Citation Nr: 0722135 Decision Date: 07/23/07 Archive Date: 08/02/07 DOCKET NO. 03-11 876 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a lumbar spine disability. 2. Entitlement to service connection for a chronic respiratory disorder to include bronchitis and/or residuals of pneumonia. 3. Entitlement to service connection for varicose veins. 4. Entitlement to an initial rating in excess of 10 percent for bilateral pes planus. 5. Entitlement to an initial rating in excess of 30 percent for post traumatic stress disorder (PTSD). 6. Enlistment to an effective date earlier than November 17, 2000 for the grant of service connection for PTSD. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL The veteran and his spouse ATTORNEY FOR THE BOARD J.R. Bryant, Counsel INTRODUCTION The veteran had active service from April 1944 to May 1946 and from March 1952 through September 1953. He was awarded the Purple Heart Medal. This matter comes before the Board of Veterans' Appeals (Board) from several rating determinations of the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah. The veteran's original VA claims file has been lost, and the current file is a rebuilt one. In October 2006, it appears that the RO implicitly reopened the veteran's lumbar spine claim by addressing the merits of the claim without specifically finding that new and material evidence had been received. Before the Board may reopen a previously denied claim, it must conduct an independent review of the evidence to determine whether new and material evidence has been submitted sufficient to reopen a prior final decision. See Barnett v. Brown, 8 Vet. App. 1 (1995); 83 F.3d 1380 (Fed. Cir. 1996). Furthermore, if the Board finds that new and material evidence has not been submitted, it is unlawful for the Board to reopen the claim. See McGinnis v. Brown, 4 Vet. App. 239, 244 (1993). Consequently, the first issue that must be addressed by the Board is whether the previously denied lumbar spine claim ought to be reopened. 38 U.S.C.A. § 5108 (West 2002). FINDINGS OF FACT 1. Efforts to reconstruct the veteran's in-service medical history have been undertaken by VA to the fullest extent possible. 2. Claims for service connection for lumbar spine disability were denied by the RO in 1948 and 1996 and not appealed. 3. Since the 1996 RO decision the veteran has submitted new evidence which was not previously submitted to agency decisionmakers, which is related to one or more unestablished facts necessary to substantiate the claim of entitlement to service connection for lumbar spine disability, and which raises a reasonable possibility of substantiating the claim. 4. The veteran has not presented competent medical evidence of a nexus between his current lumbar spine disability and active military service. 5. The veteran's in-service respiratory symptoms were acute and transitory, and a continuing or chronic disability was not then present. The veteran is not shown to have a diagnosis of asbestos-related disease or disorder; nor does the clinical evidence attribute any claimed disability to asbestos exposure in service. 6. The veteran's varicose veins did not manifest during active service and are not related to active service. 7. The veteran's bilateral pes planus is manifested by symptoms that more nearly approximate moderate but not severe or pronounced acquired flatfoot; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achillis on manipulation have not been demonstrated. 8. The veteran's PTSD has been manifested primarily by symptoms of depression, difficulty with short-term memory, irritability, nightmares and recurring thoughts of combat. These symptoms demonstrate occupational and social impairment, with no more than occasional decreases in work efficiency and intermittent periods of inability to perform occupational tasks. 9. The veteran was separated from a second period of active military service in September 1953, and he initiated his claim for service connection for PTSD by submitting a written informal claim on November 17, 2000, more than one year after his separation. 10. By rating decision dated in September 2001, the RO granted service connection for PTSD. A 10 percent evaluation was assigned, effective from November 17, 2000. 11. The RO was not in possession of any communication prior to November 17, 2000, that can reasonably be construed as a formal or informal claim for entitlement to VA compensation benefits based upon PTSD. CONCLUSIONS OF LAW 1. The RO's unappealed 1948 and 1996 decisions denying service connection for a lumbar spine disability are final. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. §§ 20.302, 20.1103 (2006). 2. New and material evidence has been submitted to reopen the application for entitlement to service connection for a lumbar spine disability; the claim is reopened. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2006). 3. A lumbar spine disability was not incurred in or aggravated by active service and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2006). 4. Varicose veins were not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. § 3.303 (2006). 5. A chronic respiratory disorder, including bronchitis and/or residuals of pneumonia, was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. § 3.303 (2006). 6. The criteria for an initial evaluation in excess of 10 percent for bilateral pes planus have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A (West 2002); 38 C.F.R. Part 4, including § 4.71a, Diagnostic Code (DC) 5276 (2006). 7. The criteria for an initial evaluation in excess of 30 percent for PTSD have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A (West 2002); 38 C.F.R. Part 4, including §§ 4.7, 4.130, DC 9411 (2006). 8. The criteria for an effective date prior to November 17, 2000, for the grant of service connection for PTSD have not been met. 38 U.S.C.A. § 5110 (West 2002); 38 C.F.R. § 3.400 (2006). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The record indicates that the veteran's original claims folder has been lost, and efforts by the RO to locate the file have been unsuccessful. A "rebuilt" claims folder has been prepared, but a number of relevant documents are not of record. The information discussed below is derived from records assembled in the attempt to reconstruct the claims file as fully as possible. These documents provide an ample basis on which to decide the present claims, including medical treatment records, and VA examination findings concerning the conditions on appeal. In addition, the Board is fully cognizant of its heightened obligation to explain its findings and conclusions in this case, and to consider carefully the benefit-of-the-doubt rule as applicable. O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). New and Material Evidence- Lumbar Spine The RO originally denied the veteran's claim for service connection for a lumbar spine disability in November 1948. The RO later affirmed the denial of service connection in May 1996. The RO's May 1996 decision is final based upon the evidence then of record. See 38 C.F.R. §§ 3.104(a), 20.302, 20.1103. A final decision cannot be reopened and reconsidered by VA unless new and material evidence is presented in connection with a request that the previously denied claim be reopened. 38 U.S.C.A. § 5108. "New" evidence means existing evidence not previously submitted to agency decision makers. "Material" evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Furthermore, the U.S. Court of Appeals for the Federal Circuit has indicated that evidence may be considered new and material if it contributes "to a more complete picture of the circumstances surrounding the origin of a veteran's injury or disability, even where it will not eventually convince the Board to alter its ratings decision." Hodge v. West, 115 F.3d 1356, 1363 (Fed. Cir. 1998). In addition, the Court of Appeals for Veterans Claims (Court) has stated that, in determining whether the evidence is new and material, the credibility of the newly presented evidence is to be presumed. See Kutscherousky v. West, 12 Vet. App. 369, 371 (1999) (per curiam) (holding that the "presumption of credibility" doctrine, as articulated in Evans v. Brown, 9 Vet. App. 273 (1996), was not altered by the ruling in Hodge, and continues to be binding precedent). The Board is required to give consideration to all of the evidence received since the last disallowance of this claim on any basis, which means, in this case, since the May 1996 RO decision. See Hickson v. West, 12 Vet. App. 247, 251 (1999). A review of the available records shows that service connection for traumatic arthritis of the lumbar spine was previously denied in November 1948 and again in May 1996. The evidence before VA at the time of the 1996 RO decision consisted of the veteran's service medical records (SMRs) and post-service treatment records reflecting diagnoses of a lumbar spine disability. In the rating decision, the RO found that new and material evidence had not been submitted to show that traumatic arthritis of the lumbar spine was treated during service, within the first post-service year, or to show that it is related to service. Thus, the claim remained final. See copy of May 1996 rating action. Notice was mailed to the veteran thereafter, but he did not appeal. Since the May 1996 rating decision the veteran has submitted additional clinical records, including statements by several physicians, linking a current back disorder to an injury in service. This evidence is new, in the sense that it was not of record when the RO previously denied the claim. It is also material because it addresses an unestablished fact necessary to substantiate the claim; namely, that the record contains medical evidence of a current disability and of a possible correlation to military service (see Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992)). Because new and material evidence has been received, the claim is reopened. Since new and material evidence has been submitted, it is necessary to consider whether the veteran would be prejudiced by the Board proceeding to a decision on the merits. The RO has adequately advised the veteran as to the basis for the previous denial and the necessary evidence to reopen his claim and obtain benefits. Also, the veteran has provided arguments addressing his claim on the merits. The Board therefore finds that, given that the veteran had adequate notice of the applicable regulations, he is not prejudiced by the Board's review of the merits of the claim at this time. See Bernard v. Brown, 4 Vet. App. 384 (1993). Pertinent Laws and Regulations for Service Connection Claims Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303(a) (2006). Where there is a chronic disease shown as such in service or within the presumptive period under 38 C.F.R. § 3.307 so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b) (2006). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2006). In order to establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). After considering all information and lay and medical evidence of record in a case with respect to benefits under laws administered by the Secretary, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. The benefit of the doubt rule is inapplicable when the evidence preponderates against the claim. Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 1. Lumbar Spine On the merits of the case, the veteran contends, in numerous lay statements beginning in 1996, that he injured his back during service when he fell 12-13 feet from a catwalk in the 1940s, and that he has continued to suffer from back pain since that time. Also of record is an October 2000 lay statement from a fellow serviceman, who served with the veteran and witnessed the in-service accident. The Board acknowledges, and has no reason to doubt, the veteran's assertions that he fell during service, or, indeed, that he sustained injuries as a result of that fall. The medical record, however, presents a different picture. Service medical records (SMRs) fail to reveal any significant back injury other than in April 1945 when the veteran was treated for complaints of generalized lumbar pain. He gave a history of such pain for about 10 years. X-ray findings of the lumbar spine were negative for arthritic changes or any pathology. In August 1945, the veteran was treated for complaints of low back pain and at that time, he again gave a history of intermittent low back pain over the last 10 years. It was also noted that the veteran was treated for flat feet which may have contributed to the back pain. Given that the SMRs note no description of the type of injury that he now details and there are no subsequently dated medical records on file reflecting further complaints, evaluation or treatment during the remaining years of service, it can only be concluded that any back injury was acute and transitory. Moreover, no pertinent complaints of findings were recorded at the time of separation from service from his first period of service in December 1945. As such, the SMRs do not affirmatively establish that a chronic lumbar spine disability had its onset during military service. The post-service evidentiary record in this case is extensive, consisting of six volumes of documents. Although the veteran has reported receiving treatment for his low back disorder from several physicians since service discharge, records of this treatment are no longer available. Thus, the claims folder is devoid of any treatment records or other medical documents pertaining to his claimed back disability for several decades following his separation from service. The claims file shows that the veteran began fairly regular treatment for low back pain in 1994 and various radiology reports beginning in 1995 show degenerative changes in the lumbar spine as well as spinal stenosis. However, there is some disagreement between examining physicians as to whether the veteran's current back disorder is related to his service. Although several private and VA physicians have provided opinions which link an injury in service to the veteran's current back disorders, at least one VA examination report contradicts this positive evidence. Therefore, these opinions must be assessed by the Board to determine their relative probative value. In multiple statements between 2002 and 2003 the veteran's private neurologist and private chiropractor both note the veteran's history of back injury, with possible injury to his vertebrae, which could be responsible for his current symptomatology. The neurologist noted treatment of the veteran since the 1990s and the chiropractor noted treatment since 1996. The physicians essentially noted the injury probably resulted in the veteran suffering unremitting pain during and after service and over the years degeneration of the spine had worsened due to the veteran's advancing age. Based on the nature and extent of the fall as described by the veteran, the chiropractor opined that any reasonable person would conclude that the injury began the degenerative process and resulted in the spinal deterioration present today. Neither physician indicated any source, independent of the veteran, regarding medical history and the extent of the claimed injury in service. The opinions, therefore, are based in significant part on the history provided by the veteran rather than on the objective medical evidence, particularly the veteran's SMRs. The veteran underwent VA examination in June 2002. X-rays of the lumbar spine revealed severe degenerative changes in the lumbar spine and narrowing of the disc space at L3-4, L4-5, L5-S1 and osteophytes at multiple levels. The clinical impression was history of chronic mechanical back pain for many years which began with a fall in service and more recently spinal stenosis which the examiner described as a common problem associated with aging and spinal degeneration. In an addendum dated in August 2002 an MRI confirmed spinal canal stenosis secondary to degenerative disc disease and narrowing of the dural sac from L2-3 through L4-5. The veteran underwent another VA examination in December 2003. Following examination of the spine and taking into account the veteran's history of a back injury during service and post-service employment history, the examiner concluded the veteran's spinal canal stenosis was primarily due to his degenerative disc and joint condition in the low back, which had developed gradually over a period of years. The physician explained that the connective tissues in the discs began to degenerate in the early 1980s, which led to further degenerative changes in the adjacent joints over a period of time. The physician could not say that the veteran's apparent hard fall on board ship was not one of the factors that led to his back gradually becoming a notable problem, but it was not due importantly or primarily to such injury. Despite the fact that the physician could not deny the back injury during service, he ultimately concluded that it was just one small facet of overall lifetime use of the veteran's back, physical activity and aging. Upon careful consideration of the conflicting evidence in this case, the Board finds that the opinion expressed by the 2003 VA examiner is more convincing and probative than the contrary opinion expressed by the veteran's private medical providers. The VA opinion is a detailed and reasoned response based upon a review and is consistent with the medical evidence of record. In rendering his opinion, the VA examiner took into account the veteran's history of injury during service, his post service employment history, and referred to specific medical history to support his conclusion. On the other hand the remaining physicians appear to place significant weight on the veteran's reports of in-service back injury. It is not clear whether these opinions were based on review of the veteran's SMRs. Nonetheless, we find that they garner less weight than the 2003 VA medical opinion. The other opinions are contradicted by other objective evidence, namely SMRs, compiled contemporaneously during the veteran's period of active duty. These records document acute episodes of back pain with no evidence that the veteran suffered any permanent sequelae. Moreover, the lack of any evidence of continuing back pain or symptoms in the intervening years since active service is itself evidence which tends to show that the back pain in the 1940s did not result in any residual disability. As noted previously, the earliest recorded medical history places the presence of back complaints in 1990, more than 30 years after he completed service in 1953. This leaves a significant gap between service separation and the initial confirmation of the disability, with no clinical support for acute or inferred manifestations or continued symptoms. Evidence of a prolonged period without medical complaint can be considered as a factor, along with other factors concerning the veteran's health and medical treatment during and after military service. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). After weighing all the evidence, the Board finds great probative value in the 2003 VA examiner's conclusions, and, in light of the other evidence of record, the opinion is sufficient to satisfy the statutory requirements of producing an adequate statement of reasons and bases where the expert has fairly considered material evidence which appears to support the veteran's position. Wray v. Brown, 7 Vet. App. 488, at 492-93 (1995). The Board has also considered the veteran's hearing testimony given during his August RO hearing as well as supportive statements of the veteran's family, his friends and individuals who reportedly served with him. In both cases, the veteran essentially reiterated previously submitted information concerning his in-service injury, as well as symptoms consistent with complaints made during VA and private examinations. In general, lay witnesses are only competent to testify as to factual matters, such as what symptoms an individual manifested at a given time, whereas issues involving medical causation or diagnosis require competent medical evidence. Espiritu v, Derwinski, 2 Vet.App. 492, 495 (1992). Further, this lay evidence is based on recollections from a point in time as early as 1945 and, because of the passage of so much time, the reliability of such recollections versus evidence recorded contemporaneously with certain events may be called into question. In this respect the Board is not finding or implying that the veteran, or any lay party on his behalf, is deliberately or consciously misrepresenting his medical history. Indeed, the Board notes, with high regard, the veteran's honorable service in the Navy and his receipt of the Purple Heart bespeaks his courageous service in the Nation's time of need. However, the contemporaneous SMRs are far more reliable as to in-service events than is remote memory and thus significantly reduce the probative weight to be assigned to his statements. Therefore a preponderance of the evidence is against the claim for service connection and that the benefit-of-the- doubt rule does not apply. 38 U.S.C.A. § 5107(b) (West 2002). 2. Chronic Respiratory Disorder-Bronchitis/Pneumonia The veteran claims that he developed bronchitis/pneumonia a result of asbestos exposure during service. There is no specific statutory or regulatory guidance with regard to claims for service connection for asbestosis or other asbestos-related diseases. However, in 1988, VA issued a circular on asbestos-related diseases that provided guidelines for considering asbestos compensation claims. See Department of Veterans Benefits, Veterans' Administration, DVB Circular 21-88-8, Asbestos-Related Diseases (May 11, 1988). The information and instructions contained in the DVB Circular have since been included in VA Adjudication Procedure Manual, M21-1, part VI, para. 7.21 (October 3, 1997) (hereinafter "M21-1"). Also, an opinion by VA's Office of General Counsel discusses the development of asbestos claims. VAOPGCPREC 4-00. VA must analyze the veteran's claim under these administrative protocols using the following criteria. Ennis v. Brown, 4 Vet. App. 523, 527 (1993); McGinty v. Brown, 4 Vet. App. 428, 432 (1993). The latency period for asbestos- related diseases varies from 10 to 45 or more years between first exposure and development of disease. M21-1, Part VI, 7.21(b)(2), p. 7-IV- 3 (January 31, 1997). An asbestos- related disease can develop from brief exposure to asbestos. Id. M21-1, Part VI, para. 7.21 contains guidelines for the development of asbestos exposure cases. Part (a) in essence acknowledges that inhalation of asbestos fibers can result in fibrosis and tumors, and produce pleural effusions and fibrosis, pleural plaques, mesotheliomas of the pleura and peritoneum, and cancer of the lung, gastrointestinal tract, larynx, pharynx and urogenital system (except the prostate), with the most common resulting disease being interstitial pulmonary fibrosis (asbestosis). Also noted is the increased risk of bronchial cancer in individuals who smoke cigarettes and have had prior asbestos exposure. M21-1, Part VI, para. 7.21(b) pertains to occupational exposure, and acknowledges that high exposure to asbestos and a high prevalence of disease have been noted in insulation and shipyard workers. Noted is that the latent period varies from 10-to-45 or more years between first exposure and development of disease. Also of significance is that the exposure to asbestos may be brief (as little as a month or two) or indirect (bystander disease). M21-1, Part VI, para. 7.21(c) provides that the clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal lung disease. M21-1, Part VI, para. 7.21(d) provides that VA must determine whether military records demonstrate evidence of asbestos exposure in service; whether there is pre-service and/or postservice evidence of occupational or other asbestos exposure; and then make a determination as to the relationship between asbestos exposure and the claimed diseases, keeping in mind the latency and exposure information pertinent to the veteran. A review of the veteran's DD Form 214 discloses he served on board the USS Aulick, the USS Maryland, and the USS Houston. Service personnel records indicate the veteran served as an apprentice seaman, but there is no official service department documentation to support or contradict his claim of exposure to asbestos during service. Assuming that he was exposed to asbestos in service, the Board notes that mere exposure to a potentially harmful agent, alone, is insufficient establish entitlement to VA disability benefits. The question in a claim such as this is whether disabling harm ensued. The medical evidence must show not only a currently diagnosed disability, but also a nexus, that is, a causal connection, between this current disability and the exposure to asbestos in service. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Available SMRs are entirely negative for evidence of a chronic respiratory disorder to include bronchitis and/or residuals of pneumonia. However these records do show that in November 1944 the veteran was treated for smoke inhalation due to smoke and fumes from a nearby explosion. On examination the veteran had a few scattered moist rales in the chest and an occasional hacking cough, but was otherwise negative. Examination of the chest and heart revealed RSR (regular sinus rhythm) and no murmurs, or rales. The lungs were clear to auscultation and percussion. Routine film of the chest showed no parenchymal lesions. The veteran was subsequently discharged to duty. Subsequent chest X-ray in July 1945 was negative. At his separation physical in December 1945 clinical evaluation of all major body systems, to include the lungs and chest, was within normal limits. The veteran's chest X- ray was normal. Although at his separation physical examination the veteran's history of smoke inhalation in 1944 was noted, the examining physician provided no further summary or elaboration, and there was no diagnosis of a chronic respiratory disorder. The post-service evidentiary record in this case is extensive, consisting of six volumes of documents. With the exception of treatment for acute episodes of pneumonia and bronchitis, the vast majority of these treatment reports, dated between 1990 and 2006, are notably negative for medical evidence documenting any complaints, findings or diagnosis pertaining to a chronic respiratory disorder. During an RO hearing in August 2003, the veteran testified that he was exposed to asbestos during service. He also testified that he has periodic episodes of bronchitis, which have not been attributed to asbestos exposure by any physician. While the Board does not dispute that the veteran may experience periodic symptoms, there are no clinical confirmations that he suffers from an actual chronic disability. See Sanchez-Benitez v. Principi, 239 F.3d 1356 (Fed. Cir. 2001); Sanchez-Benitez v. West, 13 Vet. App. 282 (1999) (service connection may not be granted for symptoms unaccompanied by a diagnosed disability). The Board is cognizant of the fact that the veteran feels he has symptoms and/or medical disorders due to asbestos exposure during his service; however, he lacks the medical expertise necessary to diagnose a specific medical disorder or conclude any condition is etiologically related to prior asbestos exposure. The Board is not concluding that he was not exposed to asbestos during service, but without medical evidence of a condition due to that exposure, the claim must be denied. As stated previously exposure to asbestos, in and of itself, is not considered a disability for VA purposes. As it is the province of trained health care professionals to enter conclusions, which require medical expertise, such as opinions as to diagnosis and causation, Jones v. Brown, 7 Vet. App. 134, 137 (1994), the veteran's lay opinions cannot be accepted as competent evidence to the extent that they purport to establish such medical causation. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-5 (1992). The veteran has also submitted excerpts from various medical sources and other medical treatise evidence in the form of articles he had printed from the Internet. In substance, these articles discuss asbestos-related disorders. However, this evidence is insufficient to provide evidence of a link between the veteran's service and a current respiratory disorder. The evidence is simply "too general and inconclusive" to make a link more than speculative or to outweigh the specific medical evidence in this case. See Sacks v. West, 11 Vet. App. 314 (1998). Therefore a preponderance of the evidence is against the claim for service connection and that the benefit-of-the- doubt rule does not apply. 38 U.S.C.A. § 5107(b) (West 2002). 3. Varicose Veins The veteran also seeks service connection for varicose veins. He claims that he had an onset of varicose veins as a result of service. However, a review of the record establishes that service connection is not warranted. The competent evidence of record does not etiologically relate the veteran's varicose veins to service or any event of service. Rather, the available SMRs are entirely negative for evidence of varicose veins. At his separation physical in December 1945 clinical evaluation of all major body systems, to include the lower extremities, was within normal limits. Indeed, pertinent post service records dated in March 1994 note the veteran's treatment for large varicosities in the greater sapheonous system of the left leg which were asymptomatic and never treated. Other records note the presence of untreated varicose veins as early as April 1985. However, no post-service medical records discuss the etiology of the veteran's varicose veins or attribute the disorder to active service. Moreover, no medical expert of record has provided an opinion that the veteran has varicose veins are in any way traceable to his military service. During an RO hearing in August 2003, the veteran testified that he first developed varicose veins in early 1944 but did not receive treatment for them at that time, but he currently received treatment for his varicose veins. The Board has reviewed all of the evidence of record and does not dispute that the veteran currently suffers from a varicose veins. However, the objective evidence of record demonstrates that the disability was not shown in service, and that it is not causally related to active service. As the veteran's current varicose veins have not been medically associated with military service, there is no foundation upon which to allow the claim. Therefore a preponderance of the evidence is against the claim for service connection for varicose veins and that the benefit-of-the-doubt rule does not apply. 38 U.S.C.A. § 5107(b) (West 2002). Pertinent Laws and Regulations for Increased Rating Claims Disability evaluations are determined by comparing a veteran's present symptomatology with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2006). When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the veteran. 38 C.F.R. § 4.3. The veteran's entire history is considered when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1995). Although a review of the recorded history of a disability is necessary in order to make an accurate evaluation, see 38 C.F.R. §§ 4.2, 4.41, the regulations do not give past medical reports precedence over current findings where such current findings are adequate and relevant to the rating issue. See Francisco v. Brown, 7 Vet. App. 55 (1994); Powell v. West, 13 Vet. App. 31 (1999). However, where the question for consideration is propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of "staged rating" is required. See Fenderson v. West, 12 Vet. App. 119 (1999). 4. Pes Planus In a February 2003 rating action, service connection was granted for pes planus and a 10 percent evaluation was assigned under DC 5276, effective September 11, 2002. The veteran appealed the initial evaluation assigned. Under DC 5276 moderate acquired flatfoot with weight-bearing line over or medial to great toe, inward bowing of the tendo Achillis, pain on manipulation and use of the feet, bilateral or unilateral, warrants a 10 percent evaluation. Severe acquired flatfoot with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities, that is bilateral in nature warrants a 30 percent evaluation, and, if unilateral in nature, a 20 percent evaluation is warranted. Pronounced acquired flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances that is bilateral in nature warrants a 50 percent evaluation and, if unilateral in nature, a 30 percent evaluation is warranted. 38 C.F.R. § 4.71, DC 5276 (2006). The initial grant of service connection was based on a December 2002 private outpatient treatment report which showed the veteran complained of ongoing discomfort in both legs and feet for over 12-15 years with gradual increasing intensity of pain. The pain ranges from a moderate aching and burning of the feet to stinging associated with the lower leg areas. Examination revealed visible severe declination of the arch of both feet in association with moderate midtarsal limited range of motion. Biomechanical examination of the feet and lower legs revealed forefoot varus of 4 percent on the right and 5 percent on the left with compensated rearfoot to forefoot deformity. There is mild rearfoot valgus of both feet. Pulses were palpable and symmetrical in both feet. Hair growth was diminished lower legs and feet. There was mild edema of both feet and ankles. Private treatment record dated in January 2003 the veteran gave history of chronic ongoing pain in both feet in the arch and forefoot area over the past 10-15 years. On examination there was visible declination of both arches in respects to normal contour. There was rearfoot valgus of approximately 4 degrees in the right foot and 5 degrees in the left foot with a compensated forefoot to the rearfoot bilateral. Subsequently the veteran has very limited range of motion in both feet as a result of the deformities. The pulses were palpable and symmetrical bilaterally. The skin was dry and thin on the feet and ankles. There was normal monofilament touch sensation in both feet. On VA examination in December 2003, examination showed the feet to have a mild degree of flattening on standing. The overall contour of the feet and heel was good. There was a reduced pedal pulse in each foot. Ankle movement was from 20 degrees of dorsiflexion to 40 degrees of plantar flexion. Although the feet were symptomatic they were not overly deformed. On VA orthopedic examination in July 2004, the veteran was found to have flat feet and at that time he was given inserts in his shoes but they did not help him. He develops pain in feet and calves on prolonged standing and walking. His right foot was weaker than the left and he limped on the right foot. He had received no current treatment for his flat feet. The pain in the feet was minimal with some swelling. The right ankle dorsiflexion was to 20, plantar flexion to 30, inversion to 20, and eversion to 10. There was some periarticular thickening of the ankle, but no tenderness. There was 2+ edema of both ankles and feet. The veteran could plantar flex the toes to 10 degrees and dorsiflex to 20 degrees. There was some cyanosis of the feet in association with diminished skin temperature. There was no palpable pulse in the right foot. The right foot showed grade 3 pes planus with slight residual metatarsal arch. The left foot dorsiflexion of the ankle was to 20 degrees, plantar flexion to 30 degrees, inversion to 10 degrees, and eversion to 20 degrees. There was less pes planus on the left with grade 2 pes planus and a slight loss of his metatarsal arch. The left foot dorsalis pedis pulse was 1/4, and posterior tibilial was absent. There was 2+ edema of the left ankle, there was acrocyanosis of the left foot and diminished skin temperature. The ventral surface of both feet showed no tenderness, callus or ulceration. The clinical impression was pes planus bilateral right more than left, minimal symptoms. There had been no current treatment of the veteran's flat feet and he wore no corrective devices. There was no painful motion or weakness, but some instability with walking on his right leg. There was evidence of abnormal weight bearing with walking on the outside of his right foot and this was reflected in his right shoe. The alignment of the Achilles' tendons was normal. There was no pain on manipulation of the feet. The veteran underwent VA examination of his feet in June 2006. The veteran reported that he has worn arch supports intermittently over the last 20 years, which did not seem to help, but rather made his symptoms worse. He had not used any special shoes or arch supports over the last three years. The right foot bothered him more than the left and was described as 5/10 in severity in terms of pain. He could stand ten minutes and walk only about 50 feet. The left foot was 4/10 in terms of pain. He was able to get around with the help of a cane but for the most part used a wheelchair. The difficulty with his feet was about the same and had not seemed to progress since he was last assessed in 2004. The veteran had a moderate amount of weakness and fatigability that resulted in his inability to walk more than half a block at a time. There was no painful motion, instability, tenderness or evidence of abnormal weight bearing. The Achilles tendon alignment was deviated medially on the left. There was no pain on manipulation of either foot. Dorsiflexion of the right foot was to 10 degrees, plantar flexion to 15 degrees, inversion to 10 degrees and inversion to 15 degrees. He could dorsiflex and plantar flex the toes 10 degrees. There was 2+ edema of the right distal leg and feet. There were no palpable pulses in the right foot and moderate periarticular thickening. There were no calluses or ulcerations on the surface of the right foot. The left foot dorsiflexion was to 10 degrees, plantar flexion to 20 degrees, eversion to 15 degrees, and inversion to 10 degrees. He could dorsiflex and plantar flex the toes to 10 degrees. There were no palpable pulses in the left foot and 2+ edema of the distal leg and foot. There was slight medial deviation of the Achilles tendon. The pes planus was grade 2+ on the left and 3+ on the right. His only medication was Tylenol, which he took three times daily. The clinical impression was pes planus bilaterally, right more than left with moderate disability. Considering the applicable criteria in light of the pertinent evidence of record, the Board finds that the veteran's level of impairment resulting from his bilateral foot disorder is appropriately evaluated at 10 percent for moderate impairment under DC 5276. Both the medical evidence and the veteran's statements reflect that the predominant symptom of his service-connected pes planus is foot pain. He has specifically remarked that he is in pain and has trouble standing or walking any distance without resting. The record reflects the veteran's complaints of chronic pain with standing or walking, etc. The Board does not doubt in the least that pes planus produces pain. However, for purposes of evaluating the service-connected disorder the subjective descriptions must be reviewed in light of the objective findings. There is no evidence of a marked deformity such as pronation or abduction. Despite the veteran's complaints of pain, there is no evidence of pain on manipulation, accentuated use, or swelling on use or characteristic callosities. Although the feet were symptomatic they were not overly deformed. The balance of the evidence fails to demonstrate that the veteran's bilateral pes planus is of such severity so as to warrant a 30 percent evaluation. The Board has also considered the veteran's complaints as well as testimony provided during his RO hearing in August 2003, however, in view of the examination findings and those noted in VA outpatient records, the Board finds that the medical evidence does not support the next higher, 30 percent, evaluation for severe impairment under DC 5276. Rather, the effects of functional loss due to pain are the foundations of the currently assigned rating. DeLuca v. Brown, 8 Vet. App. 205 (1995). 38 C.F.R. §§ 4.40, 4.45, 4.59. It has also been held that where a diagnostic code is not predicated on limited range of motion alone, the provisions of 38 C.F.R. §§ 4.40 and 4.45, with respect to pain, do not apply. See Johnson v. Brown, 9 Vet. App. 7, 11 (1996). As DC 5276, is not predicated on limited range of motion, the current case law supports the conclusion that §§ 4.40 and 4.45 are not applicable. Under the rating schedule, a higher rating may be assigned to several other foot disabilities, if shown. These are weak foot (DC 5277), claw foot (DC 5278), metatarsalgia (DC 5279), hammertoe (DC 5282), and malunion or nonunion of the tarsal or metatarsal bones (DC 5283). 38 C.F.R. § 4.71a (2006). However, the medical evidence does not show that any of these conditions are present, nor does the veteran assert such. Given the aforementioned, the preponderance of the evidence is against the claim and there is no reasonable doubt to be resolved. 38 U.S.C.A. § 5107(b) (West 2002). 5. PTSD The veteran also seeks a higher rating for his service- connected PTSD. Under the General Rating Formula for Mental Disorders, a 30 percent evaluation is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, DC 9411 (2006). A 50 percent evaluation is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation requires occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near- continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted if there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. Id. In a September 2001 rating action, service connection was granted for PTSD and a 10 percent evaluation was assigned under DC 9411, effective November 17, 2000. The veteran appealed the initial evaluation assigned. During the pendency of the appeal, the rating was increased to 30 percent effective from the date of service connection. Service connection was based primarily on complaints and clinical findings at March 2001 VA examination. It was noted that the veteran was 82 years old and had been married for 63 years with two children, five grandchildren and three great- grandchildren. He served in the US Navy and received a Purple Heart. Post service he worked doing manual labor and upholstery work for 27 years and in 1961 he and his brother opened a business together until 1969 and then he and his wife went into business up to 1979. He retired doing some occasional work. The veteran reported that he did some exercising and that his appetite was good. Although he had occasional combat dreams, his sleep was also pretty good. He indicated that he did not do much and was pretty idle. He stated that he keeps his stress inside but occasionally "explode" and sometimes gets depressed and cries. He has had some very brief passing thoughts of suicide, but no attempts. Mental status examination revealed the veteran was casual and neat in dress. He was pleasant, likable, cooperative, and goal oriented with a sense of humor. He was oriented to time, place, and person. He was able to organize his thoughts and express himself. Speech, affect and mood were all normal with no evidence of psychosis. His memory good and judgment were both good. The clinical impression was mild PTSD with a global assessment of functioning (GAF) score of 78. At VA psychiatric examination in June 2002, the veteran's appetite was described as okay and he was sleeping well. He handled stress by getting upset and occasionally "venting", but later felt bad about it. He stated that he recalls events of war frequently and becomes depressed and cries with some relief. He had no thoughts of suicide. He performed similarities and differences reasonably well and proverbs well. He was able to recall 3 of 3 items that he had been asked to remember for short-term memory. On examination the veteran was pleasant, likable, cooperative, goal oriented, and oriented to location, and person, but not date. He could organize and express his thoughts, but it was not as easy as before. His affect was moderate with tension and anxiety. His mood was moderate depression. There was no psychosis, delusions, or hallucinations. He had some mild organicity, loss of memory, and ability loss. His judgment was competent and his insight was slight. The clinical impression was very mild PTSD with GAF score of 75. During an RO hearing in August 2003, the veteran testified that his PTSD had gotten worse with an increase in depression and nightmares. During VA psychiatric examination in July 2004, the examiner noted that in spite of the veteran's stressors he suffered relatively little emotional residue. On examination, the veteran was pleasant and cleanly dressed. The examiner noted the veteran had an immense amount of records which were almost totally related to his physical problems and administration correspondence. The veteran was in good spirits and was able to participate in his examination meaningfully. Nevertheless he did have some memory problems and a mild degree of dementia. The veteran had good contact with outside reality and no delusional or anxiety problems were noticed. He complained of a little "downheartedness" but denied any psychiatric problem stating that he had no symptoms. However, combat memories were returning to him and he was bothered by this. The veteran did not provide much information in regards to daily activity except that he watched a little television and did a little yard work. He spends his time with his wife and they support each other psychologically. The veteran did not receive psychiatric treatment or hospitalization and was not on any medication. The clinical impression was mild PTSD and mild old-age dementia with a GAF score of 50. On VA psychiatric examination in June 2006, the veteran's mental condition was fairly clear given his age and Parkinson's disease. He complained of depression, difficulty in walking, and reported nightmares. The medication helped with his sleeping difficulties. The nightmares occurred on a weekly basis. The examiner noted that the Parkinson's disease was associated with psychiatric manifestations, depression, anger, impatience or dullness. The veteran was fairly alert mentally, given his age, and he had good contact with outside reality. He was able to express himself and cognitive functioning was within acceptable normal limits. In spite of his age and limited education, the veteran was competent. In his free time he watched television. The clinical impression was PTSD aggravated by Parkinson's disease and mild to moderate depression. The examiner noted the veteran had more serious PTSD than he was currently rated and listed a GAF scale score of 40. After reviewing the pertinent evidence of record in conjunction with applicable law and regulations, the Board finds that the veteran's symptoms and manifestations are productive of no more than occasional decreases in work efficiency and intermittent periods of inability to perform occupational tasks. The veteran's subjectively reported complaints and descriptions of his PTSD appear to be far worse than the objective clinical manifestations indicate, especially with respect to his degree of social adjustment. Few, if any, of the criteria for a 50 percent rating have been met. Although his symptoms of depression, short-term memory problems and irritability, are well documented, they are adequately compensated by the current 30 percent rating under DC 9411, since a rating at this level presumes that he will experience these symptoms and, in fact, are expressly mentioned in the diagnostic code. The veteran has also complained of some loss of motivation but the evidence does not otherwise show disturbance of affect or mood, speech suggestive of disorders of thought or perception, panic attacks, difficulty understanding commands, or significant impairment of memory, judgment, or abstract thinking. No examiner has reported impairment of thought process, nor have they observed delusions, hallucinatory phenomenon or psychosis. The veteran's affect has been described as pleasant and in general, appropriate to mood. He has required no inpatient psychiatric treatment. Although the record shows a clear connection between PTSD and interference with the veteran's social interaction and ability to enjoy life, it does not show that he is prevented from establishing and maintaining positive relationships. This is demonstrated by his long-term relationship with his wife of 60+ years and his positive relationships with his children, grandchildren and great-grandchildren. The veteran has not worked since 1976, but the record shows that he stopped working after more than 30 years of employment. Therefore, his maintenance of relationships under these circumstances is inconsistent with the interpersonal relationship skills of a person suffering PTSD symptomatology warranting a 50 percent disability rating. Finally, the Board acknowledges that the veteran's GAF score has most recently been assessed at 40 which, according to the Fourth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV), represents some impairment in reality testing or communication (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) with major impairment in work, school or family relations, judgment, thinking or mood (e.g., avoiding friends, neglects family and is unable to work). While such a GAF score suggests a greater level of impairment than is contemplated by the current 30 percent rating, the veteran has manifested none of the symptoms typically considered indicative of that level of impairment, to include suicidal ideation, severe obssessional rituals, or frequent shoplifting. Simply stated, when considered in light of the actual symptoms demonstrated, the recently-assigned GAF score does not provide a basis, alone, for assignment of a higher rating. The Board notes that, the veteran was found to have significant symptoms associated with Parkinson's disease in addition to symptoms of PTSD. The Parkinson's disease is not service-connected, but, according to the evidence, causes some level of additional social and occupational impairment. The currently identified symptoms attributable to Parkinson's disease include depression, anger, impatience and dullness. Consistent with the foregoing analysis, the Board finds that, even if all disability which might arguably be attributable to the Parkinson's disease were instead found to be attributable to PTSD or deemed part of the service-connected disability, the proper rating would still be 30 percent. See Mittleider v. Brown, 11 Vet. App. 181 (1998). In other words, the Board has not discounted any disability evaluation in this decision on the basis that certain psychiatric disability is due to non-service-connected Parkinson's disease rather than service-connected PTSD. Given the aforementioned, the preponderance of the evidence is against the claim and there is no reasonable doubt to be resolved. 38 U.S.C.A. § 5107(b) (West 2002). Earlier effective date for PTSD November 17, 2000 Finally, the veteran also contends that an effective date earlier than November 17, 2000 is warranted for the grant of service connection for PTSD. Under 38 U.S.C.A. § 5110(b)(1) and 38 C.F.R. § 3.400(b)(2)(i), the effective date for a grant of direct service connection will be the day following separation from active service, or the date entitlement arose if a claim is received within one year after separation from service. Otherwise the effective date is the date of receipt of claim or date entitlement arose, whichever is later. A specific claim in the form prescribed by the Secretary is necessary for disability benefits to be paid to any individual under the laws administered by VA. 38 U.S.C.A. § 5101(a); 38 C.F.R. § 3.151. In this context, it should be noted that the provisions of 38 U.S.C.A. § 5110 refer to the date an "application" is received. While the term "application" is not defined in the statute, the regulations use the terms "claim" and "application" interchangeably, and they are defined broadly to include "a formal or informal communication in writing requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit." 38 C.F.R. § 3.1(p); Servello v. Derwinski, 3 Vet. App. 196, 198 (1992). The veteran was discharged from his second period service in September 1953, and a claim for service connection for PTSD was received in November 2000. In support of his claim is the March 2001 VA examination which diagnosed mild PTSD. In September 2001, the RO granted service connection for PTSD, assigning a 10 percent rating. The effective date established was November 17, 2000, the date of receipt of the veteran's claim. The veteran essentially contends that he experienced symptoms of depression at least 15 years earlier and therefore he is entitled to compensation from that point. Service connection was ultimately granted based on the veteran's specific request for service connection for PTSD received on November 17, 2000. The Board has reviewed the evidence to determine whether a claim, formal or informal, was received before November 17, 2000. A careful review of the record reflects that the veteran had previously filed claims with VA for various disabilities, but those claims did not indicate a desire or intent to claim service connection for PTSD. The record shows that the first and only claim for VA benefits was the one date-stamped as received at the RO on November 17, 2000. With regard to this finding, the Board notes that the claims file does not include any communication of record dated prior to that time that can be construed as an informal claim for benefits. 38 C.F.R. § 3.155(a). Accordingly, the earliest date that may be assigned for service connection for this disorder is the date of receipt of the veteran's claim, November 17, 2000, which is well after the one year separation from service period. Although it may be argued that entitlement arose earlier than the current effective date based on the veteran's assertion that he experienced symptoms of depression 15 years earlier, there is no medical evidence to support his contention. Even if such evidence was of record "the mere presence of medical evidence [in the record] does not establish an intent on the part of the veteran" to seek service connection for a condition. Brannon v. West, 12 Vet. App. 32, 135 (1998). The Court has emphasized this point: "The effective date of an award of service connection is not based on the date of the earliest medical evidence demonstrating a causal connection [between a claimed disorder and a service- connected disorder] but on the date that the application upon which service connection was actually awarded was filed with VA." Since all of the evidence indicates that November 17, 2000, was the date of receipt of the veteran's PTSD claim, and there is no evidence indicating that he filed a claim prior thereto, the assignment of an effective date prior to November 17, 2000, is not warranted. Duty to Notify and Assist 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. 2006); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2006). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim, (2) that VA will seek to provide, and (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in his possession that pertains to the claim, in accordance with 38 C.F.R. § 3.159(b)(1). The U.S. Court of Appeals for Veterans Claims (Court) has held that VCAA notice should be provided to a claimant before the initial RO decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). However, if VCAA notice is provided after the initial decision, such a timing error can be cured by subsequent readjudication of the claim, as in a Statement of the Case (SOC) or Supplemental SOC (SSOC). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as a SOC or supplemental SOC (SSOC), is sufficient to cure a timing defect). In letters dated in November 2002, December 2002, October 2003, March 2006 and October 2006, the RO informed the veteran of its duty to assist him in substantiating his claims under the VCAA, and the effect of this duty upon his claims. The letters informed him that VA would obtain all relevant evidence in the custody of a Federal department or agency, including VA, the service department, the Social Security Administration, and other pertinent agencies. He was advised that it was his responsibility to send any other medical records supporting his claims, or to provide a properly executed release so that VA could request the records for him. The veteran was also specifically asked to provide "any evidence in your possession that pertains to your claim." During the pendency of this appeal, on March 31, 2006, the Court issued a decision in the appeal of Kent v. Nicholson, 20 Vet. App. 1 (2006), which establishes new requirements regarding the VCAA notice and reopening claims. The Court held that the VCAA notice must include the bases for the denial in the prior decision and VA must respond with a notice letter that describes what evidence would be necessary to substantiate that element or elements required to establish service connection that were found insufficient in the previous denial. Id. Therefore, the question of what constitutes material evidence to reopen a claim for service connection depends on the basis on which the prior claim was denied. See Evans v. Brown, 9 Vet. App. 273, 283 (1996) (holding evidence is material if it is relevant to and probative of an issue that was a specified basis for the last final disallowance). The Board finds that the contents of the above letters provided to the veteran complied with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) regarding VA's duty to notify and assist. He was provided opportunities to submit additional evidence. The Board finds that the purpose behind the notice requirement has been satisfied because the veteran has been afforded a meaningful opportunity to participate effectively in the processing of his claims. In addition, it appears that all obtainable evidence identified by the veteran relative to his claims has been obtained and associated with the claims file, and that neither he nor his representative has identified any other pertinent evidence, not already of record, which would need to be obtained for a fair disposition of this appeal. It is therefore the Board's conclusion that the veteran has been provided with every opportunity to submit evidence and argument in support of his claims, and to respond to VA notices. In addition to the foregoing analysis, to whatever extent the recent decision of the Court in Dingess v. Nicholson, 19 Vet. App. 473 (2006), requires more extensive notice in claims for compensation, e.g., as to potential downstream issues such as disability rating and effective date, the Board finds no prejudice to the veteran in proceeding with the present decision. Since the claims are being denied, any such effective date questions are moot. The veteran has had ample opportunities to meaningfully participate in the adjudicative claims process. Any error or deficiency in this regard is harmless, and not prejudicial to the veteran. In light of the foregoing, the Board is satisfied that all relevant facts have been adequately developed to the extent possible; no further assistance to the veteran in developing the facts pertinent to the issues on appeal is required to comply with the duties to notify and assist. 38 U.S.C.A. §§ 5103 and 5103A; 38 C.F.R. § 3.159. ORDER New and material evidence having been received the claim of entitlement to service connection for a lumbar spine disability is reopened. Service connection for a lumbar spine disability is denied. Service connection for a chronic respiratory disorder, claimed as bronchitis and/or pneumonia is denied. Service connection for varicose veins is denied. An initial evaluation in excess of 10 percent for bilateral pes planus is denied. An initial evaluation in excess of 30 percent for PTSD is denied. The assignment of an effective date earlier than November 17, 2000 for PTSD is denied. ____________________________________________ C. CRAWFORD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs