Citation Nr: 0812042 Decision Date: 04/11/08 Archive Date: 04/23/08 DOCKET NO. 05-18 008 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a skin disorder, to include as due to herbicide exposure. 2. Entitlement to service connection for a skin disorder, to include as due to herbicide exposure. 3. Entitlement to service connection for a neck tumor, to include as due to herbicide exposure. 4. Entitlement to an initial evaluation in excess of 10 percent for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD M. Donovan, Associate Counsel INTRODUCTION The veteran served on active duty from January 1970 to September 1971. This case comes before the Board of Veterans' Appeals (Board) on appeal from June 2004 and February 2006 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. The June 2004 rating decision, in pertinent part, denied service connection for hypertension, skin problems, and a tumor on the left side of the neck, and found that the claim for service connection for PTSD remained denied because the evidence submitted was not new and material. In December 2004 the veteran testified before a Decision Review Officer at the RO (RO hearing). A transcript of that hearing is of record. During the hearing, the veteran withdrew his claim of entitlement to service connection for hypertension. In the February 2006 rating decision, the RO granted service connection for PTSD, evaluated as 10 percent disabling, effective February 10, 2004. The veteran expressed disagreement with this initial evaluation assigned. In August 2006 the veteran testified before a Decision Review Officer at the RO (RO hearing) regarding his claim for an initial evaluation in excess of 10 percent for PTSD. A transcript of that hearing is of record. In August 2007 the veteran testified before the undersigned sitting at the RO (Travel Board hearing). A transcript of that hearing is also of record. In regard to the issue of whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a skin disorder, the Board notes that the veteran initially filed a claim of entitlement to service connection for a skin disorder, and noted contact with Agent Orange, in January 1994. A January 1995 rating decision, in pertinent part, denied service connection for a skin rash. In February 2004 the veteran again filed a claim for service connection for skin problems. The June 2004 rating decision denied service connection for a skin disorder on the merits Where the claim in question has been finally adjudicated at the RO level and not appealed, the statutes make clear that the Board has a jurisdictional responsibility to consider whether it was proper for a claim to be reopened, regardless of whether the previous action denying the claim was appealed to the Board. Jackson v. Principi, 265 F. 3d 1366 (Fed. Cir. 2001). Thus, while the June 2004 rating decision addressed the merits of the service connection claim, the Board must address the issue of new and material evidence in the first instance. Therefore, this issue on appeal has been characterized as reflected on the first page of this decision. The issue of entitlement to an initial evaluation in excess of 10 percent for PTSD is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, D.C. FINDINGS OF FACT 1. The January 1995 rating decision, which, in pertinent part, denied the veteran's claim for service connection for a skin rash, is final. 2. Evidence received since the January 1995 rating decision relates to previously unestablished facts necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim. 3. A current skin disorder is related to service. 4. While the veteran served in Vietnam during the Vietnam era, and is, thus, presumed to have been exposed to herbicides during service, a lipoma is not among the disabilities recognized by VA as etiologically related to herbicide exposure. 5. There is no medical evidence of a neck tumor in service or for many years thereafter, and it is not shown by competent medical evidence to be related to service, to include presumed herbicide exposure. CONCLUSIONS OF LAW 1. The January 1995 rating decision, which denied service connection for a skin rash, is final. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. § 20.1103 (2007). 2. New and material evidence has been associated with the claims file subsequent to the January 1995 rating decision, and the claim of entitlement to service connection for a skin disorder is reopened. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156(a) (2007). 3. Service connection for a skin disorder is warranted. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2007). 4. The criteria for service connection for a neck tumor, to include as due to herbicide exposure, are not met. 38 U.S.C.A. §§ 1110, 1113, 1116, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Preliminary matters-The Veterans Claims Assistance Act of 2000 (VCAA) The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2007). The VCAA is not applicable where further assistance would not aid the appellant in substantiating his claim. Wensch v. Principi, 15 Vet App 362 (2001); see 38 U.S.C.A. § 5103A(a)(2) (Secretary not required to provide assistance "if no reasonable possibility exists that such assistance would aid in substantiating the claim"); see also VAOPGCPREC 5-2004; 69 Fed. Reg. 59989 (2004) (holding that the notice and duty to assist provisions of the VCAA do not apply to claims that could not be substantiated through such notice and assistance). In view of the Board's favorable decision in this case in regard to the application to reopen the claims for service connection for a skin disorder, and the decision on the merits, further notice or assistance is unnecessary to aid the veteran in substantiating this claim. A. The duty to notify In Pelegrini v. Principi (Pelegrini II), 18 Vet. App. 112, 120-21 (2004), the United States Court of Appeals for Veterans Claims (Court) held that under the VCAA, 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 request that the claimant provide any evidence in his possession that pertains to the claim. 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2007). An April 2004 VCAA letter advised the veteran of the information and evidence required to establish service connection for a tumor in the left side of the neck. This VCAA letter satisfied the second and third elements of the duty to notify by informing the veteran that VA would try to obtain service records and medical records but that he was nevertheless responsible for providing enough information about the records and any necessary releases to enable VA to request them from the person or agency that had them. With respect to the fourth element, the VCAA letter stated, "If you have any evidence in your possession that pertains to your claim, please send it to us." The veteran was thus adequately advised of the fourth element of the duty to notify. In Pelegrini II, the Court also held that VCAA notice should be given before an initial AOJ decision is issued on a claim. Pelegrini II, 18 Vet. App. at 119-120. VCAA notice was timely provided prior to the December 2004 rating decision. The Court has also held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). A March 2006 letter provided notice regarding disability ratings and effective dates. This letter had a timing deficiency which was remedied by the issuance of notice followed by readjudication of the claims. Mayfield v. Nicholson, 444 F. 3d 1328 (Fed. Cir. 2006). The February 2007 supplemental statement of the case (SSOC) considered the claim based on the evidence of record, remedying any timing defect regarding the notice. Thus, all required notice has been given. B. The duty to assist The VCAA also requires VA to make reasonable efforts to help a claimant obtain evidence necessary to substantiate his claim(s). 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159(c), (d) (2007). This "duty to assist" contemplates that VA will help a claimant obtain records relevant to his claim, whether or not the records are in Federal custody, and that VA will provide a medical examination and/or opinion when necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4). In the present case, the duty to assist has been fulfilled. The veteran's service medical records, service personnel records, and VA and private treatment records have been associated with the claims file. The Board notes that the veteran has not been afforded a VA examination to evaluate his neck tumor. Under the VCAA, VA is obliged to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service; and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C.A. § 5103A(d). The evidence of a link between current disability and service must be competent. Wells v. Principi, 326 F. 3d 1381 (Fed. Cir. 2003). In this case, as will be discussed in greater detail below, there is no competent evidence that the veteran has a current neck tumor which may be related to service. Thus, the Board finds that a VA examination to determine whether a neck tumor is associated with service is not warranted. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4). For the reasons set forth above, the Board finds that VA has complied with the VCAA's notification and assistance requirements. The appeal is thus ready to be considered on the merits. II. Skin Disorder Service connection is warranted where the evidence establishes that an injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303(a) (2007). Generally, to prove service connection, there must be (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in- service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Hickson v. West, 12 Vet. App. 247, 253 (1999); Pond v. West, 12 Vet. App. 341, 346 (1999). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1, 8 (1999). A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975 shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 U.S.C.A. § 1116(f); 38 C.F.R. §§ 3.307, 3.309. A disease associated with exposure to certain herbicide agents, listed in 38 C.F.R. § 3.309 will be considered to have been incurred in service even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.309. The veteran's service personnel records indicate that he served in Vietnam from February to March 1971, therefore, exposure to herbicides is presumed. The only skin disorder recognized as presumptively related to service, chloracne, is not among the skin conditions with which the veteran has been diagnosed. Consequently, the presumptive provisions of 38 U.S.C.A. § 1116 do not apply. See 38 C.F.R. § 3.309(e). Failure to establish presumptive service connection based on herbicide exposure does not preclude the veteran from establishing direct service connection. Combee v. Brown, 34 F. 3d 1039 (Fed. Cir. 1994). The veteran was initially denied service connection for a skin rash in a January 1995 rating decision. That denial was based on there being no objective evidence of current skin problems. The evidence of record at the time of the January 1995 rating decision included service medical records, reflecting complaints regarding and treatment for a facial rash, pseudofolliculitis on the face, athlete's foot on the right foot, a rash on the left arm and shoulder, and tinea versicolor. Also of record were records of VA treatment from May 1974 to February 1983 which are negative for complaints regarding or treatment for a skin disorder. The veteran did not file a notice of disagreement within one year of the January 1995 rating decision. That determination is now final. 38 U.S.C.A. § 7105(c); 38 C.F.R. § 20.302. However, the veteran may reopen his claim by submitting new and material evidence. 38 U.S.C.A. § 5108. "New evidence" means evidence not previously submitted to VA decisionmakers; "material evidence" means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim; "new and material evidence" can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and it must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). When determining whether the veteran has submitted new and material evidence sufficient to reopen a claim, consideration must be given to all the evidence since the last final denial of the claim on any basis, i.e., on the merits or denying reopening. Evans v. Brown, 9 Vet. App. 273 (1996). In the present case, the January 1995 rating decision, which the veteran did not appeal nor asked to be reconsidered, was the last final denial of the claim. Thus, the evidence to be reviewed for purposes of determining whether new and material evidence sufficient to reopen the claim has been received is the evidence that was associated with the record since January 1995. Additionally, it has been held that, in determining whether evidence is new and material, the "credibility of the evidence is to be presumed." Justus v. Principi, 3 Vet. App. 510, 513 (1992). Evidence submitted after the January 1995 denial of the veteran's claim for service connection for a skin disorder includes records of VA treatment demonstrating current skin problems. Specifically, in April 2002 the veteran presented with complaints of a rash over the left lower extremity. The impression was allergic eczema. The veteran presented in January 2004 with complaints of itching in the groin. The diagnosis was tinea. A May 2004 record of VA treatment notes that the veteran needed a refill of Clotrimazole for his skin. A July 2004 record of treatment noted that, despite Clotrimazole use, the veteran had recalcitrant groin itch. Most recently, an October 2006 record of VA treatment noted that the veteran needed something for jock itch. In addition to the foregoing, in a June 2006 statement, the veteran clarified that he was seeking service connection for a skin disorder both on a direct basis and as related to Agent Orange exposure. He stated that he first started having skin problems on active duty and that he had continued to experience those same symptoms since that time. The veteran is competent to report a continuity of symptomatology. Duenas v. Principi¸18 Vet. App. 512 (2004); Charles v. Principi, 16 Vet. App. 370 (2002). The records of VA treatment associated with the claims file since the January 1995 rating decision, and the veteran's June 2006 statement are new in that they were not previously of record, and are material, in that they demonstrate current skin problems and relate to a nexus between such skin problems and service. Therefore, this evidence raises a reasonable possibility of substantiating the claim. As such, the evidence submitted since the January 1995 rating decision is new and material, and the claim for service connection for a skin disorder is reopened. 38 C.F.R. § 3.156(a). Having determined that the claim is reopened, the Board must next consider the merits of the reopened claim. Manio v. Derwinski, 1 Vet. App. 140 (1991). In Barr v. Nicholson, 21 Vet. App. 303, 307 (2007), the Court held that establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995); see also Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303. Under § 3.303(b) an alternative method of establishing the second and/or third Caluza element is through a demonstration of continuity of symptomatology. See Savage, 10 Vet. App. at 495-97; see also Clyburn v. West, 12 Vet. App. 296, 302 (1999). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. As indicated above, VA treatment records from April 2002 to October 2006 report complaints and findings of various skin disorders, including allergic eczema, tinea in the groin, and jock itch. The foregoing medical evidence demonstrates a current skin disorder. Thus, the first criteria of a successful service connection claim is satisfied. The second element is also satisfied in this case, as the service medical records show complaints and findings of skin disorders, including athlete's foot, a rash, and tinea versicolor. In his June 2006 statement the veteran reported a continuity of skin problems since service. The veteran is competent to report the symptoms of skin problems because they are capable of lay observation. See Jandreau v. Nicholson, 492 F. 3d. 1372 (Fed. Cir. 2007). The finding of a continuity of symptomatology is bolstered by the VA treatment records which reflect ongoing complaints regarding and treatment for skin problems, specifically, itching in the groin, from January 2004 to October 2006. There is no clearly contradictory evidence. The Board finds that this continuity of symptomatology satisfies the third element of the service connection claim. See Barr v. Nicholson, 21 Vet. App. 303 (2007). The conclusion that service connection for a skin disorder is warranted is bolstered by a VA skin examination conducted in December 2005. The veteran reported that he developed a rash over his arm, shoulder, and leg and tinea versicolor in service, and that he had an itchy rash which was worse in the summer. While examination revealed normal skin of the arms, legs, and shoulder, with no residuals on examination, the examiner, who had reviewed the claims file, did note that tinea versicolor was identified on the veteran's entrance examination on January 15, 1970, but was not visible currently. While the VA examiner indicated that the January 1970 finding of tinea versicolor was made on the veteran's entrance examination, the Board notes that the veteran's entrance examination was conducted on January 12, 1970, and evaluation of the skin on that date was normal. Therefore, the December 2005 VA examination report, acknowledging tinea versicolor in service, and the veteran's complaints of skin problems (although not visible on the date of VA examination), coupled with recent VA treatment records demonstrating current skin problems, supports the claim for service connection. Based on the findings of athlete's foot, a rash, and tinea versicolor in service, the reported continuity of symptoms, and the current diagnoses of tinea and jock itch, and resolving all doubt in favor of the veteran, the Board finds that service connection is warranted. 38 U.S.C.A. § 5107(b) (West 2002). III. Neck Tumor Records of VA treatment indicate that the veteran underwent excision of a left neck lipoma in July 2003. As noted above, the veteran had service in Vietnam during the Vietnam era, thus, exposure to herbicides is presumed. However, a lipoma is not among the conditions listed in 38 C.F.R. § 3.309(e) that are recognized by VA as being etiologically related to herbicide exposure; as such, the veteran is not entitled to presumptive service connection on this basis. The Board notes that the Secretary of Veterans Affairs (Secretary) has determined that there is no positive association between exposure to herbicides and any condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Notice, 68 Fed. Reg. 27,630-41 (May 20, 2003); see also Notice, 61 Fed. Reg. 41,442-49 (1996); Notice, 59 Fed. Reg. 341-46 (1994). The Board has also considered whether the veteran's neck tumor may, in fact, be causally linked to service, to include his presumed herbicide exposure. Combee v. Brown, 34 F. 3d 1039 (Fed. Cir. 1994). Service medical records do not indicate any complaints regarding or treatment for a neck tumor in service. Separation examination in August 1971 specifically included normal clinical evaluation of the head, face, neck, and scalp, and skin. VA treatment records from May 1974 to February 2007 include a January 2003 record of treatment which notes a soft tissue mass on the neck, which had been there for the past 10 to 12 years, increasing and decreasing in size. The impression was soft tissue mass, left side of neck, rule out lipoma. The veteran underwent excision of a lipoma, left posterior neck, in July 2003. The VA treatment records do not include any medical opinion regarding etiology of this lipoma. During the December 2004 RO hearing, the veteran reported that he had a small knot in his neck in the early 1970s, just after he got out of Vietnam. He added that he did not know it was a tumor, but that it was removed in July 2003. During the August 2007 Travel Board hearing, the veteran reiterated that he first noticed a knot on his neck in service, but added that the condition was not diagnosed while he was on active duty. The veteran reported that he did not currently seek treatment for a neck tumor, as he had follow-ups after its removal, but that it was fine. While the veteran has described a small knot on his neck in service, and the VA treatment records reveal a lipoma which was removed in July 2003, he has not specifically asserted a continuity of symptomatology of this condition. Rather, the first mention of a soft tissue mass on the neck during VA treatment, in January 2003, included the description of this condition as being present for the past 10 to 12 years. The Board notes that the fact that the record does not reflect the veteran making complaints regarding, or seeking treatment for a neck tumor until over 30 years after service, weighs against the finding of a nexus between that condition and service. Maxson v. Gober, 230 F. 3d 1330, 1333 (Fed. Cir. 2000). Even if the veteran's recent testimony that he had a knot on his neck in service, which was later removed in July 2003, could be read as claiming a continuity of symptomatology, such history would be contradicted by the separation examination, the medical records from May 1974 to February 1983, which show no complaints or findings referable to a neck tumor, to include a January 1976 report of VA hospitalization which specifically noted that the veteran's physical examination was essentially negative, and the January 2003 VA treatment record, which describes a soft tissue mass on the left neck present for 10 to 12 years. See Buchanan v. Nicholson, 451 F. 3d 1331, 1336-7 (Fed. Cir. 2006) (holding Board is obligated to, and fully justified in, determining whether lay testimony is credible in and of itself, because of conflicting statements, and that the Board may weigh the absence of contemporary medical evidence against lay statements). Therefore, review of the record reveals no competent medical evidence linking the veteran's neck lipoma to service, to incude presumed herbicide exposure. While the veteran himself has made the claim of service connection, as a layperson he is not competent to express an opinion as to medical causation, as he has neither claimed, nor shown, that he is a medical expert, capable of rendering medical opinions. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). In the absence of competent evidence of a nexus between a neck tumor and service, to include presumed herbicide exposure, the service connection claim must be denied. Based on the foregoing, the Board finds that the preponderance of the evidence is against the claim. Since the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim is denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER New and material evidence having been submitted, the claim of entitlement to service connection for a skin disorder, to include as due to herbicide exposure, is reopened. Entitlement to service connection for a skin disorder is granted. Entitlement to service connection for a neck tumor, to include as due to herbicide exposure, is denied. REMAND VA is required to make reasonable efforts to help a claimant obtain records relevant to his claim, whether or not the records are in Federal custody. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159(c) (2007). At the August 2007 Travel Board hearing the veteran reported that he was receiving treatment for PTSD at the Jackson VA Medical Center (VAMC), and that he was most recently treated one month earlier. The most recent VA treatment records in the claims folder are from February 2007. As any records of treatment for the veteran's PTSD since February 2007 are potentially pertinent to the claim on appeal and within the control of VA, they must be obtained and associated with the claims file. Dunn v. West, 11 Vet. App. 462, 466-67 (1998); Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). The veteran also reported during the August 2007 Travel Board hearing that he received treatment for PTSD at the Jackson Vet Center, and that he had most recently received treatment about two months earlier. The most recent records of treatment from the Jackson Vet Center are from May 2006. VA has an obligation to seek to obtain these more recent records of treatment from the Jackson Vet Center. 38 U.S.C.A. § 5103A(c). The veteran's PTSD was evaluated at VA examination in December 2005. The veteran is entitled to a new VA examination where there is evidence (including his statements) that the condition has worsened since the last examination. Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994); VAOPGCPREC 11-95 (1995). At the December 2005 VA examination, the examiner noted that the veteran met the criteria for diagnoses of both PTSD and major depressive disorder. The examiner noted that the veteran's depression appeared to cause more impairment in industrial and social functioning than PTSD, and assigned a Global Assessment of Functioning (GAF) score of 60 for major depressive disorder, which caused moderate impairment, and assigned a GAF score of 65 for PTSD, which caused mild impairment. Records of VA treatment since the December 2005 VA examination include April, September, and December 2006 and February 2007 records of treatment in which the impression was chronic PTSD and anxiety state not otherwise specified, decline in functioning due to psychosocial stressors. These records note GAF scores ranging from 50 to 55. These VA treatment records, noting a decline in functioning, and the lower GAF scores, suggest a worsening of the veteran's PTSD since the December 2005 VA examination. During the August 2007 Travel Board hearing, the veteran indicated that he was having problems with his memory, which had been found to be grossly intact for recent and remote events during the December 2005 VA examination. The veteran indicated during the Travel Board hearing that he would be willing to report for a new VA examination to evaluate his PTSD. As the recent records of VA treatment and the veteran' testimony reflect a worsening of PTSD symptoms since December 2005, the Board finds that a new VA examination is warranted. Finally, the Board is also aware of the Court's recent decision in Vazquez-Flores v. Peak, 22 Vet. App. 37 (2008). In Vazquez-Flores, the Court found that, at a minimum, adequate VCAA notice requires that VA notify the claimant that, to substantiate a claim for an increased rating: (1) the claimant must provide, or ask VA to obtain, medical or lay evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on the claimant's employment and daily life; (2) if the diagnostic code under which the claimant is rated contains criteria necessary for entitlement to a higher disability rating that would not be satisfied by the claimant demonstrating a noticeable worsening or increase in severity of the disability and the effect of that worsening on the claimant's employment and daily life (such as a specific measurement or test result), the Secretary must provide at least general notice of that requirement to the claimant; (3) the claimant must be notified that, should an increase in disability be found, a disability rating will be determined by applying relevant diagnostic codes; and (4) the notice must also provide examples of the types of medical and lay evidence that the claimant may submit (or ask VA to obtain) that are relevant to establishing entitlement to increased compensation. On remand, the veteran should be sent corrective notice which complies with Vazquez-Flores. Accordingly, the case is REMANDED for the following action: 1. Send the veteran a corrective notice letter which complies with Vazquez-Flores v. Peak, 22 Vet. App. 37 (2008). 2. Request all records of VA treatment for PTSD since February 2007. 3. Request all records of treatment for PTSD from the Jackson Vet Center since May 2006. 4. Schedule the veteran for a VA examination to evaluate PTSD. The examiner should review the claims file and note such review in the examination report or in an addendum. The examiner should provide an assessment of the veteran's level of social and occupational impairment, and should discuss his or her rationale for such an assessment. The examiner should comment on any depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, or memory loss, as well as the veteran's ability to establish and maintain effective work and social relationships. The examiner should also report the veteran's Global Assessment of Functioning (GAF) score resulting from his PTSD, and explain what that specific score represents. The requested findings are needed in order to evaluate the veteran's disability in accordance with the rating schedule, it is therefore imperative that the examination report contain the requested findings. 5. After ensuring the above, and any additional development deemed appropriate, is complete, re-adjudicate the claim. If the claim is not fully granted, issue a supplemental statement of the case before returning the claim to the Board, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matter that 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). ______________________________________________ JOHN L. PRICHARD Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs