Citation Nr: 0810254 Decision Date: 03/28/08 Archive Date: 04/09/08 DOCKET NO. 03-35 695 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for PTSD. 2. Entitlement to service connection for a skin disorder, including as due to Agent Orange exposure. 3. Entitlement to service connection for bronchitis, including as due to Agent Orange exposure. 4. Whether new and material evidence has been received to reopen a claim for entitlement to service connection for a low back disorder to include related right lower extremity impairments, and, if so, whether service connection is warranted. 5. Whether new and material evidence has been received to reopen a claim for entitlement to service connection for residuals of a right fifth finger injury, and, if so, whether service connection is warranted. REPRESENTATION Appellant represented by: Georgia Department of Veterans Services WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD S. Grabia, Counsel INTRODUCTION The veteran served on active duty for training from August 1962 to February 1963, and on active duty from May 1963 to March 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Atlanta, Georgia, Regional Office (RO) of the Department of Veterans Affairs (VA). The veteran presented testimony at a hearing before the undersigned Veterans Law Judge in November 2007. A transcript is associated with the veteran's claims folder. For the reasons indicated, the claim of entitlement to service connection for residuals of a right fifth finger injury is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the veteran if further action is required. FINDINGS OF FACT 1. The veteran did not engage in combat with the enemy during military service. 2. The preponderance of the objective evidence is against finding a verifiable in-service stressor. 3. There is no diagnosis of PTSD linked to a confirmed in- service stressor. 4. There is no competent evidence indicating that a skin disorder is etiologically related to the veteran's military service, including exposure to Agent Orange. 5. There is no competent evidence indicating that bronchitis is etiologically related to the veteran's military service, including exposure to Agent Orange. 6. Entitlement to service connection for a low back disorder was denied in an April 1981 rating decision. 7. In August 2001, the RO continued the previous denial of the veteran's claim to reopen the claim for service connection for a low back disorder. 8. The evidence associated with the claims file since the August 2001 decision does not raise a reasonable possibility of substantiating the claim of entitlement to service connection for a low back disorder, to include related right lower extremity impairments. 9. In August 2001, the RO denied the veteran's claim of entitlement to service connection for a right fifth finger injury. 10. The evidence associated with the claims file since the August 2001 decision raises a reasonable possibility of substantiating the claim of entitlement to service connection for residuals of a right fifth finger injury. CONCLUSIONS OF LAW 1. PTSD was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002 & Supp 2007); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2007). 2. A chronic skin disorder was not incurred in or aggravated during military service, and such a disorder may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1110, 1116, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2007). 3. Bronchitis was not incurred in or aggravated by military service. 38 U.S.C.A. §§ 1110, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 4. The August 2001 rating decision, denying the claim to reopen a claim of entitlement to service connection for a low back disorder, is final; the evidence presented since the August 2001 rating action is not new and material. 38 U.S.C.A. §§ 5108, 7105 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.156, 20.1103 (2007). 5. The August 2001 rating decision, denying entitlement to service connection for residuals of a right fifth finger injury is final; the evidence presented since the August 2001 rating action is new and material. 38 U.S.C.A. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The requirements of the Veterans Claims Assistance Act of 2000 (VCAA) have been met. There is no issue as to providing an appropriate application form or completeness of the application. VA notified the appellant in February 2002, September 2003, December 2003, November 2005, April 2006, and December 2006 correspondence; as well as in attachments to August 2005 correspondence, of the information and evidence needed to substantiate and complete a claim, to include notice of what part of that evidence is to be provided by the claimant and notice of what part VA will attempt to obtain. VA has fulfilled its duty to assist the claimant in obtaining identified and available evidence needed to substantiate a claim. VA informed the claimant of the need to submit all pertinent evidence in his possession, and provided adequate notice of how disability ratings and effective dates are assigned. In regards to the claims to reopen previously denied claims, the veteran has been adequately informed of the specific basis for the prior denial of his claims. Kent v. Nicholson, 20 Vet. App. 1 (2006). While the appellant may not have received full notice prior to the initial decisions, after notice was provided the claimant was afforded a meaningful opportunity to participate in the adjudication of the claims, and the claims were readjudicated in a January 2007 supplemental statement of the case. The claimant was provided the opportunity to present pertinent evidence and testimony. In sum, there is no evidence of any VA error in notifying or assisting the appellant that reasonably affects the fairness of this adjudication. Regarding VA's duty to assist, it is noteworthy that service medical records from the veteran's period of service are not available. A June 2002 letter from the National Personnel Records Center, St. Louis confirmed that the veteran's medical records were loaned to the VA, Atlanta, Georgia in October 1975 but never returned. The veteran's personnel records and DD 214 discharge document are in the file. In such a situation there is a heightened duty to assist a claimant in developing his claim. O'Hare v. Derwinski, 1 Vet. App. 365 (1991). There is also a heightened obligation on the Board's part to explain its findings and conclusions, and carefully consider the benefit-of-the-doubt rule. Cromer v. Nicholson, 19 Vet. App. 215 (2005). The RO made exhaustive efforts over several decades to obtain the service medical records. The RO explained to the veteran several times that his service medical records could not be located, and no known source of these records remains unsearched. I. Service Connection To establish service connection for a disability there must be medical evidence of a current disability; medical or, in certain circumstances, lay evidence of in-service incurrence of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury (disability). Hickson v. West, 13 Vet. App. 247, 248 (1999). In deciding whether the veteran has a current disability due to military service, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307, 310-11 (1999). The chronicity provision of 38 C.F.R. § 3.303(b) is applicable where the evidence, regardless of its date, shows that the veteran had a chronic condition in service or during an applicable presumptive period and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under the United States Court of Appeals for Veterans Claims case law, lay observation is competent. Savage v. Gober, 10 Vet. App. 488, 498 (1997); 38 C.F.R. § 3.303(b). In addition, if a condition is not shown to be chronic, then generally a showing of continuity of symptomatology and competent evidence relating the present condition to that symptomatology are required. Id. Where the determinative issue involves medical causation or a medical diagnosis, there must be competent medical evidence to the effect that the claim is plausible; lay assertions of medical status do not constitute competent medical evidence. Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Service connection for PTSD requires: (1) medical evidence diagnosing PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. See 38 C.F.R. § 3.304(f)(1). The provisions of 38 C.F.R. § 4.125(a) in turn require that a diagnosis of a mental disorder conform to the American Psychiatric Association's DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 4th Edition (1994) (DSM IV). If it is determined that a veteran did not engage in combat with the enemy, or the claimed stressor is not related to combat, then the veteran's lay testimony alone will not be enough to establish the occurrence of the alleged stressor. In such cases, the record must contain service records or other corroborative evidence which substantiates or verifies the veteran's testimony or statements as to the occurrence of the claimed stressors. See Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). Under VA law and regulations, a veteran who served in the Republic of Vietnam during the Vietnam era shall be presumed to have been exposed during such service to herbicides, to include Agent Orange. 38 C.F.R. § 3.307(a)(6)(iii) (2007). If a veteran was exposed to an herbicide agent during service, certain diseases are presumed service- connected even if there is no record of such disease during service, provided that the requirements of 38 C.F.R. § 3.307(a)(6)(ii) and 38 C.F.R. § 3.307(d) regarding the time in which the disabilities must manifest and the rebuttal of the presumption are also satisfied. See 38 C.F.R. § 3.309(e). The list of diseases includes "chloracne or other acneform disease consistent with chloracne." Dermatitis and bronchitis are not presumptive diseases pursuant to 38 C.F.R. §§ 3.307, 3.309. Notwithstanding the foregoing service connection for a disability claimed as due to exposure to Agent Orange may be established by showing that a disorder resulting in disability or death is, in fact, causally linked to such exposure. Combee v. Brown, 34 F.3d 1039, 1044 (Fed. Cir. 1994). a. PTSD The veteran contends that he has PTSD due to stressors related to his service in Vietnam. These include his opening a latrine door and finding his "best friend" shot in the mouth. Reportedly, there was blood, brains, and feces everywhere. He reportedly constantly thought about this incident but did not remember the name of his best friend. He also reportedly witnessed an ammunition dump explosion. He was not at the dump at the time. He also reports hearing about a soldier getting his head cut off but no one ever confirmed this incident. The service personnel records reveal that he served as a repair parts clerk in Thailand and Vietnam. He received no awards indicative of any combat service. Treatment records from B. Dixit, M.D., were received in November 2001 revealing treatment from August through October 2001. It is noted that the veteran was referred by Mr. Harold McRae a counselor. The veteran had no psychiatric treatment until he first saw Mr. McRae two months prior. The veteran reported drinking 8 to 12 beers regularly for the past 25 years, and smoking 2 to 3 packs of cigarettes daily. He reported having nightmares and flashbacks of Vietnam. The diagnoses were major depression, PTSD, anxiety disorder not otherwise specified, and rule out alcohol abuse. No nexus opinion was offered. In a February 2002 letter from Harold W. McRae, Jr., a licensed professional counselor notes that he initially saw the veteran in July 2001. The veteran reported serving in Viet Nam from 1967 to 1968. He was referred to Dr. B. Dixit and was being treated for PTSD. No nexus opinion was offered. The veteran reported several stressor incidents. These included: Opening an outhouse door and finding his close friend shot in the mouth. Feces and brains were splattered everywhere. Witnessing an ammo dump explosion. One night North Vietnamese Army soldiers slipped into his base camp and slit the throats of 27 men in their sleep. By rating action in May 2002 entitlement to service connection for PTSD was denied. In making that determination the RO noted a current diagnosis of PTSD but no corroborating evidence of a stressful event in service. In an October 2003 stressor report the veteran reported vaguely remembering many encounters. The one stressor he constantly and continually thought about was the close friend sitting on the toilet and shot in the mouth. He could not remember the friend's name. VA Medical Center mental health clinic treatment records from May through November 2005 note a diagnosis of mood disorder due to his general medical health, rule out PTSD. A November 2006 VA Medical Center mental health psychological evaluation diagnosed PTSD noting the veteran's stressors were possible throat cancer and life phase problems. The file contains extensive and duplicate copies of documents and evidence assembled by the veteran. These provide neither a nexus opinion nor any independent confirmation of the claimed in-service stressors. Analysis In this case, the veteran had active duty in Vietnam but there is no evidence that he served in combat. Assuming, without conceding, that the diagnosis of PTSD is adequate, there remains a need to corroborate the claimed stressors. A stressor involves exposure to a traumatic event in which the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others and the person's response involved intense fear, helplessness, or horror. Cohen v. Brown, 10 Vet. App. 128 (1997). The sufficiency of a stressor is a medical determination and is presumed by a medical diagnosis of PTSD. Id. Nevertheless, the occurrence of a stressor is an adjudicatory determination. "Credible supporting evidence" is necessary to verify noncombat stressors and may be obtained from service records or other sources. The United States Court of Appeals for Veterans Claims (Court) has held that the regulatory requirement for "credible supporting evidence" means that "the appellant's testimony, by itself, cannot, as a matter of law, establish the occurrence of a noncombat stressor." Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). The record preponderates against finding that the veteran engaged in combat. Therefore, the claimed stressors require independent corroboration. Moreover, the diagnosis of PTSD must be based on an independently verified account of events. The Board is not bound to accept any diagnosis not conforming to the DSM-IV criteria and no probative weight may be assigned to any diagnoses of PTSD based on the veteran's incredible account of combat participation or unverified stressors. The veteran has identified various vague stressors which were noted in his treatment records as well as at his November 2007 Travel Board testimony. He has, in essence, repeated a particular stressor in numerous stressor reports and statements. Regarding the alleged stressor that he witnessed the remains of his closest friend in the latrine shot in the mouth, the Board finds it incredible that he cannot remember his "closest" friend's name. In addition, while the veteran has alleged this event as being a stressor which caused PTSD, it has not been addressed as such by any medical opinions. In fact, the medical opinions which support a diagnosis of PTSD were based on the likelihood that the stressors associated with the veteran's PTSD were general health conditions, including possible throat cancer and life phase problems. The veteran has not described any of the alleged events in sufficient detail such that a verification search by the U.S. Army and Joint Services Records Research Center (JSRRC) could be conducted. The veteran has been asked specifically in letters from VA for names, dates, and places in an effort to assist him in identifying any of his alleged stressors. He has testified that he could not remember the requested information. While VA is obligated to assist a claimant in the development of a claim, there is no duty on the VA to prove the claim. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). "If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence." Id. For the foregoing reasons, the Board finds that there is no credible corroborating evidence that the veteran was exposed to an in- service stressor. In the absence of a verified stressor the claim must be denied. An opinion by a mental health professional based on a post- service examination of the veteran cannot be used to establish the occurrence of the stressor. The Board is not required to accept an unsubstantiated diagnosis that the alleged PTSD had its origins in the veteran's service. West v. Brown, 7 Vet. App. 70, 78 (1994). Since the veteran's claimed stressors have not been verified, any diagnosis of PTSD was based on an unsubstantiated history that is inadequate for rating purposes, and may not be relied upon by the Board. Id. The reasonable doubt doctrine is not applicable in this case as the evidence is not evenly balanced. 38 C.F.R. § 3.102 (2007). b. Skin disorder and bronchitis including as due to Agent Orange exposure In May 2003 the veteran filed a claim for entitlement to service connection for a chronic cough and a skin condition affecting both thighs as a result of exposure to Agent Orange. In a June 2003 VA Medical Center record the veteran reported a two month history of cold symptoms. He had a nonproductive cough, and he described smoking 11/2 packs of cigarettes daily. The clinician referred him to a tobacco cessation counselor. In a December 2003 VA Medical Center dermatology consultation the veteran complained of recurrent "boils" on the legs and periumbilical area. He denied recurring scarring, or acne cysts on the face, neck, or ears. The examination was essentially negative with no clinical presence of chloracne, soft tissue sarcoma, or furunculosis. By rating actions in March and April 2004 service connection was denied for bronchitis and for a skin disorder finding that neither was incurred in or caused by service. In addition, while questionable bronchitis was noted in the treatment records, the veteran smoked 11/2 packs of cigarettes daily, and was nicotine dependent. The coughing was opined to be associated with his heavy smoking. Significantly, the evidence does not reveal any skin disorder. The April 2004 rating decision added that while the current evidence did not reveal any chronic skin disorder, dermatitis had been diagnosed. Analysis The competent evidence while substantiating the presence of a chronic cough and dermatitis, preponderates against finding that either disorder is attributable to an incident of the veteran's service, including Agent Orange exposure. Based on his service in Vietnam the veteran is presumed to have been exposed to herbicides in service. However, the current regulation pertaining to presumptive service connection of certain diseases due to Agent Orange exposure does not, include bronchitis or dermatitis as presumptive diseases. 38 C.F.R. § 3.309(e). Indeed, the Secretary of VA has determined, based on a National Academy of Science report issued in March 2005 finding no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined, that a presumption of service connection is not warranted. See Notice, 72 Fed. Reg. 32395-32407 (June 12, 2007). Notwithstanding the above, the veteran may still provide medical evidence that his herbicide exposure directly caused the disorder claimed. Combee. Notably, however, there is no medical evidence indicating or suggesting that either bronchitis or dermatitis is attributable to service including, but not limited to, the effect of herbicide exposure. As mentioned, there is no record of bronchitis or dermatitis during service. The initial evidence of coughing or possible bronchitis is recorded in a June 2003 VA Medical Center evaluation report, while no skin disorder was found in a December 2003 VA Medical Center evaluation report. These reports were prepared more than three decades following service discharge. Thus, even if there had been a confirmed skin disability or diagnosis of bronchitis during service, there was no continuity of symptomatology demonstrating ongoing illness. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). The additional records of treatment reveal no current chronic skin disorder. In addition the veteran's chronic cough unfortunately appears not to be related to bronchitis, but to his recently diagnosed larynx cancer for which service connection has been granted. Accordingly, the record preponderates against finding a competent medical basis upon which to find that a skin disorder or bronchitis have any objective relationship to service. This includes the potential likelihood of whether it is associated with the veteran's presumed herbicide exposure. The Board has considered the veteran's assertions and is mindful that his active duty service medical records are unavailable. The Board is cognizant of its heightened obligation to explain its findings and conclusions. However, while the Board does not doubt the sincerity of the veteran's belief that his bronchitis or dermatitis is related to service, to include herbicide exposure, this claim turns on a medical matter. As a layperson without the appropriate medical training and expertise, the veteran simply is not competent to provide a probative opinion on such a matter. Bostain v. West, 11 Vet. App. 124, 127 (1998). For that reason, the veteran's own unsupported assertions, without more, simply do not constitute persuasive evidence in support of the claim. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the appellant's claims, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet.App. 49 (1990). II. New and material evidence Generally, a claim which has been denied in a final rating decision may not thereafter be reopened and allowed. 38 U.S.C.A. §§ 7105. The exception to this rule is 38 U.S.C.A. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. 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 claims. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claims sought to be reopened, and must raise a reasonable possibility of substantiating the claims. 38 C.F.R. § 3.156(a) (2007). The Board must initially consider whether new and material evidence has been received because it goes to the Board's jurisdiction to reach the underlying claim and adjudicate the claim de novo. If the Board finds that new and material evidence has not been submitted, that is where the analysis must end, and what the RO may have determined in that regard is irrelevant. Further analysis, beyond consideration of whether the evidence received is new and material is neither required nor permitted. The United States Court of Appeals for Veterans Claims (Court) has held that the Board is required to review all of the evidence submitted by a claimant since the last final disallowance of a claim on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). For the purpose of determining whether a case should be reopened, the credibility of the evidence added to the record is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). a. Low back disorder In an August 2001 rating decision the RO found that new and material evidence had not been submitted to reopen the previously denied claim to reopen a claim for service connection for a low back disorder. The claim was denied because there was no evidence that the veteran's low back disorder was related to his period of service. The evidence of record revealed current treatment for a chronic and severe low back condition which was not related to any incident or injury in service. The veteran was notified of the decision and of his appellate rights, but he did not appeal. In February 2005 the veteran filed a claim to reopen a claim for service connection for a low back disorder. In an August 2005 rating decision the RO found that new and material evidence had not been submitted to reopen the claim. The claim was denied because the evidence still failed to relate the low back disorder to the veteran's period of service. In addition it was noted that the evidence of record revealed the earliest diagnosis of a low back syndrome was in September 1980, over 12 years after service, when the veteran twisted his back while getting out of his car. The evidence received was essentially duplicates of the previously considered evidence and was merely cumulative and redundant. The evidence on file at the time of the August 2001 rating decision did not include any service medical records. A search in January 1981, noted that the veteran's claims file could not be located and it was assumed to be missing. The evidence of record received on behalf of the veteran's claim included: A letter from Bruce Newson, M.D., noting no treatment records for the veteran from 1969 to 1970. Dr. Newson noted that if he had treated the veteran for a serious condition those records would have been in the current files. Records of very minor illness would be placed in storage. Treatment records from John G. Durden, M.D., including hospital admission records from September 1980 noted that the veteran suffered a twisting movement injury getting out of his car. There were no fractures, dislocations or osseous lesions. The sacroiliac joint was also normal. X-rays revealed normal lumbar spine disc space and height. Dr. Durden's records revealed a diagnosis of low back syndrome with radiation to the right leg. Evidence received since the August 2001 rating decision includes treatment records from the Tuskegee VA Medical Center noting treatment for degenerative disc disease of the lower back The new evidence does not offer any nexus opinion linking a current disorder to the veteran's period of service. The newly acquired evidence reveals no competent evidence of residuals of a low back disorder which is related to service. See 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2007); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992) (establishing service connection requires finding a relationship between a current disability and events in service or an injury or disease incurred there). Accordingly, the newly received evidence proves nothing that was not previously shown, i.e., the veteran has a low back disorder due to service but which is not supported by a medical opinion that any back injury was incurred during military service. This is not new evidence within the context of 38 C.F.R. § 3.156. The claim is denied. In reaching this decision the Board did not overlook the statements offered by the veteran and his friends. While lay witnesses are competent to describe experiences and symptoms that result therefrom, because laypersons are not trained in the field of medicine, they are not competent to provide medical opinion evidence as to the etiology of any disability. Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). Therefore, these statements are not competent. Finally, since the veteran has not fulfilled his threshold burden of submitting new and material evidence to reopen his finally disallowed claim, the benefit of the doubt doctrine is inapplicable. Annoni v. Brown, 5 Vet. App. 463, 467 (1993). b. Right fifth finger injury In an August 2001 rating decision the RO denied a claim for service connection for a right fifth finger injury. In making that determination the RO noted that the service medical records were not available. In addition the available medical evidence of record was negative for treatment of a chronic, right, small finger disorder. The veteran was notified of the decision and of his appellate rights, but he did not perfect his appeal. In August 2005 the veteran filed a claim to reopen the claim for service connection for a right little finger injury. In a March 2006 rating decision the RO found that new and material evidence had not been submitted to reopen the claim and the claim was denied. The evidence on file at the time of the August 2001 rating decision was void of any reference to treatment for a right little finger injury. Subsequent to the March 2006 rating decision the RO received several new pieces of evidence from the veteran. These included: A July 2006 medical record from Jerry Goldsmith, M.D. This evidence noted a completely healed fracture of the right little finger with severe carpometacarpal joint arthritis with almost dislocation. Several buddy statements dated in December 2006 from various friends and Army buddies attesting to the fact the veteran had no right little finger injury before service, but had one during service or shortly thereafter. Three 8x10 photographs of the veteran received January 2007, showing the veteran during service with what appears to be a deformity of his right little finger. The photographs received in January 2007 are applicable to the issue on appeal; such evidence raises a reasonable possibility of substantiating the claim as it reveals an apparent right little finger injury during service, and the claim is reopened and remanded to the RO for additional development. ORDER Entitlement to service connection for post traumatic stress disorder is denied. Entitlement to service connection for a skin disorder, including as due to Agent Orange exposure, is denied. Entitlement to service connection for bronchitis, including as due to Agent Orange exposure, is denied. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for a low back disorder. New and material evidence having been presented, the claim of entitlement to service connection for right small finger injury is reopened. REMAND The photographs received by the RO in January 2007 after the RO found that new and material evidence had not been submitted raise a reasonable possibility of allowing the claim. In light of the decision reached above, this case is remanded to the RO to comply with the due process requirements of law. Bernard v. Brown, 4 Vet. App. 384, 392 (1993). Therefore, this case is REMANDED for the following action: 1. The RO must contact the veteran and request that he identify the specific names, addresses, and approximate dates of treatment for all health care providers, private and VA, from whom he has received treatment for his right fifth finger disorder which he has not previously identified. When the requested information and any necessary authorization has been received, the RO must attempt to obtain copies of all pertinent records which have not already been obtained. The veteran should also be afforded an opportunity to submit any additional evidence, not already of record supporting his claim. 2. After completion of the above, the veteran should be afforded a VA examination for the purpose of determining the nature and etiology of any right little finger condition. The claims folder, including a copy of this REMAND and the aforementioned photographs, must be made available to and reviewed by the examiner. Based on examination findings, historical records, medical principles, and, any evidence associated with the record as a result of the development ordered above, the physician must opine whether it is at least as likely as not that a chronic right little finger disorder was incurred during service or caused by any incident in- service. A complete rationale must be provided for any opinion offered. 3. The veteran is hereby notified that it is his responsibility to report for the VA examination, to cooperate in the development of the claim, and that the consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655 (2007). In the event that the veteran does not report for any ordered examination, documentation should be obtained which shows that notice scheduling the examination was sent to the last known address prior to the date of the examination. It should also be indicated whether any notice that was sent was returned as undeliverable. 4. If, while in remand status, additional evidence or information received triggers a need for further development or assistance under the VCAA, such as providing the veteran with updated notice of what evidence has been received and not received by VA as well as who has the duty to request evidence, then such development must be undertaken by VA. 38 U.S.C.A. §§ 5100, 5103 (West 2002 & Supp. 2007); 38 C.F.R. § 3.159 (2007). 5. Thereafter, the RO should readjudicate the claim based on all the evidence of record. If any benefit sought on appeal remains denied, a supplemental statement of the case must be provided to the veteran and his representative. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). ____________________________________________ DEREK R. BROWN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs