Citation Nr: 0111121 Decision Date: 04/17/01 Archive Date: 04/23/01 DOCKET NO. 00-02 495 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUES 1. Entitlement to service connection for residuals of exposure to asbestos. 2. Entitlement to service connection for insomnia. 3. Entitlement to service connection for temporomandibular joint syndrome (TMJ). 4. Entitlement to service connection for a bilateral hand disability, claimed as arthritis and "tingling" of both hands. 5. Entitlement to service connection for urethritis. 6. Entitlement to service connection for prostatitis. 7. Entitlement to service connection for gastritis. 8. Entitlement to a compensable evaluation for sinusitis. 9. Entitlement to a compensable evaluation for status post excision of a ganglion cyst of the right foot. 10. Entitlement to a compensable evaluation for status post excision of a carbuncle of the right arm. 11. Entitlement to service connection for a heart murmur. 12. Entitlement to service connection for atypical chest pain. 13. Entitlement to service connection for right ventricular hypertrophy with non-specific T-wave changes. 14. Entitlement to service connection for hypertension. 15. Entitlement to service connection for periodontal disease. 16. Entitlement to service connection for varicose veins in both legs. 17. Entitlement to service connection for cramping in both feet. 18. Entitlement to service connection for chronic low back pain. 19. Entitlement to service connection for tinnitus. REPRESENTATION Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD M.S. Lane, Associate Counsel INTRODUCTION The veteran served on active duty from June 1977 to July 1980 and from June 1981 to June 1998. This matter comes to the Board of Veterans' Appeals (the Board) on appeal from a January 1999 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) which denied the veteran's claims of entitlement to service connection for various disabilities. The January 1999 RO rating decision also granted the veteran's claims of entitlement to service connection for sinusitis, status post excision of a ganglion cyst of the right foot and status post excision of a carbuncle of the right arm. Noncompensable disability ratings were assigned. The veteran disagreed with the assigned disability ratings. For reasons which will be explained in the REMAND section below, the Board believes that additional development is required with respect to all claims except the claims of entitlement to service connection for residuals of exposure to asbestos, insomnia, TMJ, arthritis of the hands, urethritis, prostatitis, and gastritis. FINDINGS OF FACT 1. The preponderance of the competent and probative evidence of record is against a finding that the veteran has asbestosis or any asbestos-related disorder. 2. The preponderance of the competent and probative evidence of record is against a finding that the veteran has a current diagnosis of insomnia. 3. The preponderance of the competent and probative evidence of record is against a finding that the veteran has a current diagnosis of TMJ. 4. The preponderance of the competent and probative evidence of record is against a finding that the veteran has a bilateral disability of the hands, to include arthritis. 5. The preponderance of the competent and probative evidence of record is against a finding that the veteran has urethritis. 6. The preponderance of the competent and probative evidence of record is against a finding that the veteran has prostatitis. 7. The preponderance of the competent and probative evidence of record is against a finding that the veteran has gastritis. CONCLUSIONS OF LAW 1. Service connection for residuals of exposure to asbestos is not warranted. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (2000). 2. Insomnia was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. 3. TMJ was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. 4. A bilateral disability of the hands, to include arthritis, was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. 5. Urethritis was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. 6. Prostatitis was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. 7. Gastritis was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran is seeking entitlement to service connection for residuals of exposure to asbestos, insomnia, TMJ, arthritis of the hands, urethritis, prostatitis and gastritis. In the interest of clarity, the Board will first review the law, VA regulations and other authority which may be relevant to the veteran's service connection claims. The Board will then address the issues on appeal. For he sake of expedience and to avoid repetition, certain issues will be addressed together. Relevant Law and Regulations Service connection - in general In general, applicable laws and regulations state that service connection may be granted for disability resulting from a disease or injury incurred in or aggravated by military service. 38 U.S.C.A. §§ 1110; 38 C.F.R. § 3.303 (2000). That a condition or injury occurred in service alone is not enough; there must be a current disability resulting from that condition or injury. See Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); Chelte v. Brown, 10 Vet. App. 268, 271 (1997); Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997). Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2000). For certain chronic disorders, such as arthritis and peptic ulcer disease, service connection may be granted on a presumptive basis if the disease is manifested to a compensable degree within one year following discharge. 38 U.S.C.A. § 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (2000). Duty to notify/assist During the pendency of this appeal, the President signed the Veterans Claims Assistance Act of 2000 (VCAA), which provides that upon receipt of a complete or substantially complete application, the Secretary shall notify the 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. Veterans Claims Assistance Act, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2096-97 (2000) (to be codified as amended at 38 U.S.C. § 5103). VCAA also requires the Secretary to make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate a claim for benefits, unless no reasonable possibility exists that such assistance would aid in substantiating the claim. The Secretary may defer providing assistance pending the submission by the claimant of essential information missing from the application. Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2097-98 (2000) (to be codified at 38 U.S.C. § 5103A). Standard of review After the evidence has been assembled, it is the Board's responsibility to evaluate the entire record. See 38 U.S.C.A. § 7104(a) (West 1991). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. §§ 3.102, 4.3 (2000). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Additional law, regulations and court decisions will be cited where appropriate below. 1. Entitlement to service connection for residuals of exposure to asbestos. Factual Background The veteran's service medical records do not indicate that he was exposed to asbestos. During service, he was not evaluated for pulmonary complaints, asbestos exposure or for any conditions found to be related to asbestos exposure. A report of medical examination completed at separation is negative for any diagnosis or findings consistent with a pulmonary disorder, asbestosis or any asbestos-related condition. Reports of chest x-rays obtained during service are also negative for any diagnoses or findings of a pulmonary disorder. In July 1998, the veteran filed a claim of entitlement to service connection for exposure to asbestos which he claimed happened between 1977 and 1980. In a letter dated in September 1998, the RO requested that the veteran identify precisely which disabilities he was claiming as a result of exposure to asbestos. The RO also requested that the veteran provide as much detail as possible regarding his duty assignments and work history while in the military, and that he describe in detail the nature and duration of his exposure to asbestos. The RO further requested that he provide any medical evidence which shows disabilities due to exposure to asbestos. The RO advised the veteran that the best evidence would be any biopsy specimens showing the existence of asbestos fibers, any chest x-rays that have been taken since service, and the results of any pulmonary function tests since service. In a response letter dated in October 1998, the veteran indicated that he had been exposed to asbestos while working as a Supply Management Craftsman in the military. He reported that after several years of handling and storing various materials, he was informed that some of these materials contained asbestos and could be dangerous. The veteran indicated that he was certain that exposure to these chemicals had affected him but that he was not certain how. In response to the RO's request for medical evidence, he reported that he had chest x-rays taken during service and that they should be included in his service medical records. He also reported that he had been treated for respiratory infections in the past and for "flem problems". In the January 1999 rating decision, the RO denied the veteran's claim of entitlement to service connection for asbestos exposure. With respect to the asbestos claim, the RO determined that the record revealed no evidence of any chronic respiratory disability or any other disability that was attributed to exposure to asbestos. The RO also determined that chest x-rays obtained during service were all found to be normal. The RO noted that there mere exposure to asbestos did not constitute a disability for which service connection could be granted. The following month, the veteran filed a Notice of Disagreement with respect to this decision. He also submitted various medical records in support of his claims. These records are negative for any notations or findings regarding exposure to asbestos. These records are also negative for any complaints or treatment for insomnia. In his Substantive Appeal (VA Form 9) submitted in January 2000, the veteran asserted that he should have been provided with a physical examination in regard to his various claimed disabilities. He reiterated this request in a statement submitted in December 2000. Relevant law and regulations The law and regulations generally pertaining to service connection have been set forth above. Asbestos exposure There is no specific statutory guidance with regard to asbestos-related claims, nor has the Secretary promulgated any regulations in regard to such claims. However, VA has issued a circular on asbestos-related diseases. DVB Circular 21- 88-8, Asbestos-Related Diseases (May 11, 1988) (DVB Circular) provides guidelines for considering compensation claims based on exposure to asbestos. The information and instructions from the DVB Circular have been included in a VA Adjudication Procedure Manual, M21-1 (M21- 1), Part VI, 7.21. The Court has held that VA must analyze an appellant's claim to entitlement to service connection for asbestosis or asbestos-related disabilities under the administrative protocols under these guidelines. Ennis v. Brown, 4 Vet. App, 523, 527 (1993); McGinty v. Brown, 4 Vet. App. 428, 432 (1993). The guidelines provide that the latency period for asbestos- related diseases varies from 10-45 years or more between first exposure and development of disease. M21-1, part VI, para. 7.21(b)(1) and (2). It is noted that an asbestos- related disease can develop from brief exposure to asbestos or as a bystander. Some of the major occupations involving asbestos exposure include work in shipyards, and accordingly, there is a prevalence of asbestos-related disease among shipyard workers since asbestos was used extensively in military ship construction. In fact, many U.S. Navy veterans during World War II were exposed to chrysotile products, as well as amosite and crocidolite, since these varieties of African asbestosis were used extensively in military ship construction. The guideline identify the nature of some asbestos-related diseases, and note that these asbestos fiber masses have a tendency to break easily into tiny dust particles that can float in the air, stick to clothes and may be inhaled or swallowed. Inhalation of asbestos fibers can produce fibrosis and tumors. The most common disease is interstitial pulmonary fibrosis (asbestosis). Asbestos fibers may also produce pleural effusions and fibrosis, pleural plaques, mesotheliomas of the pleura and peritoneum, lung cancer, and cancers of the gastrointestinal tract. Cancers of the larynx and pharynx as well as urological system (except of the prostate) are associated with asbestos exposure. M21-1, part VI, para. 7.21(a)(1). The Court has further held that in adjudicating asbestos- related claims, it must be determined whether development procedures applicable to such claims have been followed. See Ashford v. Brown, 10 Vet. App. 120 (1997). The guidelines provide, in part, that the clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal disease; that rating specialists are to develop any evidence of asbestos exposure before, during and after service; and that a determination must be made as to whether there is a relationship between asbestos exposure and the claimed disease, keeping in mind the latency period and exposure information. M21-1, part VI, para. 7.21(d)(1). Analysis Preliminary matters As discussed above, the VCAA provides that VA has a duty to notify a claimant of any information, and any medical or lay evidence, not previously provided that is necessary to substantiate the claim. Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2096-97 (2000) [to be codified as amended at 38 U.S.C. § 5103]. The veteran was specifically informed in the September 1998 letter from the RO of the type of information and evidence that would best service to substantiate his claim. Moreover, the veteran was also advised by virtue of the rating decision and Statement of the Case issued during the pendency of the appeal of the type of information or evidence that would best service to substantiate his claims. For these reasons, the Board finds that the veteran and his representative have been given notice of the information, medical evidence, or lay evidence necessary to substantiate his service connection claim. Accordingly, the Board believes that VA has no outstanding duty to inform the veteran that any additional information or evidence is needed with respect to this claim. VA also has a duty to make reasonable efforts to assist the veteran in obtaining evidence necessary to substantiate his claim for benefits. See the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2097-98 (2000) [to be codified at 38 U.S.C. § 5103A]. The Board notes that the veteran's complete service medical records have been obtained and associated with his VA claims folder (with the exception of some dental records, as will be addressed in the remand portion of this decision). Neither the veteran nor his representative have pointed to any additional evidence, including post-service medical records, which has not been obtained and which would be pertinent to the veteran's claim. The Board concludes that all relevant evidence which is available has been obtained by the RO to the extent possible; consequently, there is no further duty to assist the appellant. As noted above, the veteran has requested that he be provided with a VA examination in regard to his claim. In this regard, the Board notes that the VCAA specifically requires that VA obtain a medical examination or opinion only when such examination or opinion is "necessary" in order to make a decision on the claim. Such an examination or opinion is deemed "necessary" when the evidence of record contains competent medical evidence of a current disability, or persistent or recurrent symptoms of disability; and indicates that the disability or symptoms may be associated with the claimant's active military service; but does not contain sufficient medical evidence for the secretary to make a decision on the claim. See the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2097-98 (2000) [to be codified at 38 U.S.C. § 5103A]. In this case, the veteran is seeking service connection for exposure to asbestos. However, as will be discussed in greater detail below, the veteran has not pointed to any specific disability relating to such exposure, and the record contains no competent medical evidence showing that any such disability exists. As noted above, VA has a duty to obtain an examination or opinion only when there is competent medical evidence of a current disability or evidence of persistent or recurring symptoms of a disability. Because there is no such evidence in the record, the Board finds that a remand of this issue in order to obtain an examination or medical opinion is not warranted. See the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2097-98 (2000) [to be codified at 38 U.S.C. § 5103A]; see also Gobber v. Derwinski, 2 Vet. App. 470, 472 (1992) [holding that VA has no duty to conduct "a 'fishing expedition' to determine if there might be some unspecified information which could possibly support a claim]. The Board recognizes that it has a duty to ensure that special development procedures applicable to asbestos-related claims have been followed. See Ashford, 10 Vet. App. at 124- 125. For example, the Board notes that rating specialists are to develop any evidence of asbestos exposure before, during and after service; and a determination must be made as to whether there is a relationship between asbestos exposure and the claimed disease, keeping in mind the latency period and exposure information. M21-1, part VI, para. 7.21(d)(1). As will be discussed in detail below, however, the Board is denying the veteran's claim on the basis that he has not pointed to any specific disability resulting from his claimed asbestos exposure. In essence, there is no "claimed disease" pursuant to M21-1, part VI, para. 7.21(d)(1). The question of whether or not the veteran was in fact been exposed to asbestos in service is moot, absent the existence of a disability resulting from such exposure. Under such circumstances, where the veteran has not pointed to any specific disability related to his asbestos exposure, the Board believes that any additional development pursuant to the requirements of M21-1, part VI, para. 7.21(d)(1) is not warranted, as such development would serve no useful purpose and would only impose unnecessary delay. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991). Because the VCAA went into effect after the SOC was issued, the Board has considered the applicability of Bernard v. Brown, 4 Vet. App. 384, 393-394 (1993). In Bernard, the Court held that before the Board addresses in a decision a question that has not been addressed by the RO, it must consider whether the claimant has been given adequate notice of the need to submit evidence or argument, an opportunity to submit such evidence or argument, and an opportunity to address the question at a hearing, and whether the claimant has been prejudiced by any denials of those opportunities. As discussed in detail above, the Board has reviewed the evidence of record and determined that all notification and development actions required by the new legislation appear to have been completed to the extent necessary under the circumstances. Remanding this case for readjudication would serve no useful purpose. Cf. Soyini, 1 Vet. App. at 546. Therefore, the Board finds that it may proceed with a decision on the merits of the veteran's claim without prejudice to the veteran. Discussion The veteran is seeking entitlement to service connection for exposure to asbestos. He has essentially asserted that he was exposed to various materials containing asbestos while working as a Supply Management Craftsman in service. The Board has reviewed all of the evidence of record. See 38 U.S.C.A. § 7104(a). The Board notes that there is no evidence of record to support the veteran's assertion that he was exposed to asbestos during service. In addition, the Board notes that the veteran did not specifically identify which materials that he was allegedly exposed to actually contained asbestos. Nevertheless, because there is no affirmative evidence indicating that the veteran was not exposed to asbestos, and because there appears to be no reason to doubt his credibility in this regard, the Board will presume for the limited purpose of this opinion that his statements regarding asbestos exposure in service are correct. See Pearlman v. West, 11 Vet. App. 443 (1998) [holding that a veteran was competent to report exposure to mustard gas]. Notwithstanding his assumed exposure to asbestos, however, the Board notes that the medical evidence of record is entirely negative for any indication that the veteran has been diagnosed with asbestosis, with any asbestos-related disease or for that matter any chronic pulmonary disorder. Indeed, the veteran has never asserted that he has any specific disability related to asbestos exposure. Although the veteran noted in his October 1998 statement that he had been treated for respiratory infections and a "flem problem" in the past, he failed to identify any current respiratory or other disability for which he was seeking service connection based on his exposure. In fact, although the veteran asserted that he had been affected by his exposure to materials containing asbestos, he specifically acknowledged that he did not know how such exposure had affected him. Although the veteran contends that he may have a disability related to his claimed asbestos exposure during service, it is now well-established that a layperson is not qualified to render medical opinions regarding the etiology and diagnosis of disorders and disabilities, and his opinion is entitled to no weight. See Cromley v. Brown, 7 Vet. App. 376, 379 (1995); Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). The veteran appears to be essentially contending that he should be granted service connection for mere exposure to asbestos without any contention of a present disability. However, mere exposure to asbestos is not a recognized disability for which service connection may be granted. In light of the complete absence of any indication that the veteran has asbestosis or some other asbestos-related disability, the Board must concluded that the preponderance of the evidence is against the veteran's claim. See Rabideau, 2 Vet. App. at 144; Chelte, 10 Vet. App. at 271; Degmetich, 104 F.3d at 1332 [service connection may not be granted unless a current disability exists]. The benefit sought on appeal is accordingly denied. 2. Entitlement to service connection for insomnia. 3. Entitlement to service connection for TMJ. 4. Entitlement to service connection for a bilateral hand disability, claimed as arthritis and "tingling" in both hands. Factual Background The veteran's service medical records reveal that in May 1993, he complained of pain in his right ear whenever he opened his mouth. Examination of the veteran's ears and throat was negative, except for some limitation of motion when he opened his mouth. The right temporomandibular joint was found to be tender to palpation. The examiner noted a diagnosis of TMJ. Subsequent service medical records are negative for any complaints or treatment for ear pain or TMJ. In April 1996, the veteran complained of difficulty sleeping and daytime drowsiness for several days. He indicated that he had no history of similar complaints. The examiner noted an assessment of rule out sleep apnea, and rule out depression and mild dysthymia. The examiner ordered sleep studies and recommended that the veteran sleep with a contour pillow. During a May 1996 follow-up study, the veteran reported that he was sleeping a bit better. He indicated that he had not get any sleep studies and that he did not take the Prozac that had been prescribed by the examiner. The examiner noted an assessment of rule out sleep apnea and dysthymia. The examiner recommended sleep studies and that the veteran take Prozac. Subsequent service medical records are negative for any complaints or treatment for insomnia or dysthymia. There is no indication in the veteran's service medical records that he was ever evaluated for any hand or wrist complaints, including "tingling" in his hands, or that he was ever diagnosed with arthritis in any of the joints of his hands. A report of medical examination completed at separation in January 1998 is negative for any findings of insomnia, TMJ or a disorder of the hands. The examiner found the veteran's mouth, throat, and upper extremities to be normal. In a report of medical history completed at separation, the veteran reported a history of swollen or painful joints. He also checked and crossed out the boxes for "yes", "no", and "don't know", in response to the question of whether he had experienced frequent trouble sleeping. In July 1998, the veteran filed claims of entitlement to service connection for insomnia and TMJ in 1995. He also filed a claim of entitlement to service connection for "tingling" in both hands, which he believed to be an early sign of arthritis. In the January 1999 rating decision which forms the basis of this appeal, the RO denied the veteran's claims of entitlement to service connection for TMJ and insomnia. The RO noted that the veteran had been seen for complaints of jaw pain and insomnia in service in 1993 and 1996, respectively, but found that there were no findings or complaints noted throughout the remainder of service. The RO concluded that insomnia and TMJ had not been incurred in or aggravated by service. The RO further concluded that there was no evidence whatsoever that the veteran had been diagnosed with arthritis or a neurological disability in his hands. As noted above, the veteran filed a Notice of Disagreement with this decision in February 1999. He also submitted various medical records in support of his claims. The records are negative for any complaints or findings regarding insomnia, TMJ or a bilateral hand disability. In his January 2000, the veteran asserted that he should have been provided with a physical examination in regard to his various claimed disabilities. He reiterated this request in a statement submitted in December 2000. Analysis Preliminary matters As noted above, the veteran was advised by virtue of the rating decision and Statement of the Case issued during the pendency of the appeal of the type of information or evidence that would best service to substantiate his claims. For these reasons, the Board finds that the veteran and his representative have been given notice of the information, medical evidence, or lay evidence necessary to substantiate his service connection claims. Accordingly, the Board concludes that VA has no outstanding duty to inform the veteran that any additional information or evidence is needed with respect to this claims under the VCAA or under any predecessor statute. The Board further concludes that all relevant evidence which is available has been obtained by the RO to the extent possible; consequently, there is no further duty to assist the appellant. The veteran's pertinent service medical records have been obtained and associated with his VA claims folder, and neither the veteran nor his representative have pointed to any additional existing evidence which has not been obtained and which would be pertinent to the veteran's claim. With respect to the veteran's request that he be provided with a VA examination, as will be addressed in greater detail below, the Board believes that the evidence of record does not demonstrate that the veteran currently has diagnoses of insomnia, TMJ or a bilateral hand disability. Under these circumstances, the Board finds that a VA physical examination is not warranted under the VCAA. VA's duty to assist as interpreted by the Court is circumscribed and appears to apply to evidence which may exist and which has not been obtained. See Counts v. Brown, 6 Vet. App. 473, 478-9 (1994). By way of contrast, the veteran wishes VA to provide evidence which admittedly does not now exist. As the Court has stated: "The VA's . . . . 'duty to assist' is not a license for a 'fishing expedition' to determine if there might be some unspecified information which could possibly support a claim." See Gobber v. Derwinski, 2 Vet. App. 470, 472 (1992). The Board is cognizant that the RO appears to have denied the veteran's claims on the basis that they were not well grounded. Accordingly, the Board has considered whether the veteran will be prejudiced by its decision to address his claims on the merits in the first instance. See Bernard, 4 Vet. App. at 393-394. However, as explained in detail above, the Board is of the opinion that all notification and development actions required by the VCAA appear to have been completed to the extent necessary under the circumstances. Remanding this case for readjudication in light of the new legislation would serve no useful purpose. Cf. Soyini, 1 Vet. App. at 546. Therefore, the Board finds that it may proceed with a decision on the merits of the veteran's claims without prejudice to the veteran. Discussion (i.) Insomnia and TMJ The Board has reviewed all of the evidence of record. See 38 U.S.C.A. § 7104(a). In support of his claim, the veteran has pointed to his service medical records, which show that in May 1993, he was treated for complaints of ear pain and received a diagnosis of TMJ. Similarly, these records also show that in April 1996, he was treated for drowsiness and difficulty sleeping, and received a diagnosis of insomnia, which was found to possibly be related to dysthymia. Although the veteran was treated for these claimed disabilities in service, the Board finds the most probative evidence of record to be the service medical records dated after he received treatment for his claimed disabilities. In particular, the Board notes that no further complaints or treatment for either ear/jaw pain or drowsiness were noted in the service medical records. These records are also negative for any diagnoses of TMJ or insomnia, even by history. The Board places the greatest weight on the report of medical examination completed at separation. In the report of that medical examination no complaints or findings regarding insomnia were noted. Similarly, the veteran's mouth and throat were found to be normal, and no complaints or findings regarding TMJ were noted. Moreover, and significantly in the judgment of the Board, although several post-service treatment records have been submitted by the veteran, these records are also negative for any treatment or diagnosis of insomnia or TMJ. Although the veteran may believe that he has insomnia and TMJ, there is no indication in the record that he possesses the specialized knowledge, skill, experience, training or education to provide competent testimony on medical matters, such as a medical diagnosis. See Espiritu v. Derwinski, 2 Vet. App. 492, 495-496 (1992). In light of the aforementioned evidence, which shows a complete absence of any subsequent complaints or treatment for insomnia or TMJ following his initial diagnoses, the Board concludes that the preponderance of the competent and probative evidence is against finding that he has current diagnoses of either insomnia or TMJ. The Court has held that in the absence of a current disability, a claim must fail. See Rabideau, 2 Vet. App. at 144; Chelte, 10 Vet. App. at 271; Degmetich, 104 F.3d at 1332. Therefore, the Board concludes that the preponderance of the evidence is against the veteran's claims of entitlement to service connection for insomnia and TMJ. The benefits sought on appeal are accordingly denied. (ii.) A bilateral hand disability, claimed as arthritis with "tingling" in both hands The veteran contends that he has experienced recurring tingling in his hands since service, which he believes to be an early sign of arthritis. Having reviewed the record, the Board finds that the preponderance of the competent and probative evidence shows that the veteran does not have a current bilateral hand disability. The Board finds the most probative evidence of record to be the veteran's extensive service medical records, which do not contain any competent medical evidence that the veteran has ever been diagnosed with arthritis in his hands or with any neurological or other disability of the hands. As noted above, his service medical records are entirely negative for any such diagnoses. Although the Board recognizes that upon the veteran's separation from service the examiner noted his complaints of sharp pain in both hands, it appears that the physician was unable to attribute this symptom to any identifiable disability. diagnosis. In addition, although the veteran submitted several post-service medical records, these records are negative for any diagnosis of a bilateral hand disability. Recently, the Court has had occasion to discuss what constitutes a disability. A symptom, such as pain, alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection may be granted. See Sanchez- Benitez v. West, 13 Vet. App. 282, 285 (1999). In this instance, there are subjective complaints of pain and tingling in the veteran's hands without any competent medical evidence of underlying pathology. Since no competent medical evidence of current existence of any clinical disability manifested primarily tingling of the hands has been presented, this claim must be denied. See Rabideau, 2 Vet. App. at 143 Although the veteran is considered competent to report his symptoms, the record does not show that the veteran possess the requisite knowledge, skill, experience, training, or education to render him competent to testify as to medical matters, such as medical diagnoses. Espiritu, 2 Vet. App. at 494. Therefore, while the veteran is competent to report that he experiences tingling in his hands, his assertion that this symptoms represent an early sign of arthritis is not competent and is of no probative value. In short, the Board finds that there is no competent medical evidence of a currently diagnosed bilateral hand disability, to include arthritis. The Court has held that in the absence of a current disability, a claim must be denied. See Rabideau, 2 Vet. App. at 143. Therefore, the Board finds that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for arthritis with tingling of the hands. The claim is accordingly denied. 5. Entitlement to service connection for urethritis. 6. Entitlement to service connection for prostatitis. 7. Entitlement to service connection for gastritis. Factual Background Service medical records show that in September 1981, the veteran was seen with complaints of urinary frequency. The examiner determined it to be "very mild" and noted a diagnosis of urinary frequency. In June 1986, the veteran reported experiencing diarrhea for several days. The examiner found evidence of a boggy prostate. A diagnosis of clinical prostatitis was noted. Subsequent records are negative for any notations or findings regarding urinary frequency or prostatitis. In July 1982, the veteran complained of a discharge from his penis. The examiner noted a diagnosis of gonorrhea. He was treated with penicillin. In October 1983, the veteran again reported experiencing a discharge from his penis. The examiner noted a diagnosis of gonorrhea. The veteran was referred for treatment. In a report of medical examination completed in November 1988, an examiner found the veteran's genitourinary system to be normal. In August 1994, the veteran complained of epigastric pain, nausea, and vomiting for two weeks. The veteran denied alcohol problems, but it was noted that his wife reported that he drank two to three six packs of beer every two days. The examiner noted a diagnosis of abdominal pain with gastrointestinal bleeding secondary to alcohol abuse. In the report of medical examination completed at separation in January 1998, the examiner found the veteran's genitourinary system to be normal. No notations or finding regarding prostatitis, urethritis, or gastritis were noted. In a report of medical history, the same examiner who conducted the veteran's physical examination noted that the veteran had been treated for a stomach ulcer in 1995, and that he had experienced a full recovery, with no complications and no sequela. In July 1998, the veteran filed a claim of entitlement to service connection for urethritis and prostatitis from September 1981 to June 1986. He also filed a claim of entitlement to service connection for alcohol use with recurring stomach pains and evidence of a developmental ulcer. In the January 1999 rating decision, the RO denied claims of entitlement to service connection for urethritis and prostatitis. The RO also denied claims of entitlement to service connection for alcohol abuse and for gastritis (claimed as an ulcer). In March 1999, the veteran underwent a prostate examination. It was noted that the veteran had no urinary complaints. Penile and rectal examinations were normal, and there was no evidence of hernias or masses found. The physician further concluded that the veteran had a normal prostate examination. Thereafter, veteran perfected a timely appeal with respect to the issues of entitlement to service connection for urethritis, prostatitis and gastritis. No appeal was filed with respect to the issue of entitlement to service connection for alcohol abuse. [The Board observes in passing that the law provides that no compensation may be paid for a disability which results from the veteran's own willful misconduct or abuse of alcohol. See Section 8052 of the Omnibus Budget Reconciliation Act of 1990, Pub. L. No. 101- 508, § 8052, 104 Stat. 1388, 1388- 351; 38 U.S.C.A. § 105 (West 1991); 38 C.F.R. §§ 3.1(n), 3.301(c) (2000)]. Analysis Preliminary matters The veteran was advised by virtue of the rating decision and Statement of the Case issued during the pendency of the appeal of the type of information or evidence that would best service to substantiate his claims. The Board finds that the veteran and his representative have been given notice of the information, medical evidence, or lay evidence necessary to substantiate his service connection claims. Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2096-97 (2000) [to be codified as amended at 38 U.S.C. § 5103]. Accordingly, the Board concludes that VA has no outstanding duty to inform the veteran that any additional information or evidence is needed with respect to these claims. The Board further concludes that all relevant evidence which is available has been obtained by the RO to the extent possible; consequently, there is no further duty to assist the appellant. See the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2097-98 (2000) [to be codified at 38 U.S.C. § 5103A]. The veteran's complete service medical records have been obtained and associated with his VA claims folder. In addition, the veteran has submitted recent post-service medical records, which have been associated with his VA claims folder. Neither the veteran nor his representative have pointed to any additional evidence, including post-service medical records, which has not been obtained and which would be pertinent to the veteran's claim. As will be discussed addressed in greater detail below, the Board believes that there is no competent medical evidence of record showing that the veteran currently has prostatitis, urethritis and/or gastritis. For this reason, the Board finds that a VA physical examination is not warranted in this instance. See the VCAA; Counts and Gobber, supra. The Board notes in passing that the veteran apparently did undergo an examination of his prostate by an Air Force physician in March 1999. The report of this examination has been obtained and associated with the claims folder. Although the veteran's certain of the veteran's claims appear to have been denied by the RO as not well grounded, the Board finds that it may proceed with a decision on the merits of the claims without prejudice to the veteran. See Bernard, 4 Vet. App. at 393-394. In essence, the Board is of the opinion that all notification and development actions required by the VCAA appear to have been completed to the extent necessary under the circumstances, and that remanding this case for readjudication in light of the new legislation would serve no useful purpose. Cf. Soyini, 1 Vet. App. at 546. Discussion (i.) Prostatitis and urethritis Having reviewed the complete record, and for the reasons and bases set forth below, the Board finds that the preponderance of the competent and probative evidence is against the veteran's claims of entitlement to service connection for prostatitis and urethritis. In regard to these claims, the Board found the most probative evidence of record to be the veteran's service medical records and the March 1999 examination report. In particular, the Board notes that although the veteran was treated for urinary frequency and gonorrhea between 1981 and 1982, subsequent service medical records are negative for any further complaints or treatment for these disabilities. Similarly, although the veteran was diagnosed with prostatitis in 1986, subsequent records reveal no further findings or notations regarding this disability. In fact, in the report of physical examination dated in November 1988, an examiner specifically found the veteran's genitourinary system to be normal. Furthermore, upon his separation in January 1998, the veteran's genitourinary system was again found to be normal. The Board believes these repeated negative findings to be consistent with the March 1999 examination report, in which a physician concluded that the veteran's prostate examination was normal. In reaching this conclusion, the physician noted that examination of the veteran's penis was normal, and that his prostate felt normal without nodules or induration. Based upon the aforementioned evidence, the Board concludes that the preponderance of the competent and probative evidence is against finding that he has current diagnoses of either urethritis or prostatitis. As discussed above, the fact that a condition or injury occurred in service alone is not enough to warrant service connection; there must be a current disability resulting from that condition or injury.. See Rabideau, 2 Vet. App. at 144; Chelte, 10 Vet. App. at 271; Degmetich, 104 F.3d at 1332. Therefore, the Board concludes that the preponderance of the evidence is against the veteran's claims of entitlement to service connection for urethritis and prostatitis. The benefits sought on appeal are accordingly denied. (ii.) Gastritis The Board has reviewed all of the evidence of record. See 38 U.S.C.A. § 7104(a). Service medical records reflect that the veteran was treated for abdominal pain with gastrointestinal bleeding in 1994. However, subsequent service medical records do not show the received any further treatment for abdominal pains or gastrointestinal bleeding during the remainder of his service. In the report of physical examination completed at separation, the examiner found the veteran's abdomen and viscera to be normal. The examiner noted that although the veteran had a history of a stomach ulcer, he had experienced a complete recovery with no complications and no sequela. In light of these reports, the Board concludes that the preponderance of the evidence is against finding that he has current a diagnosis of gastritis. As noted above, service connection may not be granted for a diagnosis of a disability by history or for symptoms unaccompanied by a current diagnosis. See Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999). The Board notes that the veteran has at times contended that he has gastritis which developed as a result of alcohol abuse in service. As noted earlier, the Omnibus Budget Reconciliation Act of 1990 prohibits payment of compensation for a disability that is a result of a veteran's own alcohol abuse. The veteran has also asserted he has gastritis which developed as a result of stress incurred in service. Although the veteran may believe that he has gastritis, and has attributed such to various incidents of his service, as discussed above there is no indication in the record that he possesses the specialized medical knowledge, skill, experience, training or education to provide competent testimony on medical matters, such as a medical diagnosis or an opinion concerning etiology. See Espiritu, 2 Vet. App. at 495-496. In summary, the Board finds that the veteran does not have a current diagnosis of gastritis. Therefore, the Board concludes that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for gastritis. See Rabideau, 2 Vet. App. at 144; Chelte, 10 Vet. App. at 271; Degmetich, 104 F.3d at 1332. The benefit sought on appeal is accordingly denied. ORDER Entitlement to service connection for residuals of exposure to asbestos is denied. Entitlement to service connection for insomnia is denied. Entitlement to service connection for TMJ is denied. Entitlement to service connection for a bilateral hand disability, claimed as arthritis and "tingling" of both hands, is denied. Entitlement to service connection for urethritis is denied. Entitlement to service connection for prostatitis is denied. Entitlement to service connection for gastritis is denied. REMAND As discussed in detail above, the VCAA requires VA to make reasonable efforts to assist all claimants in obtaining evidence necessary to substantiate a claim for benefits. See the Veterans Claims Assistance Act of 2000, Pub. L. No. 106- 475, § 3(a), 114 Stat. 2096 (2000) (to be codified at 38 U.S.C. § 5103A). Such assistance also includes providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on the claim. In accordance with this duty, and for the reasons and bases set forth below, the Board finds that additional evidentiary development is necessary before the veteran's claims can be adjudicated. The VCAA further requires that VA shall notify a claimant and the claimant's representative of any information, and any medical or lay evidence, not previously provided to the Secretary that is necessary to substantiate the claim. Veterans Claims Assistance Act, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2096-97 (2000) (to be codified as amended at 38 U.S.C. § 5103). While this case is in remand status, the RO should review the veteran's claims file and ensure that all notification action required by the VCAA is completed in full. In addition, the RO should also ensure that all relevant records have been obtained and associated with the veteran's claims folder, to include any recent VA or private treatment records. Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096 (2000) (to be codified at 38 U.S.C. § 5103A). In the interest of clarity, the Board has divided the remaining portion of this remand into six separate discussions. Entitlement to compensable evaluations for sinusitis, status post excision of a ganglion cyst of the right foot, and status post excision of a carbuncle of the right arm. The veteran is seeking a compensable evaluation for his service-connected sinusitis. He is also seeking compensable evaluations for his service-connected status post excisions of a ganglion cyst of the right foot and a carbuncle of the right arm. The veteran essentially contends that his disabilities are more severe than is contemplated by his noncompensable evaluations. As noted above, VA has a duty to make reasonable efforts to assist all claimants in obtaining evidence necessary to substantiate a claim for benefits. Such assistance also includes providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on the claim. See the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096 (2000) (to be codified at 38 U.S.C. § 5103A). The Board notes that a VA examination has not been conducted in regard to any of the veteran's service-connected disabilities. Although the veteran was apparently scheduled for a VA examination in order to ascertain the severity of his sinusitis in February 2000, a computer printout sheet from the VA Medical Center (VAMC) shows that this examination was canceled by the Medical Administration Service for the stated reason that the veteran had withdrawn his claim. Thereafter, the RO apparently rescheduled the veteran for another examination in regard to his sinusitis in April 2000, but a separate computer printout sheet from the VAMC shows that this examination was canceled because the veteran failed to report. The veteran subsequently submitted a statement in December 2000, in which he reported that he had only recently learned of his failure to report for a scheduled VA examination. He indicated that he had never received notice of this examination and that he was unaware that one had been scheduled. He noted that he was currently in Germany, but that he would soon be returning to the United States. He indicated that it had always been his wish to undergo a VA physical examination. The Board notes that a copy of the notification letter issued to the veteran regarding his scheduled VA examination has not been associated with the claims folder. Thus, the Board can find no indication that the veteran was given adequate notice of the scheduled examination, to include advising him of the consequences of a failure to report for the examination. For this reason, the Board finds that a remand is warranted, in order to provide the veteran with the another opportunity to appear for another VA examination in regard to his service- connected sinusitis. Furthermore, the Board finds that the RO should ensure that the veteran is also examined for his service-connected status post excisions of a ganglion cyst of the right foot and a carbuncle of the right arm. Although the Board believes that the veteran should be provided with another opportunity to appear for a VA examination, the Board believes that it is appropriate to caution the veteran as to his own responsibilities in this matter. The Court has held that VA's duty to assist him in the development of his claim is not a one-way street, meaning that he cannot sit by when requested to submit additional evidence or to report for examination. "If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence." Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The Board expects the veteran to cooperate in the development of evidence pertinent to this case. The Board also advises the veteran that when a claimant fails without good cause to report for an examination scheduled in conjunction with a claim for an increased rating, the claim shall be denied. 38 C.F.R. § 3.655 (2000). Entitlement to service connection for cramping in both feet and bilateral varicose veins. The veteran's service medical records reflect that in January 1998, he was seen with complaints of chronic right foot pain. It was noted that he had a history of dropping a 55-gallon drum on his foot many years ago. In the report of medical history completed at discharge, the veteran reported that he experienced pain in both feet and that he had developed varicose veins in both legs. Examination of the right foot revealed tenderness to the right forefoot with prominence. Thereafter, in May 1999, the veteran underwent a private physical examination in which he again reported experiencing pain in both feet. A mass was found on the right foot, which the examiner determined to be ganglion. The examiner noted that the cramps he experienced were partly due to the loafer type shoes he wore. Upon examination, the examiner noted that the superficial veins were becoming "tortuous", which might also explain the cramping in his feet. For his varicosities, the examiner advised the veteran to wear support hose to see if it helped his plantar arch cramps. The Board believes that the veteran has submitted competent evidence suggesting that he has a current bilateral foot disability, in the form of the May 1999 examiner's diagnosis of varicosities, which the examiner concluded may in part account for the veteran's plantar arch cramps. The Board also believes that there is evidence suggesting a link between this disability and service, in the form of the veteran's in-service reports of symptoms similar to those noted during his May 1999 examination. See the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096 (2000) (to be codified at 38 U.S.C. § 5103A). Therefore, the Board finds that a remand of these issues is warranted, so the RO can provide the veteran with an examination that addresses the nature and etiology of the veteran's claimed cramping in both feet and bilateral varicose veins. Entitlement to service connection for a heart murmur, atypical chest pain, right ventricular hypertrophy with non- specific T-wave changes, and hypertension. The Board believes that a brief discussion regarding the medical evidence underlying these claims would be appropriate. The veteran's service medical records reflect that throughout 1979, he complained of pain and tightness in his chest. Examination and testing revealed no evidence of cardiovascular disability. Subsequent service medical records indicate that the veteran continued to complain of chest pain periodically until his discharge from service in 1998. Several examiners noted that the etiology of the veteran's chest pain was unknown, and one examiner indicated that the pain may be due to anxiety. During service, several electrocardiograms (ECG) were obtained, which showed a normal study. However, an ECG performed in January 1984 showed evidence of right axis deviation and right ventricular hypertrophy. An EKG performed in October 1988 also showed evidence of right axis deviation and possible right ventricular hypertrophy. A subsequent ECG study obtained in May 1993 showed no evidence of right ventricular hypertrophy. Upon the veteran's separation from service in January 1998, an examiner found his heart to be normal, but determined that he had a "borderline ECG". The report of ECG dated in January 1998 contains findings of sinus tachycardia, rightward axis, and borderline ECG. The Board notes that the veteran's service medical records reveal evidence of occasional elevated blood pressure readings throughout service, but contain no indication that he was ever diagnosed with hypertension. These records also show that the veteran was found on several occasions to have a heart murmur. For example, a January 1983 clinical note shows that the veteran was found to have a low-grade systolic murmur. Similarly, in October 1996, the veteran was again found to have an innocent systolic murmur of no hemodynamic significance. The Board notes that a post-service examination conducted in March 1999 revealed evidence of elevated blood pressure. Based on the evidence discussed above, the Board believes that there is ambiguity in the record regarding whether or not the veteran has a cardiovascular disability, and, if so, the nature and etiology of such disability. The Board finds believes that it would be inappropriate to address any of the veteran's aforementioned claims, until such time as the veteran is provided with a VA cardiovascular examination. See the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096 (2000) (to be codified at 38 U.S.C. § 5103A). Entitlement to service connection for periodontal disease. The veteran is seeking entitlement to service connection for periodontal disease. He contends that he was treated for severe periodontal disease while on active duty, and that he had a number of teeth pulled as a result. The Board notes that there are no service dental records dated after July 1980 presently associated with the veteran's VA claims folder. A physical profile serial report dated in January 1996 contains a notation that the veteran had undergone the removal of 4 teeth and that he was in dental Class III corrected status. Another physical profile dated in January 1996 contains a notation that the veteran was in dental Class III for severe periodonitis. In the report of medical history completed at separation, it was noted that the veteran had been treated for gum disease in 1997, and that he had nine teeth pulled. The report of physical examination conducted at separation contains no findings or other information pertinent to the veteran's teeth. The VCAA requires VA to make reasonable efforts to obtain relevant records that the claimant adequately identifies and authorizes VA to obtain. The VCAA further provides that whenever VA attempts to obtain records from a Federal department or agency, the efforts to obtain those records shall continue until the records are obtained unless it is reasonably certain that such records do not exist or that further efforts to obtain those records would be futile. Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2097-98 (2000) (to be codified at 38 U.S.C. § 5103A). As noted above, some of the veteran's service dental records are not associated with his claims folder. Thus, in compliance with the requirements of the VCAA, the Board finds that a remand of this issue is warranted so the RO in order to allow the opportunity to obtain the veteran's complete service dental records. The Board notes that while this case is in remand status, the RO remains free to undertake any additional evidentiary in order to ensure full compliance with the requirements of the VCAA, to include providing the veteran with a VA dental examination if deemed necessary. See the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2097-98 (2000) [to be codified at 38 U.S.C. § 5103A]. In January 1999 rating decision, the RO denied the veteran's claim of entitlement to service connection for periodontal disease on the basis that such disease is not considered a disabling condition subject to compensation under VA laws. While it is true that service connection is not available for periodontal disease for the purpose of obtaining compensation, the Board notes that periodontal disease may be service-connected solely for the purpose of determining entitlement to dental examinations or outpatient dental treatment. See 38 U.S.C.A. § 1712 (West 1991 & Supp 1999); 38 C.F.R. §§ 3.382(a), 4.149, 17.161 (effective prior to June 8, 1999); 38 C.F.R. § 3.381 (effective after June 8, 1999). The Board finds that while this claim is in remand status, the RO should readjudicate the veteran's claim of entitlement to service periodontal disease, with specific consideration given to the issue of entitlement to service-connection solely for the purpose of determining entitlement to dental examinations or outpatient dental treatment. See Mays v. Brown, 5 Vet. App. 302 (1993) [holding that a claim for service connection for a dental disorder raises a claim for outpatient dental treatment]. Entitlement to service connection for chronic low back pain. The veteran's service medical records reflect that in January 1998, he reported a one-year history of chronic low back pain. In a clinical note dated in January 1998, an examiner noted a diagnosis of myofascial low back pain. Other examiners during this period also noted diagnoses of chronic low back pain and mechanical low back pain. In a report of medical examination completed at separation, an examiner noted that the veteran had a history of low back strain in 1994. The examiner noted that examination had revealed evidence of right low back pain and tenderness, with left L-5 rotation restriction. The Board is of the opinion that the diagnosis of left L-5 rotation restriction obtained at discharge arguably provides competent evidence of a low back disability. Accordingly, the Board finds that a remand of this issue is warranted, in order to provide the veteran with a VA examination that addresses the nature and etiology of his claimed low back disorder. Entitlement to service connection for tinnitus. The veteran is seeking entitlement to service connection for tinnitus. He contends that he has experienced a recurring ringing in his ears since service, and that he believes that this ringing is due to exposure to loud aircraft while working as a supply specialist in the Air Force. In general, lay persons are not considered competent to offer opinions on medical matters, such as causation or diagnosis. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-495 (1992). However, in Falzone v. Brown, 8 Vet. App. 398, 403 (1995), the Court held that a lay person is considered competent to testify as to the symptoms of a disability, such as pain. The Court also held that the veteran's disability in that case, pes planus, is of the type that "lends itself to observation by a lay witness". There is no indication in the record that the veteran has been diagnosed with tinnitus. However, the veteran has reported experiencing a recurring ringing in both ears since 1994. Tinnitus has been defined by the Court as a ringing, buzzing noise in the ears. See YT v Brown, 9 Vet. App. 195, 196 (1996); Kelly v. Brown, 7 Vet. App. 471 (1995) (citing Dorland's Illustrated Medical Dictionary 1725 (27th ed. 1988)). In this instance, the Board believes that the veteran's claimed disability is of the type that lends itself to observation by a lay witness. Because the veteran has pointed to a specific in-service event, noise exposure, as being the cause of his claimed tinnitus, the Board believes that a VA examination is necessary under the provisions of the VCAA in order to determine whether the veteran in fact has tinnitus, and, if so, whether such disability is the result of noise exposure in service. See the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2097-98 (2000) [to be codified at 38 U.S.C. § 5103A]. Accordingly, this case is remanded for the following actions: 1. The RO should attempt to obtain the veteran's complete service dental records. If for any reason these records are unavailable, such should be noted in the claims folder. 2. The RO should contact the veteran and his representative and inform them of the type of evidence that would best serve to substantiate his claims. As part of this notice, the RO should specifically request that the veteran provide the names and addresses of any additional health care providers who may possess additional records pertinent to his claims which are not presently part of his VA claims folder. With any necessary authorization from the veteran, the RO should attempt to obtain copies of any pertinent treatment records identified by the veteran in response to this request which have not been previously secured. 3. The veteran should be afforded a VA compensation and pension physical examination. The veteran's claims folder and a copy of this remand must be made available to the physician for review in conjunction with the examination. The examiner must respond to the specified inquiries and state the rationale for any and all opinions expressed. Any diagnostic tests and studies deemed necessary by the examiner in order to respond to the specified inquiries should be conducted. If deemed to be necessary by the examiner, specialist consultations should be scheduled. The report of the examination should be associated with the claims folder. a.) After a review the veteran's medical history, the examiner (or specialist consultant) should offer an opinion as to the approximate date of onset of any diagnosed cardiovascular disorder and whether it is at least as likely as not that any diagnosed cardiovascular disorder is related to the veteran's military service. b.) The examiner should also be asked to determine the extent of impairment caused by the veteran's service-connected sinusitis. The examiner should attempt to identify the extent to which the veteran has received antibiotic treatment for sinusitis and the existence of any symptoms, including headaches, pain, purulent discharge or crusting. The examiner should also comment on whether any chronic osteomyelitis requiring repeated curettage is apparent. c.) The examiner should also describe any scars and discuss the extent of any impairment caused by the veteran service- connected status post excision of a ganglion cyst of the right foot and status post excision of a carbuncle of the right arm. d.) The examiner should also be asked to specify whether examination reveals any evidence of varicose veins in the veteran's legs. If found, the examiner should review the evidence of record and determine the most likely etiology of the veteran's varicose veins. In addition, the examiner should also specifically comment on whether any medically identifiable cause exists for the veteran's complaints of cramping in his feet and if so what that cause is. e.) The examiner (or specialist consultant) should also identify any disorders of the low back and express an opinion as to whether it is at least as likely as not that any such disorder is related to the veteran's service. f.) The examiner (or specialist consultant) should also offer an opinion as to the existence and, if diagnosed, the etiology of the veteran's claimed tinnitus, to include noise exposure during service. 4. Following completion of the foregoing, the RO should review the veteran's VA claims folder and ensure that all developmental and notification actions required by VCAA have been completed in full. Thereafter, the RO should readjudicate the veteran's claims, taking into consideration the provisions of the VCAA. If the benefits sought on appeal remain denied, the veteran and his representative should be furnished with copies of a Supplemental Statement of the Case and given an opportunity to respond. Thereafter, the case should be returned to the Board, if in order. The veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. 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 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 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. 2000) (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. Barry F. Bohan Member, Board of Veterans' Appeals