Citation Nr: 0813267 Decision Date: 04/22/08 Archive Date: 05/01/08 DOCKET NO. 06-07 444 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for a heart disorder to include rheumatic heart disease. 2. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a left internal intracanalicular tumor mass as secondary to service-connected rheumatic fever. 3. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for hypertension on a direct basis. 4. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a disorder claimed as multiple joint pain. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD M. Scott Walker, Associate Counsel INTRODUCTION The veteran served on active duty from August 1942 to July 1943. This matter comes before the Board of Veterans' Appeals (Board) on appeal from August 1995 and April 2005 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The veteran's claims were remanded by the Board for further development in September 2006. Specifically, the Board remanded the issue of entitlement to service connection for a heart disability, to include rheumatic heart disease, for the purpose of obtaining a VA examination and etiological opinion. The issues of whether new and material evidence has been received to reopen the claims for entitlement to service connection for a left internal intracanalicular tumor mass, as secondary to service-connected rheumatic fever, hypertension on a direct basis, and multiple joint pain were remanded for further development pursuant to the directives of the Veterans Claims Assistance Act of 2000 (VCAA), as well as those of the United States Court of Appeals for Veterans Claims (Court) in the case of Kent v. Nicholson, 20 Vet. App. 1 (2006). These actions were completed, and all issues are properly before the Board for adjudication at this time. FINDINGS OF FACT 1. A heart disability, to include rheumatic heart disease, was not manifest during service; a heart disability, to include rheumatic heart disease, was not manifest within one year of separation; and any heart disability, to include rheumatic heart disease, is not attributable to service. 2. In a March 2003 decision, the RO denied entitlement to service connection for a left internal intracanalicular tumor mass. A notice of disagreement was not received within the subsequent one-year period. 3. Evidence submitted since the RO's March 2003 decision, by itself or when considered with previous evidence of record, does not relate to an unestablished fact necessary to substantiate the claim, and therefore does not raise a reasonable possibility of substantiating the claim. 4. In a June 1987 decision, the RO denied entitlement to service connection for hypertension. A notice of disagreement was not received within the subsequent one-year period. 5. Evidence submitted since the RO's June 1987 decision does not bear directly and substantially upon the specific matter under consideration, is either cumulative or redundant and by itself, or in connection with evidence previously assembled, is not so significant that it must be considered in order to fairly decide the merits of the claim. 6. In a July 1997 decision, the Board denied entitlement to service connection for a disorder claimed as multiple joint pain. A notice of disagreement was not received within the subsequent one-year period. 7. Evidence submitted since the Board's July 1997 decision, by itself or when considered with previous evidence of record, does not relate to an unestablished fact necessary to substantiate the claim, and therefore does not raise a reasonable possibility of substantiating the claim. CONCLUSIONS OF LAW 1. A heart disability, to include rheumatic heart disease, was not incurred in or aggravated by service and may not be presumed to have been incurred or aggravated therein. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113 (West 2002 & Supp. 2006); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2007). 2. The RO's March 2003 rating decision is final. 38 U.S.C.A. § 7105 (West 2002 & Supp. 2006). 3. New and material evidence has not been received since the RO's March 2003 rating decision; thus, the claim for entitlement to service connection for a left internal intracanalicular tumor mass, as secondary to service- connected rheumatic fever, is not reopened. 38 U.S.C.A. §§ 5108, 7105 (West 2002 & Supp. 2006), 38 C.F.R. § 3.156 (2007). 4. The RO's June 1987 rating decision is final. 38 U.S.C.A. § 7105 (West 2002 & Supp. 2006). 5. New and material evidence has not been received since the RO's June 1987 rating decision; thus, the claim for entitlement to service connection for hypertension on a direct basis is not reopened. 38 U.S.C.A. §§ 5108, 7105 (West 2002 & Supp. 2006), 38 C.F.R. § 3.156 (2007). 6. The Board's July 1997 rating decision is final. 38 U.S.C.A. § 7105 (West 2002 & Supp. 2006). 7. New and material evidence has not been received since the Board's July 1997 rating decision; thus, the claim for entitlement to service connection for a disorder claimed as multiple joint pain is not reopened. 38 U.S.C.A. §§ 5108, 7104 (West 2002 & Supp. 2006), 38 C.F.R. § 3.156 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VCAA As a preliminary matter, the Board notes that regulations enacted under the Veterans Claims Assistance Act of 2000 (VCAA) require VA to notify claimants and their representatives of any information that is necessary to substantiate a claim for benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103(a), 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159(b), 3.326(a). The Court has held that this notice must be provided to a claimant prior to an initial, unfavorable decision on a claim for VA benefits by any VA regional office (RO). Pelegrini v. Principi, 18 Vet. App. 112 (2004) [Pelegrini II]. Regulations also dictate that VA has a duty to assist claimants, essentially providing that VA will make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate a claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(c). In the present case, the issues on appeal arise from claims for service connection for a heart disability, to include rheumatic heart disease, and whether new and material evidence has been received to reopen the veteran's claims to entitlement to service connection for a left internal intracanalicular tumor mass, as secondary to service- connected rheumatic fever, hypertension on a direct basis, and a disorder characterized by multiple joint pain. The Board notes that the veteran's application to reopen his claim for service connection for a heart disability, to include rheumatic heart disease, was received in November 2001. In November 2003, the RO provided notice to the claimant regarding the VA's duty to notify and to assist with regard to a claim for service connection. The claimant was aware that it was ultimately the claimant's responsibility to give VA any evidence pertaining to the claim. Specifically, the VCAA notification instructed the claimant to provide any relevant evidence in the claimant's possession. See Pelegrini II. In particular, the VCAA notification: (1) informed the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) informed the claimant about the information and evidence that VA will seek to provide; (3) informed the claimant about the information and evidence that the claimant is expected to provide; and (4) requested that the claimant provide any evidence in his possession that pertains to the claims. See Pelegrini II. Thus, the Board finds that the content and timing of the November 2003 notice comports with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). With respect to the veteran's claim for service connection for a heart disorder, the Board notes that the veteran has undergone several VA examinations in conjunction with his claim for service connection. 38 C.F.R. § 3.159(c)(4). There is no objective evidence indicating that there has been a material change in the veteran's condition since the claimant was last examined. 38 C.F.R. § 3.327(a). The duty to assist does not require that a claim be remanded solely because of the passage of time since an otherwise adequate VA examination was conducted. See VAOPGCPREC 11-95. The VA examination reports are thorough, the examinations in this case are adequate upon which to base a decision, and the records satisfy 38 C.F.R. § 3.326. As to the veteran's new and material evidence claims, these claims were remanded by the Board in September 2006 for the purpose of providing adequate VCAA notification. The Court stated that in order to successfully reopen a previously and finally disallowed claim, the law requires the presentation of a special type of evidence-evidence that is both new and material. The terms "new" and "material" have specific, technical meanings that are not commonly known to VA claimants. Because these requirements define particular types of evidence, when providing the notice required by the VCAA it is necessary, in most cases, for VA to inform claimants seeking to reopen a previously and finally disallowed claim of the unique character of evidence that must be presented. This notice obligation does not modify the requirement that VA must provide a claimant notice of what is required to substantiate each element of a service-connection claim. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). In other words, VA must notify a claimant of the evidence and information that is necessary to reopen the claim and VA must notify the claimant of the evidence and information that is necessary to establish his entitlement to the underlying claim for the benefit sought by the claimant. In addition, VA's obligation to provide a claimant with notice of what constitutes new and material evidence to reopen a service-connection claim may be affected by the evidence that was of record at the time that the prior claim was finally denied. In order to satisfy the legislative intent underlying the VCAA notice requirement to provide claimants with a meaningful opportunity to participate in the adjudication of their claims, the VCAA requires, in the context of a claim to reopen, the Secretary to look at the bases for the denial in the prior decision and to respond with a notice letter that describes what evidence would be necessary to substantiate that element or elements required to establish service connection that were found insufficient in the previous denial. Therefore, the question of what constitutes material evidence to reopen a claim for service connection depends on the basis on which the prior claim was denied. In December 2006, the veteran was provided notice as to the appropriate standard for new and material evidence, and he was notified as to the reason for the prior, final denial for each of his claims. Therefore, VCAA requirements were ultimately satisfied by the December 2006 letter, as well as an updated VCAA notification of May 2007. Further, the claimant's service medical records and pertinent post-service medical records have been obtained, to the extent available. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. There is no indication in the record that any additional evidence, relevant to the issue decided herein, is available and not part of the claims file. Additional efforts to assist the veteran in accordance with the VCAA would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements in the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). In summary, the evidence does not show, nor does the veteran contend, that any notification deficiencies have resulted in prejudice. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006) (holding that due process concerns with respect to VCAA notice must be pled with specificity). Therefore, the Board finds that it would not be prejudicial to the veteran to render a decision at this time. Service Connection The Court held that, in order to prevail on the issue of service connection on the merits, there must be medical evidence of (1) 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 disease or injury. Hickson v. West, 12 Vet. App. 247, 253 (1999). A claim of service connection for a disability must be accompanied by medical evidence establishing that the claimant currently has a claimed disability. Absent proof of a present disability, there can be no valid claim. See, e.g., Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (38 U.S.C. § 1110 requires current symptomatology at the time the claim is filed in order for a veteran to be entitled to compensation); Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997) (38 U.S.C. § 1131 requires the existence of a present disability for VA compensation purposes). In order to establish service connection for a claimed disability, the facts must demonstrate that a disease or injury resulting in current disability was incurred in active military service or, if pre-existing active service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. Service connection may also be granted for any disease diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, certain chronic diseases may be presumed to have been incurred or aggravated during service if they become disabling to a compensable degree within one year of separation from active duty. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Secondary service connection may be granted for a disability that is proximately due to, or the result of, a service- connected disease or injury. 38 C.F.R. § 3.310(a). With regard to the matter of establishing service connection for a disability on a secondary basis, the Court has held that there must be evidence sufficient to show that a current disability exists and that the current disability was either caused by or aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Additionally, when aggravation of a nonservice-connected disability is proximately due to or the result of a service connected condition, such disability shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Id.; see also 71 Fed. Reg. 52744-52747 (Sept. 7, 2006). In this case, the veteran's claim for service connection for heart disease was originally denied in June 1987 because the veteran's service medical records were silent for complaints, treatment, or diagnosis of heart disease. A September 2006 Board decision reopened the veteran's claim following the receipt of private medical evidence, proffered by Dr. D.R., in which he stated that the veteran had first degree AV block "which is assumed to have formed by scar tissue caused by rheumatic fever." The veteran's claim was remanded for an updated VA medical examination with an etiological opinion. While on active duty, the veteran was diagnosed with rheumatic fever in April 1943. At that time, no heart murmurs were reported and cardiac sounds were of good quality. A May 1943 report noted complete recovery. No complaints of dyspnea, pain, or palpitations were reported. His heart borders were well within normal limits on percussion, sounds were regular and of good quality, and no murmurs or friction rub were present. On June 11, 1943, the veteran received a cardiac consultation in response to his diagnosis of rheumatic fever. At that time, the veteran no longer had a fever. No cardiac symptoms were present, and the veteran stated repeatedly that he felt well and had no complaints of any kind. Neither thrills nor murmurs were detected on examination. An EKG performed in the same month demonstrated a sinus rhythm within normal limits. Numerous premature ventricular systoles were noted. A July 1943 progress note stated that cardiac consultation revealed numerous premature ventricular systoles, but not enough evidence to make a definite diagnosis of rheumatic heart disease. A March 1975 medical report noted that the veteran wished to file a claim for a heart disorder, however, a heart disorder was not diagnosed at that time. A May 1975 VA examination revealed normal cardiac sinus rate and rhythm with a questionable systolic mitral murmur on standing, though the murmur was not heard when lying or sitting. During an August 1994 VA examination, the veteran reported chest pain with exertion which was relieved with nitroglycerine. He stated that the pain typically lasted 3-4 minutes. His heart rate was regular with a 1/6 systolic ejection murmur heard at the base without radiation. EKG readings revealed a first degree AV block. There was no left ventricular hypertrophy by voltage criteria, and x-ray results showed poor inspiratory effort but no evidence of congestive heart failure or cardiomegaly. The veteran was diagnosed with angina. The examiner stated that the EKG revealed no evidence of a previous infarct, however a stress EKG showed some question of some ischemia in February 1994, as well as some mild left ventricular hypertrophy. It was further noted that the veteran's presumed coronary artery disease would be related to his diabetes and hypertension, and not his rheumatic heart fever in 1943, as the residuals of significant rheumatic fever are valvular lesions, and there were no valvular lesions noted on the EKG from 1994. As noted above, a private medical opinion, proffered by Dr. D.R., stated that the veteran had first degree AV block "which is assumed to have formed by scar tissue caused by rheumatic fever." A review of the veteran's claims file was not noted. The veteran was afforded an additional VA examination in August 2007. The examiner noted a review of the veteran's claims file. Upon examination, there was no evidence of cardiac enlargement. The point of maximal impulse was the midclavicular line. There was no murmur, thrill, or click. The examiner did not find evidence of cardiac disease. Although the examiner confirmed the existence of a first degree AV block, it was noted that the veteran did not have rheumatic carditis or valvular heart disease as a result of his service-connected acute rheumatic fever. Further, the examiner stated that the veteran, at age 86, did not have any specific cardiac illness. The examiner opined that it was not at least as likely as not that any current heart disability was related to the veteran's inservice rheumatic fever. According to a subsequent VA medical report of August 2007, the size and function of the left ventricle was normal. Moderate concentric left ventricular hypertrophy was noted. The right ventricular size was mildly enlarged, and the function was normal. The left atrial size was moderately enlarged, and the right atrial size was mildly enlarged. The aortic, mitral, and tricuspid valves were structurally normal in appearance, with mild regurgitation. As to diastolic function, the examiner noted a delayed relaxation pattern consistent with mild diastolic dysfunction. Normal pulmonary artery systolic pressure was recorded. These findings were nearly identical to a VA outpatient report from September 2000. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To do so, the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the appellant. See Masors v. Derwinski, 2 Vet. App. 181 (1992). To that end, an award of service connection must be based on reliable competent medical evidence. Conjectural or speculative opinions as to some remote possibility of such relationship are insufficient. See 38 C.F.R. § 3.102 (2006); see also Morris v. West, 13 Vet. App. 94, 97 (1999) (diagnosis that appellant was "possibly" suffering from schizophrenia deemed speculative); Bloom v. West, 12 Vet. App. 185, 186-87 (1999) (treating physician's opinion that veteran's time as a prisoner of war "could" have precipitated the initial development of his lung condition found too speculative to be sufficient medical nexus evidence); Davis v. West, 13 Vet. App. 178, 185 (1999) (any medical nexus between in-service radiation exposure and fatal lung cancer years later was speculative at best, even where one physician opined that it was probable that lung cancer was related to service radiation exposure); see also Obert v. Brown, 5 Vet. App. 30, 33 (1993) (physician's statement that the veteran may have been having some symptoms of multiple sclerosis for many years prior to the date of diagnosis deemed speculative); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992) (medical evidence which merely indicates that the alleged disorder "may or may not" exist or "may or may not" be related, is too speculative to establish the presence of the claimed disorder or any such relationship). Service medical records, written immediately following the veteran's acute rheumatic fever, specifically stated that there was not enough evidence to render a diagnosis of rheumatic heart disease. Heart disease was not diagnosed during cardiac examinations in 1975. In August 1994, a VA examiner noted that the veteran's presumed coronary artery disease would be related to his diabetes and hypertension, and not his rheumatic heart fever in 1943, as the residuals of significant rheumatic fever are valvular lesions, and there were no valvular lesions noted on the EKG from 1994. Moreover, the most recent examination of record found that the veteran does not currently have heart disease. Although the November 2005 opinion by Dr. D.R. noted first degree AV block secondary to rheumatic fever, the Board finds that opinion to be less probative than the August 2007 VA examiner's opinion. The private physician did not note a review of the veteran's claims file. Further, he provided no rationale to support his opinion, nor did he provide evidence that scar tissue had actually formed (from rheumatic fever or otherwise). Finally, the Board notes that the word "assumed" denotes an opinion that is equivocal in nature, without the support of medical reasoning. In contrast, the veteran's August 2007 VA examiner noted a review of the claims file. Although he diagnosed the veteran with a first degree AV block as per EKG records, he did not diagnose the veteran with heart disease. He saw no evidence of rheumatic carditis within the veteran's record, and he noted that the veteran did not demonstrate cardiac disease even at the age of 86. The examiner examined EKG and x-ray evidence prior to forming his opinion, and his opinion was neither speculative nor equivocal in nature. Neither the Board nor the veteran is competent to supplement the record with unsubstantiated medical conclusions. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Conversely, health professionals are experts and are presumed to know the requirements applicable to their practice and to have taken them into account in providing a diagnosis. Cohen v. Brown, 10 Vet. App. 128 (1997). In this case, the record is insufficient to grant service connection for a heart disorder, either directly or secondary to the veteran's service-connected rheumatic fever. The veteran's service medical records are silent as to a diagnosis of heart disease, and a medical report from July 1943 specifically stated that insufficient evidence existed to render a diagnosis of rheumatic heart disease. Finally, an analysis of the probative evidence in this case shows that the veteran does not currently have heart disease. Although a positive medical nexus opinion exists, linking a current AV block to the veteran's inservice rheumatic fever, the most recent VA examination failed to show the existence of heart disease. Instead, the VA examiner noted that a connection of any current cardiac condition to the veteran's active service, or the occurrence of rheumatic fever therein, was not likely. His opinion was proffered following a review of the veteran's claims file, a chest x-ray, and EKG reports. Accordingly, the Board finds that the preponderance of the evidence is against the veteran's claim for entitlement to service connection for a heart disorder, to include rheumatic heart disease. Therefore, service connection must be denied. In reaching this decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the appellant's claim, the doctrine is not for application. New and Material Evidence Prior unappealed decisions are final. However, a claim will be reopened and the former disposition reviewed if new and material evidence is presented or secured with respect to the claim which has been disallowed. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a). The Court has held that, when "new and material evidence" is presented or secured with respect to a previously and finally disallowed claim, VA must reopen the claim. Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). The Board notes that the legal standard of what constitutes "new and material" evidence was recently amended. Regarding the issue of hypertension, this amendment is inapplicable as the amendment applies prospectively to claims filed on or after August 29, 2001. See 38 C.F.R. § 3.156(a). The veteran's application to reopen the claim of service connection for hypertension was received prior to that date. As to the issue of hypertension, the applicable VA regulation requires that new and material evidence is evidence which has not been previously submitted to agency decision-makers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant and which, by itself, or in connection with evidence previously assembled, is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a); Hodge v. West, 155 F. 3d 1356 (Fed. Cir. 1998). As to the issues of a left intracanalicular tumor mass and a disorder claimed as multiple joint pain, the amendment is applicable as the amendment applies prospectively to claims filed on or after August 29, 2001, and these claims were so filed. See 38 C.F.R. § 3.156(a). Under the new standard, new evidence means existing evidence not previously submitted to agency 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 must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a) (2005). According to the Court, the pertinent VA law requires that in order to reopen a previously and finally disallowed claim, there must be new and material evidence presented or secured since the time that the claim was finally disallowed on any basis. Evans v. Brown, 9 Vet. App. 273 (1996). In considering whether to reopen a claim, VA must assume the credibility of the aforementioned evidence which supports the veteran's claim as required by Justus v. Principi, 3 Vet. App. 510, 513 (1992). Left internal intracanalicular tumor mass, claimed as secondary to service-connected rheumatic fever In November 2001, the veteran stated that he had an enhancing left internal intracanal tumor mass. He noted that it was inoperable due to its location, and that he believed the mass was related to his service-connected rheumatic fever. At the time of the prior denial, service connection for an internal intracanalicular tumor was denied because the veteran's record was silent as to any medical evidence linking the veteran's tumor to his inservice rheumatic fever (noted as malaria on the March 2003 rating decision). A notice of disagreement was not received within the subsequent one-year period. Therefore, the RO's March 2003 rating decision is final. 38 U.S.C.A. § 7105. Since the prior final decision, evidence has been added to the claims file. The additional evidence of record consists of voluminous VA outpatient reports from 1995 through 2005. However, the additional evidence is not new and material. Although it is new, it does not include any competent evidence that cures the prior evidentiary defect. Numerous medical reports document the existence of a tumor, though none of the evidence within the veteran's file provides an etiological nexus between the veteran's tumor and any inservice illness or injury. An outpatient report from October 2003 noted that the tumor was stable, and a medical nexus to rheumatic fever was not provided. Although the veteran asserted in a November 2001 statement that a medical nexus existed between his currently-diagnosed tumor and his service-connected rheumatic fever, lay persons are not shown to possess the appropriate medical expertise and training to competently offer an opinion as to current medical diagnoses, thus, any statements purporting to do so cannot constitute material evidence. See Jones v. Brown, 7 Vet. App. 134, 137 (1994); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). For these reasons, unsupported lay statements, even if new, do not serve as a predicate to reopen a previously disallowed claim. See Moray v. Brown, 5 Vet. App. 211, 214 (1993). Laypersons are not competent to give a medical opinion as to diagnosis or causation. Therefore, statements to that effect are not new and material evidence, see Vargas-Gonzalez v. West, 12 Vet. App. 321 (1999), and are insufficient to reopen the claim. See Savage v. Gober, 10 Vet. App. 488 (1997); Moray. New and material evidence has not been received since the RO's March 2003 decision; thus, the claim is not reopened. 38 U.S.C.A. §§ 5108, 7105; 38 C.F.R. § 3.156. Hypertension The veteran's claim for service connection for hypertension was initially denied in an August 1975 rating decision. The RO subsequently denied service connection in a June 1987 rating decision because the evidence failed to demonstrate that his hypertension was in any way related to his military service. A notice of disagreement was not received within the subsequent one-year period. Therefore, the RO's June 1987 rating decision is final. 38 U.S.C.A. § 7105. Since the prior final decision, evidence has been added to the claims file. As noted above, the additional evidence of record consists of several VA outpatient records from 1994 through 2005, private medical reports regarding the veteran's treatment for hypertension, and statements from the veteran linking his hypertension to his period of active service. Hypertension was noted in a July 1999 VA outpatient report, but an etiological connection to the veteran's active service was not provided. An August 2002 VA outpatient report actually noted that the veteran had hypotension, as opposed to hypertension. Although new, none of the evidence in the veteran's claims file bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant and which, by itself, or in connection with evidence previously assembled, is so significant that it must be considered in order to fairly decide the merits of the claim. Although new and evidence has been submitted since the veteran's prior, final denial, the record is still silent as to a medical opinion linking his current diagnosis of hypertension to his period of active duty. 38 C.F.R. § 3.156(a); Hodge. As noted above, lay persons are not shown to possess the appropriate medical expertise and training to competently offer an opinion as to current medical diagnoses, thus, any statements purporting to do so cannot constitute material evidence. See Jones. For these reasons, unsupported lay statements, even if new, do not serve as a predicate to reopen a previously disallowed claim. See Moray. Laypersons are not competent to give a medical opinion as to diagnosis or causation. Therefore, statements to that effect are not new and material evidence, and they are insufficient to reopen the claim. See Vargas-Gonzalez; Savage; Moray. New and material evidence has not been received since the RO's June 1987 decision; thus, the claim is not reopened. 38 U.S.C.A. §§ 5108, 7105; 38 C.F.R. § 3.156. Disorder characterized by multiple joint pain The veteran's claim for service connection for multiple joint pain was denied in July 1997 Board decision. In essence, at the time of the prior denial, the veteran's claim was denied because the veteran's joint pain had been attributed to degenerative joint disease, and not secondary to rheumatic fever. A notice of disagreement was not received within the subsequent one-year period. Therefore, the Board's July 1997 decision is final. 38 U.S.C.A. § 7105. A VA treatment report from July 1999 shows complaints of joint pain, but a diagnosis was not rendered at that time. An August 1999 VA outpatient report noted that the veteran was diagnosed with degenerative joint disease of the knees. The report stated that the veteran continued to talk about rheumatic fever as the causal factor, but the examiner explained to the veteran that there were no specific markers for rheumatic disease to explain degenerative joint disease. An August 2003 VA outpatient report diagnosed the veteran with severe degenerative joint disease of the left hip, but the examiner did not provide an etiological connection to his military service. A subsequent radiological report diagnosed the veteran with minimal osteoarthritic changes in the left hip, but the examiner did not link that diagnosis to the veteran's period of active service. Although the veteran was asked to submit additional evidence on several occasions, most recently in May 2007, he has failed to provide any evidence to support an etiological nexus between any current disorder manifested by joint pain and his period of service. Therefore, the additional evidence is not new and material. It does not include any competent evidence that cures the prior evidentiary defect. New and material evidence has not been received since the Board's July 1997 decision; thus, the claim is not reopened. 38 U.S.C.A. §§ 5108, 7105; 38 C.F.R. § 3.156. ORDER Entitlement to service connection for a heart disorder, to include rheumatic heart disease, is denied. The application to reopen the claim for service connection for a left internal intracanalicular tumor mass, as secondary to service-connected rheumatic fever, is denied. The application to reopen the claim for service connection for hypertension on a direct basis is denied. The application to reopen the claim for service connection for a disorder claimed as multiple joint pain is denied. ____________________________________________ S. L. Kennedy Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs