Citation Nr: 0813239 Decision Date: 04/22/08 Archive Date: 05/01/08 DOCKET NO. 95-25 194 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUES 1. Entitlement to service connection for an eye disorder, on a primary basis as a residual of disease or injury in service. 2. Entitlement to service connection for sinusitis. 3. Entitlement to service connection for a heart disorder. 4. Entitlement to service connection for cold weather injuries. 5. Entitlement to service connection for prostatitis. 6. Entitlement to service connection for the residuals of taking Seldane and Erythromycin, with blackouts and dizziness. 7. Entitlement to service connection for a skin disorder. 8. Entitlement to service connection for a psychiatric disorder. 9. Entitlement to service connection for bilateral pes planus. 10. Entitlement to service connection for the residuals of a left hand injury. 11. Entitlement to service connection for chronic gastritis. 12. Entitlement to an increased rating for residuals of a cervical strain and traumatic cervical spondylosis, initially rated as 10 percent disabling prior to January 26, 2005, and as 20 percent disabling as of that date. 13. Entitlement to an initial disability rating in excess of 10 percent for degenerative joint disease of the right knee and donor site residuals of a right knee bone graft. 14. Entitlement to an increased rating for the post operative residuals of right subtalar joint fusion, initially rated as 10 percent disabling prior to December 1, 2003, and as 20 percent disabling as of that date. 15. Entitlement to an increased rating for an irritable bowel syndrome, initially rated as noncompensable prior to February 3, 2005, and as 10 percent disabling as of that date. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD Clifford R. Olson, Counsel INTRODUCTION The veteran served on active duty from May 1976 to May 1979 and from August 1984 to February 1993. This matter came before the Board of Veterans' Appeals (Board) from a March 1994 decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. The veteran currently resides in the jurisdiction of the Pittsburgh, Pennsylvania VARO. The case was previously before the Board in June 1999, it was determined that new and material evidence had been received to reopen claims for service connection for a psychiatric disorder, pes planus, residuals of a left hand injury, and chronic gastritis. The Board remanded the case for further development. The requested development has been completed. The Board now proceeds with its review of the appeal. When the case was previously before the Board, in June 1999, the issues included service connection for an eye disorder and the veteran was claiming that conjunctivitis in service resulted in a visual impairment. This claim will be decided below. At his January 2008 Board hearing, the veteran asserted that blindness in one eye is service-connected. The evidence shows that this was incurred after the Board's remand, in a fall that could be a suicide attempt related to a psychiatric disorder. The veteran is claiming service connection for a psychiatric disorder. Because this eye impairment is different from that originally claimed, and because the etiology is different from the original claim, this is a new claim. It is referred to the RO for adjudication in the first instance, after readjudicating the claim for service connection for a psychiatric disorder. In June 2006, while the case was in remand status, the RO granted a 20 percent rating for residuals of a cervical strain and spondylosis, effective January 26, 2005; and a 10 percent rating for an irritable bowel syndrome, effective February 3, 2005. The veteran specifically disagreed with the effective dates and a statement of the case (SOC) as to the effective dates was issued in February 2007. A March 2007 statement by the veteran's representative meets the requirements for a timely substantive appeal. Moreover, since the grants were not the maximum ratings assignable, the originally perfected appeals for higher ratings encompass the effective dates of increase. See Shipwash v. Brown, 8 Vet. App. 218, 224 (1995). In January 2008, a hearing was held before the undersigned Veterans Law Judge, who is the Board member making this decision and who was designated by the Chairman to conduct that hearing, pursuant to 38 U.S.C.A. § 7102(b) (West 2002). The issues of entitlement to service connection for sinusitis, a skin disorder, a psychiatric disorder, and residuals of a left hand injury, as well as the claims for increased ratings, 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. FINDINGS OF FACT 1. There is no competent medical evidence that the veteran currently has an eye disorder, on a primary basis as a residual of disease or injury in service. 2. There is no competent medical evidence that the veteran currently has a heart disorder. 3. There is no competent medical evidence that the veteran currently has residuals of cold weather injuries. 4. There is no competent medical evidence that the veteran currently has prostatitis. 5. There is no competent medical evidence that the veteran currently has any residuals of taking Seldane and Erythromycin, including blackouts and dizziness. 6. Bilateral pes planus was noted when the veteran was examined and accepted for service and there is no competent medical evidence that it increased in severity during service. 7. There is no competent medical evidence that the veteran currently has chronic gastritis. CONCLUSIONS OF LAW 1. An eye disorder, on a primary basis as a residual of disease or injury in service, was not incurred in or aggravated by active military service and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 101(16), 1101, 1110, 1112, 1131, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 4.9 (2007). 2. A heart disorder was not incurred in or aggravated by active military service and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 101(16), 1101, 1110, 1112, 1131, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2007). 3. Residuals of cold weather injuries were not incurred in or aggravated by active military service and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 101(16), 1101, 1110, 1112, 1131, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 4.9 (2007). . 4. Prostatitis was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2007). 5. Residuals of taking Seldane and Erythromycin, including blackouts and dizziness, were not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2007). 6. Bilateral pes planus was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2007). 7. Chronic gastritis was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs (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). Duty to Notify Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his 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 possession that pertains to the claim in accordance with 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In the present case, the unfavorable AOJ decision that is the basis of this appeal was already decided and appealed prior to the enactment of the current section 5103(a) requirements in 2000. The U.S. Court of Appeals for Veterans Claims (Court) acknowledged in Pelegrini that where, as here, the § 5103(a) notice was not mandated at the time of the initial AOJ decision, the AOJ did not err in not providing such notice. Rather, the appellant has the right to a content complying notice and proper subsequent VA process. Pelegrini, 18 Vet. App. at 120. Errors in notice may be cured by issuance of a fully compliant notice, followed by readjudication of the claim. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). With regard to the issues decided herein, a VCAA content complying notice was sent to the veteran in July 2004 and he was 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 by way of a supplemental statement of the case (SSOC) issued in December 2004, a rating decision issued in June 2006, and a SSOC issued in November 2006. In Dingess v. Nicholson, 19 Vet. App. 473 (2006), 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 this case, the notice was provided in November 2006. Because the VCAA was not in effect at the time of the initial rating, the initial notice did not address either the rating criteria or effective date provisions that are pertinent to the appellant's claim. Nevertheless, such error was harmless given that service connection is being denied, and hence no rating or effective date will be assigned with respect to the issues decided herein. Duty to Assist 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. The Board finds that, for the issues decided herein, 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 the service medical records and VA records. The veteran has been examined and medical opinions obtained. The veteran testified at RO and Board hearings. All treatment records identified by him have been obtained. 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 claim 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 claim. 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). Service Connection In order to establish service connection, three elements must be established. There must be medical evidence of a current disability; medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See 38 U.S.C.A. §§ 101(16), 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2007); see also Hickson v. West, 12 Vet. App. 247, 253 (1999). It is not enough to show injury during service, there must currently be a residual disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). There must be a current disability. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). An Eye Disorder, on a Primary Basis as a Residual of Disease or Injury in Service The veteran is seeking service connection for a psychiatric disability and has testified that he lost the sight in one eye due to a suicide attempt. The issue of entitlement to service connection for a psychiatric disability is the subject of a remand at the end of this decision. Service connection may be granted for a disability which is proximately due to and the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (2007). As a secondary condition and claim, residual blindness from a suicide attempt, has been referred to the RO for initial adjudication and will not be further discussed here. This part of the decision addresses the initial claim that conjunctivitis in service resulted in an eye disability. At his January 2008 Board hearing, the veteran testified that he was temporarily blinded in service due to an eye infection diagnosed as conjunctivitis. He reported subsequent treatment for his refractive error and blindness due to an injury in a suicide attempt. The blindness resulting from the suicide attempt will be addressed separately, following remand development of the psychiatric claim. The veteran did not identify any current diagnoses of conjunctivitis or its residuals. A review of the veteran's service medical records reveals that in June 1976 he was seen complaining that his vision blurred after reading for a short while; the veteran reported that he had worn glasses two years previously and that he had worn glasses since 1962; uncorrected vision was noted to be 20/20 bilaterally at the time. A diagnosis was not indicated. Upon entering his second period of service, it is noted that the veteran wore glasses (according to the March 1984 report of medical history). The veteran was diagnosed with hyperopic astigmatism in March 1985 and March 1986. In July 1986, he was seen complaining of bilateral eye irritation, redness, and itching after wearing contact lenses for three days. He was diagnosed with a conjunctival infection and photophobia. In February 1987, he was diagnosed with resolving kerectasis secondary to wearing his contact lenses overnight. In July 1990, he was diagnosed with superficial punctate keratitis of the left eye secondary to Bell's palsy. In January 1992, he was diagnosed with allergic conjunctivitis by history. A current eye disability was not diagnosed. The veteran's eyes were examined by VA in November 1993. The diagnosis was hyperopic presbyopia, correctable to 20/20 bilaterally. However, hyperopia and presbyopia are types of refractive error. See M21-1, Part VI, Subchapter II, para. 11.07(a)(b) (February 1997). VA regulations provide that refractive error of the eye is not a disease or injury within the meaning of the applicable legislation providing compensation benefits. 38 C.F.R. §§ 3.303(c), 4.9 (2007). During the November 1997 RO hearing, the veteran testified that he contracted photophobia as a result of wearing contact lenses, but that he no longer suffers from this condition. However, he reported that his eyes water. On optometry examination in February 2003, no residuals of conjunctivitis were identified. The conjunctivae were white and quiet. The right eye did have epiretinal membrane changes and optic neuropathy, which were noted to coincide with the veteran's head trauma. When the veteran was seen at a VA optometry clinic, in November 2003, he reported a head injury 3 years earlier and a decrease in vision in the right eye for one year. Corrected visual acuity was 20/40 on the right and 20/20 on the left. A detailed report has repeatedly normal findings, including the conjunctivae. The examiner expressed the opinion that the visual deficits were due to optic atrophy caused by the head injury 3 years earlier. There was no other diagnosis. No residuals of conjunctivitis were identified. Conclusion As explained to the veteran in the July 2004 VCAA letter, service connection requires evidence of a current disability. Further, that evidence must be competent, such as a diagnosis from a trained medical professional. 38 C.F.R. § 3.159 (2007). In this case, the veteran has not identified and the record does not show any competent medical diagnosis of a disability resulting from conjunctivitis in service. The evidence is to the contrary. It contains reports of examinations of the veteran after service, which show that the veteran has refractive error and residuals of a post service head injury. These post service medical reports form a preponderance of evidence, which establishes that the veteran does not currently have residuals of the eye infection in service. Without a current disability, service connection cannot be granted. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable and the appeal must be denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). A Heart Disorder Cardiovascular disease, including hypertension, and arteriosclerosis may be presumed to have been incurred during active military service if it is manifest to a degree of 10 percent within the first year following active service. 38 U.S.C.A. §§ 1101, 1112, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2007). At his January 2008 Board hearing, the veteran testified that during service he was found to have a mitral valve prolapse and experienced heart palpitations. He reported that he still had palpitations. He acknowledged that he had been tested, including stress tests, but the doctors could not tell the cause of the palpitations. He said that he had been to a cardiologist, but the doctor was not able to diagnose anything in particular. They said it was a T-wave abnormality. He had not been treated with medication. The service medical records for the veteran's first period of service do not contain any complaints, findings, or diagnoses of a heart disorder, including palpitations. The report of a May 1979 chest examination indicates that the veteran did not have a history of or current cardiopulmonary disease. The report of the May 1979 separation examination reflects a normal heart and vascular system. The records covering the veteran's second period of service reveal that he was seen complaining of chest pain in April 1991 and of right sided chest pain in June 1991. In June 1991, it was noted that his heart had a regular rhythm and rate, and that he was diagnosed with probable airway disease. An undated record noted that the veteran gave a past medical history of mitral valve prolapse. An August 1993 record (an evaluation for the Medical Evaluation Board) indicates that the veteran gave a history of mitral valve prolapse associated with intermittent stabbing pains in his chest; on examination, direct pressure reproduced these symptoms to a degree. The relevant diagnosis noted in this record was history of mitral valve prolapse, existing prior to service ("EPTS"). A November 1992 record indicates that an echocardiogram found the veteran's heart to be within normal limits at that time. A report from the Medical Evaluation Board dated the day after this evaluation notes the that the veteran had a history of mitral valve prolapse that was permanently aggravated by service. The Board notes that there are no clinical findings or an explanation to support this conclusion. After service, in November 1993, the veteran had a VA cardiovascular examination. The diagnosis was recurrent chest pain of noncardiac origin and the examiner specified that he found no evidence of mitral valvular prolapse or other cardiac disorder. The Board notes that the examination report reflects that in addition to examining the veteran, the examiner thoroughly reviewed all of the medical evidence of record - including the veteran's service medical records - in arriving at his conclusions. The Board notes that the veteran was hospitalized from March to April 1996 for psychiatric difficulty; the report of this admission lists diagnoses of chest pain of unknown etiology and rule out mitral valve prolapse. At his November 1997 RO hearing, the veteran testified that he has a heart disorder - mitral valve prolapse - that had its onset during his second period of service, and that his chest pain, while not treated with medication in service, was currently treated with nitroglycerin. In October 1998, the veteran was seen at the emergency room of a university hospital. He complained of abdominal pain. He reported chest pain with exertion, relieved by rest and nitroglycerin. He denied palpations, irregular beats, orthopnea, diaphoresis or dizziness. His heart rhythm and first and second heart sounds were normal. There were no murmurs rubs or gallops. The record includes extensive subsequent private and VA clinical records. These records do not document any cardiovascular disease, and certainly do not link such disease to service. The veteran has submitted the report of a detailed examination by his private physician, J. A., M.D., in January 2007. Blood pressure was within normal limits at 140/78 and pulse was regular at 80. The heart had a regular rate without murmur. There was no cardiovascular diagnosis. Dr. J. A. examined the veteran again, in March 2007, with normal findings. Blood pressure was normal at 120/64 and pulse was regular at 72. Conclusion The veteran feels that he has a cardiovascular disorder and that it began in service; however, there is no competent medical evidence confirming that claim. The service medical records show only a history provided by the veteran and do not have actual findings by trained medical personnel that document any chronic cardiovascular disease during service. There is no competent evidence that a cardiovascular disease was manifested in the year following service. Most importantly, there is no competent evidence that the veteran currently has cardiovascular disease. As discussed above, service connection is granted for disabilities and, without a current disability, service connection cannot be granted. In this case, the medical evidence is substantially more probative than the veteran's claims and provides a preponderance of evidence, which establishes that the veteran does not have the claimed heart disorder. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable and the appeal must be denied. 38 U.S.C.A. § 5107(b); Gilbert; Ortiz. Cold Weather Injuries The veteran testified, during his January 2008 Board hearing, that he had hypothermia and frostbite, as a result of cold exposure during a training exercise in his second period of service. He described prolonged exposure during training. He particularly reported that the cold weather injury involved his left hand. He believed it caused a knot at the base of his thumb and arthritic symptoms, as well as a stabbing sensation in his fingers and hands. The symptoms were particularly acute in cold weather. The service medical records for the veteran's first period of service do not document any complaints, findings, or diagnoses of cold weather injuries. The May 1979 separation examination is negative for any such treatment or complaints, showing the upper and lower extremities to be normal. In December 1979, the veteran was seen at a VA medical center for complaints including his hands sweating on and off, for little or no reason, in hot or cold weather. There were also foot complaints. X-rays of the hands showed only old trauma to the ungula tuft of the right index finger. There were no arthritic changes. The left foot was normal. The right foot had a deformity of the talus at the talo-navicular joint. (Service connection has been established for the right foot changes.) The veteran's extremities were examined and diagnosed. There were no cold weather injury diagnoses. During his second period of service, in August 1985, the veteran was seen complaining of right toe numbness while stationed at Fort Benning, Georgia. The record of this complaint does not indicate that this was related to cold weather exposure and there was no diagnosis documented regarding the toe. In February 1988, while stationed at Fort Lewis, he was seen complaining of numbness in his finger tips and toes, and pain in his hands, due to his exposure to cold weather. He related that pain in his hands began one week prior to his complaint. In early February 1988 he was diagnosed with mild sensory loss; a week later cold induced metatarsalgia was ruled out and he was assessed with a history of cold exposure without documentation. In July 1990, the veteran complained of numbness in his right buttock, leg, and foot. Examination led to the impression that the symptomatology was due to a lower back disorder. On the November 1993 VA general examination, the veteran was not diagnosed with any cold weather injuries. On neurological examination, the veteran did complain of paresthesias about the fingertips but noted that this was experienced while at home sleeping and was not present during the examination. No diagnosis in this regard was made by the examiner. During his November 1997 RO hearing, the veteran testified that as a result of exposure to cold in service, he currently experiences pain in his fingertips two to three times a week, and is bothered by the weather. Conclusion The veteran believes that he has residuals of exposure to cold. As a lay witness, he is not competent to diagnose any symptoms he may feel. 38 C.F.R. § 3.159; see also Espiritu v. Derwinski, 2 Vet. App. 492 (1992). He has made this assertion to physicians, but they have not validated his self diagnosis. Review of the extensive record does not disclose any competent medical evidence confirming that claim. As noted above, service connection is granted for disabilities and, without competent medical evidence of a current disability, service connection cannot be granted. The medical evidence in this case is substantially more probative than the veteran's claims and provides a preponderance of evidence, which establishes that the veteran does not have residuals of exposure to cold. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable and the appeal must be denied. 38 U.S.C.A. § 5107(b); Gilbert; Ortiz. Prostatitis At his January 2008 Board hearing, the veteran testified that he had been followed by an urologist throughout service and had been on antibiotics several times. He reported experiencing pain in the prostate gland. He said he continued to have problems up until a year ago. As to symptoms, he reported having a discharge with a bowel movement. A review of the service medical records covering the veteran's first period of service reflects that the veteran was provisionally diagnosed with (the impression noted on the bottom of this medical report is illegible) chronic prostatitis/urethritis in June 1977 when seen complaining of a history of urethral discharge. In March and April 1978 he was diagnosed with recurrent prostatitis, and with nonspecific urethritis in July 1978 after again complaining of a urethral discharge. A diagnosis of prostatitis was made in April 1979. The May 1979 separation examination report reflects, however, that the veteran's genitourinary system was normal at the time. A review of the records from the veteran's second period of service reflects that he was again diagnosed with possible urethritis in September 1985 and possible prostatitis in January 1986. In early June 1989 the veteran complained of a discharge from his penis when defecating. The possibility of prostatitis was considered. The veteran was referred for further examination. A rectal examination showed no masses, tenderness or gross blood. The prostate was slightly boggy. Laboratory studies were done. Later that month, a rectal examination showed there was no abnormality as to size or consistency. A proctoscopic examination was within normal limits. At the end of June 1989, the case was reviewed and it was concluded that the veteran had questionable resolving prostatitis verses questionable Chlamydia or a possible lack of bulk in his diet. He was again diagnosed with questionable prostatitis in July 1989. Prostatic message in August 1989 resulted in a physiologic discharge. Laboratory study of the expressed fluid did not reveal any organisms or other abnormality. In December 1992, the veteran was provisionally diagnosed with prostatitis; following an examination at that time, he was ultimately diagnosed with likely Chlamydia urethritis/prostatitis. After service, the veteran was examined by VA in November 1993. The report of that examination shows that the veteran's prostate was small, soft, smooth, and symmetrical at the time. The result of this examination was a diagnosis of chronic prostatitis by history, which is not a current diagnosis. The veteran was hospitalized at a VA medical center for approximately 23 days for his psychiatric disorder, in March and April 1996. A history of prostatitis was noted but there were no relevant complaints or findings. During the November 1997 RO hearing, the veteran testified that he continued to suffer from prostatitis since service, and currently suffered from the disorder. A VA clinical note, dated in August 1998, shows the veteran reported an occasional discharge of pus from his penis. He had 3 to 4 healed lesions on the shaft of the penis. There was no discharge, redness, or pain. On rectal examination, the prostate was not tender and there was no evidence of acute prostatitis. The examiner commented that he might have some chronic prostatitis and an antibiotic was recommended. The same physician saw the veteran again in September 1998 and noted the veteran's complaint of pus coming out of his penis during bowel movements. His last urinalysis was negative and no obvious abnormalities were detected on physical examination, aside from 3 to 4 healed lesions in the genital area. It was noted that he had completed the course of antibiotics. In October 1998, the veteran was seen at the emergency room of a university hospital. He complained of abdominal pain. The veteran gave a history of genitourinary symptoms and reported that he had no recent prostate symptoms. Genitourinary examination was benign except for two small easily reducible hernias. Rectal examination revealed a nontender prostate gland. Urinalysis was unrevealing. There was no prostate or genitourinary diagnosis. In January 1999, it was reported that a microbiology study was positive for Gardnerella vaginosis and the veteran was treated accordingly. The veteran was hospitalized at a VA medical center for approximately 5 days for his psychiatric disorder, in April and May 1999. A history of prostatitis was noted but there were no relevant complaints or findings and urinalysis was normal. In March 2000, the veteran gave a history of chronic prostatitis and reported that a whitish uretral discharge was present on bowel movements. It was noted that these complaints had been unresponsive to antibiotics and past cultures had been negative. Further evaluation was recommended. The veteran was seen at a VA emergent care center in November 2002. His chief complaint was frequent urination, 4-5 times at night. He also complained of mucous discharge through the penis on defecation. Otherwise, there was no burning sensation and he had a good urinary stream. Rectal examination showed no enlargement of the prostate gland, but there was some tenderness. A urinalysis had been negative for leukocytes, nitrites, blood, and protein. On microscopic examination, white blood cells were less than 2. It was noted that a urinary tract infection was ruled out by the urinalysis and microscopic examination, but there was still a possibility of chronic prostatitis. Evaluation by the urology service was recommended. A VA clinical note shows that in December 2002, the veteran complained of chronic prostatitis and an antibiotic was prescribed. However, no symptoms were reported or manifestations documented. A genitourinary examination was scheduled. The report of the VA genitourinary examination, in March 2003, shows that the veteran was examined for his complaints of chronic prostatitis and a discharge from his penis during defecation. He reported awakening once a night to urinate. He described his stream as strong. He denied urinary hesitancy, frequency, incontinence, and dysuria. He had had an episode of renal calculus in 1994 or 1995, which passed spontaneously, without recurrence. He usually felt empty after voiding. Tests of urine had normal gravity and acidity, and were otherwise negative. Prostate screening antigen (PSA) tests, in 1998, twice in 1999, and twice in 2002, had been consistently within normal limits. Examination showed the external genitalia to be within normal limits. The veteran refused digital rectal examination. The impression was that there was no significant evidence of genitourinary pathology; no evidence of prostatitis by urinalysis or PSA history. Conclusion The VA clinical notes contain several assessments of chronic prostatitis based on history provided by the veteran. However, those are not persuasive because, as a lay witness, the veteran lacks the training and experience to diagnose himself. 38 C.F.R. § 3.159(a); see also Espiritu; Warren v. Brown, 6 Vet App 4 (1993). Additionally, the record shows he has had a genitourinary infection and he does not have the medical expertise to diagnose it as prostatitis. Rather, the diagnosis provided by the trained medical personnel, based on pathology studies is substantially more persuasive. Further more, the opinion of the trained medical professional is much more persuasive than the veteran's claims because it is explained. Here, a physician explained that based on pathology, urinalysis, and PSA history, there was no evidence of prostatitis. It should also be noted that rectal examinations over the years have not revealed any evidence of prostatitis. The competent medical evidence forms a preponderance of evidence which outweighs the veteran's lay self-diagnosis. The medical evidence establishes that the veteran does not currently have prostatitis, so service connection for such disability cannot be granted. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable and the appeal must be denied. 38 U.S.C.A. § 5107(b); Gilbert; Ortiz. Residuals of Taking Seldane and Erythromycin The veteran testified, during his January 2008 Board hearing, that when he was in service, his allergies were being treated with Seldane, and he was subsequently prescribed erythromycin as a precaution for dental work. He recounted that be began having blackouts and heart palpitations, and losing track of time. The records for the veteran's first period of service do not reflect treatment with Seldane and erythromycin, a diagnosis of their residuals, or the claimed residuals of blackouts and dizziness. The May 1979 separation examination is negative for any such treatment or complaints. During the veteran's second period of service, in August 1992, he was seen for a near syncopal episode while driving and taking Seldane. At that time, he complained of recurrent episodes since he stopped taking Seldane. He further related that, in June 1992, he began taking Seldane for allergies and subsequently, while driving, experienced four episodes of lost vision without losing consciousness; each episode reportedly lasted "seconds." The veteran further reported palpitations and chest pain. He noted that he then took erythromycin prior to having dental work done, and that this caused him to feel ill. The veteran was assessed with presyncopal episodes on Seldane; it was noted that there was concern that these episodes continued or would continue, but that this could not be proven. The post service medical evidence of record is negative for any complaints of or treatment for any residuals of taking Seldane and erythromycin, to include blackouts and dizziness. The report of a November 1993 VA psychiatric examination indicates that the veteran had a history of a seizure after being treated with Seldane and erythromycin (which, obviously, is not a current diagnosis). During the November 1997 RO hearing, the veteran testified that he has continued to suffer from the residuals of taking Seldane and Erythromycin; specifically, he noted that occasionally his mind and senses "go blank," including when he is driving. Extensive medical records have subsequently been developed. These records do not provide competent medical documentation of any residuals of taking Seldane and erythromycin, including blackouts and dizziness. Conclusion The veteran reports that he has occasional episodes when his mind goes blank and diagnoses these as the residuals of medication taken years ago. However, any lay statements made by the veteran do not provide a sufficient basis to conclude that he currently has residuals of taking Seldane and erythromycin. 38 C.F.R. § 3.159(a); see also Espiritu. There is no competent medical evidence of record demonstrating that the veteran currently suffers from the residuals of taking Seldane and erythromycin, with blackouts and dizziness. The veteran has had extensive recent medical examination and evaluations, without any of the medical reports identifying residuals of these medications. The recent medical reports form a preponderance of evidence in this case and establish that the veteran's medical problems do not include any residuals of taking Seldane and erythromycin. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable and the appeal must be denied. 38 U.S.C.A. § 5107(b); Gilbert; Ortiz. Pes Planus At his January 2008 Board hearing, the veteran testified that he had flat feet before service. He felt that the stresses of running and other training aggravated his condition. He reported that it required the service to issue him arch supports and he continued to need treatment. He pointed out that foot surgery was required. The veteran had several right foot surgeries and service connection has been granted for the residuals. Specifically, service connection has been granted for the post operative residuals of a right subtalar joint fusion. This is currently rated as 10 percent disabling under diagnostic code 5272, pertaining to ankylosis of the subastragalar or tarsal joint. On the December 2003 VA examination of the veteran's joints, the doctor noted that the veteran's service-connected disability is more appropriately called a right foot disability, rather than a right ankle disability. The same disability cannot be compensated twice under different diagnostic criteria. 38 C.F.R. § 4.14 (2007). Therefore, the question becomes did disease or injury in service result in any additional pes planus, beside the foot condition that has already been service-connected. When the veteran was examined for his first period of service, the May 1976 pre-enlistment examination disclosed pes planus. In April 1979, he was seen complaining of flat feet for two to three months and was apparently fitted for arch supports. There is, however, no indication in these records, including on the May 1979 separation examination report, that the veteran's preexisting pes planus increased in severity during his first period of service. The report of a December 1979 VA examination shows that the veteran had worn arch supports during his youth, and that physical examination of the feet revealed an ankle pronated to 6 degrees, and flat longitudinal and metatarsal arches. X-rays were negative, and the relevant diagnosis was pes planus, third degree, symptomatic. The report of an August 1981 VA examination also notes a diagnosis of third degree pes planus. There is no indication in these records that the veteran aggravated his preexisting pes planus during his first period of active duty. A review of the service medical records covering the veteran's second period of active duty service reflects that pes planus was a noted on the March 1984 entrance examination report. In October 1985, he was seen complaining of foot pain and was diagnosed with symptomatic pes planus. In March 1988 he seen complaining that his orthotics were not working and he was ordered new ones; the diagnosis noted in this March 1988 record was rigid pes planus; a similar diagnosis was noted in July 1988. X-rays taken of the right foot in October 1988 revealed the pes planus deformity, and at that time the veteran was seen complaining of right foot and ankle pain, and a decreased range of motion and strength was noted. Similar diagnoses were made in December 1988, February 1989, and June 1991. In September 1991, the veteran's subtalar joint was fused. Following service, examination of the veteran's feet, in November 1993, indicated symptoms including pain in the left instep and right foot, ankle, and great toe with weather changes. Great toe pain was reported to be constant, and right fifth toe was reported to be numb. The veteran wore foot orthoses at the time, ambulated with the use of a cane, and reported that he took medication as needed for pain. Objective findings included an inability to squat without pain in the right foot and ankle and the appearance of bilateral pes planus. His gait was apropulsive and antalgic on the right. His pes planus was described as moderate to severe with mid-stance pronation noted on the left and pronation on the right throughout his gait cycle. The relevant diagnosis was bilateral pes planus deformity, moderate to severe. There was no indication that the veteran's preexisting pes planus was aggravated by his military service. At his November 1997 RO hearing, the veteran testified that his pes planus preexisted service but was aggravated by service; specifically, he stated that he entered both periods of service with pes planus but that this disorder became worse during each period in that his feet became more painful. The subastragalar joint is situated inferior to the astragalus. It is also known as the subtalar joint, talus being another name for the astragalus. Dorland's Illustrated Medical Dictionary, 1594, 1598 (28th ed., 1994). April 2003 VA X-rays of the right foot revealed a fusion of the subtalar joint, with a screw running from the posterior inferior aspect of the calcaneus into the anterior aspect of the talus. The remaining osseous structures were normally maintained. X-rays of the right ankle showed it to be normal in appearance. X-rays of the right foot, in November 2003, showed the staples and screws to be in good position and unchanged. The report of the December 2003 VA joints examination does not address the left foot. The right foot fusion was discussed in detail. As previously noted, the examiner explained that this was more properly called a right foot disability than a right ankle disability. Due to the subtalar injury and fusion, there was a well-documented secondary complication of midfoot arthritis which resulted in significant disability and a talonavicular fusion. Therefore, it was felt that the veteran's foot was significantly worse. It was at least as likely that the veteran's worse foot condition was related to his previous injury. The possible further changes in the foot were detailed. A steel shank insertion into his shoe with a rocker bottom sole could decrease the possibility. It was noted that the veteran had a decreased ankle range of motion and strength secondary to his fusions. Conclusion The veteran has testified that his preexisting pes planus was symptomatic in service. It may well have responded to the stresses of training with pain and other symptoms. But, these symptoms do not mean that the underlying foot disorder became worse. Similarly, treatment of the symptoms with arch supports or other treatment does not mean that the underlying arch disorder advanced in severity. The veteran's reliance on these factors to support his claim underlines the fact that as a lay witness, he does not have the necessary medical training and experience to identify an actual increase in the severity of the underlying, pre-existing disorder. In this case, the veteran's feet have been examined numerous times and there is no competent medical opinion or other competent medical evidence that the pre-existing pes planus increased in severity during service, in addition to the changes which have already been granted service connection. The medical reports form a preponderance of evidence in this case. Because they repeatedly did not identify any increase in severity during service, other than the already service- connected changes, this preponderance of evidence is against the claim. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable and the appeal must be denied. 38 U.S.C.A. § 5107(b); Gilbert; Ortiz. Chronic Gastritis At his January 2008 Board hearing, the veteran testified that he had stomach pains during service and was given Maalox. He reported that the problems he had in service were now worse, and he had an episode were he had to go to an emergency room. Testing was scheduled. There was no diagnosis of gastritis during the veteran's first period of service. He was seen in August 1977 complaining that his stomach was "growling" but was diagnosed with flatulence. In February 1978, he was seen complaining of an upset stomach, but was not diagnosed with a gastrointestinal disorder. His abdomen was found to be within normal limits at the time. In April 1979, he was seen for complaints of stomach cramps but was diagnosed with prostatitis. The May 1979 separation examination report is negative for a diagnosis of chronic gastritis or any other gastrointestinal disorder. Evidence of record dated subsequent to the first period of service includes the report of the December 1979 VA examination, wherein it is noted that examination of the veteran's digestive system revealed no palpable organs or masses. Outpatient treatment records from Community Medical Associates reveal that, in February 1980, the veteran was seen complaining of an upset stomach and was diagnosed with gastritis. In April 1980, he was again seen there complaining of mid-abdominal pain but objective findings included that the abdomen was normal. An upper gastrointestinal series, accomplished in May 1980 at Community Medical, was normal. In June 1980, he was seen complaining of abdominal pain and was diagnosed with ulcer disease. A November 1980 VA medical record indicates that the veteran suffered from chronic gastritis that had improved with medication. It was also noted that an upper gastrointestinal series was negative for ulcers but that the symptoms were definite for gastritis. An April 1981 VA record, however, notes that the veteran gave a history of having chronic gastritis improved with medication. Examination of the abdomen at that time revealed a soft and slightly tender epigastrium, and the diagnosis was chronic anxiety with gastritis. In a June 1981 letter, F. W. J., M.D. reported that he examined the veteran and found excessive motility of the gastrointestinal tract, with resultant pain, distress, and poor appetite. The report of the August 1981 VA examination shows the abdomen was flat and soft, but not tender, with no masses. The examiner noted that an upper gastrointestinal series was negative, and that the veteran apparently had a gastroscopy in July 1981 which resulted in a diagnosis of increased motility and gastrointestinal spasm. The August 1981 report indicates that the veteran was diagnosed with, among other things, chronic gastritis by history. A review of the service medical records covering the veteran's second period of active duty reflects that his abdomen was found to be normal when he was examined in March 1984. In October 1987, he was seen complaining of severe abdominal pain and was diagnosed with acute appendicitis. There is no indication that the veteran was diagnosed with gastritis, chronic or otherwise, during this second period of service. The report of a November 1993 VA stomach examination indicates that the veteran gave a history of never having peptic ulcer disease or gastrointestinal bleeding. On physical examination, diffuse pain throughout the abdomen was noted but could be localized to the left quadrant. The veteran reported that exacerbations occurred three to four times per year and could last several days. Examination of the abdomen found it to be soft, nontender, and nondistended. There were no appreciable masses or organomegaly. The examiner's impression was that the veteran's history of abdominal discomfort appeared to relate to the character of his stools in that during constipation he developed cramping and discomfort. It was noted that the symptoms described were strongly suggestive of irritable bowel syndrome. On VA hospitalizations for his psychiatric disorder, in September and October 1995, and March and April 1996, there were no gastrointestinal complaints, findings or diagnoses. During the 1995 hospitalization, examination revealed that the veteran's abdomen had no distension, tenderness, organomegaly, or masses. Bowel sounds were within normal limits. During the November 1997 RO hearing, the veteran testified that gastritis had its onset during his first period of service and appeared to relate it to medication taken for a skin irritation he was having due to shaving. He noted that symptoms included stomach pain. In October 1998, the veteran was seen at the emergency room of a university hospital. He complained of abdominal pain. His abdomen was soft and nontender in all four quadrants. Bowel sounds were normoactive. There was no hepatospenomegaly. A left inguinal hernia was noted. The pain resolved and his discharge diagnoses were abdominal pain, resolved, and left inguinal hernia. The veteran was hospitalized at a VA medical center for approximately 5 days for his psychiatric disorder, in April and May 1999. There were no gastrointestinal complaints. His abdomen was nontender. There was no gastrointestinal diagnosis. In August 2000, the veteran was treated at a private hospital after he was found in an alley with an obvious head injury. He was diffusely tender in the abdominal area, but had normoactive bowel sounds. An abdominal contusion was considered but not part of the final diagnosis. VA clinical notes followed the veteran's progress, in October 2002, it was recorded that he had no gastrointestinal disturbances. In December 2002, he telephoned and complained of increased abdominal pain. When he was seen later that month, the veteran's abdomen was soft. There was no gastrointestinal complaint or diagnosis. Conclusion Here, again, as a lay witness, the veteran does not have the medical knowledge to diagnosis a chronic gastritis or to distinguish it from his service-connected irritable bowel syndrome. See Espiritu; 38 C.F.R. § 3.159(a). The medical professionals who have considered his complaints have not found chronic gastritis. These medical reports form the preponderance of evidence on this issue and establish that the veteran does not have chronic gastritis. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable and the appeal must be denied. 38 U.S.C.A. § 5107(b); Gilbert; Ortiz. ORDER Service connection for an eye disorder, on a primary basis as a residual of disease or injury in service, is denied. Service connection for a heart disorder is denied. Service connection for cold weather injuries is denied. Service connection for prostatitis is denied. Service connection for the residuals of taking Seldane and Erythromycin, including blackouts and dizziness, is denied. Service connection for bilateral pes planus is denied. Service connection for chronic gastritis is denied. REMAND While the case was in remand status, the rating criteria for diseases and injuries of the spine was changed to provided for rating based on limitation of motion with separate evaluation of any associated objective neurologic abnormalities. In his recent testimony at a Board hearing, the veteran asserted that he had headaches due to his service-connected cervical spine disability. A January 2007 report from a private neurologist contains an assessment of musculoskeletal cervicalgia with possible cervicogenic headache component. In light of this evidence and the veteran's claims, further development is warranted to determine the likelihood that the veteran's headaches are due to the service-connected disability and, if so, the extent of the disability. Under the case law in effect at the time of the Board remand, in June 1999, a claimant had to submit a well grounded claim. That is, he had to submit evidence on each element necessary to prove the claim. For a claim of service connection, he had to submit evidence of disease or injury in service, of current disability, and of a connection between the current disability and the disease or injury in service. Moreover, the evidence had to be competent. As a lay witness, a claimant could report competent evidence of what he experienced in service, but he could not provide a medical diagnosis of his current condition or link it to service. Those elements required evidence from a competent medical professional. The VCAA became law in November 2000. Part of the purpose of the new law was to do away with the requirement that the claimant submit evidence of a well grounded claim and, particularly, to shift the burden of obtaining medical evidence to VA. The new law, in part, provided that if the evidence of record, taking into consideration all information and lay or medical evidence (including statements of the claimant) contained competent evidence of a current disability and indicated that the disability might be associated with service, VA shall obtain a medical opinion. 38 U.S.C.A. § 5103A(d) (West 2002). In this case, there are psychiatric diagnoses between the veteran's periods of active service, but not during them. The veteran has testified that his medical retirement for the second period of service caused psychiatric problems while he was still in service, but examination and treatment could not be scheduled before he left service. A memorandum from the service department, dated in May 1993, approximately 3 months after service, reports that he was examined and treated for a psychiatric illness prior to retirement. The diagnosis was adjustment disorder with physical complaints. In November 1993, less than a year after service, a VA examiner diagnosed dysthmia. What we need now is a competent medical opinion as to whether it is at least as likely as not that the psychiatric disability was incurred in or aggravated in service. The case is remanded for such an opinion. In as much as the record indicates the veteran lost sight in his eye due to an injury sustained in a suicide attempt, the claim for service connection for an eye disorder due to trauma is deferred pending the medical opinion on the psychiatric claim. The service medical records appear to contain a December 1978 diagnosis of sinusitis. In April 1987, the veteran complained of headaches and noted a history of headaches with sinus pains. He was seen in July 1987 with complaints of sinus congestion and was diagnosed with a possible sinus problem. In April 1989, he was seen complaining of headaches and nasal congestion and was diagnosed with probable sinusitis. In May 1989, he complained of a sinus problem and was diagnosed with a viral upper respiratory disorder. At the time of the Board's previous remand, in 1999, there was no medical evidence of a current sinus disorder. More recently, in November 2007, VA found that the veteran had right maxillary fungal sinusitis, which required surgery. In light of the recent medical confirmation of a current disability, the AOJ should obtain an opinion as to whether the current condition is related to the episodes of sinusitis in service. The service medical records document various skin findings. In June 1976, the veteran complained of a rash about the arms, back, and feet; the assessment was rule out contact dermatitis. In December 1976, he was seen with a three day history of a swollen painful lump inside the right thigh and was diagnosed with tinea cruris. In September 1976, February 1977, August 1977, September 1977, October 1977, November 1977, January 1979, and February 1979, he was diagnosed with pseudofolliculitis and was put on shaving profile on each occasion. In July 1978, he complained of a rash on his lower back with intermittent itching, and an intermittent stomach rash. Objective findings included four discolored patches about the low back with small papules. The diagnosis was rule out fungal. In August 1984, he was treated for poison ivy about the forearms and right thigh. In May 1985, he was treated for facial skin irritation caused by shaving and put on a shaving profile. In May 1988, he was seen with a bump on the back of his neck and was diagnosed with a carbuncle. In February and May 1990, he was seen with a nontender lump on his back and was diagnosed with a lipoma; and a July 1990 record indicates that surgery was to be scheduled to excise this lipoma. In October 1991, the veteran was seen with a rash about his right arm, diagnosed as contact dermatitis. In June 1992, he had 5 to 6 small papules about the right arm and hand, left arm, and back. There were excoriations on the back and arms, but no lesions were found on the legs or genitals. The assessment was a history of allergies with generalized itching without lesions. In July 1992, he was seen with complaints of itching. The report of a December 1993 VA skin examination shows the veteran had residual hypopigmented markings about the penis, with areas of recurrent herpes simplex, a mild chronic toenail onychomycosis, and a scar from an infection of the right upper thigh. In January 2008, the veteran testified that recent private medical treatment for his skin complaints resulted in a diagnosis of seborrheic dermatitis. He has submitted records of private treatment in April, May, and August 2007, showing a diagnosis of seborrheic dermatitis. VCAA provides that where there is competent medical evidence of a current disability and, as here, evidence of disease or injury in service, VA will obtain a medical examination and opinion. The service medical records document left hand trauma in service and trauma residuals were noted on a 1993 VA examination. However, January 1994 X-ray studies were interpreted as showing a normal left hand. The veteran ascribes weakness and other symptoms to the injury. Under these circumstances, a current examination is desirable to determine if there is a current disability. The current claims for increased ratings arise from the initial ratings assigned following the grant of service connection in March 1994. It was not until after the initial adjudication of the claims that the veteran was provided with the rating criteria. The rating criteria were originally provided in the April 1995 statement of the case (SOC) and most recently in a November 2006 SSOC, which included the new criteria for rating the spine. The Court has held that VA's duty to notify may not be "satisfied by various post- decisional communications from which a claimant might have been able to infer what evidence the VA found lacking in the claimant's presentation," such as a SOC or SSOC. See Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008). Rather, such notice errors may instead be cured by issuance of a fully compliant notice, followed by readjudication of the claim. 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) see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as a SOC or SSOC, is sufficient to cure a timing defect). In this case, although the veteran was provided the rating criteria in the November 2006 SSOC, the ratings were not subsequently readjudicated. To cure the notice defect, the veteran should be sent a VCAA notice letter informing him of the applicable rating criteria. Then, after the veteran has been given an opportunity to respond, the ratings must be readjudicated. While the further delay of this case is regrettable, due process considerations require such action. Accordingly, the claims for service connection for sinusitis, a skin disorder, a psychiatric disorder, and residuals of a left hand injury, as well as the claims for increased ratings, are REMANDED for the following action: 1. The AOJ must review the claims file and ensure that all notice obligations have been satisfied in accordance with the recent court decisions, as well as 38 U.S.C.A. §§ 5102, 5103, and 5103A (West 2002), and any other applicable legal precedent. Specifically, in accordance with the ruling in Vazquez- Flores: a. The veteran should be asked to provide evidence showing the effects of the worsening or increase in severity upon his employment and daily life, and b. The veteran should be informed of all of the potentially applicable diagnostic codes, including: 5237, 5257, 5260, 5261, 5272, 5293, 5295, 7319, and for any neurologic deficits found to be due to the service- connected neck disability. 2. The veteran should be scheduled for a neurologic examination. The claims folder should be made available to the examiner for review prior to the examination. Any tests or studies needed to respond to the following questions should be done. The examiner should provide a complete explanation in response to the following questions: a. Are the veteran's headaches at least as likely as not (a 50 percent or greater probability) due to his service-connected cervical spine disability? If so, describe the extent and frequency of the headaches. b. What, if any, other neurologic abnormalities are at least as likely as not due to the service-connected cervical spine disability? If there are none, so state. If there are related neurologic abnormalities, specify the nerve involved and describe their extent. 3. Thereafter, the AOJ should adjudicate whether the veteran has neurologic deficits due to his service- connected cervical spine disability and, if so, rate under the appropriate diagnostic codes. 4. The veteran should be scheduled for a psychiatric examination. The claims folder should be made available to the examiner for review prior to the examination. Any tests or studies needed to respond to the following questions should be done. The examiner should provide a complete explanation in response to the following questions: a. What is the veteran's current psychiatric diagnosis? If a psychiatric diagnosis is not applicable, the examiner should so state. b. If the veteran has a psychiatric diagnosis, given the psychiatric treatment before service, the diagnosis and treatment of an adjustment disorder during service, and the diagnosis of dysthmia approximately 9 months after service, is it at least as likely as not (a 50 percent or greater probability) that: i. a pre-service psychiatric disability increased in severity during service? ii. a new psychiatric disability began in service? iii. the veteran's service-connected physical disabilities, their symptoms, and their impact on his social and occupational functioning caused or contributed to cause an acquired psychiatric disability? iv. the psychiatric disorder caused or contributed to cause the veteran's suicide attempt and eye injury? 5. The claims folder should be made available to a VA physician for review and a medical opinion on sinusitis. If the doctor feels that an examination, tests, or studies are needed, they should be done. The physician should express an opinion as to whether it is at least as likely as not that the veteran's sinus problems in service caused or contributed to cause his current sinus disorder. The examiner should provide a complete explanation with his response. 6. The veteran should have a VA skin examination. The claims folder should be made available to the examiner for review prior to the examination. Any tests or studies required to respond to the following questions should be done. a. What are the veteran's current skin diagnoses? All manifestations of each diagnosis should be described. b. Which of the veteran's current skin diagnoses are, at least as likely as not a residual of the skin findings noted during his active service? The examiner should provide a complete explanation for his response. c. If the examiner finds that a current skin disorder is not related to service, he should explain the basis for his conclusion. 7. The veteran should be scheduled for an examination of his left hand. The claims folder should be made available to the examiner for review in conjunction with the examination. X-rays, or any other tests or studies which may be indicated should be done. The examiner should respond to the following: a. What is the correct diagnosis for the veteran's left hand? The manifestations of any left hand disability should be described in detail. If there is no current disability the examiner should so state. b. Is it at least as likely as not that a current left hand disorder is the result of trauma during the veteran's active service? 8. The veteran should be afforded an opportunity to respond to the VCAA notice letter. Thereafter, the AOJ should readjudicate the remanded issues. If the determination remains unfavorable to the veteran, he and his representative should be furnished a SSOC and afforded the applicable time period in which to respond. 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). 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). ______________________________________________ J. A. MARKEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs