Citation Nr: 0814322 Decision Date: 05/01/08 Archive Date: 05/12/08 DOCKET NO. 04-24 085 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for post- traumatic stress disorder (PTSD). 2. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for an acquired psychiatric disorder, previously classified as manic depressive disorder and now classified as stress. 3. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a skin disorder, previously classified as rash, psoriasis, fungal infection, onychomycosis, and tinea pedis, and now classified as subcutaneous tarda, to include as secondary to exposure to herbicides in service. 4. Entitlement to service connection for a prostate disorder, to include as secondary to exposure to herbicides in service. 5. Entitlement to service connection for a disorder manifested by blood in the stool, to include as secondary to exposure to herbicides in service. 6. Entitlement to service connection for a respiratory disorder, to include as secondary to exposure to herbicides in service. 7. Entitlement to service connection for peripheral neuropathy of the right and left upper and lower extremities, to include as secondary to exposure to herbicides in service. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD T. Hal Smith, Counsel INTRODUCTION The veteran served on active duty from September 1967 to August 1971. This matter is before the Board of Veterans' Appeals (Board) on appeal of rating decisions of the Department of Veteran's Affairs (VA) Regional Office (RO) in Los Angeles, California. A Travel Board hearing was held before the undersigned Veterans Law Judge in January 2008. A copy of the transcript of that hearing is of record. For purposes of clarity, the issues of entitlement to service connection for peripheral neuropathy of the right upper extremity, left upper extremity, right lower extremity, and left lower extremity have been combined as reflected on the title page of this decision. As will be explained, the Board is reopening the claim for service connection for PTSD based upon receipt of new and material evidence. The Board will then remand this claim to the RO via the Appeals Management Center (AMC), in Washington, DC, for further development and consideration before readjudicating it on the underlying merits. VA will notify the veteran if further action is required on his part concerning this claim. FINDINGS OF FACT 1. In an unappealed rating decision in April 2001, the RO denied service connection for manic depressive disorder and PTSD. 2. As to the PTSD claim, evidence received since the April 2001 rating decision includes evidence that relates to an unestablished fact necessary to substantiate the claim, is not cumulative or redundant of the evidence previously of record and is sufficient to raise a reasonable possibility of substantiating the claim. 3. Evidence received since the April 2001 rating decision does not include any evidence that tends to relate an acquired psychiatric disorder, to include manic depressive disorder or stress, to the veteran's service. 4. The unappealed rating decision in April 2001 also denied service connection for skin disorders classified as rash, psoriasis, fungal infection, onychomycosis, and tinea pedis. These disorders were held to have first manifested years after service. Appellant was notified and did not timely disagree therewith. 5. Evidence received since the April 2001 rating decision does not include any evidence that tends to relate a skin disorder to the veteran's service, to include inservice herbicide exposure. 6. There is no competent evidence that the veteran has a chronic prostate disorder. 7. There is no competent evidence that the veteran has a chronic genitourinary disorder manifested by blood in the stool. 8. There is no competent evidence that the veteran has a chronic respiratory disorder. 9. There is no competent evidence that the veteran has peripheral neuropathy of the right and left upper or lower extremities. CONCLUSIONS OF LAW 1. New and material evidence has not been received, and the claim seeking to establish service connection for an acquired psychiatric disorder, previously claimed as manic depressive disorder and now claimed as stress, is not reopened. 38 U.S.C.A. §§ 5108, 7105 (West 2002 & Supp. 2007); 38 C.F.R. § 3.156 (2007). 2. New and material evidence has been received to reopen a claim of entitlement to service connection for PTSD. 38 U.S.C.A. §§ 5108, 7105 (West 2002 & Supp. 2007); 38 C.F.R. § 3.156 (2007). 3. New and material evidence has not been received, and the claim seeking to establish service connection for a skin disorder, previously claimed as rash, psoriasis, fungal infection, onychomycosis and tinea pedis, now claimed as subcutaneous tarda, is not reopened. 38 U.S.C.A. §§ 5108, 7105 (West 2002 & Supp. 2007); 38 C.F.R. § 3.156 (2007). 4. Service connection for a chronic prostate disorder, to include as due to exposure to herbicides in service, is not established. 38 U.S.C.A. §§ 1101, 1110, 1112, 1116, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2007). 5. Service connection for a chronic genitourinary disorder manifested by blood in the stools, to include as due to exposure to herbicides in service, is not established. 38 U.S.C.A. §§ 1101, 1110, 1112, 1116, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2007). 6. Service connection for a chronic respiratory prostate disorder, to include as due to exposure to herbicides in service, is not established. 38 U.S.C.A. §§ 1101, 1110, 1112, 1116, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2007). 7. Service connection for peripheral neuropathy of the right and left upper and lower extremities, to include as due to exposure to herbicides in service, is not established. 38 U.S.C.A. §§ 1101, 1110, 1112, 1116, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In November 2000, the Veterans Claims Assistance Act of 2000 (VCAA) was signed into law. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107 (West 2002 & Supp. 2007). To implement the provisions of the law, VA promulgated regulations codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2006). The VCAA and its implementing regulations include, upon the submission of a substantially complete application for benefits, an enhanced duty on the part of VA to notify a claimant of the information and evidence needed to substantiate a claim, as well as the duty to notify him what evidence will be obtained by whom. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). In addition, they define the obligation of VA with respect to its duty to assist a claimant in obtaining evidence. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). Subsequent judicial decisions have clarified the duties to notify and assist imposed by the VCAA, to include Pelegrini v. Principi, 18 Vet. App. 112 (2004), Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 ((Fed. Cir. 2006), and Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). In light of the favorable determination with respect to whether new and material evidence has been received to reopen the claim of entitlement to service connection for PTSD, and the need to remand that issue for additional information with regard to the merits of the case, no further discussion of VCAA compliance is needed. As to other claims on appeal, a December 2002 letter to the veteran from the RO specifically notified him of the substance of the VCAA, including the type of evidence necessary to establish entitlement to service connection on a direct and presumptive basis, and of the division of responsibility between the veteran and the VA for obtaining that evidence. Consistent with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), VA essentially satisfied the notification requirements of the VCAA by way of these letters by: (1) informing the veteran about the information and evidence not of record that was necessary to substantiate his claims; (2) informing the veteran about the information and evidence VA would seek to provide; (3) informing the veteran about the information and evidence he was expected to provide; and (4) requesting the veteran to provide any information or evidence in his possession that pertained to the claims. Second, VA has made reasonable efforts to assist the veteran in obtaining evidence necessary to substantiate his claims. 38 U.S.C.A. § 5103A (West 2002 & Supp. 2007). The information and evidence associated with the claims file consist of the veteran's service treatment records, VA medical treatment records, private post-service medical treatment records, VA examinations, and statements and testimony from the veteran and his representative. There is no indication that there is any additional relevant evidence to be obtained by either VA or the veteran. As to previously denied claims, in Kent v. Nicholson, 20 Vet. App. 1, 10 (2006), the Court held that 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 entitlement to the underlying claim for the benefit sought by the claimant. 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. In the present case regarding previously denied claims of an acquired psychiatric disorder and skin disorders, the veteran has been notified of the evidence and information necessary to reopen the claim and to establish entitlement to the underlying claim for benefit sought in the December 2002 VCAA letter mentioned above. Lastly, during the pendency of this appeal, the Court issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), which held that the VCAA notice requirements apply to all five elements of a service connection claim, including the rating and effective date of an award. For the reasons described below, service connection and/or an increased rating for the claimed disabilities is being denied and neither a rating nor an effective date will be assigned. As such, there is no prejudice to the veteran with respect to any notice deficiencies related to the rating or effective date. See Bernard v. Brown, 4 Vet. App. 384 (1993); Sutton v. Brown, 9 Vet. App. 553 (1996); see also 38 C.F.R. § 20.1102 (harmless error). PTSD Background Initially, the veteran was denied entitlement to service connection for PTSD in an unappealed rating decision, dated in April 2001, based on the RO's determination that the veteran did not present evidence of a verifiable stressor or a confirmed diagnosis of PTSD. The evidence then of record included the service treatment records, a 2000 statement by the veteran regarding inservice stressors, and post service VA treatment records dated from 1997 through 2000. The veteran's stressor statement reflected that he reported an inservice event in which his platoon gathered 3 weeks prior to graduation from boot camp to hear announcements relating to next duty stations for each recruit. He recalled that the environment was noisy, and he did not hear or respond to his name being called. Due to repercussion of this, he was sent o the drill instructor's hut where he was beaten and bloodied. He alleged that he never reported this incident because he was afraid he would not be allowed to graduate. He stated that he was not seen by a medical doctor while in service or until years later. Criteria and Analysis Because the veteran did not file a timely appeal as to the April 2001 denial of his claim for service connection for PTSD, that decision became final and binding on him based on the evidence then of record. 38 U.S.C.A. § 7105 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.104(a), 20.200, 20.1103 (2007). This means there must be new and material evidence since that decision to reopen this claim and warrant further consideration of it on a de novo basis. 38 U.S.C.A. § 5108, 38 C.F.R. § 3.156; Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). According to the amended version of 38 C.F.R. § 3.156(a) (2007), new evidence means 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. Materiality contemplates evidence that "tend[s] to prove the merits of the claim as to each essential element that was a specified basis for that last final disallowance of the claim." Evans v. Brown, 9 Vet. App. 273, 284 (1996). The Court in Evans held that the evidence to be considered is that added to the record since the last final denial on any basis. Id. When determining whether evidence is new and material, the "credibility of the evidence is to be presumed." Justus v. Principi, 3 Vet. App. 510, 513 (1992). In Kutscherousky v. West, 12 Vet. App. 369 (1999), the Court held that the prior holding in Justus that the credibility of the evidence is to be presumed was not altered by the Federal Circuit's decision in Hodge. The subsequently received evidence includes a June 2004 statement from the veteran which relates inservice stressors not previously reported. In addition, the veteran has submitted VA treatment records dated through 2006 which now include a diagnosis of PTSD. A VA examiner opined that the veteran's PTSD was related to inservice combat stressors, as related by the veteran. This evidence is new. Furthermore, it is not cumulative or redundant of the evidence previously of record, relates to an unestablished fact necessary to substantiate the claim, and is sufficient to raise a reasonable possibility to substantiate the claim. Accordingly, it is new and material and reopening of the claim for service connection for PTSD is in order. An Acquired Psychiatric Disorder and a Skin Disorder Background In addition to the denial of service connection for PTSD as discussed above, the April 2001 rating decision also denied service connection for manic depressive disorder and for skin disorders, classified as rash, psoriasis, fungal infection, onychomycosis, and tinea pedis. The evidence considered at that time included the veteran's service treatment records which show that he was seen in April 1971 in an anxious state of mind because he was having "washed up feelings" and suspected that he might have been drugged. By the time of his initial psychiatric evaluation, however, he was under good control, and he was much less anxious. The problem was attributed to situational maladjustment, and it was felt that there was no need to proceed further. At the time of separation, he was described as psychiatrically normal. The service treatment records are negative for complaints of, treatment for, or diagnoses of skin disorders. At time of service discharge exam, his skin was normal. Post service VA treatment records reflect treatment as early as 1998 for psoriasis. At that time, the veteran gave a 7 to 8 year history of this condition. Subsequently dated reports also confirmed this diagnosis. Additionally, the veteran was seen in March 1999 for onychomycosis of the thumbnails. This condition was later shown to involve the toenails as well as the fingernails. Later that year in December 1999, the veteran also reported jungle rot, a problem which he had had since separation from service. He was assessed with tinea pedis. As to psychiatric symptoms, the post service treatment records reflect that the veteran was seen for psychiatric care in April 2000 due to depression associated with his work situation and dire financial situation. There were no complaints referencing his military service at this time. The veteran was diagnosed with a manic depressive disorder. The RO denied service connection for an acquired psychiatric disorder, manic depressive disorder, and for skin disorders, variously diagnosed, in April 2001 as none of these conditions were diagnosed during service or for many years thereafter. Evidence added to the record since the April 2001 RO denial includes private and VA treatment records which reflect that the veteran continues to be seen for psychiatric and skin complaints. The veteran continues to be diagnosed by VA personnel with depressive disorder. He also continues to be treated for various skin disorders, to include onychomycosis, ingrown nails, fungal infection, and psoriasis. He continues to allege that skin problems originated during military service and have continued to the present day. Also added to the record is the transcript of a January 2008 personal hearing where the veteran reiterated his contentions regarding the etiology of his psychiatric disorder and skin problems. Criteria and Analysis Generally, when a claim is denied by the RO and becomes final, it may not be reopened unless new and material evidence is received. 38 U.S.C.A. § 5108. 38 C.F.R. § 3.156(a), which defines "new and material evidence," was revised, effective August 29, 2001. The instant claim to reopen was filed after that date (in October 2002), and the new definition applies. As already noted earlier in this decision and repeated here for clarity, under the amended version, "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. 38 C.F.R. § 3.156(a). 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. Id. The VCAA provides that nothing in the section shall be construed as requiring VA to reopen a previously disallowed claim except when new and material has been presented or secured. See 38 U.S.C.A. § 5103A. When determining whether a claim should be reopened, the credibility of the newly submitted evidence is to be presumed. Justus, supra. Regarding materiality, the Court has held that the newly presented evidence need not be probative of all the elements required to award the claim but that the evidence must tend to prove the merits of the claim as to each essential element that was a specified basis for the last final disallowance of the claim. Evans, supra. An April 2001 rating decision denied service connection for an acquired psychiatric disorder classified as major depressive disorder, and for various skin disorders, to include as secondary to exposure to herbicides in service. It was noted at that time that chronic psychiatric or skin conditions were not noted during service or for many years thereafter, and that such were not now shown to be related to such service. Moreover, as to the skin disorders, it was noted that the skin conditions presently diagnosed were not one of the conditions for presumptive service connection based on exposure to herbicides used in Vietnam and that there was no evidence of a relationship between the veteran's service and his present skin disorders. The April 2001 decision was the last prior final decision regarding these matters. For evidence to be new and material in light of the prior findings, it would have to tend to show that the veteran's presently acquired psychiatric disorder, major depressive disorder, classified as stress, and current skin disorders, were related to his service, and as for the skin conditions, or to herbicide (Agent Orange) exposure. The only evidence received since the April 2001 RO decision consists of private treatment records from 2001 which show treatment for depression and VA records which reflect continued treatment for various disorders, to include major depressive disorder. The VA records also show continued treatment for skin problems, variously diagnosed as summarized above. Also added was the January 2008 hearing transcript. None of these records relate any current psychiatric disorder, other than PTSD which has been separately addressed, or any skin conditions to the veteran's service (or skin disorders to herbicide exposure). A chronic psychiatric disorder, depression, or chronic skin disorders, variously diagnosed, were not clinically shown until many years after service discharge. The veteran's contentions as to etiology of these conditions remains unsupported by the medical evidence. As no evidence received since the April 2001 decision suggests a relationship between military service and his major depressive disorder or his variously diagnosed skin conditions, to include exposure to herbicides, the evidence received since 2001 does not, by itself, or when considered with previous evidence of record, relate to an unestablished fact necessary to substantiate the claims, does not raise a reasonable possibility of substantiating the claims, and is not new and material. Consequently, the claims may not be reopened. A Prostate Disorder, Disorder Manifested by Blood in the Stool, a Respiratory Disorder, and Peripheral Neuropathy of the Right and Left Upper and Lower Extremities. The veteran is seeking service connection for a prostate disorder, a genitourinary disorder manifested by blood in the stool, a respiratory disorder, and peripheral neuropathy of the upper and lower extremities. His primary contention is that these disorders are due to exposure to herbicides (Agent Orange) in service. Background, Criteria, and Analysis In general, service connection may be granted for disability resulting from disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. § 1110. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). A veteran who had active service in the Republic of Vietnam at any time from January 9, 1962, to May 7, 1975, will be presumed to have been exposed to an herbicide agent during that service. 38 U.S.C.A. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). When such a veteran develops a disorder listed in 38 C.F.R. § 3.309(e), which disorders have been shown to be caused by exposure to Agent Orange, to a degree of 10 percent or more within the specified period, the disorder shall be presumed to have been incurred during service. 38 U.S.C.A. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Diseases to which the presumption applies are: chloracne or other acneform diseases consistent with chloracne, Type 2 diabetes (also known as Type II diabetes mellitus or adult- onset diabetes), Hodgkin's disease, chronic lymphocytic leukemia, multiple myeloma, non-Hodgkin's lymphoma, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea) and soft-tissue sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). 38 U.S.C.A. § 1116; 38 C.F.R. § 3.309(e). The above-listed diseases shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne, porphyria cutanea tarda, and acute and subacute peripheral neuropathy shall have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. 38 U.S.C.A. § 1116; 38 C.F.R. §§ 3.307(a)(6)(ii). As noted above, the veteran is seeking service connection for a prostate disorder, a disorder manifested by blood in the stool, a respiratory disorder, and peripheral neuropathy of the upper and lower extremities. None of these conditions was noted while the veteran was in service. Similarly the post service treatment records are negative for specific diagnoses as to these claims. While the veteran was seen for hematuria in his urine and stools as early as the late 1990s (apparently due to kidney stones which were first diagnosed many years after service), no chronic prostate disorder or disorder manifested by blood in the stools was diagnosed at that time or thereafter. Similarly, while the veteran was seen in 2002 for tingling in the feet and hands, peripheral neuropathy was not diagnosed at that time and is not currently diagnosed. Moreover, he has not been diagnosed as having a chronic respiratory disorder. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. § 1110; Degmetich v. Brown, 104 F.3d 1328 (1997). It is well-settled that in order to be considered for service connection, a claimant must first have a disability. In Brammer v. Derwinski, 3 Vet. App. 223 (1992), it was noted that Congress specifically limited entitlement for service- connected disease or injury to cases where such incidents resulted in disability. See also Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) (service connection may not be granted unless a current disability exists); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). In this case, the only evidence that the veteran has the claimed disabilities, consists of the veteran's statements and hearing testimony. The record does not show, nor does the veteran contend, that he has specialized education, training, or experience that would qualify him to provide an opinion on this matter. It is now well established that a lay person such as the veteran is not competent to opine on medical matters such as medical diagnosis or the etiology of medical disorders, and his opinion that he has chloracne is therefore entitled to no weight of probative value. Cromley v. Brown, 7 Vet. App. 376, 379 (1995); Espiritu v. Derwinski, 2 Vet. App. 492, 494- 95 (1992). In view of the foregoing, the Board finds there is no competent evidence that the veteran has the claimed disabilities of a prostate disorder, a genitourinary disorder manifested by blood in the stool, a respiratory disorder, or peripheral neuropathy of the upper and lower extremities, and in the absence of a showing of such, the preponderance of the evidence is against the claims. Moreover, there is no basis for a grant of service connection for these disabilities on a presumptive basis under the provisions of 38 U.S.C.A. § 1116 and 38 C.F.R. § 3.309(e) based on exposure to Agent Orange. As the preponderance of the evidence is against the claims, the benefit of the doubt doctrine does not apply, and the claims must be denied. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). ORDER The appeal to reopen a claim seeking service connection for an acquired psychiatric disorder, previously classified as manic depressive disorder and now classified as stress, is denied. New and material evidence having been submitted, the claim of entitlement to service connection for PTSD is reopened; to this extent only, the appeal is granted to this extent. The appeal to reopen a claim seeking service connection for a skin disorder, previously classified as fungal infection, onychomycosis, and tinea pedis, and now classified as subcutaneous tarda, to include as secondary to exposure to herbicides in service, is denied. Entitlement to service connection for a prostate disorder, to include as secondary to exposure to herbicides in service, is denied. Entitlement to service connection for a disorder manifested by blood in the stool, to include as secondary to exposure to herbicides in service, is denied. Entitlement to service connection for a respiratory disorder, to include as secondary to exposure to herbicides in service, is denied. Entitlement to service connection for peripheral neuropathy of the right and left upper and lower extremities, to include as secondary to exposure to herbicides in service, is denied. REMAND Service connection for PTSD requires medical evidence diagnosing the condition in accordance with § 4.125(a) of this chapter; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. The veteran contends that he has PTSD as a result of stressful events that took place during his tour in Vietnam. Claimed combat exposure includes his being involved in a chopper crash due to enemy fire near a Vietnamese landing zone. During the assault, two Vietnamese people in the helicopter were killed by bullets and rocket mortar. Their bodies were splattered all over the inside of the chopper and on the veteran. On another occasion, while searching for downed pilots, the veteran and his unit undertook heavy fire. He witnessed several people perish including the pilot close to him. He recalled how this experience caused him distress and remained active in his intrusive memories and dreams. Apart from obtaining service personnel records, it does not appear that the RO made efforts to verify the veteran's claimed combat stressors. This is likely due to the fact that his contentions are too vague. However, he should be provided with additional opportunity to give additional details which might allow for meaningful verification efforts of the alleged stressors. As the claim is otherwise being remanded, the veteran should be asked to provide further information relating to the circumstances of these deaths, to include buddy statements or other lay evidence. The Board notes that the veteran has a diagnosis of PTSD that was rendered by a VA social worker in 2006. The record also includes earlier diagnosis of PTSD by staff psychiatrists. These reports note the claimed stressor history, albeit with some variances and discrepancies. At this point in time, however, because none of the veteran's stressors have been verified, the veteran has not received a diagnosis relating PTSD to a verified stressor(s). This matter should be clarified on remand by way of another examination to ascertain whether the veteran's PTSD is due to his military service, and in particular to a verified stressor. As the claim is otherwise being remanded, the agency of original jurisdiction should take efforts to ensure that all duties to notify and assist are met. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006); aff'd sub nom. Hartman v. Nicholson, No. 2006-7303 (Fed. Cir. Apr. 5, 2007). Accordingly, the case is REMANDED for the following action: 1. Provide the veteran with proper notice under the VCAA. See 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2007). This notice should address the disability rating and effective date elements of his claim, should service connection be established. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006); aff'd sub nom. Hartman v. Nicholson, No. 2006-7303 (Fed. Cir. Apr. 5, 2007). 2. The RO should undertake appropriate development to obtain any pertinent evidence identified but not provided by the veteran. If the AMC/RO is unable to obtain any pertinent evidence identified by the veteran, it should so inform the veteran and his representative and request that they submit the outstanding evidence. He should be asked to supply dates for the reported stressors within 2 month periods so that a meaningful search for information might be made. 3. If appropriate information is provided, the AMC/RO should request that Marine Corps Historical Center in Quantico, Virginia ascertain whether the veteran's Division and Transport Battalion Company came under attack while in Vietnam. Also, if the RO determines that it has enough information to attempt to verify any other claimed stressor, to include the veteran's reports of casualties, appropriate development action should be taken. 4. Following receipt of a response from appropriate JSRRC, Marine Corps Historical Center, or other entities, the AMC/RO should prepare a report detailing the nature of any combat action (to which a purported stressor is related) and/or other in- service stressor(s) that it has determined are established by the record. This report is then to be added to the claims file. If no combat action (referred to above) or alleged in-service stressor has been verified, then the RO should so state in its report and proceed with development. 5. If, and only if, a stressor is verified, the veteran should be afforded a VA examination by a psychiatrist determine the nature and etiology of his PTSD. The claims folder must be made available to and reviewed by the examiner. Any indicated studies should be performed. The examiner should read the report listing any verified in-service stressors. Based upon the claims folder review and the examination results, the examiner should identify all currently present acquired psychiatric disorders. The examiner should specifically address whether the veteran has PTSD due to a stressor which has been verified. If PTSD due to a verified in service stressor is diagnosed, the examiner should identify the elements supporting the diagnosis. If the examiner does not diagnose PTSD due to an in-service stressor, the examiner should explain why the veteran does not meet the criteria for this diagnosis. The rationale for all opinions expressed must also be provided. 6. Then, the RO should readjudicate the veteran's claim for service connection for PTSD based on a de novo review of the record. If any benefit sought on appeal is not granted to the veteran's satisfaction, the veteran and his representative should be furnished a supplemental statement of the case (SSOC) and provided an appropriate opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action, if otherwise in order. By this remand, the Board intimates no opinion as to any final outcome warranted. 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). ______________________________________________ MICHAEL D. LYON Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs