Citation Nr: 0734522 Decision Date: 11/02/07 Archive Date: 11/19/07 DOCKET NO. 96-00 023A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to service connection for depression. 2. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for residuals of a lumbosacral spine injury claimed as secondary to the service-connected residuals of the removal of benign tumors of the left arm. 3. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for residuals of a cervical spine injury claimed as secondary to the service-connected residuals of the removal of benign tumors of the left arm. 4. Entitlement to a rating in excess of 10 percent for residuals of the removal of benign tumors of the left arm. 5. Entitlement to a total rating based on individual unemployability (TDIU). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant, Spouse ATTORNEY FOR THE BOARD G.A. Wasik, Counsel INTRODUCTION The veteran had active duty service from April 1979 to November 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeals from rating decisions by a Regional Office (RO) of the Department of Veterans Affairs (VA). The veteran testified at personal hearings at the RO in July 1996 and October 2005. The issue of entitlement to a rating in excess of 10 percent for residuals of the removal of benign tumors from the left arm was originally before the Board in March 2001 when it was remanded for additional evidentiary development. The issues of entitlement to service connection for depression and entitlement to TDIU are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will inform the veteran if any further action is required on his part. FINDINGS OF FACT 1. The November 1996 rating decision which denied service connection for cervical and lumbar spine disabilities is final. 2. The evidence received since the November 1996 rating decision bears directly and substantially upon the underlying questions of whether the veteran has cervical and lumbosacral spine disorders which were secondary to the service-connected residuals of the removal of benign tumors in the left arm and is by itself, or in connection with the evidence previously assembled, so significant that it must be considered in order to fairly decide the merits of the veteran's claims. 3. A cervical spine disability was not present during active duty or for several years thereafter nor is a cervical spine disability otherwise related to such service or to the service-connected residuals of the removal of benign tumors from the left arm. 4. A lumbosacral spine disability was not present during active duty or for several years thereafter nor is a lumbosacral spine disability otherwise related to such service or to the service-connected residuals of the removal of benign tumors from the left arm. 5. The service-connected residuals of the removal of benign tumors from the left arm are manifested by pain, sensory loss and moderate paralysis of the radial nerve. CONCLUSIONS OF LAW 1. The November 1996 rating decision which denied entitlement to service connection for cervical and lumbosacral spine disabilities is final. 38 U.S.C.A. 7105(c) (West 1991). 2. Evidence received since the November 1996 rating decision which denied entitlement to service connection for cervical and lumbosacral spine disabilities is new and material, and the veteran's claims for those benefits has been reopened. 38 U.S.C.A. §§ 5107, 5108. 7105 (West 2002); 38 C.F.R. § 3.156 (2007). 3. A cervical spine disability was not incurred in or aggravated by the veteran's active duty service, nor is a cervical spine disability proximately due to or caused by a service-connected disability. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2007). 4. A lumbosacral spine disability was not incurred in or aggravated by the veteran's active duty service, nor is a lumbosacral spine disability proximately due to or caused by a service-connected disability. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2007). 5. The criteria for assignment of a 20 percent evaluation but no more for residuals of the removal of benign tumors from the left arm have been met. 38 U.S.C.A. § 1155 (West 2002 & Supp. 2007); 38 C.F.R. § 4.124a, Diagnostic Code 8514 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), VA has a 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. 2007); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2007). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, 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); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA 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; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in his or her possession that pertains to the claim in accordance with 38 C.F.R. § 3.159(b)(1). Additionally, as to timing, VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004); see also Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the United States Court of Appeals for Veterans Claims (the Court) held that, upon receipt of an application for a service- connection claim, 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating, or is necessary to substantiate, each of the five elements of the claim, including notice of what is required to establish service connection and that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. In the current case, the veteran was provided with an inadequate VCAA notice in July 2002. The veteran was provided with the laws and regulations pertaining to claims for service connection. He was subsequently provided with adequate notice via a statement of the case dated in December 2004. In correspondence dated in March 2006, the veteran was provided with notice of what is required to establish a disability rating and an effective date for the award of benefits. Subsequent to the notifications, the claim was readjudicated and that adjudication is memorialized in the November 2006 supplemental statement of the case. The Board further notes that the veteran has been represented throughout the course of the appeal by a veterans service organization. The statements submitted by the veteran's representative indicate knowledge of VA laws and regulations including those required to be provided by VCAA. The Board imputes this knowledge to the veteran via his representative. In Kent v. Nicholson, 20 Vet. App. 1 (2006), the Court held that in order to successfully reopen a previously and finally disallowed claim, the law requires the presentation of a special type of evidence-evidence that is both new and material. The terms "new" and "material" have specific, technical meanings that are not commonly known to VA claimants. Because these requirements define particular types of evidence, when providing the notice required by the VCAA it is necessary, in most cases, for VA to inform claimants seeking to reopen a previously and finally disallowed claim of the unique character of evidence that must be presented. This notice obligation does not modify the requirement that VA must provide a claimant notice of what is required to substantiate each element of a service- connection claim. See Dingess v. Nicholson, 19 Vet. App. 473 (2006). Accordingly, VA must both notify a claimant of the evidence and information that is necessary to reopen the claim and notify the claimant of the evidence and information that is necessary to establish his or her entitlement to the underlying claim for the benefit sought. In the current case, VA did not comply with holdings in Kent. As demonstrated below, however, the Board has determined that new and material evidence has been received to reopen the claims. There is no prejudice to the veteran by VA's failure to comply with Kent. Here, the VCAA duty to notify was satisfied by way of a statement of the case sent to the appellant in December 2004 that fully addressed all four notice elements. The document informed the appellant of what evidence was required to substantiate the claims and of the appellant's and VA's respective duties for obtaining evidence. The appellant was also asked to submit evidence and/or information in his possession to the AOJ. Although the statement of the case was not sent before the initial AOJ decision in this matter, the Board finds that this error was not prejudicial to the appellant because the actions taken by VA after providing the notice have essentially cured the error in the timing of notice. Not only has the appellant been afforded a meaningful opportunity to participate effectively in the processing of his claim and given ample time to respond, but the AOJ also readjudicated the case after the notice was provided. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006) (where notice was not provided prior to the AOJ's initial adjudication, this timing problem can be cured by the Board remanding for the issuance of a VCAA notice followed by readjudication of the claim by the AOJ). For these reasons, it is not prejudicial to the appellant for the Board to proceed to finally decide this appeal as the timing error did not affect the essential fairness of the adjudication. VA has a duty to assist the veteran in the development of the claim. This duty includes assisting the veteran in the procurement of service medical records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d) and 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. The types of evidence that "indicate" that a current disability "may be associated" with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the veteran has been afforded adequate VA examinations. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the appellant. See Bernard v. Brown, 4 Vet. App. 384 (1993). The RO has obtained VA and private treatment records identified by the veteran. The veteran was afforded RO hearings and was provided an opportunity to set forth his contentions during the hearings. Significantly, neither the appellant nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claims that has not been obtained. Hence, no further notice or assistance to the appellant is required to fulfill VA's duty to assist the appellant in the development of the claims. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Entitlement to an initial rating in excess of 10 percent for residuals of the removal of benign tumors from the left arm. The veteran submitted his claim for an increased rating in March 1995. Disability evaluations are determined by comparing a veteran's present symptomatology with criteria set forth in the VA's Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. 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. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. The veteran's entire history is reviewed when making disability evaluations. See generally, 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. 38 C.F.R. § 4.14. In Esteban v. Brown, 6 Vet. App. 259, 262 (1994), the Court held that evaluations for distinct disabilities resulting from the same injury could be combined so long as the symptomatology for one condition was not "duplicative of or overlapping with the symptomatology" of the other condition. The service-connected residuals of the removal of benign tumors from the left arm are currently evaluated as 10 percent disabling under Diagnostic Code 7805. Diagnostic Code 7805 provides the rating criteria for evaluations of scars and provides that the disability should be rated on limitation of function of the part affected. Diagnostic Code 5215 provides the rating criteria for evaluation of limitation of motion of the wrist. When dorsiflexion is less than 15 degrees, a 10 percent evaluation is warranted. When palmar flexion is in line with the forearm, a 10 percent evaluation is warranted. A rating in excess of 10 percent is not provided under this diagnostic code. Diagnostic Code 5206 provides the rating criteria for evaluation of limitation of flexion of the forearm. When flexion of the minor arm is limited to 100 degrees, a 10 percent evaluation is warranted. When flexion of the minor arm is limited to 90 degrees, a 20 percent evaluation is warranted for the minor arm. When flexion is limited to 70 degrees, a 20 percent evaluation is warranted for the minor arm. Diagnostic Code 5207 provides the rating criteria for evaluation of limitation of extension of the forearm. When extension of the minor arm is limited to 60 degrees, a 10 percent evaluation is warranted. When extension of the minor arm is limited to 75 degrees or 90 degrees, a 20 percent evaluation is warranted. The normal range of motion for elbow flexion is from 0 to 145 degrees. The normal range of motion for wrist dorsiflexion is from 0 to 70 degrees and the normal range of motion for wrist palmar flexion is from 0 to 80 degrees. 38 C.F.R. § 4.71 Plate I. The veteran's right hand is his dominant hand as demonstrated in the report of the April 1996 VA examination. The veteran has argued that he is entitled to a separate evaluation for neurological disabilities associated with the removal of the benign tumors. As set out in a February 2001 letter from a private physician, Dr. C.N.B. determined that the in-service operation to remove the benign tumors on the left arm involved the left ulnar and left radial nerves. Diagnostic Code 8514 sets out the rating criteria for evaluation of the musculospinal (radial) nerve. This Diagnostic Code provides that a 20 percent evaluation is assignable for mild incomplete paralysis of the minor radial nerve, or moderate incomplete paralysis of the minor radial nerve. A 40 percent evaluation is assignable for severe incomplete paralysis of the minor radial nerve. A 60 evaluation is assignable for complete paralysis of the minor radial nerve with drop of hand and fingers, wrist and fingers perpetually flexed, the thumb adducted falling within the line of the outer border of the index finger; can not extend hand at wrist, extend thumb, or make lateral movement of wrist; supination of hand, extension and flexion of elbow weakened, the loss of synergic motion of extensors impairs the hand grip seriously; total paralysis of the triceps occurs only as the greatest rarity. 38 C.F.R. § 4.124a, DC 8514. Diagnostic Code 8516 sets out the rating criteria for evaluation of injuries to the ulnar nerve. Under this Diagnostic Code, complete paralysis with "griffin claw" deformity, due to flexor contraction of ring and little fingers, atrophy very marked in dorsal interspace and thenar and hypothenar eminences; loss of extension of ring and little fingers, cannot spread the fingers (or reverse), cannot adduct the thumb; flexion of wrist weakened warrants a 50 evaluation for the minor hand. Severe incomplete paralysis of the median nerve warrants a 30 percent evaluation for the minor hand. Moderate incomplete paralysis of the median nerve warrants a 20 percent evaluation for the minor hand. Mild incomplete paralysis of the median nerve warrants a 10 percent evaluation for the minor hand. The term "incomplete paralysis," with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Factual Background At the time of a September 1995 VA skin examination, the veteran reported that he was unable to grasp or lift heavy things. He stated he experienced pain in his left wrist and forearm. Physical examination revealed a scar on the left upper forearm 3 centimeters by 2 centimeters. There was a scar on the left wrist 2 centimeters by 1/2 centimeter. The scar had slight keloid formation but was non-tender and superficial. There as no evidence of inflammation. The veteran was able to move his fingers without limitation. The diagnoses were history of pain in the left arm and history of excision of fibroma, left upper forearm and left wrist ulnar side. An October 1995 VA clinical record indicates the veteran reported that he had an increase in left arm symptoms for the past six months. He reported severe pain in the left wrist with increasing numbness and tingling of the fingertips and an inability to hold something in the left hand secondary to being unable to feel it. This had increased to severe pain that morning. Physical examination revealed sensory lack in the arm and hand and only minimal sensory ability in the finger tips. It was also noted that the veteran had decreased sensation in the forearm and arm in a C-5 C-6 distribution. The strength examination was limited due to pain in the wrist. The diagnosis was right hand pain. In January 1996, the veteran complained of pain in the left arm which had been present for six months. He was dropping objects when trying to use the left arm. There was no significant past medical history. The veteran also reported pain in the left arm when lifting objects. On VA hand, thumb and finger examination in April 1996, the veteran complained of aching, soreness, and tenderness in the wrist, some pain with use as well as some pain with gripping and grabbing and diminished grip and grabbing on the left. He dropped things. He was right handed. Physical examination revealed scars over the proximal arm and over the ulnar styloid. There was tenderness, soreness and pain to palpation. There was diminished grip and grasp on the left side. The dynamometer average was 70 pounds on the right and 20 pounds on the left. The diagnosis was residual postoperative incision of tumors of the left arm and hand. The examiner found it difficult to determine the etiology of the left arm pain. It could have been a combination of his neck, also some left wrist pain and tenderness from the excision of the benign tumors as well, so it was probably a combination of both problems. A VA diseases/injuries of the spinal cord examination was conducted in April 1996. The veteran reported weakness in his left grip as well as weakness in the left wrist and elbow. He also reported pain from the fingertips to the shoulder. The pain in the arm became noticeable three or four years prior. The veteran reported that he injured his neck in 1988 when lifting a drum at work. He also injured his lower back in the incident. Physical examination revealed that the veteran could make a normal fist. Fine movements of the fingers were bilaterally normal. Left elbow flexion and extension were 80 percent of normal. Left wrist flexion and extension were 75 percent of normal. Hypesthesia was present in the left upper and lower extremity. The examiner opined that there might have been some minor weakness or some partial sensory loss, minor in degree, secondary to removal of the benign tumors of the left arm. The veteran appeared to have sensory and motor problems of the left upper and left lower extremities which, more than likely, stem from spinal cord or vertebral difficulty from the accident. The examiner opined that the service-connected benign tumor excision of the left arm would have little to do with the veteran's current symptoms although they might have a minor role. The loss of feeling and position sense in the left and weakness in the left arm, radiation of pain, radiculopathy of the upper and lower extremities and the back condition all appeared to have been the result of the barrel accident at work. The diagnosis was minimal residuals of the left arm for removal of benign tumors from the left arm, left elbow and wrist with minor weakness and minimal loss of feeling. All were considerably aggravated by the industrial injury to the lower back and neck with left upper extremity and lower extremity radiculopathy, motor and sensory changes. At the time of an April 1996 VA general medical examination, physical examination revealed a scar on the left upper forearm which measured 2 centimeters in length with 4 stitch mark scars which measured 2 centimeters in length. There was also a 2 centimeter scar on the left lower forearm area. The scar looked benign and there was no tenderness. There was some keloid formation on the scar on the left upper forearm. There was no limitation of motion of the part affected. The diagnosis was residual scar from excision of benign tumor of the left upper and left lower forearm and history of left arm pain, joint pains. A VA brain and spinal cord examination was conducted in July 1998. The veteran reported he was injured at work in 1988 when a drum fell on his arm. He re-injured his arm, back and neck at that time. He reported that his whole left arm was weak. He reported numbness of the left forearm and hand and weakness in the left grip. Physical examination revealed that the left fist could flex to one half inch of the mid- line crease. The veteran had exaggerated difficulty performing fine movements with his left hand. Position sense appeared normal. Hyperesthesia was present in the ulnar nerve distribution of the left arm and hand. The examiner noted that the veteran was mentally ill and his pain was not entirely explained by neurological findings. There were objective neurological findings but subjective complaints of neck and back pain and radiculopathy of both upper extremities and lower extremities secondary to cervical and lumbar injury. An annotation to the document indicates that there was probably emotional overlay. The veteran could not complete needle testing part of EMG so no definite EMG diagnosis could be made. On VA general medical examination in July 1998, physical examination revealed a superficial non-tender benign 1.5 centimeters by 2 centimeters scar on the left forearm. The veteran was able to move all his extremities without weakness. Sensory and motor were intact. The diagnosis was residual benign scar on the left forearm. Sensory and motor nerve conduction studies in August 1998 were notable only for reduction in median motor amplitudes bilaterally which were of borderline significance on the right and of moderate significance on the left. Extensive nerve conduction studies were notable for reduced amplitude of the muscles bilaterally. Without needle examination, this finding was of very limited localizing value although it might reflect pathology of the right and left median nerves, brachial plexus or C8/T1 nerve roots. The veteran refused to complete the needle testing. In February 2001, Dr. C.N.B. wrote that he had reviewed the claims file including the service medical records for the veteran. The physician cited to the fact that the schwannoma, by definition, was a benign tumor which involved the nerve fibers and not just the skin. He quoted a treatise as demonstrating that the tumor cells were associated with the nerves and that the tumors removed from the veteran's arm involved the left radial nerve and the left ulnar nerve. The physician found that the nature of the post-operative nerve residuals would cause the veteran to have partial muscle function of the hand and forearm which would result in spontaneous fatigue and sudden loss of strength. In December 2002, it was noted that the veteran complained of left arm weakness and pain. A VA scars examination was conducted in June 2003. The veteran reported occasional swelling over the location of the scars on his forearm and an occasional pulling sensation with any type of lifting. Physical examination revealed a 3 centimeter by .5 centimeter vertical scar which was not tender. There was no adherence to the underlying tissue. The texture of the scar was irregular. There was no ulceration or breakdown of the skin. The scar was slightly elevated. No depression was present. The scar was superficial. There was no inflammation, edema or keloid formation. The color of the scar was slightly lighter than the surrounding skin. There were no areas of induration or inflexibility of the skin in the area of the scar. The veteran stated he experienced a pulling sensation with flexion and extension of the elbow but there was no limitation in the elbow. There was also a scar over the left wrist which was 3 centimeters by .2 centimeters. No tenderness was present in the scar. There was no adherence to the underlying tissue. The texture of the scar was normal. There was no ulceration or breakdown of the skin. The scar was neither elevated nor depressed. The scar was superficial. There was no inflammation, edema or keloid formation. The color of the scar was the same color as the surrounding skin. There were no areas of induration or inflexibility of the skin in the area of the scar. The diagnosis was removal of benign fatty tumors with residual scar formation on the left forearm and left wrist. At the time of a VA joints examination which was conducted in June 2003, the veteran stated he had chronic aching and pain in the elbow and wrist. He also reported difficulties with repetitive gripping and grabbing as well as fatigability with constant repetitive use in the left upper extremity. The pain was described as a chronic ongoing pain rather that any specific flare-ups. Weather changes aggravated the condition. The veteran was right handed. Physical examination revealed tenderness to palpation on the forearm and wrist. Flexion of the elbow was from 0 degrees to 145 degrees. Pronation and supination were normal at 85 degrees and 80 degrees. Dorsiflexion of the wrist could be accomplished to 70 degrees, palmar flexion to 80 degrees, radial deviation of 20 degrees and ulnar deviation of 45 degrees. The veteran had excellent strength in the elbow. No manual muscle weakness was noted in the wrist or forearm. The diagnosis was post-operative excision of the tumor from the left forearm and wrist. A VA neurological examination was conducted in June 2003. The examiner indicated that he did not have access to the veteran's claims file. The veteran reported that he was unable to grip anything in the left hand for very long. He had pain in the wrist and reported that he would drop things when he turned his head away. The sensation in the left hand was significantly depressed. He had intermittent pain in the elbow but this was less than the pain in the wrist. He felt that his left wrist would collapse if he carried anything greater than five to ten pounds. He claimed that he hardly used his left wrist for anything anymore. He was not receiving any treatment for his left arm or wrist. He reported he was unable to lift anything due to weakness in the wrist and pain. He reported he could not work due to problems with his wrist. Physical examination revealed two small surgical scars. There was good tone and bulk in both forearms and biceps. There was no gross difference in muscle bulk or tone of the hands or fingers. There was no evidence of interossei atrophy. Motor testing revealed 4+/5 strength in the left biceps and triceps. There was also 4-/5 graded strength in dorsiflexion of the left wrist but no wrist drop was noted. There was a similar 4-/5 strength of wrist flexion on the right. There was 3+/5 radial deviation on the left but +5/5 ulnar deviation strength. Grip strength on the left was +4/5. There was a good range of motion without restrictions or limitations. There were no complaints of significant pain during passive maneuvers. Sensory testing revealed mild decrease to pin prick and light touch over the scar area on the left wrist but otherwise normal sensation was present over the arm, forearm, hand and fingers on the left. The impression from the examination was that the veteran demonstrated motor weakness in the radial nerve distribution which could be graded mild moderate due to a lack of an obvious wrist drop. The weakness was as likely as not to be a residual to the tumor removal during active duty. No significant limitations or ongoing neurologic deficits were noted secondary to the surgery over the left elbow. An August 2003 addendum to this examination report indicates that, after the examiner had a chance to review the veteran's claims file, he found no changes were necessary in his prior report. In October 2003, a VA physician reported that he had reviewed Dr. C.N.B.'s report and concurred with the doctor's opinion. The physician found that the veteran would have difficulty with repetitive use of the left upper extremity with anything requiring heavy, repetitive pushing, pulling, gripping, or grabbing. The pain problem would also be an issue. A December 2005 VA clinical record reveals the veteran attempted to shovel snow but could not due to a reported increase in symptoms. There were no complaints regarding his left arm. The veteran testified at a RO hearing in October 2005 that he had difficulty picking objects up with his left hand and that his left arm would give out. He reported pain in his left arm and elbow. An October 2005 VA clinical record reveals the veteran complained of some left wrist pain and whole body pain. He reported that his wrist occasionally would swell and the dorsum of his hand would occasionally go numb. Physical examination of the left wrist did not demonstrate any masses or specific points of tenderness. The veteran complained of his whole general hand hurting including the palms and fingertips. Strength was 5/5. X-rays did not reveal any significant abnormality in the left wrist. The impression was chronic pain syndrome. The examiner opined that he could not find anything in the physical examination which would account for the severity of the pain reported by the veteran. The examiner found it interesting that, upon leaving the examination, the veteran walked out carrying what appeared to be at least a twenty pound duffle bag with his left wrist. The examiner opined that there was nothing in the physical examination or reported history that would limit the veteran's ability to work. The veteran felt he could not work due to the amount of pain that he had. The examiner opined that the veteran was in pain. Analysis The Board finds that an increased rating is not warranted for the service-connected left arm disability when it is evaluated based on demonstrated limitation of motion under Diagnostic Codes 5215, 5206, and 5207 via Diagnostic Code 7805. The May 2004 rating which increased the rating to 10 percent did so based on functional loss due to pain and repetitive use. An increased rating is not warranted under Diagnostic Code 5215. The veteran is already receiving the schedular maximum which can be assigned under this Diagnostic Code, 10 percent. An increased rating is not warranted under Diagnostic Code 5206 as the evidence of record does not demonstrate that the service-connected left arm disability is productive of limitation of flexion to 90 degrees or less. The greatest limitation of flexion objectively documented in the medical evidence is at the time of the April 1996 VA examination for diseases and injuries of the spine. At that time, the examiner determined that left elbow flexion was approximately 80 percent of normal. The Board notes that the normal range of motion for flexion of the elbow is from 0 degrees to 145 degrees. Eighty percent of 145 equates to 116 degrees. Limitation of flexion to 116 degrees is noncompensable under Diagnostic Code 5206. Evidence dated subsequent to that time demonstrates a greater range of motion for flexion. The examiner who conducted a June 2003 joints examination determined that the range of motion for the left elbow was flexion to 145 degrees which is full. The examiner who conducted the June 2003 neurological evaluation determined that the veteran had a good range of motion without restrictions or limitations. The Board finds that an increased rating is not warranted when the service-connected residuals of the removal of benign tumors on the left arm is evaluated under Diagnostic Code 5207 based on limitation of extension of the forearm. The evidence of record does not document that extension of the left arm was limited to 75 degrees or more. The greatest restriction in extension of the elbow is that documented at the time of the April 1996 examination for disease/injuries of the spine. At that time, left elbow extension was determined to be 80 percent of normal. However, concurrent and subsequent evidence demonstrates a greater range of motion. At the time of the April 1996 VA general medical examination, it was determined that there was no limitation of motion of the part affected. At the time of the June 2003 VA neurological evaluation, the examiner noted that there was a good range of motion without restrictions or limitations. The Board finds that an increased rating is not warranted for the service-connected residuals of the removal of benign tumors from the left arm based upon application of 38 C.F.R. §§ 4.40, 4.45 and the holdings in Deluca. Dr. C.N.B. wrote in February 2001, that the nature of the post-operative nerve residuals would have cause the veteran to have partial muscle function of the hand and forearm which would result in spontaneous fatigue and sudden loss of strength. The Board notes, however, that this physician never actually examined the veteran. His opinion was based on a review of the evidence of record but without a physical examination. The Board finds that Dr. C.N.B.'s statements are general with regard to the expected residuals of an injury such as the veteran had but do not actually determine the specific extent of disability particular to the veteran. The statements are not probative with regard to the extent of functional loss the veteran actually experiences. The veteran has not indicated that he experiences any additional loss in the range of motion of his elbow or wrist as a result of his service-connected disability. He has reported increased pain, numbness and a tendency to drop things or an inability to hold things. The Board notes that 38 C.F.R. §§ 4.40, 4.45 and the holdings in Deluca are only applicable for increasing disability evaluations based on range of motion. The veteran has not alleged a loss of range of motion as a result of functional loss. There is no objective evidence demonstrating that the veteran experiences additional loss of motion due to pain on use or during flares and the veteran has not reported the presence of such symptomatology. The most recent clinical records pertain mainly to treatment for mental disorders. There are very few references to problems with the left arm or hand. This would support a finding by the Board that the symptomatology reported by the veteran is not as significant as he has set out. The veteran has alleged that he experiences severe disability as a result of his service-connected left arm disability. The Board finds that reduced probative value is to be accorded the veteran's self-reported medical history due to exaggerations which symptoms are not objectively confirmed. At the time of the June 2003 VA neurological examination, the veteran reported that he was unable to carry more than five or 10 pounds and that he hardly ever used his left arm anymore. He also indicated he was unable to lift anything due to weakness and wrist pain. However, the examiner who conducted the June 2003 VA examination specifically noted that there was good muscle tone and bulk bilaterally without any gross difference in the muscle bulk or tone of the hands or fingers. Motor testing revealed only slight decrease in strength on the left when compared to the right. The Board finds that the physical findings contradict the veteran's subjective complaints. If the veteran was no longer using his left arm, there likely would be a difference in the size of the muscles due to atrophy from lack of use. The veteran testified in October 2005 that he had difficulty picking up objects with his left hand and that his left arm would give out. However, a VA clinical record dated the same month indicates that the clinician at that time specifically observed the veteran leaving the appointment while carrying a duffle bag in his left hand which was estimated to weigh at least twenty pounds. There are also several references in the clinical records to the veteran's complaints of pain not being supported by the objective evidence of record. Based on the above, the Board finds that reduced probative value should be placed on the veteran's self-reported symptomatology. The Board finds that an increased rating to 20 percent but no more is warranted when the service-connected left arm disability is evaluated under Diagnostic Code 8514. There is conflicting evidence in the claims file as to whether the veteran experiences any weakness due to an injury to the radial nerve. The veteran has reported the presence of weakness in the arm. At the time of the April 1996 VA hand, thumb and finger examination, it was noted that the veteran had diminished grip and grasp on the left with a dynamometer reading of 70 pounds for the right but only 20 pounds for the left. However, the examiner who conducted the April 1996 diseases and injuries to the spine examination opined that any weakness present which was due to the nerve injury was only minor in degree. In July 1998, it was noted that the veteran was able to move all his extremities without weakness. At the time of the June 2003 VA joints examination, the examiner determined that there was no muscle weakness noted in the wrist or forearm. However, this examiner also opined that the veteran had motor weakness in the radial nerve distribution which could be graded mild/moderate due to a lack of obvious wrist drop. The Board notes that the opinion included in the June 2003 joints examination is the only one of record which attempts to quantify the extent of disability directly associated with the radial nerve. Based on a benefit of the doubt, the Board finds that the service-connected residuals of the removal of benign tumors from the left arm are manifested by moderate incomplete paralysis of the radial nerve. A higher rating is not warranted as there is no competent evidence of record documenting that the veteran experiences any symptomatology approaching the drop of the hand or fingers, perpetually flexed wrist or fingers, an inability to extend the hand at the wrist, an inability to extend the proximal phalanges of the fingers or thumb. There is no limitation in the ability to make lateral movements of the wrist. There is no evidence documenting weakened supination of the hand or the loss of synergic motion of the extensors nor evidence of total paralysis of the triceps. The Board finds that the evidence of record, at most, more nearly approximates a moderate incomplete paralysis of the radial nerve. The Board finds that an increased rating is not warranted when the service-connected left arm disability is evaluated under Diagnostic Code 8516 based on paralysis of the ulnar nerve. There is no competent evidence of record which indicates that the ulnar nerve is compromised to a compensable degree. There is no evidence of symptomatology approaching "griffin claw" deformity, atrophy in the dorsal interspace and thenar and hypothenar eminences, loss of extension of ring and little fingers, an inability to spread the fingers (or reverse), an inability to adduct the thumb or any weakened flexion of the wrist. The majority of the competent evidence of record demonstrates that the scars resulting from the in-service surgical procedure are small and asymptomatic and described as superficial. The Board finds that a separate evaluation is not warranted for any symptomatology associated with the scars under either the old or current rating criteria. See 38 C.F.R. §§ 7801-7804. A separate evaluation is not warranted for limitation of motion of the fingers. There is no evidence of record that the veteran experiences complete or incomplete ankylosis of any finger as a result of the service-connected disability. There is only one objective piece of evidence which indicates that the veteran had any limitation of motion of the fingers. At the time of the July 1998 VA brain and spinal cord examination, it was observed that the fingers could flex to within one half inch of the mid-line crease. The preponderance of the other evidence of record demonstrates that the veteran was not limited in movements of the fingers. In September 1995, it was noted that the veteran was able to move his fingers without limitation. At the time of the April 1996 VA examination, it was determined that the veteran could make a normal fist and had normal fine movements of the fingers bilaterally. At the time of the April 1996 VA general medical examination, it was noted that there was no limitation of motion of the part affected. At the time of the July 1998 VA general medical examination, it was determined that the veteran could move all his extremities without weakness. At the time of the June 2003 neurological examination, it was noted that there was a good range of motion without restrictions or limitations. The Board finds that the correct evaluation for the service- connected residuals of the removal of the benign tumor from the left arm should be under Diagnostic Code 8514. The Board finds that a separate evaluation is not warranted under any other Diagnostic Code. The preponderance of the medical evidence of record demonstrates that the veteran does not experience any compensable limitation of motion of the finger, wrist or elbow. His primary complaints are weakness, problems with grip and sensory disability. These complaints are accounted for under Diagnostic Code 8514. The Board further notes that the veteran's complaints of pain in the left extremity have also been attributed to radiculopathy due to the non-service connected cervical disability. Additionally, the Board does not find that consideration of an extraschedular rating under the provisions of 38 C.F.R. § 3.321(b)(1) is in order. The evidence in this case fails to show that the veteran's left arm disability now causes or has in the past caused marked interference with his employment, or that such has in the past or now requires frequent periods of hospitalization post-service rendering impractical the use of the regular schedular standards. Id. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for residuals of a lumbosacral spine injury as secondary to the service- connected residuals of the removal of benign tumors of the left arm. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for residuals of a cervical spine injury as secondary to the service- connected residuals of the removal of benign tumors of the left arm. In November 1996, the RO denied service connection for residuals of lumbosacral and cervical spine injuries. The RO noted the veteran was claiming that he injured his back and neck because of his left hand giving out. The claim was denied as the treatment records from the time of the back accident did not confirm that the veteran's left hand was the cause of the accident. The RO observed that the veteran was treated for problems with his right arm at the time of the industrial accident. The veteran failed to submit a notice of disagreement with the November 1996 denials of service connection for residuals of cervical and lumbar spine injuries. The Board finds that the November 1996 rating decision became final by reason of the failure to file a notice of disagreement to initiate an appeal. 38 U.S.C.A. 7105(c). In June 1998, the veteran's representative submitted a statement which has been construed as a request to reopen the claims of entitlement to service connection for cervical and lumbar spine disabilities. Applicable law provides that a claim which is the subject of a prior final decision may nevertheless be reopened if new and material evidence is presented or secured. 38 U.S.C.A. 5108. New and material evidence is defined by regulation. See 38 C.F.R. 3.156. The Board notes here that the provisions of 38 C.F.R. 3.156(a) were amended. However, the amended version is only applicable to claims filed on or after August 29, 2001. The change in the regulation therefore does not impact the present case. The veteran's request to reopen the claim was received in June 1998. New and material evidence means evidence not previously submitted which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with the evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C F R. 3.156(a) (2001); see also Hodge v. West, 155 F.3d 1356, 1363 (Fed. Cir 1998). In Hodge, the United States Court of Appeals for the Federal Circuit noted that new evidence could be sufficient to reopen a claim if it could contribute to a more complete picture of the circumstances surrounding the origin of a veteran's injury or disability, even where it would not be enough to convince the Board to grant a claim. Id. at 1363. For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). In Kutscherousky v. West, 12 Vet. App. 369 (1999) the Court held that the prior holding in Justus that the evidence is presumed to be credible was not altered by the Federal Circuit decision in Hodge. However, the "benefit of the doubt doctrine" does not apply to the preliminary question as to whether new and material evidence has been received to reopen a claim. Martinez v. Brown, 6 Vet. App. 462 (1994). The evidence of record at the time of the November 1996 rating decision which denied service connection for back and neck injures consists of the service medical records, the report of an April 1996 VA examination, VA outpatient treatment records from June 1986 to January 1996, private treatment records from 1986 and the transcript of the veteran's testimony at a RO hearing in July 1996. The evidence added to the record subsequent to the November 1996 rating decision includes VA and private clinical records, reports of VA examinations and a letter from a private physician. The Board finds that some of this evidence is new and material and the claims of entitlement to service connection for residuals of lumbosacral and cervical spine injuries have been reopened. In February 2001, Dr. C.N.B. wrote that he had reviewed the claims file including the service medical records for the veteran. The physician found it clear that the examiners who provided impressions of the etiology of the veteran's present disabilities were unaware of the fact that the veteran had partial removal of two schwannomas in his left forearm. The physician cited to the fact that the schwannoma, by definition, was a benign tumor which involved the nerve fibers and not just the skin. He quoted a treatise as demonstrating that the tumor cells were associated with the nerves and that the tumors removed from the veteran's arm involved the left radial nerve and the left ulnar nerve. The physician opined that the partial removal of the left ulnar and radial nerves during service caused the veteran to have weakness in the left hand when he later attempted to lift the water filled barrel in 1988. The physician found that the nature of the post-operative nerve residuals would cause the veteran to have partial muscle function of the hand and forearm which would result in spontaneous fatigue and sudden loss of strength. The physician found that the veteran's statements that described an acute and rapid loss of strength in the left hand while lifting the heavy barrel was totally consistent with the veteran's pathology (partial nerve resection of the ulnar and radial nerves in service). The Board finds Dr. C.N.B.'s letter constitutes new and material evidence. The evidence is new as it was not of record at the time of the prior final decision. The evidence is also material is it provides a potential link between the service-connected disability and the veteran's injuries to his cervical and lumbar spine. The Board notes that for the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The Board finds that Dr. C.N.B.'s letter which was received subsequent to the November 1996 rating decision which denied service connection for cervical and lumbosacral spine disabilities bears directly and substantially upon the specific matters under consideration and, by itself or in connection with the evidence previously assembled, is so significant that it must be considered in order to fairly decide the merits of the claims. As new and material evidence has been received, the claims of entitlement to service connection for residuals of a lumbosacral spine injury as secondary to the service-connected residuals of the removal of benign tumors of the left arm and entitlement to service connection for residuals of a cervical spine injury as secondary to the service-connected residuals of the removal of the benign tumors of the left arm have been reopened. The Board will adjudicate the reopened claims on a de novo basis. Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in active military service. 38 U.S.C.A. 1110; 38 C.F.R. 3.303. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. 3.303(b). Service connection may also 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). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310; see also Harder v. Brown, 5 Vet. App. 183, 187 (1993). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). When aggravation of a veteran's non-service-connected condition is proximately due to or the result of a service-connected condition, the veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. Allen v. Brown, 7 Vet. App. 439 (1995). The term "disability" refers to impairment of earning capacity, and such definition mandates that any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service- connected condition, shall be compensated. 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). The Board finds that service connection is not warranted for residuals of a cervical spine and lumbosacral spine disorder on a direct basis. The service medical records are silent as to complaints of, diagnosis of or treatment for any cervical or lumbosacral spine disorders. While there is competent evidence of the current existence of cervical and lumbosacral spine disorders, there is no competent evidence of record which links either disability to the veteran's active duty service on a direct basis. The veteran has not argued that his cervical and lumbar spine disorders were the direct result of his active duty service. The veteran has claimed that he currently experiences cervical and lumbosacral spine disorders as a result of an industrial accident which occurred in 1988. He has testified that his left hand gave out while lifting a heavy barrel, causing the barrel to fall on the veteran injuring his neck and low back. Service connection is in effect for residuals of a removal of benign tumors of the left arm. The veteran is claiming entitlement to service connection for the cervical and lumbosacral spine disorders on a secondary basis. The competent evidence of record demonstrates that the veteran currently experiences cervical and lumbar spine disabilities. A July 1998 report of a VA spine examination included diagnoses of residuals of an injury to the cervical spine and residuals of an injury to the lumbosacral spine. Reports of X-ray examinations conducted in August 2005 include an impression of a normal lumbar spine and degenerative changes present in the cervical spine. Furthermore, the claims file documents the fact that service connection has been granted for residuals of removal of benign tumors from the left arm. Significantly, the Board finds that the preponderance of the evidence of record weighs against a finding that there is a link between service- connected left arm disability and the cervical and lumbosacral spine disorders. This is based on the Board's determination that the evidence of record indicates that the veteran did not injure himself as a result of his left arm giving out due to the service-connected injury. As noted above, the veteran has claimed that he injured his neck and back when a barrel he was lifting fell on him due to his left arm giving out. He testified that he was hurt in June 1988 when he was lifting a drum, it started to fall, and he tried to catch it but his arm gave out and he fell to the ground. He reported that he had had back problems since that time. The objective evidence of record does not support the veteran's allegations that he was injured when his service- connected left arm gave way while lifting a barrel, causing the current injuries. First, the Board notes the clinical evidence of record dated prior to the reported accident does not indicate the level of impairment as alleged by the veteran. There is no indication that the veteran experienced any difficulties, let alone significant ones, as a result of his service-connected left arm disability. In May 1984, the veteran informed a clinician that he had to quit his job as a machine operator due to dizziness and multiple complaints. The main complaint was bilateral pain in the sides. A private clinical record dated in August 1986 indicates the veteran sought treatment for chest pains. A September 1986 private clinical record indicates the veteran reported he used to lift weights a lot but was unable to do so anymore due to chest pain. In the portion of the record dealing with past medical history, it was noted that the veteran had two lipomas removed from the left arm. The Board finds it significant that there was no indication that the veteran had had problems with his left arm giving out while lifting weights. In February and March of 1987, the veteran sought treatment for flank pain. There were no reports of problems with the left arm. In December 1987, the veteran complained of chest and back pains. The back pain was usually associated with exercise. The symptoms began approximately one year prior. There was no indication of problems with the left arm. None of the clinical records dated prior to the June 1988 industrial accident indicates that the veteran had any disability, let alone significant disability, in the left arm which was productive of a loss of power in the arm. The contemporaneous evidence dated in June 1988 does not demonstrate that the veteran injured his back or neck as a result of his left arm giving way. A June 1988 VA clinical record indicates the veteran was seeking treatment for low back pain which had been present since Monday. It was noted that there was no significant past medical history. The Board finds this very significant that the veteran did not report any prior problems with weakness in the left arm or indicate in any way that the cause of the accident in June 1988 was linked to problems with his left arm. The veteran reported that he was well until two days prior when he developed low back pain and neck pain which began in the morning after working with steel drums the night prior. It was noted that there was no numbness or motor deficit. The veteran reported that pain radiated down his right arm but not his left. There was no report at all regarding the left arm giving way. (In fact, this evidence indicates that the cause of the problem was the veteran working with multiple barrels without any indication that a barrel had fallen on the veteran.) The Board finds this account of the accident outweighs the veteran's subsequent allegations of problems with his left arm causing the accident. These statements were made contemporaneous with treatment rendered and made prior to the time the claim was filed when there was potential for pecuniary gain. The evidence associated with the claims file dated subsequent to the June 1988 industrial accident does not demonstrate impairment in the left arm until the mid 1990's. The evidence also tends to indicate that the left arm problems did not begin until the accident or subsequent to the accident. The report of a July 1998 VA brain and spinal cord examination includes the annotation that the veteran was injured in 1988 at work when a drum fell on his arm. He re- injured his left arm, neck and back at that time. The veteran reported that his whole left arm was weak and that he had numbness of the left forearm and hand and weakness in the left grip. In March 1995, when the veteran submitted a claim for an increased rating for his left arm, he wrote that he had problems with losing strength in the left arm as well as pain. He indicated that when he would lift something, the arm would go out. He did not indicate at that time that he injured his back as a result of his arm giving way. In October 1995, the veteran reported that he had had intermittent swelling in the left arm but within the last six months, his symptoms had increased to pain in the hand radiating up the arm and also numbness. It was noted that the veteran was complaining of severe pain in the left wrist which had been present for six months with increasing numbness and tingling of the fingertips and an inability to hold something in his hand secondary to being unable to feel it. This had progressed to severe pain in the morning. It was in a December 1995 statement that the veteran first indicated he injured his back and neck due to his hand giving out. This is seven years after the industrial accident. A January 1996 VA clinical record includes the annotation that the veteran had pain in the left arm which had been present for six months. He reported he was dropping objects when trying to use the left arm. The Board has placed reduced probative value on the veteran's self-reported medical history due to inconsistencies in his testimony and statements. The veteran testified at a local RO hearing in July 1996 that he lost a job after discharge at Cleveland Metals due to his arm giving out. However, a May 1984 VA clinical record reveals that the veteran informed a clinician that he had to quit his job as a machine operator due to dizziness and multiple complaints. The main complaint was bilateral pain in the sides. There was no mention in the clinical record of any problems with the left arm. The veteran testified in July 1996 that he had received continuous treatment for his arm beginning in 1983. Clinical records associated with the claims file do not document such treatment. There is no documentation of continuous treatment for left arm problems in the clinical records associated with the claims file. One clinical record demonstrates that the veteran has indicated a willingness to lie to health care professionals. A July 1998 VA clinical record indicates the veteran was being seen for increasing emotional difficulties since injuring his back and ceasing work in June. The veteran reported that he felt that he was unable to get assistance by telling the truth and he felt that he has only had people pay attention to his needs when he "lies about problems." It is the duty of the Board as the fact finder to determine the credibility of the testimony and other lay evidence. Culver v. Derwinski, 3 Vet. App. 292, 297 (1992). It is further noted that not only may the veteran's memory have dimmed with time, but self interest may play a role in the more recent statements. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) [interest may affect the credibility of testimony]; cf. Pond v. West, 12 Vet. App. 341, 346 (1999). For the above reasons, the Board finds that reduced probative value is to be accorded the veteran's self-reported medical history. It is not apparent to the Board why the veteran failed to file a claim for compensation with VA in 1988 after the industrial accident if, in fact, it was caused by a service- connected disability. Service connection was in effect for the left arm at the time of the accident. The Board notes the veteran did file a claim for Workman's Compensation and was apparently successful in that claim as he testified in October 2005 that he was drawing Workman's Compensation benefits for seven years. The Board finds the failure of the veteran to file for compensation from VA shortly after the accident, instead filing a Workman's Compensation claim demonstrates to the Board that the veteran did not believe the cause of the accident at that time was due to a service- connected disability. This evidence weighs against a finding that the veteran was injured in June 1988 as a result of his service-connected left arm. The Board notes that Dr. C.N.B. wrote in February 2001 that, in his opinion, the partial removal of the left ulnar and radial nerves during service caused the veteran to have weakness in his left hand when he later attempted to lift the water barrel in 1988. This opinion, however, is based on a self-reported history provided by the veteran. As found above, the veteran's self-reported history is not supported by the objective evidence of record and the Board has found reason to place reduced probative value on the veteran's allegations. The Court has held on a number of occasions that a medical opinion premised upon an unsubstantiated account is of no probative value. See, e.g., Reonal v. Brown, 5 Vet. App. 458, 460 (1993); Moreau v. Brown, 9 Vet. App. 389, 395-96 (1996); Swann v. Brown, 5 Vet. App. 229, 233 (1993). The February 2001 letter from Dr. C.N.B. is based on a factual background which is not supported by the objective evidence of record. Based on the above, the Board finds that the preponderance of the evidence is against a finding that the veteran's current cervical and lumbosacral spine disorders were secondary to the service-connected residuals of removal of benign tumors of the left arm. The objective evidence of record does not support a finding that the veteran's left arm was the cause of his industrial accident in June 1988 and reduced probative value is accorded the veteran's own self-reported history. After reviewing the totality of the relevant evidence, the Board is compelled to conclude that the preponderance of such evidence is against entitlement to service connection for the disabilities currently on appeal. It follows that there is not a state of equipoise of the positive evidence with the negative evidence to permit favorable determinations pursuant to 38 U.S.C.A. § 5107(b). ORDER New and material evidence having been received, the claim of entitlement to service connection for a lumbosacral spine injury claimed as secondary to the service-connected residuals of the removal of benign tumors from the left arm has been reopened. The appeal is granted to that extent only. New and material evidence having been received, the claim of entitlement to service connection for a cervical spine injury claimed as secondary to the service-connected residuals of the removal of benign tumors from the left arm has been reopened. The appeal is granted to that extent only. Service connection for a lumbosacral spine disability is not warranted. The appeal is denied. Service connection for a cervical spine disability is not warranted. The appeal is denied. Entitlement to a 20 percent rating but no more for residuals of the removal of benign tumors from the left arm is granted, subject to the laws and regulations governing monetary awards. REMAND In February 2001, the veteran's representative submitted a claim of entitlement to service connection for depression which was alleged to be secondary to pain caused by the service-connected left arm disability. Associated with the claims file are clinical records which include diagnoses of mental disorders including depression. The Court has held that, in situations in which there is competent evidence of a current disability and evidence indicating there may be an association between the claimant's disability and his active service, VA is to obtain a medical opinion as to whether there is a nexus between that disability and his active service, under 38 U.S.C.A. § 5103A. Charles v. Principi, 16 Vet. App. 370 (2002). See also 38 C.F.R. § 3.159. The Board finds that the veteran should be afforded a VA examination to determine the nature, extent and etiology of any mental disorder found on examination. The veteran has also claimed entitlement to TDIU. The Board finds that this claim is inextricably intertwined with the claim of entitlement to service connection for depression. This is due to the fact that service connection is only in effect for one disability at the time this decision is written. Service connection could potentially be granted for the depression claim which is being remanded by this decision. If service connection is granted for depression, VA would have to determine if the veteran is unemployable due to the left wrist disability and/or the depression. Accordingly, the case is REMANDED for the following action: 1. Schedule the veteran for a mental disorders examination to be conducted by a suitably qualified health care professional in order to determine the nature, extent and etiology of any mental disorders found on examination. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater likelihood) that the veteran currently has a mental disorder which was incurred in or aggravated by active duty or was proximately due to, the result of, or increased in severity beyond the natural progression due to the service-connected residuals of the removal of benign tumors from the left arm. The examiner must provide a rationale for his opinion(s). The claims folder must be made available to the examiner, and pertinent documents therein reviewed, in conjunction with providing the requested opinion. 2. Thereafter, and after completing any further development determined to be warranted by the RO or the AMC, the claim of entitlement to service connection for depression and entitlement to TDIU should be adjudicated based on all the evidence in the claims file. If any of the benefits sought on appeal are not granted to the veteran's satisfaction, a supplemental statement of the case should be issued, and the veteran should be afforded the requisite opportunity to respond before the claims folder is returned to the Board for further appellate action. The appellant and his representative have the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). ______________________________________________ BARBARA B. COPELAND Veterans Law Judge, Board of Veterans' Appeals Important Notice: Attached to this decision is a VA Form that provides information concerning your rights to appeal our decision. Due to recent changes in the law, some of the information contained in the attached notice of appellate rights form is no longer accurate concerning the ability to pay attorneys and agents to represent you. Some additional information follows that summarizes the current law. To the extent that the information contained in the attached VA Form conflicts with the summary below, please disregard the information on the VA Form and instead rely upon the following information: Do I have to pay an attorney or agent to represent me? An attorney or agent may charge a fee to represent you after a notice of disagreement has been filed with respect to your case, provided that the notice of disagreement was filed on or after June 20, 2007. See Veterans Benefits, Health Care, and Information Technology Act of 2006, Pub. L. No. 109-461, 120 Stat. 3403 (2006). If the notice of disagreement was filed before June 20, 2007, an attorney or accredited agent may charge fees for services, but only after the Board first issues a final decision in the case, and only if the agent or attorney is hired within one year of the Board's decision. The notice of disagreement limitation does not apply to fees charged, allowed, or paid for services provided with respect to proceedings before a court. VA cannot pay the fees of your attorney or agent, with the exception of payment of fees out of past-due benefits awarded to you on the basis of your claim when provided for in a fee agreement. VA is in the process of amending its regulations governing representation of claimants for veterans' benefits in order to implement the provisions of the new law. More information concerning the regulation changes and related matters can be obtained at http://www1.va.gov/OGC (click on "Accreditation and Recognition of Service Organizations"). Fee for VA home and small business loan cases: An attorney or agent may charge you a reasonable fee for services involving a VA home loan or small business loan. For more information, read section 5904, title 38, United States Code. Filing of Fee Agreements: In all cases, a copy of any fee agreement between you and an attorney or accredited agent must be sent to the Secretary at the following address: Office of the Chief Counsel for Policy (01C3) Board of Veterans' Appeals 810 Vermont Avenue, NW, Washington, DC 20420 Facsimile: (202) 565-5643 (When final regulations are published to implement the requirements of the new law, fee agreements must be filed with the VA Office of the General Counsel and not the Board.) Department of Veterans Affairs