Citation Nr: 0608688 Decision Date: 03/24/06 Archive Date: 04/04/06 DOCKET NO. 02-07 158 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Whether new and material evidence was received to reopen a claim for entitlement to service connection for submaxillary salivary gland mucoepidermoid carcinoma secondary to Agent Orange. 2. Whether new and material evidence was received to reopen a claim for entitlement to service connection for skin rash secondary to Agent Orange. 3. Entitlement to service connection for post-traumatic stress disorder (PTSD). 4. Entitlement to service connection for hypertension secondary to PTSD. 5. Entitlement to service connection for cancer of the larynx. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD T. L. Douglas, Counsel INTRODUCTION The appellant is a veteran who served on active duty from February 1969 to February 1973. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2001 rating decision by the Columbia, South Carolina, Regional Office (RO) of the Department of Veterans Affairs (VA). In July 2004, the Board reopened the veteran's claim for entitlement to service connection for PTSD and remanded the issues remaining on appeal for additional development. The issue of entitlement to service connection for submaxillary salivary gland mucoepidermoid carcinoma secondary to Agent Orange is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. All relevant evidence necessary for the equitable disposition of the issues on appeal was obtained. 2. In an April 1994 rating decision the RO denied entitlement to service connection for skin rash and submaxillary salivary gland mucoepidermoid carcinoma secondary to Agent Orange; the veteran did not appeal after being notified of that decision. 3. Evidence received since the April 1994 rating decision does not bear directly and substantially upon issue of service connection for submaxillary salivary gland mucoepidermoid carcinoma secondary to Agent Orange; it is cumulative and redundant, and by itself or in connection with evidence previously assembled is not so significant that it must be considered in order to fairly decide the merits of the claim. 4. Evidence received since the April 1994 rating decision bears directly and substantially upon the specific matters of service connection for service connection for a skin rash secondary to Agent Orange; it is neither cumulative nor redundant, and 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. 4. A chronic skin disorder, pseudofolliculitis barbae, is shown to have been incurred during active service. 5. PTSD was not present in service and is not shown to been incurred as a result of a verified event during active service. 6. Hypertension was not present in service and is not shown to be related to service nor to be proximately due to or the result of a service-connected disability. 7. There is no competent evidence of a cancer of the larynx. CONCLUSIONS OF LAW 1. The RO, in April 1994 denied service connection for a skin rash; the veteran did not appeal that decision, and it became final. New and material evidence has been not been submitted and the claim of entitlement to service connection for submaxillary salivary gland mucoepidermoid carcinoma is not reopened. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (effective prior to August 29, 2001). 2. New and material evidence has been submitted and the claim of entitlement to service connection for skin rash is reopened. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (effective prior to August 29, 2001). 3. A chronic skin disorder, pseudofolliculitis barbae, was incurred in service. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. § 3.303 (2005). 4. PTSD was not incurred in or aggravated by service nor as a result of a verified stressor during active service. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2005). 5. Hypertension was not incurred in or aggravated by service and is not proximately due to or the result of a service- connected disability. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2005). 6. A cancer of the larynx was not incurred in or aggravated by service nor may it be presumed to be service connected. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. § 3.303 (2005). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2005); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2005). In this case, the veteran was notified of the VCAA duties to assist by correspondence dated in April 2001, August 2004 and August 2005. The veteran's service medical records and all identified and authorized post-service medical records relevant to the issues on appeal have been requested or obtained. Although the veteran claims he served in Vietnam for 18 months, the Board finds this claim is inconsistent with the information in his service department records. There is no credible evidence disputing the veracity of these service department reports. Further attempts to obtain additional evidence would be futile. The Board also finds the available medical evidence is sufficient for adequate determinations. The duty to assist and duty to notify provisions of the VCAA have been fulfilled. During the pendency of this appeal, on March 3, 2006, the United States Court of Appeals for Veterans Claims (hereinafter "the Court") issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, Nos. 01- 1917 and 02-1506, which discussed the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). As stated above, full compliance with VCAA has been accomplished regarding the procedural and assistance requirement for reopening claims based on new and material evidence, and there has been full compliance regarding the duties associated with issues of service connection. Except for the issue of service connection for a skin disorder, all other claims before the Board are being denied; therefore, any other notice requirements beyond those cited for service connection claims, are not applicable. Therefore, as there has been substantial compliance with all pertinent VA law and regulations, to move forward with adjudication of those claims would not cause any prejudice to the veteran with respect solely to this issue. Regarding the issue of whether new and material evidence has been submitted to reopen a claim for entitlement to service connection for skin rash secondary to Agent Orange, because of the favorable decision in this claim, there is no prejudice to the veteran in going forward with the decision. New and Material Evidence Claims The Board, in the first instance, must rule on the matter of reopening a claim. The Board has a jurisdictional responsibility to consider whether it is proper for a claim to be reopened, . Jackson v. Principi, 265 F.3d 1366 at 1369 (Fed. Cir. 2001) and Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). VA regulations providing the conditions under which a previously denied claim may be reopened were amended effective for claims filed on or after August 29, 2001. 38 C.F.R. § 3.156(a). A review of the record shows the veteran submitted his request to reopen these claims in September 2000. VA regulations effective prior to August 29, 2001, provided that under 38 U.S.C.A. § 5108, "[i]f 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." "New and material evidence" meant evidence not previously submitted to agency decision makers which bears "directly and substantially" upon the specific matter under consideration. Such evidence must have been neither cumulative nor redundant, and, by itself or in connection with evidence previously assembled, such evidence must have been "so significant that it must be considered in order to fairly decide the merits of the claim." 38 C.F.R. § 3.156(a) (prior to August 29, 2001); see also Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). The claimant does not have to demonstrate that the new evidence would likely change the outcome of the prior denial. Rather, it is only important that there be a complete record upon which the claim can be evaluated and that the new evidence may contribute to a more complete picture of the circumstances surrounding the origin of a claimant's injury or disability. Hodge, 155 F.3d at 1363. In an April 1994 rating decision the RO denied entitlement to service connection for skin rash and submaxillary salivary gland mucoepidermoid carcinoma secondary to Agent Orange. The determinations were based primarily upon findings that these were not disorders incurred in service, nor was cancer demonstrated within a years following service separation, and that there was no evidence demonstrating that the disorders were due to Agent Orange exposure during active service. The veteran did not appeal and the decision became final. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. § 3.104 (2005). Regarding the issue of service connection for submaxillary salivary gland mucoepidermoid carcinoma secondary to Agent Orange, the Board finds that the evidence added to the claims file since April 1994 includes evidence that was not previously submitted to agency decisionmakers; however, it does not bear directly and substantially upon the specific matters under consideration and is not so significant that it must be considered in order to fairly decide the merits of the claims. The pertinent evidence includes an April 2002 statement from Dr. H.C.M., a VA staff physician, indicating his understanding that salivary gland tumors had been considered in relation to Agent Orange. This statement is neither new nor material. Rather, it is a general statement that the physician understood that category of salivary gland cancer had been studied as having a relationship to Agent Orange. It does not address the veteran's cancer specifically, nor does it relate his cancer to exposure to Agent Orange. The remaining evidence, while new, likewise does not bear "directly and substantially" upon the specific issue of salivary cancer being the result of the veteran's exposure to Agent Orange. The claim for service connection for submaxillary salivary gland mucoepidermoid carcinoma secondary to Agent Orange is not reopened. Concerning the skin disorder, the Board notes that an August 2005 VA examiner found a March 1970 service medical report most likely represented pseudofolliculitis barbae and that this disorder, to a minimal extent, was shown on the present examination. As these opinions were was not of record at the time of the last final decision and address directly the basis for the prior denial of the veteran's claims, they are "new and material" and the claims must be reopened. It is significant to note that the RO re-adjudicated the issue of entitlement to service connection for skin rash on the merits in a November 2005 supplemental statement of the case. In light of the RO's development actions and the favorable determination below, the veteran is not prejudice by an appellate review of this matter based upon the present record. Service Connection Claims Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in line of duty or for aggravation of preexisting injury suffered or disease contracted in line of duty. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2005). A disability which is proximately due to or the result of a service-connected disease or injury shall be considered service connected. 38 C.F.R. § 3.310 (2005). In the case of a veteran who engaged in combat with the enemy in active service with a military, naval, or air organization of the United States during a period of war, the Secretary of VA shall accept as sufficient proof of service-connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service. 38 U.S.C.A. § 1154(b) (West 2002); 38 C.F.R. § 3.304(d) (2005). VA's General Counsel has held in a precedent opinion that "the ordinary meaning of the phrase 'engaged in combat with the enemy,' as used in 38 U.S.C.A. § 1154(b), requires that a veteran participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality." The determination as to whether evidence establishes that a veteran engaged in combat with the enemy must be resolved on a case-by-case basis with evaluation of all pertinent evidence and assessment of the credibility, probative value, and relative weight of the evidence. VAOGCPREC 12-99 (Oct. 18, 1999). Where a veteran served 90 days or more of continuous, active military service during a period of war or during peacetime service on or after January 1, 1947, and certain chronic diseases become manifest to a degree of 10 percent within one year from date of termination of service, such disease shall be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 2002 & Supp. 2005); 38 C.F.R. §§ 3.307, 3.309 (2005). Certain disorders associated with herbicide agent exposure in service may be presumed service connected. See 38 U.S.C.A. § 1116 (West 2002); 38 C.F.R. §§ 3.307, 3.309. Chloracne or other acneform disease consistent with chloracne and porphyria cutanea tarda are enumerated diseases for presumptive service connection purposes if the disorder became manifest to a degree of 10 percent within a year of the last date of exposure and respiratory cancers, including cancer of the larynx, are included if the disorder became manifest to a degree of 10 percent at any time after service. 38 C.F.R. § 3.307(a)(6)(ii). Veterans who served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iii). Under the authority granted by the Agent Orange Act of 1991 and the Veterans Education and Benefits Expansion Act of 2001, VA has determined that a presumption of service connection based on exposure to herbicides used in the Republic of Vietnam during the Vietnam Era is not warranted unless the disorder is specifically recognized by VA regulation. See 68 Fed. Reg. 27,630 (May 20, 2003). The U.S. Court of Appeals for the Federal Circuit (Federal Circuit) has also held that when a claimed disorder is not included as a presumptive disorder direct service connection may nevertheless be established by evidence demonstrating that the disease was in fact "incurred" during the service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In addition, service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). For the showing of chronic disease in service, there are required a combination of manifestations sufficient to identify a disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. Continuity of symptomatology is required only where the condition noted during service is not, in fact, shown to be chronic or when the diagnosis of chronicity may be legitimately questioned. 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). In order to prevail on the issue of service connection on the merits, there must be medical evidence of (1) 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 in-service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247, 253 (1999). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that a veteran seeking disability benefits must establish the existence of a disability and a connection between service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). The Court has held that where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence is required. Grottveit v. Brown, 5 Vet. App. 91 (1993); see also Espiritu v. Derwinski, 2 Vet. App. 492 (1992). VA is free to favor one medical opinion over another provided it offers an adequate basis for doing so. See Owens v. Brown, 7 Vet. App. 429 (1995). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case with all reasonable doubt to be resolved in favor of the claimant; however, the reasonable doubt rule is not a means for reconciling actual conflict or a contradiction in the evidence. 38 C.F.R. § 3.102 (2005). Skin Disorder The veteran contends, in essence, that he has skin disorders as a result of active service, including due to exposure to Agent Orange while serving in Vietnam. In his September 2000 correspondence he requested entitlement to service connection for skin cancer to the leg as a result of Agent Orange exposure. Records show the veteran served in the Republic of Vietnam in 1970 and he is presumed to have been exposed to Agent Orange. Service medical records dated in July 1970 show the veteran was seen for a rash on his face after shaving with a bladed razor and advised to obtain an electric razor for shaving every other day. There are no other records indicative of complaint, treatment, or diagnosis for skin disorder. The veteran's February 1973 discharge examination revealed a normal clinical evaluation of the skin. During a November 1993 VA Agent Orange registry examination the veteran complained of a rash on the feet. However, evaluation of the skin was normal. VA treatment records dated in January 2001 noted a diagnosis of atopic dermatitis. Examination at that time revealed rash to the extensor surfaces of the arms, legs, buttocks, and stomach. A March 2001 report noted hand dermatitis of unclear etiology. Private medical correspondence dated in April 2001 obtained from the Social Security Administration (SSA) noted it appeared the veteran had chronic hand eczema and a history of acute repetitive exposure to cleaners that exacerbated his disorder. VA examination in August 2005 revealed scaling to the left palm and the soles of the feet. KOH preparations were positive for fungus. Serum testing was compatible with a diagnosis of atopy. The diagnoses included one hand-two foot syndrome (tinea manuum plus tinea pedis) and suspected atopic diathesis. The examiner noted that neither atopic disorders nor fungal disorders were related to Agent Orange and that while Vietnam was a prime area for exposure to fungal elements there was no evidence of any treatment in service. It was noted service medical records most likely represented pseudofolliculitis barbae of which there was a minimal amount shown on present examination. The examiner stated an opinion as to the origin of the veteran's skin problems would require pure speculation, but noted that atopy was generally considered an inherited disorder. Based upon the evidence of record, the Board finds a chronic skin disorder, pseudofolliculitis barbae, is shown to have been incurred during active service. Although the RO denied service connection for this disorder because it was not shown to have been chronic during active service, the Board finds the examiner's recommendation in March 1970 that the veteran use an electric razor every other day is indicative of a chronic disorder. There is no probative evidence demonstrating that the veteran participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality and he is not considered to be a combat veteran for VA purposes. While the veteran believes he has skin problems other than pseudofolliculitis barbae as a result of Agent Orange exposure, he is not a licensed medical practitioner and is not competent to offer opinions on questions of medical causation or diagnosis. There is also no competent evidence of skin cancer nor any skin disorder for which a presumption of service connection is warranted. Therefore, the Board finds entitlement to service connection for a chronic skin disorder is warranted, but only for pseudofolliculitis barbae. PTSD The veteran contends that he has PTSD as a result of traumatic events during service in the Republic of Vietnam. Service medical records are negative for complaint, treatment, or diagnosis of any psychiatric disorders. The veteran's February 1973 discharge examination revealed a normal clinical psychiatric evaluation. Service records show he was assigned to a unit at Camp Pendleton, California, in May 1969 with primary duties as a messman. Records show that from March 1, to July 14, 1970, he served in Da Nang, Vietnam, as a bulk fuelman and messman. Details of service include note of a counterinsurgency operation Da Nang, RVN, but no awards indicative of combat. In correspondence dated in November 1993 the veteran reported he had been exposed to traumatic events during service in Vietnam including rocket attacks two or three times per week and that he witnessed living quarters near his own totally destroyed. He stated he had seen friends killed and injured. In correspondence dated in April 1994 he reported that his first tour of duty in Da Nang had been in May 1969 and that the helicopter bringing in his unit was unable to land because of a fire fight. He stated that on average they had been under siege approximately three times per weeks and recalled the bunker next to his being hit and of helping clean up the bodies of persons killed in rocket attacks. In his September 2000 application to reopen the claim he asserted there were several months of service spent in Vietnam that were not reported. Vet Center correspondence dated in February 2001 noted the veteran had been provided a diagnosis of moderate PTSD with depression. It was noted that his military history was significant and that he had been an aircraft refueler in Da Nang during 1971 which was under constant fire. VA outpatient treatment records dated in December 2001 show the veteran was seen during an initial visit by Dr. M.F.D., a board certified psychiatrist with over 25 years of VA medical experience. In treatment records and correspondence provided in support of the veteran's claim Dr. M.F.D. noted a diagnosis of chronic and severe PTSD directly related to military service in Da Nang. In correspondence submitted in May 2002 the veteran reported that he had served in Vietnam for approximately 18 months and that upon his arrival on or about March 1, 1970, the plane was fired upon from the ground and rockets and mortars were pounding the runway area. He stated he had been assigned to Marine Air Group 11 and that several of their fighter jets never returned from missions. Many of the pilots were presumed missing or killed. He reported they were under constant mortar and rocket attacks and experienced fire fights along the security perimeter. He stated he saw marines blown up in their sleeping area and that he had to help put bodies and body parts into body bags. He reported three of his friends had been killed, but could only remember their nicknames. VA treatment records dated in November 2003 noted the veteran complained of vivid dreams of Vietnam of returning to a hooch and finding fellow soldiers dead. He stated he saw himself placing them in body bags and could still sense the smell. A diagnosis of PTSD was provided by a VA staff psychiatrist. The veteran's service representative submitted information obtained as a result of an internet search in June 2004, including a history report noting the Marine Air Group (MAG) 11 was deployed to Da Nang from April 1965 to February 1971. An article was also provided from the Pacific Stars and Stripes dated March 19, 1970, noting 22 persons died in the crash of a U.S. Navy plane on landing at the Da Nang airport. In a June 2004 brief the representative noted the veteran claimed his plane was under fire upon landing in March 1970, but did not indicate how that might have been related to the crash described in the article provided. VA treatment records dated in April 2005 noted the veteran reported serving in Da Nang and that they were frequently under rocket and mortar attack. He stated that he had to collect body parts and put them in body bags and that every time he did he would get sick. Records include diagnoses of PTSD and major depressive disorder without reference to etiology or any specific stressor event. In correspondence dated in April 2005 the service department, in essence, noted that unit diaries dated from March 1, to July 14, 1970, revealed two marines were wounded by shrapnel on April 8, 1970. It was also noted that all U.S. installations in Vietnam were within enemy rocket range, that most were within mortar range, and that it was uncommon for a veteran to have served in Vietnam without having been rocketed or mortared, but that there were no means to verify the veteran's claims without specific information. On VA examination in September 2005 the veteran reported he was in the combat theater for 18 months, from summer 1969 to the fall of 1971, and stationed with the MAG 11 at Da Nang. He stated his unit received incoming mortar or rocket round three to four times per month and that his position in the flight line took regular fire. He reported an incident in which the hooch next to his was hit by a direct rocket attack and all four men were killed. He also reported that he had been involved in supply missions to another base in Da Nang which were ambushed on several occasions. He stated he had fired his weapon at the enemy on four occasions during those missions. The VA psychologist noted that a review of the evidence of record, in essence, showed the veteran's claim that he did not receive any disciplinary actions or demotions during service was false. It was also noted that he could not provide the names of the people in his unit who were killed and that service department research acknowledging mortar and rocket attacks indicated no marines were killed at his base while he was in service in Da Nang. The examiner noted there was no verified experience such as the veteran described. Upon examination in was noted that the veteran, after finishing the description of his alleged hallucinations, responded affirmatively when asked if he felt a tingling in the arms only during these hallucinations. The examiner noted this was not typical of such experiences. Psychological testing suggested such defensiveness that the protocol should not be interpreted. In summary, the examiner stated the veteran's claim of PTSD was not supported by verifiable history and was called further into doubt by at best inaccurate information and at most deliberately misleading information. It was noted that the evidence of record included several clear instances of contradictory information between what the veteran claimed during the interview and what his records indicated as to call into question his general credibility. In reconciling the provided opinion with the previous diagnoses of PTSD, the examiner stated it was impossible to know how those clinicians had reached their conclusions and that it was likely they took the veteran's various assertions at face value without attempting to verify his claims or establish credibility. It was the examiner's opinion that the veteran did not appear to have the basis for a diagnosis of PTSD. An Axis I diagnosis of malingering, rule out benzodiazepine dependence or abuse, was provided. For PTSD claims VA law provides that service connection "requires medical evidence diagnosing the condition in accordance with § 4.125(a) of this chapter; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. . . ." 38 C.F.R. § 3.304(f) (2005). Section 4.125(a) of 38 C.F.R. incorporates the 4th edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) as the governing criteria for diagnosing PTSD. The Court has held that credible supporting evidence of the actual occurrence of an in-service stressor cannot consist solely of after-the-fact medical nexus evidence. See Moreau v. Brown, 9 Vet. App. 389, 396 (1996). In Cohen v. Brown, 10 Vet. App. 128 (1997), the Court held that VA had adopted the 4th edition of the DSM-IV and noted that the major effect was that the criteria changed from an objective "would evoke ... in almost anyone" standard in assessing whether a stressor is sufficient to trigger PTSD to a subjective standard requiring exposure to a traumatic event and response involving intense fear, helplessness, or horror. The Court further held the sufficiency of a stressor was now a clinical determination for an examining mental health professional. Id. at 140, 141. Based upon the evidence of record, the Board finds PTSD was not present in service and is not shown to been incurred as a result of a verified event during active service. Although it has been verified, generally, that the veteran was exposed to rocket and mortar attacks during service in Vietnam, the opinion of the September 2005 VA psychologist that a diagnosis of PTSD is not warranted is considered to be persuasive. The opinion is shown to have been based upon a thorough examination and review of the evidence of record. The Board notes the record also includes opinions from VA psychiatrists providing diagnoses of PTSD related to military service in Vietnam, but that those opinions are not shown to have included consideration of the available evidence of record such as service personnel records. Although VA psychiatrists have provided diagnoses of PTSD in this case, the September 2005 psychologist apparently performed a more thorough review of the record, and based his opinion on the inconsistencies in the veteran's statements as to service in Vietnam and the absence of a verified specific stressor event. Therefore, the Board finds the claim for service connection for PTSD must be denied. When all the evidence is assembled VA is then 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 the claim in which case the claim is denied. Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). The preponderance of the evidence is against the veteran's claim. Hypertension Based upon the evidence of record, the Board finds hypertension was not present in service and is not shown to be related to service nor to be proximately due to or the result of a service-connected disability. Service medical records are negative for complaint, treatment, or diagnosis related to hypertension. The veteran's February 1973 discharge examination revealed a normal clinical evaluation of the heart and vascular system. A blood pressure reading of 140/76 was provided at that time. A March 1994 private medical treatment summary noted that hypertension was first noted in November 1988 during treatment for a job-related injury. The Board notes there is no evidence linking the veteran's hypertension to any injury or disease during service nor demonstrating the disorder was manifest within the first post-service year. The veteran claims the disorder was incurred as a result of PTSD due to events in Vietnam. In light of the Board's determination that service connection is not warranted for PTSD, the claim for entitlement to service connection for hypertension must also be denied. The preponderance of the evidence is against the claim. Cancer of the Larynx Based upon the evidence of record, the Board finds no competent evidence of a cancer of the larynx. The veteran's September 2000 claim specifically requested service connection for a cancer of the larynx; however, he provided no subsequent information as to this disorder. Medical records show he underwent excision of a submaxillary salivary gland mucoepidermoid carcinoma in approximately December 1987, but include no reference to a cancer of the larynx. In the absence of any evidence of this disorder, no further development is warranted. The claim for entitlement to service connection must be denied. The preponderance of the evidence is against the claim. ORDER New and material evidence not having been received, the claim for entitlement to service connection for submaxillary salivary gland mucoepidermoid carcinoma secondary to Agent Orange is not reopened. New and material evidence having been received to reopen, the claim for entitlement to service connection for skin rash secondary to Agent Orange is reopened. Entitlement to service connection for pseudofolliculitis barbae is granted. Entitlement to service connection for PTSD is denied. Entitlement to service connection for hypertension secondary to PTSD is denied. Entitlement to service connection for cancer of the larynx is denied. ______________________________________________ RENÉE M. PELLETIER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs