Medical Center (VAMC) with a four month history of intermittent black out spells. The diagnoses were maxillary sinusitis, an abnormal electroencephalogram (EEG) suggestive of cerebral dysrhythmia, and possible psychoneurosis. There is no documentation of peripheral neuropathy noted in these records. On VA examination in December 1971 the veteran reported being hit over the head by a two by four by a man while he was taking care of prisoners while in the service in Vietnam in 1964. On examination there was photophobia and poor pronation and supination with the right arm. There was a tremor of the hands with some tension quality. Neurological examination was otherwise normal. There was documentation of a diagnosis of peripheral neuropathy. A February 1992 progress note from Kirk U.S. Army Health Clinic (KUSAHC), shows that the veteran wanted to discuss peripheral neuropathy. He was seen at KUSAHC in January 1993 with complaints of a tingling sensation on the right foot. Examination revealed a white discolored area at the end of the toe area. The diagnosis was a possible cold injury of both great toes. Follow-up notes from January 1993 indicated that the veteran had sustained a possible cold injury while working as a security guard. Examination of the toes revealed white spots with areas of erythema. The diagnosis was mild frostbite to the toes. In September 1996, the veteran, in pertinent part, raised a claim of service connection for peripheral neuropathy as secondary to Agent Orange exposure. In February 1997 the veteran underwent an orthopedic examination of the left shoulder and elbow. It was noted that there had been a severe work-related injury to the left upper extremity in August 1995. Since that time, it was reported that there had been pain in the mid and lower arm, down to the elbow. Weakness and a sense of tingling in the radial border of the hand was reported. On examination, active and passive range of motion in the left upper extremity was limited. There was decreased sensation to palpation along the radial border of the second metacarpal. Sensation was otherwise intact. Grip strength was weaker on the left side. The diagnosis was severe left arm pain, status post crush injury. The examiner concluded that he could not rule out partial radial neuropathy in the left arm. In March 1997 a magnetic resonance imaging scan (MRI) of the left shoulder revealed an incomplete tear of the upper surface of the supraspinatus at the musculotendinous junction, and inflammation, with chronic and acute degeneration of the supraspinatus tendon. In March 1997, Dr. H.B.P. performed a neurological examination on the veteran. The veteran was noted as stating that he had been exposed to Agent Orange while in the service and that he had had a tremor of the upper extremities since that time. He also noted that the tremor had worsened on the left after an August 1995 injury to the left upper extremity. A history of left elbow surgery was noted. Neurological examination revealed cogwheel rigidity of the left upper extremity to a moderate degree, and action tremor of the upper extremities, moderately severe on the left and mild on the right. Gait was relatively normal, and there was left supraclavicular tenderness and tenderness of the left elbow and shoulder. A nerve conduction study was interpreted as being abnormal in terms of the left upper extremity with a left brachial plexus neuropathy. The diagnoses were left brachial plexus neuropathy; and Parkinsonism, which was indicated as possibly being secondary to toxins and/or a head injury, exacerbated by stress. In April 1997 a VA general medical examination was conducted. Neurological examination was indicated as being normal. No diagnosis of peripheral neuropathy was documented. The veteran presented testimony before the undersigned in September 1999. Regarding peripheral neuropathy, the representative initially contended that the veteran was associating it with a head injury rather than with herbicide exposure. The veteran testified that he had sustained a head injury during an attack from a fellow soldier while he was stationed in the Canal Zone. He stated that he thought the attack had occurred in 1967. Transcript, pp. 5-6. He indicated that his peripheral neuropathy was secondary to this head injury. Tr., p. 6. The veteran testified to having had continuous tremors and tingling ever since the injury. Tr., p. 7. He testified to being involved in an industrial accident in August 1995, but that his symptoms of peripheral neuropathy had been around before that. He stated that his symptoms of shaking hands had been present since 1970. Tr., p. 8. He also reported continuous tingling in his upper extremities. Id. He denied being told by a physician that this condition was linked to service; however, he also testified that Dr. H.P.B. had told him that this problem could be exacerbated by stress. Tr., p. 9. Criteria Pursuant to 38 U.S.C.A. § 5107(a), a person who submits a claim for benefits under a law administered by the Secretary shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well-grounded. The United States Court of Appeals for Veterans Claims (Court) has held that a well-grounded claim is "a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of § [5107(a)]." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The Court has also held that although a claim need not be conclusive, the statute provides that it must be accompanied by evidence that justifies a "belief by a fair and impartial individual" that the claim is plausible. Tirpak v. Derwinski, 2 Vet. App. 609, 610 (1992). The Court has held that "where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence to the effect that the claim is 'plausible' or 'possible' is required." Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993) (citing Murphy, at 81). The Court has held that a well-grounded claim requires competent evidence of current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the in-service injury or disease and the current disability (medical evidence). See Epps v. Brown, 126 F.3d. 1464, 1468 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). In order to establish service connection for a claimed disability the facts must demonstrate that a disease or injury resulting in current disability was incurred in active military service or, if pre-existing active service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1999). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). Continuous service for 90 days or more during a period of war, and post-service development of a presumptive disease to a degree of 10 percent within one year from the date of termination of such service, establishes a presumption that the disease was incurred in service. 38 C.F.R. §§ 3.307, 3.309 (1999). In addition to law and regulations regarding service connection, the Board notes that a disease associated with exposure to certain herbicide agents listed in 38 C.F.R. § 3.309(e) (1999) will be considered to have been incurred in service under the circumstances outlined in that section, even though there is no evidence of such disease during such period of service. 38 C.F.R. § 3.307(a) (1999). If a veteran was exposed to a herbicide agent during such active military, naval, or air service, the following diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there was no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied: Chloracne or other acneiform disease consistent with chloracne; Hodgkin's disease; non-Hodgkin's lymphoma; acute and subacute peripheral neuropathy; Porphyria cutanea tarda; Prostate cancer; Multiple myeloma; Respiratory cancers (cancers of the lung, bronchus, larynx or trachea); or Soft tissue sarcoma. 38 C.F.R. § 3.309(e) (1999). For purposes of this section, the term acute and subacute peripheral neuropathy means transient peripheral neuropathy that appears within weeks or months of exposure to a herbicide agent and resolves within two years of the date of onset. 38 C.F.R. § 3.309(e) (1999). These diseases shall become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other disease consistent with chloracne, and porphyria cutanea tarda shall have become manifest to a degree of 10 percent or more within a year, and respiratory cancers within 30 years, after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307(a)(6)(ii) (1999). The Secretary has also determined that there was no positive association between exposure to herbicides and any other condition for which he has not specifically determined that a presumption of service connection is warranted. 59 Fed. Reg. 57589 (1996) (codified at 38 C.F.R. §§ 3.307, 3.309). Where there is a chronic disease shown as such in service or within the presumptive period under § 3.307 so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b) (1999). This rule does not mean that any manifestation in service will permit service connection. To show chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the disease identity is established, there is no requirement of evidentiary showing of continuity. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1999). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When, after consideration of all of the evidence and material of record in an appropriate case before VA, there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt doctrine in resolving each such issue shall be given to the veteran. 38 U.S.C.A. § 5107(b) (West 1991); 38 C.F.R. §§ 3.102, 4.3 (1999). Analysis Section 5107 of Title 38, United States Code unequivocally places an initial burden upon the veteran to produce evidence that his claim is well grounded; that is, that his claim is plausible. Grivois v. Brown, 6 Vet. App. 136, 139 (1994); Grottveit v. Brown, 5 Vet. App. 91, 92 (1993). Because the veteran has failed to meet this burden, the Board finds that his claim of entitlement to service connection for peripheral neuropathy must be denied as not well grounded. The Board reiterates the three requirements for a well grounded claim: (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in- service incurrence or aggravation of a disease or injury; and, (3) medical evidence of a nexus between the claimed inservice injury or disease and a current disability. See Caluza, supra. There is no documentation indicating that the veteran was treated for acute or subacute peripheral neuropathy in service or following his discharge from service much less during the presumptive period. See 38 C.F.R. §§ 3.307, 3.309(e). Nor has the veteran provided medical evidence of a nexus between his current disability and service. The record shows that the veteran has current brachial plexus neuropathy. There are no documented medical opinions or other competent evidence of record linking the veteran's current brachial plexus neuropathy to service. Dr. H.B.P. diagnosed brachial plexus neuropathy and Parkinsonism. He concluded that the Parkinsonism was possibly secondary to toxins and/or head injury, exacerbated by stress. He did not conclude that the neuropathy was secondary to the above mentioned factors. In addition, the Board notes that there is no record of the veteran being diagnosed with peripheral neuropathy, much less as secondary to any incident of service including a claimed head injury. As the Board reported earlier, the service medical records are negative for a head injury, and the veteran denied having sustained such when he completed a report of medical history while on active duty. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992) The veteran's own opinions and statements will not suffice to well-ground his claim. While a lay person is competent to provide evidence on the occurrence of observable symptoms during and following service, such a lay person is not competent to make a medical diagnosis or render a medical opinion, which relates a medical disorder to a specific cause. Espiritu v. Derwinski, 2 Vet. App. 492, 494-495 (1992). The Board is not competent to supplement the record with its own unsubstantiated medical conclusions as to whether the veteran's current disability is related to a disease or injury incurred during service. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). The Board further finds that the RO has advised the veteran of the evidence necessary to establish a well grounded claim, and the veteran has not indicated the existence of any evidence that has not already been obtained that would well ground his claim. McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997); Epps v. Brown, 9 Vet. App. 341, 344 (1996), aff'd sub nom. Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). For these reasons, the Board finds that the veteran has not presented or identified probative medical evidence of a nexus between a current neuropathy disability and military service. Consequently, the Board concludes that the veteran's claim of entitlement to service connection for peripheral neuropathy is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). The Board views its foregoing discussion as sufficient to inform the veteran of the elements necessary to complete his application to reopen this claim. See Graves v. Brown, 8 Vet. App. 522 (1996); Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995); McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997); Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). As the veteran's claim for service connection of peripheral neuropathy is not well grounded, the doctrine of reasonable doubt has no application to his claim. II. New and material evidence to reopen the claims of service connection for lung and skin disabilities as secondary to exposure to herbicides Factual Background The veteran's enlistment examination in April 1962 noted a 1.5 centimeter (cm) scar on the right side of the neck. It was noted that a gland had been removed from the right anterior cervical area when he was five years old. Examination of the sinuses, ears, mouth and throat, lungs, chest, and skin, all were indicated as being normal. A chest x-ray was described as being negative. Physical examination in August 1964 indicated that the veteran's lungs, chest, and skin were normal. No diagnosis of a skin or lung disorder was documented. A chest x-ray was described as being negative. In November 1964 the veteran was seen for a sore throat with difficulty swallowing, and pain in his upper chest for two days. Examination revealed enlarged tonsils with exudate. The chest was clear. The diagnosis was tonsillitis. In April 1967 the veteran was seen for an infected and tender prominence on the dorsal aspect of his right foot. Also noted was a beginning furuncle on the right posterior thigh. X-rays were negative. On follow-up, a history of abundant swelling of the feet was noted. The diagnosis was a possible ganglion cyst. A follow-up in April 1967 noted that he was being seen for an infected bunion. The veteran was treated for a cold with cough productive of yellow sputum in November 1967. The chest was clear on examination. The diagnosis was post-nasal drainage. On examination in November 1967 a history of, in pertinent part, exostosis of the feet was noted. The veteran reported a history of boils, skin diseases, gonorrhea, pain or pressure in the chest, and ear, nose, and throat trouble. He denied a history of a head injury and shortness of breath. It was noted on examination that the boils and gonorrhea had been treated and that there were no residuals. Skin, lungs, and chest were described as normal. A chest x-ray was described as being within normal limits. The diagnosis, in pertinent part, was moderate talipes cavus. There was no specific diagnosis of a respiratory disorder or a skin disease. In October 1969 the veteran was seen with a round, firm, raised, movable swelling on the inner border of the left lower lip. Periodic swelling was reported. The mass was excised and biopsied. The diagnosis upon biopsy was mucocele. In January 1970, the veteran was seen for a complaint of a rash on both wrists and pain in his right leg. It was concluded that this was secondary to contact with "cedar." In January 1970 it was noted that the veteran was unable to wear boots due to excessive "hyperdrosis." The diagnosis was moderate "hyperdrosis." In a report of medical history dated in April 1970, the veteran denied ever being treated for, in pertinent part, lung disease, and also denied ever having shortness of breath. Physical examination in June 1970 disclosed surgical/bayonet scars on the chin, right neck, and forehead noted as being incurred while in Vietnam. The skin, lungs, and chest were documented as being normal. A chest x-ray was described as being negative. The diagnosis, in pertinent part, was multiple shrapnel wounds sustained in the Republic of Vietnam. VA examination in February 1971 documented no complaints or diagnoses of skin diseases or respiratory problems. In May 1971 the veteran was admitted to the Perry Point VA Medical Center (VAMC) with a four month history of intermittent black out spells. The diagnoses were maxillary sinusitis, an abnormal electroencephalogram (EEG) suggestive of cerebral dysrhythmia, and possible psychoneurosis. No complaints or diagnoses of a skin disorder or lung disability were documented on VA examination in December 1971. In November 1980, the veteran submitted a claim of service connection for a respiratory disorder as secondary to herbicide exposure. On VA examination in February 1981, the veteran reported, in pertinent part, a history of a skin rash and lung problems. It was noted by the examiner that there had been an unusual pre-employment chest x-ray at Kirk Army Hospital in the fall of 1979, after which he was admitted to Fallston General Hospital with confirmation of the abnormality in the left lower lung field. A bronchoscopy, bronchial washings, and a bronchial biopsy performed at Fallston were "said to have shown scar tissue of unknown etiologic origin." On examination, the veteran denied hemoptysis, exertional dyspnea, chronic cough, sputum, and chest pain. He reported that he felt well and denied losing any time from work since starting his employment in March 1980. Weight was 238 pounds, and cigarette smoking was denied. A history of exposure to silica dust or employment in a coal mine was denied. There was a flat percussion note and absent tactile fremitus at the left base with elevated left diaphragm, without clearly demonstrable excursion on physical examination. Expiratory breath sounds were prolonged bilaterally with wheezes and rhonchi on forced expiration. A pulmonary function test was found to be abnormal with a slight restrictive and obstructive defect noted with associated mild hypoxemia. The diagnoses were restrictive and obstructive lung disease, with elevation in the left diaphragm, chronic, etiology unknown; mild hypertension (hitherto undiagnosed); exogenous, moderate obesity; and an abnormal echocardiogram (ECG) with Bifascium Black. In May 1981 the RO notified the veteran that it had denied service connection for a lung condition and a skin condition as being secondary to herbicide exposure. A timely appeal was not filed and this decision became final. In June 1991 the veteran raised a claim to re-open his claim of service connection for a lung disability as secondary to exposure to herbicides. The veteran reported that he had been exposed to defoliants in Vietnam called Agent Green and Agent Pink in 1962 and 1963. Submitted with this claim were copies of the admission reports from the Perry Point VAMC dated May 1971 and June 1972. Also submitted were records from Fallston General Hospital where he was treated by Dr. A.S. The reports from Fallston show that the veteran underwent a bronchofibroscopy in December 1979. It was noted that he had left lower lobe infiltrates with partial atelectasis and elevated diaphragm without clinical respiratory symptoms, except for a productive cough. The broncofibroscopy was interpreted as showing marked inflammatory narrowing of segmental bronchi in the left lower lobe bronchus. There was no bronchoscopic evidence of endobronchial lesions. A biopsy of the left lower lobe was found to reveal fibrin and an unremarkable low columnar epithelium. In February 1992 the veteran submitted a claim for service connection of a lung disability and service connection for a tingling sensation in the right leg and foot. He contended that these disabilities were secondary to exposure to Agent Orange. The RO denied service connection for these disabilities in March 1994. A timely appeal was not filed and the decision became final. In September 1996 the veteran submitted claims to re-open his previously denied claims of service connection for disabilities of the lungs and skin. In January 1997 the RO found, in pertinent part, that new and material evidence had not been presented to re-open the claims of service connection for disabilities of the lung and skin as secondary to exposure to herbicides. The RO noted that it had sent a request in October 1996 requesting new and material evidence and that the veteran had not responded. In March 1997 the veteran submitted evidence in support of his claims for service connection of disabilities of the lung and skin as secondary to herbicide exposure. The evidence submitted with the March 1997 statement consists of medical records from Kirk U.S. Army Health Clinic (KUSAHC), Fallston General Hospital, service records, and VA records already on file. Records from KUSAHC show that the veteran underwent a pre- employment physical in September 1979 during which a chest x- ray was found to suggest some loss of volume on the left side as well as suggestion of some ill-defined infiltrates in the inner portion of the left lung. A discharge report from Fallston dated in December 1979 shows a discharge diagnosis of left lower lobe atelectasis, partial, associated with elevated left diaphragm possibly due to pneumonic process of unknown etiology. In December 1979, Dr. A.S., of Fallston General Hospital, wrote that the veteran had been admitted for investigation of a chest x-ray abnormality with elevated left diaphragm and a partial atelectasis of the left lower lobe. Dr. A.S. found the tentative diagnosis to be a probable benign inflammatory process of unknown etiology with no concrete evidence of a malignant infectious process. Progress notes from February 1981 show treatment of a swollen right index finger which was subsequently found to be a staph infection of the fingers of the right hand (the index and little fingers). Progress notes from March 1986 show treatment of cellulitis in the left great toe that was improving with treatment. An October 1986 chest x-ray from KUSAHC revealed marked elevation of the hemidiaphragm with a patchy area of infiltration in the left infra hilar area. It could not be determined whether these changes were chronic or acute in nature. A chest x-ray in October 1988 was found to reveal no gross change since the October 1986 x-ray. It was presumed that the changes in the veteran's lungs were chronic and inactive in nature. In January 1992 the veteran was seen at KUSAHC for a bruised rib cage following a motor vehicle accident. A history of a lung condition was noted. In April 1992 the veteran reported dryness in his throat with blackened nasal discharge. It was also noted that a furnace had been broken and repaired but that it was still putting out soot. It was noted that similar symptoms had been experienced in that building before. The veteran was asymptomatic on examination. He was advised not to work in the aforementioned building or to wear a filter mask when doing so. The veteran was seen at KUSAHC in January 1993 with complaints of a tingling sensation on the right foot. Examination revealed a white discolored area at the end of the toe area. The diagnosis was a possible cold injury of both great toes. Follow-up notes from January 1993 indicated that the veteran had sustained a possible cold injury while working as a security guard. Examination of the toes revealed white spots with areas of erythema. The diagnosis was mild frostbite to the toes. In April 1997 a VA general medical examination was conducted. The VA examiner noted that chest x-rays showed a blunting of the costophrenic angle, without changes and that there was no history of significant pulmonary disease. He also noted that the chest x-ray finding was once attributed to weakness of the left hemidiaphragm. On examination the oral mucosa was pink without edema or rashes. There was no peripheral edema or cyanosis and no significant varicosities. Chest expansion was normal and symmetric. The lungs were clear to percussion and auscultation. Musculoskeletal examination revealed no significant deformities, atrophy, or amputation. Neurological examination was indicated as being normal. The diagnoses were, in pertinent part, a minor deformity on chest x-rays, unchanged for many years, probably representing localized weakness of the left hemidiaphragm with no significant history of pulmonary diseases. In October 1997 a personal hearing was conducted. Regarding his skin disorder, the veteran testified to receiving treatment for jungle rot while he was in the service. He testified to going to dermatologists and that he had been told that they did not know what caused it or how to cure it. Tr., p. 3. He testified that the condition was primarily located primarily on his feet, in between the toes and the heels. Tr., p. 4. Regarding his lung condition, the veteran testified that he first started having trouble in 1964 when he went in for sick call for trouble with breathing. He reported experiencing shortness of breath and coughing. He indicated that this was due to Agent Gray and Agent Pink, which were precursors to Agent Orange. Tr., pp. 4-5. He reported being told, while in the military, that a chest x-ray had revealed a white spot in his lungs which could possibly be pneumonia. Tr., p. 5. He testified that he currently experienced shortness of breath. Id. In November 1997 a VA skin disorders examination was conducted. The veteran reported a history of fissuring in the fourth and fifth toe web on both feet since 1962. He stated that it began in 1962 while he was stationed in Vietnam. He reported receiving a variety of treatment without success since that time until 1981, when he reported that he did not want to continue treatment since he was not benefiting from it. Examination revealed a linear fissure with a maceration bilaterally and overlying body crust. There was thickening and yellowing on the right foot, the first, the third, fourth, and fifth toenails. All five toenails of the left foot were thickened and yellow. The diagnosis was tinea pedis with maceration and fissures, and onychomycosis. A VA respiratory examination was conducted in November 1997. The veteran reported that the left lower lobe atelectasis was found during a routine x-ray during the late 1960s. He stated that he was asymptomatic then and that he continued to be asymptomatic following his discharge from service. On examination, the skin was clear without significant rashes. The lungs were clear to percussion and auscultation and there was no dyspnea, wheezing, or cough. The diagnosis was atelectasis of the left lower lobe, discovered on routine examination in the 1960s, substantially unchanged since then, always asymptomatic. The cause had not been determined. In September 1999 a hearing before the Board was conducted. The veteran testified that the skin disorder was on his hands and feet. He reported being exposed to this in the service in unsanitary living conditions, and that he had suffered from these symptoms ever since. Tr., p. 10. He reported that the skin would blister over, get a very dark spot, enlarge, turn white, then peel off. Tr., p. 12. The veteran testified that he had incurred his lung disability while in the service as a result of exposure to Agent Green and Agent Pink, not Agent Orange. Tr., p. 13. He testified to having trouble breathing while he was in the service. Tr., p. 15. When asked whether any doctors had related this condition to service, the veteran initially answered in the affirmative. The physician he mentioned in association with this answer was Dr. A.S. He testified that he had tested his lungs and taken samples, and that the samples had been found to be of "unethnic origin." Tr., p. 14. When later asked whether any doctors had made any type of opinion relating his respiratory problems to chemical exposure in the service, he testified that he did not know. Tr., p. 16. Criteria If no notice of disagreement is filed within the prescribed period, the action or determination shall become final and the claim will not thereafter be reopened or allowed, except as otherwise provided by regulation. 38 U.S.C.A. § 7105(c); 38 C.F.R. § 20.1103. If new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. 38 U.S.C.A. § 5108. A decision of a duly constituted rating agency or other agency of original jurisdiction shall be final and binding on all field offices of the Department of Veterans Affairs as to conclusions based on the evidence on file at the time VA issues written notification in accordance with 38 U.S.C.A. § 5104 (West 1991). A final and binding agency decision shall not be subject to revision on the same factual basis except by duly constituted appellate authorities or except as provided in § 3.105 of this part. 38 C.F.R. § 3.104(a). Despite the finality of a prior final RO decision, a claim will be reopened and the former disposition reviewed if new and material evidence is presented or secured with respect to the claim which has been disallowed. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a). The United States Court of Appeals for Veterans Claims (Court) has held that, when "new and material evidence" is presented or secured with respect to a previously and finally disallowed claim, VA must reopen the claim. Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). The Court has held that VA is required to review for its newness and materiality only the evidence submitted by an appellant since the last final disallowance of a claim on any basis in order to determine whether a claim should be reopened and readjudicated on the merits. Evans v. Brown, 9 Vet. App. 273 (1996). In order to reopen a claim by providing new and material evidence, the appellant must submit evidence not previously submitted to agency decision makers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 CFR § 3.156(a) (1999). New evidence is evidence which (1) was not in the record at the time of the final disallowance of the claim, and (2) is not merely cumulative of other evidence in the record. Smith v. West, 12 Vet. App. 312 (1999); Evans v. Brown, 9 Vet. App. 273, 283 (1996). New evidence is considered to be material where such evidence provides a more complete picture of the circumstances surrounding the origin of the veteran's injury or disability, even where it will not eventually convince the Board to alter its decision. See Hodge v. West, 155 F.3d 1356, 1363 (Fed. Cir. 1998). If the Board determines that new and material evidence has been presented under 38 C.F.R. §3.156(a), the claim is reopened, and it must next be determined whether the appellant's claim, as then reopened, is well grounded in terms of all the evidence in support of the claim, generally presuming the credibility of that evidence. See Elkins v. West, 12 Vet. App. 209, 218-219 (1999). If the claim is well grounded, the case will be decided on the merits, but only after the Board has determined that VA's duty to assist under 38 U.S.C.A. § 5107 has been fulfilled. The Court noted in Elkins and Winters v. West, 12 Vet. App. 203 (1999) that by the ruling in Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998), the Federal Circuit Court "effectively decoupled" the determinations of new and material evidence and well groundedness. Thus, if the Board determines that additionally submitted evidence is "new and material," it must reopen the claim and perform the second and third steps in the three-step analysis, evaluating the claim for well-groundedness in view of all the evidence, both new and old, and if appropriate, evaluating the claim on the merits. Elkins v. West, 12 Vet. App. 209 (1999); Winters v. West, 12 Vet. App. 203 (1999). New and material evidence Analysis When a claim is finally denied by the RO, it may not thereafter be reopened and allowed, unless new and material evidence has been presented. 38 U.S.C.A. § 7105; 38 C.F.R. § 3.104. When an appellant seeks to reopen a finally denied claim, the Board must review all of the evidence submitted since that action to determine whether the claim should be reopened and readjudicated on a de novo basis. Glynn v. Brown, 6 Vet. App. 523, 529 (1994). In order to reopen a finally denied claim there must be new and material evidence presented since the claim was last finally disallowed on any basis, not only since the claim was last denied on the merits. Evans v. Brown, 9 Vet. App. 273 (1996). Under Evans, evidence is new if not only previously of record and is not merely cumulative of evidence previously of record. Evidence has been submitted which was not in the record at the time of the previous final determinations. This evidence consists of, in pertinent part, records from Fallston General Hospital; records from KUSAHC; medical records from Dr. H.B.P. and Susquehanna Orthopedic Associates; VA examinations, including November 1997 VA skin and respiratory examinations and an April 1997 VA general medical examination; and statements from the veteran, including testimony from hearings conducted in October 1997 and September 1999. Review of the RO's January 1997 findings show, in essence, that it found no new and material evidence had been submitted to reopen the appellant's claim for service connection for disabilities of the lungs and skin as secondary to herbicide exposure. In the case at hand, the Board finds that evidence has been submitted which was not in the record at the time of the final disallowances of the claims. This evidence consists of, in pertinent part, records from Fallston General Hospital; records from KUSAHC; November 1997 VA skin and respiratory examinations and an April 1997 VA general medical examination; and statements from the veteran, including testimony from hearings conducted in October 1997 and September 1999. In general, the medical records referred to above, submitted since the last final disallowance, were not previously in the record. Since there is no other such evidence in the record, these statements are neither duplicative nor cumulative, and therefore constitute new evidence. The Board also concludes that some of this evidence bears directly and substantially upon the specific issues being considered in this case because it provides a more complete picture of the circumstances surrounding the origin of the veteran's lung and skin disabilities. See Hodge, supra. Such evidence is significant and must be considered in order to fairly decide the merits of the claims. The Board therefore finds that new and material evidence has been received since the final determinations, and the veteran's claims are therefore reopened. Service connection Analysis Section 5107 of Title 38, United States Code unequivocally places an initial burden upon the veteran to produce evidence that his claim is well grounded; that is, that his claim is plausible. Grivois v. Brown, 6 Vet. App. 136, 139 (1994); Grottveit v. Brown, 5 Vet. App. 91, 92 (1993). Because the veteran has failed to meet this burden, the Board finds that his claims of entitlement to service connection for disabilities of the lungs and skin as secondary to herbicide exposure must be denied as not well grounded. The Board reiterates the three requirements for a well grounded claim: (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in- service incurrence or aggravation of a disease or injury; and, (3) medical evidence of a nexus between the claimed inservice injury or disease and a current disability. See Caluza, supra. The record shows that the veteran was treated for a possible ganglion or infected bunion of the right foot, boils, a mucocele of the lip, a rash on both wrists, and various cold symptoms in service. The record shows that the veteran has current disabilities of the skin and lungs. However, the veteran has failed to provide medical evidence of a nexus between these current disabilities and service. There are no documented medical opinions or other competent evidence of record linking the veteran's current skin and lung disabilities to service. Id. On VA examination for respiratory disorders in November 1997, the VA examiner diagnosed atelectasis of the left lower lobe, discovered on routine examination in the 1960s. The Board concludes that this opinion does not provide competent medical evidence of a nexus because it is based on an inaccurate history provided by the veteran. The November 1997 VA examination report notes the veteran's reporting that left lower lobe atelectasis was found during a routine x-ray in the late 1960s. Service medical records show that chest x-rays were consistently found to be negative. Nor is there a documentation of a diagnosis of a lung disorder in the service medical records. The Board is not bound to accept medical opinions which are based on history supplied by the veteran where that history is clinically unsupported and in fact contradicted by the record, or where the opinion is contingent on an inaccurate factual background. See Bloom v. West, 12 Vet. App. 185 (1999); Black v. Brown, 5 Vet. App. 177 (1993); Swann v. Brown, 5 Vet. App. 229 (1993); Reonal v. Brown, 5 Vet. App. 458 (1993); Guimond v. Brown, 6 Vet. App. 69 (1993); see also Owens v. Brown, 7 Vet. App. 429 (1995) (Court held that Board is justified in rejecting a physician's opinion which relies on a medical history from the appellant that conflicts with the service medical records). The veteran also indicated at the September 1999 hearing that Dr. A.S. had opined that his lung condition could be related to some type of chemical or herbicide exposure. Transcript, p. 14 (September 30, 1999). Pursuant to 38 U.S.C.A. § 5103(a), if VA is placed on notice of the possible existence of information that would render the claim plausible, and therefore well grounded, VA has the duty to advise the appellant of the necessity to obtain the information. McKnight v. Gober, 131 F.3d 1483, 1484-1485 (Fed. Cir. 1997); Robinette v. Brown, 8 Vet. App. 69, 80 (1995). In this case, the records of Fallston General Hospital have already been obtained, which include reports from Dr. A.S. None of these reports document Dr. A.S. providing an opinion that any lung disability the veteran may have had was linked to service. To the contrary, he concluded that it was of "unknown etiology." In this regard, the Board notes that the veteran elaborated in his testimony that Dr. A.S. had found his disability to be of "unethnic origin," and later testified that he did not know if a physician had related his respiratory problems to some type of chemical exposure in service. Tr., pp. 14, 16. Therefore, the duty to advise was discharged in this instance. The veteran has not been diagnosed with a presumptive disease associated with exposure to certain herbicide agents. See 38 C.F.R. § 3.309(e). In addition, there is no evidence that the veteran was diagnosed with any chronic disease in service or during an applicable presumption period. See 38 C.F.R. §§ 3.307 and 3.309. Nor is there medical evidence of a relationship between the veteran's current symptomatology and his alleged continuity of symptomatology. See Voerth v. West, No. 95-904 (U.S. Vet. App. Oct. 15, 1999); McManaway v. West, No. 97-280 (U.S. Vet. App. Sept. 29, 1999); Savage v. Gober, 10 Vet. App. 488 (1997). The veteran's own opinions and statements will not suffice to well-ground his claims. While a lay person is competent to provide evidence on the occurrence of observable symptoms during and following service, such a lay person is not competent to make a medical diagnosis or render a medical opinion, which relates a medical disorder to a specific cause. Espiritu v. Derwinski, 2 Vet. App. 492, 494-495 (1992). Neither is the Board competent to supplement the record with its own unsubstantiated medical conclusions as to whether the veteran's disabilities are related to a disease or injury incurred during service. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). The Board further finds that the RO has advised the veteran of the evidence necessary to establish a well grounded claim, and the veteran has not indicated the existence of any other evidence that has not already been obtained that would well ground his claims. McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997); Epps v. Brown, 9 Vet. App. 341, 344 (1996), aff'd sub nom. Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). For these reasons, the Board finds that the veteran has not presented or identified probative medical evidence of a nexus between his current disabilities of the skin and lungs and an in-service injury or disease. Consequently, the Board concludes that the veteran's claims of entitlement to service connection for a disability of the lungs and a disability of the skin are not well grounded. 38 U.S.C.A. § 5107(a). The Board views its foregoing discussion as sufficient to inform the veteran of the elements necessary to complete his application to reopen his claims. See Graves v. Brown, 8 Vet. App. 522 (1996); Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995); McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997); Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). As the veteran's claims for service connection of a lung disability and a skin disability are not well grounded, the doctrine of reasonable doubt has no application to his claims. ORDER The veteran, not having submitted a well grounded claim of entitlement to service connection for peripheral neuropathy as secondary to a head injury, the appeal is denied. The veteran having submitted new and material evidence to reopen claims of entitlement to service connection for a lung disability and a skin disability as secondary to exposure to herbicides, the appeal is granted to this extent. The veteran, not having submitted well-grounded claims of entitlement to service connection for a lung disability and a skin disability as secondary to exposure to herbicides, the appeal is denied. REMAND The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the RO. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board or by the Court for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44-8.45 and 38.02-38.03. The veteran raised, in pertinent part, a claim for an increased evaluation of his service-connected anxiety in September 1996. The Board finds that his claim of entitlement to an increased evaluation for anxiety is well grounded within the meaning of 38 U.S.C.A. § 5107(a); that is, a plausible claim has been presented. Murphy v. Derwinski, 1 Vet. App. 78 (1990). In general, an allegation of increased disability is sufficient to establish a well grounded claim seeking an increased rating. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). However, the Board is not satisfied that all relevant facts have been properly developed to their full extent and that VA has met its duty to assist. Godwin v. Derwinski, 1 Vet. App. 419 (1991); White v. Derwinski, 1 Vet. App. 519 (1991). With respect to the claim for an increased rating for anxiety, the veteran's last VA examination for mental disorders was conducted in November 1997. At that examination, the veteran essentially denied any psychological symptoms, including any symptoms of anxiety. In September 1999, the veteran provided testimony at a hearing before the Board in which he indicated that his anxiety symptoms were significantly worse. The duty to assist includes providing a thorough and contemporaneous medical examination, especially where it is necessary to determine the current level of a disability. Peters v. Brown, 6 Vet. App. 540, 542 (1994). The Board notes a similar history of inconsistent documentation of anxiety symptoms. On VA examination in November 1996, the veteran essentially denied having any psychological problems, but then subsequently testified during the October 1997 hearing to having frequent crying spells as well as other symptoms of anxiety. If the medical evidence of record is insufficient, or, in the opinion of the Board, of doubtful weight or credibility, the Board is always free to supplement the record by seeking an advisory opinion, ordering a medical examination or citing recognized medical treatises in its decisions that clearly support its ultimate conclusions. However, it is not free to substitute its own judgment for that of such an expert. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Regarding the claim for service connection of a jaw disability, in September 1970 the veteran raised claims of, in pertinent part, service connection for disabilities of the heels and a jaw disability. These claims were denied in March 1971. In September 1971 the veteran submitted, in pertinent part, a notice of disagreement (NOD) with respect to the denial of the claims of service connection for the heel and jaw disabilities. The claim for service connection of the heels was later granted in June 1976 and was not subsequently appealed by the veteran. However, there is no indication that the veteran was ever provided with a statement of the case (SOC) pertaining to the claim for service connection of a jaw disability. When there has been an initial RO adjudication of a claim and an NOD has been filed as to its denial, the veteran is entitled to an SOC, and the RO's failure to issue an SOC is a procedural defect requiring remand. Manlincon v. West, 12 Vet. App. 238 (1999); Godfrey v. Brown, 7 Vet. App. 398, 408-10 (1995); see also Bernard v. Brown, 4 Vet. App. 384 (1993). Accordingly, the issues of entitlement to an increased rating for anxiety and service connection for a jaw disability are remanded for the following development: 1. The RO should request the veteran to identify the names, addresses, and approximate dates of treatment for all health care providers, VA and non-VA, inpatient and outpatient, who may possess additional records pertinent to his claims. After securing any necessary authorization or medical releases, the RO should attempt to obtain legible copies of the veteran's complete treatment records from all sources identified whose records have not previously been secured. Regardless of the veteran's response, the RO should secure all outstanding VA treatment reports. All information which is not duplicative of evidence already received should be associated with the claims file. 2. Following the above, the veteran should be examined by a VA psychiatrist to determine the level of impairment caused by the anxiety. The claims file and a separate copy of this remand should be made available to and reviewed by the examiner prior and pursuant to conduction and completion of the examination and the examination report must be annotated in this regard. Any further indicated special studies, including psychological studies, should be accomplished. The examiner should identify all of the symptoms or manifestations of the veteran's service-connected anxiety and offer an opinion as to how, and to what extent, the symptoms or manifestations affect the veteran's reliability, flexibility, and efficiency, and his social and industrial adaptability, in general. The examiner should also determine to what extent the veteran's subjective complaints are consistent with the examiner's objective findings. If there are other psychiatric disorders found, in addition to anxiety, the examiner should specify which symptoms are associated with each disorder(s). If certain symptomatology cannot be dissociated from one disorder or another, it should be so indicated. If a psychiatric disorder(s) other than anxiety is or are found on examination, the examiner should offer an opinion as to whether any such disorder is causally or etiologically related to anxiety, and, if so related, whether the veteran's anxiety has any effect on the severity of any other psychiatric disorder. The examiner should provide a numerical score on the Global Assessment of Functioning (GAF) Scale provided in the Diagnostic and Statistical Manual for Mental Disorders (DSM IV), in relation to the veteran's impairment from anxiety. The examiner must include a definition of the numerical GAF score assigned, as it relates to the veteran's occupational and social impairment. If the historical diagnosis of anxiety is changed following examination, the examiner should state whether the new diagnosis represents progression of the prior diagnosis, correction of an error in the prior diagnosis, or development of a new and separate condition. The examiner must be requested to express an opinion as to the impact of the anxiety on the veteran's ability to obtain and retain substantially gainful employment. Any opinions expressed must be accompanied by a complete rationale. 3. Thereafter, the RO should review the claims file to ensure that all of the foregoing requested development has been completed. In particular, the RO should review the requested examination report and required opinions to ensure that they are responsive to and in complete compliance with the directives of this remand, and if they are not, the RO should implement corrective procedures. Stegall v. West, 11 Vet. App. 268 (1998). 4. After undertaking any development deemed essential in addition to that specified above, the RO should readjudicate the issue of entitlement to an increased rating for anxiety with documentation of its consideration of the applicability of the provisions of 38 C.F.R. §§ 3.321(b)(1) (1999). 5. Regarding the issue of service connection for a jaw disability, the RO will undertake such development or review action as it deems proper regarding the issue on appeal. If such action does not resolve the disagreement either by granting the benefit sought or through withdrawal of the NOD, such agency shall prepare a statement of the case, with notification of the to the veteran of his need to timely file a substantive appeal if he wishes appellate review of this claim. If the benefits requested on appeal, for which a timely NOD has been filed are not granted to the appellant's satisfaction, the RO should issue a supplemental statement of the case containing all applicable criteria pertinent to the appellant's claims. A reasonable period of time for a response should be afforded. Thereafter, the case should be returned to the Board for final appellate review, if otherwise in order. By this remand, the Board intimates no opinion as to any final outcome warranted. No action is required of the appellant until he is notified by the RO. RONALD R. BOSCH Member, Board of Veterans' Appeals