Citation Nr: 0814880 Decision Date: 05/06/08 Archive Date: 05/12/08 DOCKET NO. 05-03 258 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for tinnitus. 2. Entitlement to service connection for a left knee disability, to include as secondary to a service-connected right knee disability. 3. Entitlement to service connection for post-traumatic stress disorder (PTSD). 4. Entitlement to service connection for a low back disability. 5. Entitlement to service connection for a cardiovascular disability, claimed as secondary to service-connected diabetes mellitus. 6. Entitlement to service connection for a kidney disability, claimed as secondary to service-connected diabetes mellitus. 7. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a cervical spine disability. 8. Entitlement to service connection for erectile dysfunction. REPRESENTATION Appellant represented by: Vietnam Veterans of America WITNESSES AT HEARING ON APPEAL Appellant, S.R. and B.H. ATTORNEY FOR THE BOARD C. M. Powell, Associate Counsel INTRODUCTION The veteran had active service from December 1967 to December 1970 and had periods of active duty for training from September 1973 to December 1977. These matters come to the Board of Veterans' Appeals (Board) on appeal from April 2004, May 2005 and October 2005 rating decisions of the St. Louis, Missouri Regional Office (RO) of the Department of Veterans Affairs (VA). The April 2004 rating decision denied service connection for PTSD. The May 2005 rating decision denied service connection for a left knee disability claimed as secondary to service-connected right knee disability, and the October 2005 rating decision denied service connection for tinnitus. The Board notes that a review of the claim files reflects that the veteran has raised inferred claims of entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus and entitlement to service connection for bilateral upper and lower extremity peripheral neuropathy, to include as secondary to service- connected diabetes mellitus. As these issues have not been developed for appellate review, they are referred to the RO for appropriate action. The issues of entitlement to service connection for a low back disability, entitlement to service connection for a cardiovascular disability, to include as secondary to service-connected diabetes mellitus, entitlement to service connection for erectile dysfunction, entitlement to service connection for a kidney disability, to include as secondary to service-connected diabetes mellitus, and whether new and material evidence has been received to reopen a claim of entitlement to service connection for a cervical spine disability, 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. Tinnitus was initially demonstrated years after service, and has not been shown by competent evidence to be causally related to the veteran's active service. 2. The competent evidence of record does not demonstrate that the veteran has a currently diagnosed left knee disability. 3. The competent evidence of record demonstrates that the veteran has a current PTSD diagnosis, but does not establish that he engaged in combat with the enemy or the occurrence of a verifiable in-service stressor. CONCLUSIONS OF LAW 1. Tinnitus was not incurred in or aggravated by active service, and may not be presumed (as an organic disease of the nervous system) to have been so incurred or aggravated. 38 U.S.C.A. §§ 1110, 5107(West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.385 (2007). 2. A left knee disability, was not incurred in, or aggravated by, active service, and is not proximately due to, or aggravated by, a service-connected disability. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2007). 3. PTSD was not incurred in, or aggravated by, active service. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (f)(2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VCAA The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2005); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2007). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her 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) (West 2002); 38 C.F.R. § 3.159(b) (2007); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice 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 her or his possession that pertains to the claim in accordance with 38 C.F.R. § 3.159(b)(1). VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). On March 3, 2006, the United States Court of Appeals for Veterans Claims (Court) issued its decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Court in Dingess/Hartman holds that the VCAA notice requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a "service connection" claim. As previously defined by the courts, those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. Upon receipt of an application for "service connection," therefore, the Department of Veterans Affairs (VA) is required 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 the elements of the claim as reasonably contemplated by the application. This includes notice that a disability rating and an effective date will be assigned in the event of the award of the benefits sought. In the present case, VA satisfied its duty to notify by means of September 2002, February 2005, July 2005, January 2006, March 2006, and October 2006 letters from the agency of original jurisdiction (AOJ) to the appellant that informed him of what evidence was required to substantiate the claims and of his and VA's respective duties for obtaining evidence, as well as requested that he submit any additional evidence in his possession pertaining to the claims. The March 2006 and October 2006 VA letters provided him with notice of the type of evidence necessary to establish a disability rating and effective date in the event of award of any benefit sought. In Pelegrini v. Principi, 18 Vet. App. 112 (2004), the U.S. Court of Appeals for Veterans Claims held, in part, that a VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits. In the present case, complete VCAA notification was not achieved until after the initial AOJ adjudication of the claims. Nevertheless, the Court in Pelegrini noted that such requirement did not render a rating decision promulgated prior to providing the veteran full VCAA notice void ab initio, which in turn would nullify the notice of disagreement and substantive appeal filed by the veteran. In other words, Pelegrini specifically noted that there was no requirement that the entire rating process be reinitiated from the very beginning. Rather, the claimant should be provided VCAA notice and an appropriate amount of time to respond and proper subsequent VA process. Here, the Board finds that any defect with respect to the timing of the VCAA notice letter was harmless error. Although additional VCAA notice was provided to the appellant after the initial adjudication, the case was readjudicated thereafter, and the appellant has not been prejudiced thereby. The content of the notice provided to the appellant fully complied with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) regarding VA's duty to notify. Not only has the appellant been provided with every opportunity to submit evidence and argument in support of his claims and to respond to VA notices, but the actions taken by VA have essentially cured the error in the timing of notice. Further, the Board finds that the purpose behind the notice requirement has been satisfied because the appellant has been afforded a meaningful opportunity to participate effectively in the processing of his claims. For these reasons, it is not prejudicial to the appellant for the Board to proceed to finally decide this appeal. With regard to the duty to assist, the claims file contains the veteran's service medical records, private and VA treatment records, and VA examination reports. Additionally, the claims file contains the veteran's statements in support of his claims. The Board has carefully reviewed such statements and concludes that he has not identified further evidence not already of record. The Board has also perused the medical records for references to additional treatment reports not of record, but has found nothing to suggest that there is any outstanding evidence with respect to the veteran's claims. Thus, based on the foregoing, the Board finds that all relevant facts have been properly and sufficiently developed in this appeal and no further development is required to comply with the duty to assist the veteran in developing the facts pertinent to his claims. Essentially, all available evidence that could substantiate the claims has been obtained. Legal Criteria and Analysis The Board has reviewed all of the evidence in the veteran's claims folder. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to each claim. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2007). Where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946 and tinnitus, as an organic disease of the nervous system, becomes manifest to a degree of 10 percent or more within one year from the date of termination of such service, such disease shall be presumed to have been incurred in, or aggravated by, such service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2007). Secondary service connection may be granted for a disability, which is proximately due to, the result of, or aggravated by, an established service-connected disorder. 38 C.F.R. § 3.310 (2007). Secondary service connection includes instances in which an established service-connected disorder results in additional disability of another condition by means of aggravation. Allen v. Brown, 7 Vet. App. 439 (1995). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either caused or aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 488 (1995). The Board notes that there was a recent amendment to the provisions of 38 C.F.R. § 3.310. See 71 Fed. Reg. 52744-47 (Sept. 7, 2006). The amendment sets a standard by which a claim based on aggravation of a non-service-connected disability by a service-connected one is judged. Although VA has indicated that the purpose of the regulation was merely to apply the Court's ruling in Allen, it was made clear in the comments to the regulation that the changes were intended to place a burden on the claimant to establish a pre- aggravation baseline level of disability for the non-service- connected disability before an award of service connection may be made. This had not been VA's practice, which suggests that the recent change amounts to a substantive change. Given what appear to be substantive changes, and because the veteran's claim was pending before the regulatory change was made, the Board will consider the version of 38 C.F.R. § 3.310 in effect before the change, which version favors the claimant. Regulations also provide that 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) (2007). 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); 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2007). 1. Tinnitus The veteran asserts that service connection is warranted for tinnitus. In terms of establishment of service connection on a nonpresumptive direct incurrence basis, the Board acknowledges that the veteran was exposed to noise trauma while in service. Indeed, the veteran's DD Form 214 reflects that his military occupational specialty was that of a light weapons infantryman. Likewise, the veteran's DA Form 20 reflects that his principal duties included that of a rifleman and a grenadier. Such form also indicates that the veteran received an award and/or decoration for the Rifle M- 14, Rifle M-16, and the Machine Gun M-60. Therefore, the Board finds that it would have been consistent with the circumstances of the veteran's service for him to have been exposed to noise trauma in service. As such, the Board concedes that the veteran was exposed to acoustic trauma in service. However, the veteran's service medical records are silent for complaints of, or treatment for, tinnitus. The record establishes that the first documentation of tinnitus was many years after the veteran's separation from service in an October 2006 letter, in which the veteran's treating physician indicated that he had been treating the veteran for tinnitus since 1987. In the absence of demonstration of continuity of symptomatology, this is too remote from service to be reasonably related to service. Further, it is significant to point out that there is no competent medical opinion of record that etiologically relates the veteran's current tinnitus to his in-service exposure to noise. In this regard, the Board notes that the examiner from the April 2007 VA examination reported that the veteran's tinnitus was not related to the veteran's exposure to noise in service. In reaching this conclusion, the examiner noted that: SMRs are negative for tinnitus complaints. The veteran waited 25 years post military to claim service connected tinnitus. There are many causes of tinnitus not related to acoustic trauma. The examiner cannot be 50 % or more certain. It is less likely as not that tinnitus was caused by or a result of military related acoustic trauma. Therefore, in the absence of any clinical evidence to the contrary, the Board finds that the preponderance of the evidence is against a grant of service connection for tinnitus on a nonpresumptive direct incurrence basis. In order to establish service connection on a presumptive basis, the veteran's tinnitus must have become manifest to a degree of 10 percent or more within one year from the date of termination of his service. In this case, the first clinical documentation of tinnitus was in 1987, which was many years after the veteran's discharge from service. As such, the Board finds that the preponderance of the evidence is against a grant of service connection on a presumptive basis. In conclusion, although the veteran asserts that his current tinnitus is related to service, he is not competent to provide an opinion requiring medical knowledge, such as a question of medical causation. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). He is competent to give evidence about what he experienced; for example, he is competent to report that he experiences certain symptoms. See, e.g., Layno v. Brown, 6 Vet. App. 465 (1994). Competency, however, must be distinguished from weight and credibility, which are factual determinations going to the probative value of the evidence. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). The negative evidence of record, including the April 2007 VA medical opinion, is of greater probative value than the veteran's statements in support of his claim. Although the Board concludes that the evidence is sufficient to establish that the veteran sustained acoustic trauma in service, the competent evidence of record fails to establish that his current tinnitus is related to such incident of service. The Board has considered the doctrine of giving the benefit of the doubt to the veteran, under 38 U.S.C.A. § 5107 (West 2002), and 38 C.F.R. § 3.102 (2007), but does not find that the evidence is of such approximate balance as to warrant its application. Accordingly, the Board finds that the preponderance of the evidence is against the veteran's claim for service connection for tinnitus and the claim must be denied. 2. Left Knee The veteran also asserts that service connection is warranted for a left knee disability, to include as secondary to a service-connected right knee disability. In order to establish service connection on a secondary basis the evidence must show (1) that a current disability exists and (2) that the current disability was either caused or aggravated by a service-connected disability. The record reflects that the veteran is currently service- connected for a right knee disability. With respect to a current disability, the record reflects that the veteran has been diagnosed with reflex sympathetic dystrophy of the left lower extremity, for which he wears a brace. However, other than on VA examination in April 2005 where the veteran complained of constant left knee pain, the record does not reflect that he has complained of, or sought treatment for a left knee disability. Indeed, although the veteran, during his April 2005 VA joints examination, indicated that his left knee pain (which he attributed to favoring his right knee and not any specific injury) began in 1990, he also indicated that he had not had any formal medical evaluation or treatment to the left knee, other than for the brace. Moreover, the April 2005 VA examiner, after an examination of the veteran's left knee stated that, "there is no evidence whatsoever that this gentleman has any type of pathologic process in the knee joint itself." In fact, the examiner attributed the veteran's left knee pain to a non-service connected disability. According to the examiner, who diagnosed the veteran with causalgia of the left leg, the veteran "apparently... does have reflexes sympathetic dystrophy of the left lower extremity and the pain, which [he] experiences in the left knee is only partial of the total leg pain." The examiner further opined that any left knee symptomology that the veteran has is not related to his service-connected right knee disability. According to examiner, "it is the opinion of this examiner that there is no evidence whatsoever that this gentleman's left knee problem is in anyway related to the right knee or true condition, which arose while he was on active duty." There is also no competent clinical evidence of record that demonstrates that the veteran's service-connected right knee disability aggravates any left knee disability. Accordingly, in the absence of any evidence that the veteran's left knee disability was caused or aggravated by his service-connected right knee disability, the preponderance of the evidence is against a grant of service connection on a secondary basis. The evidence of record also does not demonstrate that the veteran is entitled to a grant of service connection on a direct incurrence basis. Indeed, with respect to an in- service injury or disease, the veteran's service medical records are silent for complaints of, or treatment for a left knee disability. Moreover, with respect to a current left knee disability, the record does not demonstrate that the veteran has a currently diagnosed left knee disability. Indeed, as noted above, the April 2005 VA examiner indicated that there was no evidence that the veteran experienced any type of pathologic process in the left knee joint itself, but that the veteran experienced left lower extremity reflex sympathetic dystrophy. Therefore, as the evidence of record does not demonstrate that the veteran has a current diagnosed left knee disability, the Board concludes that an award of service connection is not justified. Support for this conclusion is found in Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) where the Court found that Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability and in the absence of proof of a present disability there can be no valid claim. Thus, in the absence of any evidence to the contrary, the Board finds that the preponderance of the evidence is against the veteran's claim for service connection for a left knee disability on a direct incurrence basis. In conclusion, although the veteran asserts that he has a current left knee disability that is related to service, including his service-connected right knee disability, he is not competent to provide an opinion requiring medical knowledge, such as a question of medical causation. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). He is competent to give evidence about what he experienced; for example, he is competent to report that he experiences certain symptoms. See, e.g., Layno v. Brown, 6 Vet. App. 465 (1994). Competency, however, must be distinguished from weight and credibility, which are factual determinations going to the probative value of the evidence. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). The negative evidence of record, including the April 2005 medical opinion, is of greater probative value than the veteran's statements in support of his claim. Accordingly, the Board finds that the competent evidence of record fails to establish that the veteran has a current left knee disability as a result of his service. The Board has considered the doctrine of giving the benefit of the doubt to the veteran, under 38 U.S.C.A. § 5107 (West 2002), and 38 C.F.R. § 3.102 (2007), but does not find that the evidence is of such approximate balance as to warrant its application. Accordingly, the Board finds that the preponderance of the evidence is against the veteran's claim for service connection for a left knee disability, to include as secondary to service-connected right knee disability and the claim must be denied. 3. PTSD Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a), 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. 38 C.F.R. § 3.304(f) (2007). The provisions of 38 C.F.R. § 4.125(a) require that a diagnosis of a mental disorder conform to the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994). Further relating to claims of service connection for PTSD, in Zarycki v. Brown, 6 Vet. App. 91 (1993), the United States Court of Appeals for Veterans Claims (Court) set forth the analytical framework and line of reasoning for determining whether a veteran was exposed to a recognizable stressor during service, which, as discussed above, is an essential element in solidifying a claim for service connection for PTSD. In Zarycki, it was noted that, under 38 U.S.C.A. 1154(b), 38 C.F.R. 3.304(d) and (f), and the applicable provisions contained in VA Manual 21-1, the evidence necessary to establish the incurrence of a recognizable stressor during service to support a claim of service connection for PTSD will vary depending on whether the veteran "engaged in combat with the enemy." See Hayes v. Brown, 5 Vet. App. 60 (1993). The determination as to whether the veteran "engaged in combat with the enemy" is made, in part, by considering military citations that expressly denote as much. Doran v. Brown, 6 Vet. App. 283, 289 (1994). However, the Court has held that the Board may not rely strictly on combat citations or the veteran's military occupational specialty to determine if he engaged in combat; rather, other supportive evidence of combat experience may also be accepted. See Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996); West v. Brown, 7 Vet. App. 70, 76 (1994). If combat is affirmatively indicated, then the veteran's lay testimony regarding claimed combat- related stressors must be accepted as conclusive as to their actual occurrence and no further development or corroborative evidence will be required, provided that the veteran's testimony is found to be "satisfactory," i.e., credible, and "consistent with the circumstances, conditions, or hardships of such service." Zarycki, 6 Vet. App. at 98. If there is no combat experience, or if there is a determination that the veteran engaged in combat but the claimed stressor is not related to such combat, there must be independent evidence to corroborate the veteran's statement as to the occurrence of the claimed stressor. Doran, 6 Vet. App. at 288-89 (1994). The veteran's testimony, by itself, cannot, as a matter of law, establish the occurrence of a non-combat stressor. Dizoglio, 9 Vet. App. at 166 (1996). Further, an opinion by a mental health professional based on a post-service examination of the veteran cannot be used to establish the occurrence of a stressor. Moreau v. Brown, 9 Vet. App. at 395-96 (1996); Cohen v. Brown, 10 Vet. App. 128 (1997). The veteran asserts that service connection is warranted for PTSD. The record demonstrates that the veteran has been diagnosed with PTSD since 2002. With respect to his in- service stressors, the veteran has claimed both combat and noncombat related stressors. With respect to his combat-related stressors, the veteran has indicated that on April 1, 1969, when he first arrived in South Korea, he and some other soldiers were chosen to go on a top secret operation in the Demilitarized Zone (DMZ), which was a combat area, to hunt down and kill any of the North Korean Special Forces that had infiltrated to the south of the parallel in an attempt to assassinate a high ranking South Korean official. According to the veteran, after the insurgents were neutralized, he came upon some American soldiers who were posing with, and taking pictures of, a North Korean Special Forces Sapper who had been hit with light weapons fire over 30 times. As a result, because the man's body was a horror to look at and was actually falling apart, the veteran had a feeling of disgust that devastated him. Another combat related stressor that the veteran reported occurred on October 18, 1969 and involved the veteran engaging in combat with insurgents after witnessing the dead bodies of four American soldiers who had been killed in an ambush in the DMZ. However, after a review of the record, the Board concludes that there is no objective competent evidence that establishes that these events occurred, or that the veteran was engaged in combat with the enemy. In this regard, the veteran's personnel records reflect that he served in Korea from April 6, 1969 to May 4, 1970. Service personnel records also establish that his principal duties were rifleman and grenadier in an infantry division from April 11, 1969 through March 9, 1970. However, such records do not demonstrate that the veteran was involved in any combat-related activity. Further, although the record reflects that the veteran received the National Defense Service Medal, Armed Forces Expeditionary Medal (Korea), a Parachutist Badge, and the Expert Infantryman's Badge (Korea), there is no evidence that such medals/badges were awarded for combat and/ or valor. Moreover, the record does not reflect that the veteran was awarded any other award or decoration indicative of combat- related service. The Board finds that the veteran has not provided any independent evidence that could corroborate his statements as to the occurrence of the claimed stressors. Other than the veteran's testimony regarding the occurrence of the aforementioned stressors, the claims folder does not contain any additional evidence of their actual happening. The Board notes that in January 2006, the RO made a formal finding that the record contained a lack of information required to verify stressors relative to the PTSD claim, despite efforts to obtain this information from the veteran. In this regard, with respect to the veteran's report that he saw soldiers who had been killed in an ambush in the DMZ, it is noted that the evidence that the veteran submitted reflected that the killed in action were from Co C, 1st BN 32d INF. However, the veteran was with Co A, 2d BN, 38th INF. Further, with respect to the incident involving North Korean infiltrators, although the veteran reported that such event occurred around April 1969, it in fact, happened in January 1968. The Board notes that such date is prior to time that the veteran was stationed in Korea. As noted above, the veteran did not arrive in Korea until April 6, 1969. With respect to non-combat related stressors, the veteran has related an incident that occurred in the early fall of 1968 at Ft. Benning, Georgia, in which his parachute malfunctioned while on his first jump. According to the veteran, while flying down, he collided with another paratrooper whose parachute had also malfunctioned. The veteran indicated that while he survived his parachute malfunction, the other paratrooper did not. The veteran has also related another incident in which he was charged with shooting another soldier and was told that he was going to be court-martialed. However, it was later found out that the soldier had shot himself. The Board again finds that the veteran has not provided any independent evidence that could corroborate his statements as to the occurrence of the claimed stressors. Other than the veteran's testimony regarding the occurrence of the aforementioned stressors, the claims folder does not contain any additional evidence of their actual happening. Indeed, in an attempt to verify the veteran's parachute malfunction stressor, a CURR response in February 2004 indicated that it did not research and/or maintain military records for the 4th student BN. It also indicated that the veteran gave conflicting dates of the incident, including in May, June, or July 1968 and the early fall of 1968 and that he did not give a name. Therefore, because the veteran has not provided any evidence of combat with the enemy or any independent evidence that could corroborate his statements as to the occurrence of the claimed stressors, the Board concludes that the veteran has not established the occurrence of a verifiable in-service stressor. In conclusion, although the veteran contends that he has a diagnosis of PTSD that is related to a stressor in service, he is not competent to provide an opinion requiring medical knowledge, such as a question of medical causation. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Thus, the Board finds that the negative evidence of record is of greater probative value than the veteran's statements in support of his claim. Accordingly, the Board finds that the competent evidence of record fails to establish that the veteran has PTSD that is related to the veteran's active military service. Thus, the Board finds that the preponderance of the evidence is against the veteran's claim for service connection for PTSD and the claim must be denied. ORDER Entitlement to service connection for tinnitus is denied. Entitlement to service connection for a left knee disability, to include as secondary to a service-connected right knee disability, is denied. Entitlement to service connection for post-traumatic stress disorder (PTSD) is denied. REMAND The record reflects that in August 2007, the veteran submitted a Notice of Disagreement with the August 2007 rating decision that, in pertinent part, denied service connection for a cardiovascular disability, claimed as secondary to service-connected disability, a kidney disability, claimed as secondary to service-connected disability, erectile dysfunction and a lumbar spine disability, and found new and material evidence had not been received to reopen a claim for service connection for a cervical spine disability. However, it does not appear that a Statement of the Case (SOC) has been issued with regard to these matters. In Manlincon v. West, 12 Vet. App. 238 (1999), the United States Court of Appeals for Veterans Claims (Court) held that in these circumstances where a Notice of Disagreement is filed, but a Statement of the Case has not been issued, the Board must remand the claim to the RO to direct that a Statement of the Case be issued. Accordingly, the case is REMANDED for the following action: Issue a Statement of the Case in response to the notice of disagreement with the August 2007 rating decision adjudication of the issues of service connection for a cardiovascular disability, to include as secondary to diabetes mellitus, new and material evidence to reopen a claim of entitlement to service connection for a cervical spine disability, service connection for a kidney disability, to include as secondary to diabetes mellitus, service connection for erectile dysfunction, and service connection for a lumbar spine disability. The veteran should be apprised that he must timely submit a substantive appeal, VA Form 9, Appeal to Board of Veterans' Appeals, to complete an appeal as to these matters. The veteran and his representative should be provided the appropriate opportunity to respond. Only if a timely substantive appeal as to any issue is received, should the case then be returned to the Board for further appellate consideration. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). ______________________________________________ U. R. POWELL Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs