Citation Nr: 0825895 Decision Date: 08/01/08 Archive Date: 08/13/08 DOCKET NO. 98-00 259 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim for service connection for a low back disorder, claimed as a residual of a combat related injury. 2. Entitlement to service connection for residuals of shell fragment wounds of the right foot. 3. Entitlement to service connection for residuals of shell fragment wounds of the face and buttocks. 4. Entitlement to service connection for peripheral neuropathy, including claimed as secondary to herbicide exposure. 5. Entitlement to service connection for other psychiatric disability, including chronic mental dysfunction impairment. 6. Entitlement to service connection for post- traumatic stress disorder. 7. Entitlement to service connection for a heart disorder. 8. Entitlement to service connection for erectile dysfunction. REPRESENTATION Appellant represented by: Kenneth M. Carpenter, attorney WITNESSES AT HEARING ON APPEAL The appellant and his spouse ATTORNEY FOR THE BOARD T. Stephen Eckerman, Counsel INTRODUCTION The veteran had active service from March 1967 to October 1969, including service in the Republic of Vietnam in 1968 and 1969. This appeal arises from October 1997 and December 1998 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri, which denied the benefits sought on appeal. In April 2001, the Board remanded the claims for additional development. In October 2004, the RO denied claims for a heart condition, and erectile dysfunction. Jurisdiction over the veteran's claims files has been transferred to the RO in Jackson, Mississippi. In December 1999, the veteran was afforded a hearing at the Board of Veterans' Appeals (BVA or Board) before the undersigned, who is the Acting Veterans Law Judge rendering the determination in this claim and was designated by the Chairman of the Board to conduct that hearing, pursuant to 38 U.S.C.A. § 7102(b) (West 2002). In February 2008, the Board sent the veteran notice that an additional BVA hearing was scheduled at his request on April 15, 2008. The veteran failed to appear for his scheduled hearing, and there is no record that a request for another hearing was ever made. Without good cause being shown for the failure to appear, no further hearing can be scheduled and appellate review may proceed. FINDINGS OF FACT 1. In an unappealed decision, dated in March 1970, the RO denied a claim of entitlement to service connection for low back strain. 2. Evidence received since the March 1970 RO decision does not bear directly and substantially on the matter under consideration and is not so significant that it must be considered in order to fairly decide the appellant's claim. 3. The veteran does not have residuals of shell fragment wounds of the right foot, residuals of shell fragment wounds of the face and buttocks, peripheral neuropathy, other psychiatric disability, including chronic mental dysfunction impairment, a heart disorder (to include hypertension), or erectile dysfunction, as a result of his service. 4. The veteran did not participate in combat. 5. The veteran does not have PTSD that was present in service or is otherwise related to such service. CONCLUSIONS OF LAW 1. New and material evidence has not been received since the RO's March 1970 decision which denied a claim of entitlement to service connection for low back strain, and the claim for service connection for a low back disorder is not reopened. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2001). 2. Residuals of shell fragment wounds of the right foot, residuals of shell fragment wounds of the face and buttocks, peripheral neuropathy, other psychiatric disability, including chronic mental dysfunction impairment, a heart disorder, and erectile dysfunction, were not incurred in or aggravated by the veteran's active military service, nor may acute or subacute peripheral neuropathy, or hypertension, be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1116, 1154, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2007). 3. PTSD was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1154, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.159, 3.304 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Background As an initial matter, the veteran asserts that he has several of the claimed disorders on appeal as a result of participation in combat during service in Vietnam, or as secondary to disabilities incurred as a result of combat, to include PTSD. In its Remand, dated in April 2001, the Board noted that questions have been raised by the RO as to the authenticity of certain documents submitted in support of the veteran's claims. The relevant background is as follows: In October 1969, VA received the veteran's claim (VA Form 21-526) for service connection for lower back strain, and a hernia. In his claim, the veteran asserted that he incurred lower back strain in Vietnam, in late May or early June of 1969, after he fell from a truck, and thought "perhaps I had pulled a ligament." He indicated that he had been treated for his back symptoms, as well as hernia symptoms, at the 93rd Evacuation Hospital in Vietnam, between June and July of 1969. He indicated that his rank was PFC. The veteran's claim was received together with a copy of the veteran's discharge (DD Form 214) which was accompanied by certification from the Register of Deeds, Dane County, Wisconsin, dated October 28, 1969 (i.e., two days after the veteran's separation from service). The certification states, "I, [H.K.H.], Register of Deeds of the County of Dane, in the state of Wisconsin, do hereby certify that the annexed copy of Report of Separation of [the veteran] has been compared by me with the records of the original in this office Recorded in Vol. 72 of Discharges, Page 52, #23891 and that same is a correct transcript therefrom, and of the whole thereof." The certification bears the seal of the Register of Deeds, Dane County. The associated copy of the veteran's DD Form 214 bears the stamp of the Register of Deeds. It indicates that the veteran received badges that included the Vietnam Service Medal, the Vietnam Campaign Medal, and the Vietnam Gallantry Cross with palm. This DD Form 214 bears the veteran's signature. It indicates that the veteran's military occupation speci alty was "64B20 Hvy Trk Dr," that his home of record prior to entry into active service was in Madison, Wisconsin, that his rank was PFC [private first class] E3, that his date of rank was April 18, 1969, that his last duty assignment was "UASRV CO A 1ST ST BN 1ST INF DIV," that he had one year and nine months of foreign and or sea service, and that he had 12 years of civilian education. In January 1970, the veteran was afforded a VA examination. The examination report shows that the veteran denied having a hernia, or putting a claim in for a hernia. He reported that he had fallen off of a truck in late May or early July of 1969, and that he was treated at the dispensary about 7 to 14 days later. He stated that he was never hospitalized in the service. An X-ray of the lumbar spine was negative. The "diagnosis" noted that he did not have an orthopedic condition on examination. In January 1970, the RO received the veteran's service medical records. These records include the following: A "Health Record - Abstract of Service" indicates that as of March 9, 1968, the veteran's station and organization" was "534 T.C." Two sheets of entries indicate that the veteran received a number treatments at A Company, 1st Medical Battalion. One sheet indicates treatment for ear symptoms on February 19th and 24th of 1969, suture removal for sutures that "bothered his eyesight" on May 30, 1969, and complaints of "drip" or painful urination on June 8th, 12th and 21st of 1969. This sheet lists his unit as "534 TC." The second sheet indicates that he received two treatments June 24, 1969. One treatment was for painful urination, and one treatment was for right testicle pain. There are initials, apparently of service health care providers, dated June 25th and 26th of 1969, which could indicate follow-up treatment. A report, dated August 6, 1969, shows treatment for right ear symptoms. A report, dated September 11, 1969, indicates that he received treatment for a sore testicle and lower back symptoms at A Company, 1st Med Battalion, and indicates he was to receive additional treatment at the 93rd Evacuation Hospital. A consultation sheet (SF 513), from HQ & A Co. 1st Med Bn, indicates that he received treatment for left testicle pain at the outpatient department, 93rd Evacuation Hospital, on August 19th and 20th of 1969, and September 11th, 1969. A scrotal support was recommended. The consultation sheet further shows that on September 12th, 17th, 19th, and 20th of 1969, he was treated for right testicular pain. The reports dated September 17th and 19th indicate that he was to board overnight at the 90th Replacement Battalion, and return for additional treatment in the morning. The consultation sheet lists his unit as A Company, 1-1st ST, 1st Infantry Division. See also September 11, 1969 report (showing his unit as "A/S&T"). The veteran's separation examination report, dated in October 1969, did not contain any findings in the clinical evaluation portion of the report (items #18 through #44). The report contains findings for such things as height, weight, urinalysis, blood pressure, and audiometric results, and shows that each aspect of his PULHES profile was rated as a "1." See Odiorne v. Principi, 3 Vet. App. 456, 457 (1992) [Observing that the "PULHES" profile reflects the overall physical and psychiatric condition of the veteran on a scale of 1 (high level of fitness) to 4 (a medical condition or physical defect which is below the level of medical fitness for retention in the military service). The "P" stands for "physical capacity or stamina;" the "U" indicates "upper extremities;" the "L" is indicative of the "lower extremities;" the "H" reflects the state of the "hearing and ear;" the "E" is indicative of the eyes; and the "S" stands for psychiatric condition).]. This report notes that his rating or specialty was heavy truck driver. An accompanying "Report of Medical History," shows that the veteran denied any relevant symptoms, to include "history of broken bones," "back trouble of any kind," "loss of arm, leg, finger, or toe," "foot trouble," "frequent or terrifying nightmares," "depression or excessive worry," and "nervous trouble of any sort." In March 1970, the RO denied the veteran's claims for service connection. In July 1970, the RO received a copy of the veteran's DD Form 214 that is identical to the copy received in October 1969. There is no record of any activity in the veteran's claims file for the next 26 years, until September 1996, at which time the veteran filed six claims, to include a claim for PTSD. As noted in the Board's April 2001 Remand, the veteran claims to have been assigned on both permanent and temporary duty bases to units not listed in his DA 20, and to have performed duties as an infantryman. His claimed assignments include duty are as follows: (as of January 10, 1968) 543rd Transportation Company, 48th GP (group) "Rifle Security" unit; (as of February 1, 1968) Company A, 3d Battalion, 7th Infantry Regiment, 199th Infantry Brigade, (between November and December of 1968) home leave due to extension in Vietnam); (as of December 30, 1968) Company A, 1st S&T Battalion "Jump Team" Reaction Force; (as of January 31, 1969) Company A, 2d Battalion, 28th Infantry Regiment, 1st Infantry Division; (third or fourth week of April 1969) Company A, 1st S&T Battalion "Jump Team" Reaction Force; (as of May 23 or 24th (or July) of 1969) Company A, 1st Battalion, 16th Regiment (Mechanized), 1st Infantry Division; (from September 6, 1969 to mid-October 1969) treatment for shell fragment wounds at several hospitals. For each infantry unit claimed, he asserts that his MOS was 11B10. With regard to his claim that he was wounded in combat on September 6, 1969, he has asserted that he was treated for his wounds for between 11/2 to 5 weeks, to include treatment at the 12th Evacuation Hospital, followed by treatment at the 3rd Army Hospital, followed by treatment at the 93rd Evacuation Hospital, with return to duty in about the "middle of October 1969," with the "1st Brigade, 1st S&T HHC," and then arrival in Japan about October 20th or 22nd, before returning home. See veteran's letter (one of two), dated in December 27, 1996; see also, veteran's letter, dated in January 2001. In support of his PTSD claim, in November 1996, the veteran submitted four copies of a DD Form 214 that are all significantly different from the version received in 1969. Specifically, these copies indicate that the veteran's rank was sergeant ("E5"), that his date of rank was April 18, 1968, that his military occupation specialty was "11B10 Rifleman," that his last duty assignment was "USARV CO A 1st 16th INF 1st DIV. In addition to the decorations and badges previously discussed in the version of the DD Form 214 received in 1969, these copies indicate that he received the Combat Infantry Badge, a Purple Heart with oak leaf cluster, a Good Conduct Medal, and the "Tet Unit Citation." These DD Form 214's further indicate that he had 15 credit hours of "college CLEP," and contain an additional notation of "UPD: 1973." Two of these copies are very dark, and of poor quality; two copies are much lighter, and are also of poor quality. One of the lighter copies has a note stapled to it, which indicates that the Recorder of Deeds, Jefferson County, Missouri, "certify that the annexed instrument is a true copy of the Discharge as the same appears in Book 9, Page 1271, in my office." This certification is dated November 26, 1996, and is apparently signed by D.H., a Deputy for the Recorder of Deeds. It does not bear a seal. One of the four copies (which is also one of the dark copies) has a stamp on the back from the Jefferson County Recorder of Deeds. Subsequently, on several occasions, the veteran submitted additional copies of the DD Form 214's that were received on or after November 1996. In a memorandum, the RO detailed the discrepancies between the DD Form 214's received in 1969 and 1996, and concluded that the DD Form 214 received in 1969 more closely resembles the service noted in the veteran's personnel file (DA 20), and that if, in fact, the DD Form 214 received in 1996 was obtained from the NPRC (National Personnel Records Center), that agency's records may have been compromised. Additional development was suggested. An email from a VA RO employee to the St. Louis RMC (Records Management Center), dated in June 1997, notes that the Army Reference Branch had been contacted in April and May in an attempt to confirm the circumstances of the veteran's service, but that on both occasions, the record had been checked out. The email further notes that, "The vet apparently came into the research room and had a bunch of copies made and certified (either that or he owns his own NPRC seal) then sent copies of the copies to us." In March and April 1997, the veteran submitted a number of service records, to include a service medical record, dated in September 1969, indicating that he sustained a shell fragment wound to his right foot, and an "extract" dated January 31, 1969, indicating an MOS of 11B20 and that he was attached to Company A, 2d Battalion, 28th Infantry. In July 1997, documentation was received from the NPRC that includes versions of the veteran's DD Form 214 that were consistent with those received in both 1969 and 1996. This documentation includes a copy of the veteran's DA Form 20 which contains handwritten notations indicating that he had pending awards of a CIB, purple heart with Oak Leaf Cluster, two Good Conduct Medals, a PUC (presidential unit citation) and treatment for a shell fragment wound in September 1969 (this document is identified as Exhibit Q-13 in the forensic laboratory report (FDL), discussed infra). In a "Report of Contact" (VA Form 119), dated in July 1997, a VA employee indicated that he had contacted the NPRC, and that the NPRC thought that several entries on the DD Form 214 (as submitted in 1996), the veteran's DA 20, and other items appeared to be suspicious. It was noted that, "She said copies of the injury report in the vet's medical record (i.e., the September 1969 service medical report noting a shell fragment wound to the right foot) was apparently added after the fact since a copy of the same page is still in the record with a blank space where the injury report now has appeared." A statement from the Chief, Army Reference Branch, dated in September 1997, notes that the veteran's NPRC record did not have an official personnel folder copy of the DD Form 214, that there was conflicting information as to whether the veteran had been awarded the Purple Heart and other medals, and whether he had been treated for a wound. The statement reports that the veteran "has been in to review his records several times and there is concern that he could have removed or amended records while he was here." In October 1997, the RO denied the veteran's claims for service connection for PTSD, residuals of a right foot wound, and residuals of facial and buttock wounds. The veteran appealed all issues. In December 1998, the RO denied the veteran's claims inter alia that new and material evidence had been submitted to reopen a claim for service connection for a low back disorder, and denied claims for service connection for peripheral neuropathy, and a chronic mental dysfunction impairment. The veteran appealed. A great deal of development followed, and the veteran submitted a great deal of additional evidence, to include the following: 1) additional copies of the service medical report, dated September 1969, which indicates that he was WIA (wounded in action), specifically, that he sustained a shell fragment wound to the right foot, and that he was to be sent to the 12th Evacuation Hospital (this document is identified as Exhibit Q-8 in the FDL, discussed infra); 2) a two-page copy of an alleged service temporary duty (TDY) order, dated in March 1968, which indicates that it was effective February 1, 1968, and that the veteran was "reassigned" to A Company, 3d Battalion, 7th Infantry Regiment, 199th Light Infantry Brigade. This document indicates that it was signed by the battalion commander, Lieutenant Colonel J.K.G., and both pages appear to have been stamped with a raised seal of the NPRC (copies of this document are identified as Exhibits Q-5, and Q-9 in the forensic laboratory report (FDL), discussed infra); 3) a document, indicating that it was issued from the Headquarters, 1st Infantry Division, dated January 31, 1969, which is titled "Extract," and which indicates that the veteran's MOS was 11B20, and that he was to be attached to Company A, 2d Battalion, 28th Infantry. This document is signed by Colonel R.F., of the Division Support Command. It appears to have been stamped with the raised seal of the NPRC (this document is identified as Exhibit Q-7 in the FDL, discussed infra); 4) a document, dated September 14, 1969, which indicates that the veteran was placed under the operational control of A Company, 1st Battalion, 16th Infantry (M), 1st Infantry Division, and that he was awarded the Purple Heart Medal for an incident on September 6, 1969, while the veteran was on convoy duty along Route 13 south of An Loc, in which he sustained "multiple fragmentation wounds to the right lower extremities which caused his evacuation to the 12th Evacuation hospital in CuChi." This document indicates that it is signed by Lieutenant Colonel K.G.C., the Battalion commander (copies of this document are identified as Exhibits Q-6 and Q-14 in the FDL, discussed infra). In December 1999, the veteran was afforded a hearing. He testified that he received a wound near his eye during combat in May 1969, and that he sustained shell fragment wounds to his right lower extremity during combat in September 1969, to include a piece of shrapnel that went "straight through" his ankle. With regard to the latter wound, he testified that he was hospitalized between 11/2 to 2 weeks, with treatment first at the 12th Evacuation Hospital, followed by treatment at the 3rd Army Hospital, followed by treatment at "Zeon" (at the 1st Infantry Division), followed by about three follow-up treatments over the next four weeks. The Board notes that in other reports, he has claimed that he was hospitalized for five weeks. See VA social survey, dated in February 1997; VA progress note, dated in February 2005. In February 2000, the Board sent a Memorandum to its Chief Counsel. The Board noted that a question has arisen concerning the authenticity of documents obtained in connection with this veteran's claims, that the veteran and his wife may have had unsupervised access to his file while at the NPRC, that the RO appeared to have determined that the veteran or his wife altered some of his records, that the RO determined that a DD Form 214 (which was obtained directly from the NPRC, which carries a raised seal from the NPRC, and which indicates that the veteran was awarded the combat infantryman badge (CIB), a Purple Heart with Oak Leaf Cluster, and a Tet Unit Citation) was not authentic, that a service medical record showing treatment for a shell fragment wound in September 1969, and certain handwritten notations on the veteran's DA Form 20 (pertaining to awards of a CIB, and a Purple Heart, and treatment for a shell fragment wound in September 1969), were not authentic. In March 2000, the Board's Vice Chairman requested the VA Inspector General's assistance in determining the authenticity of the aforementioned documents. In July 2000, the Board received a report from the Director, Forensic Document Laboratory (DFDL) (in an April 2005 statement, the DFDL officially approved the release of this document). In his cover letter, the DFDL stated that he had determined that documents have been altered. The associated forensic laboratory report (FLR) is ten pages long. It notes the following: 1) the copy of the DD Form 214 received in 1969 (Exhibit K-1) was the most critical and valid copy; it revealed details of the creation of the document that were accurate and valid; there were features that make it unique when compared to other versions of the DD Form 214, specifically, it contained clear numbers, sharp and clear lines, clear pre-printed information and words at the bottom of the form, clear typing w ith words within boxes for each subject; sharp and clear signatures at the bottom with clear indications of pressure points of individual letters; a clear reverse stamp of the Office of Register of Deeds, Dave [should be "Dane"] County Wisconsin, dated October 28, 1969; clear entries for the veteran's MOS number and title (noting 64B20, HVY TRK DR, and a clear entry for the related civilian occupation and D.O.T. (Department of Transportation) number 905.883 TRK DVR); a clear and in-line entry for "Grade, Rank or Rank at Time of Entry"; and entries in block #24 ("Decorations, Medals, Badges, Commendations, Citations and Campaign Ribbons Awarded or Authorized") were all typed with the same typewriter, and within the block provided for this information. The FLR then compared the version of the veteran's DD Form 214 received in 1969 (Exhibit K-1), with seven versions of the DD Form 214 received in 1996 or thereafter (Exhibits Q-1, Q-2, Q-3, Q-4, Q-10, Q-11, and Q-12). The FLR indicated that Exhibit K-1 was a genuine document, and it discussed a number of features of these "Q" exhibits. This discussion stated that it had determined that the "Q" Exhibits contained forged signatures, "false additional information," and "additional changed information." It described one of the exhibits as, "a more creative product of fraud" when compared to other Q Exhibits," and another Q Exhibit as "a fourth right [sic] attempt to alter and create a DD Form 214, and states, "in this case the individual leaves all the evidence on the document." The FLR concluded that, "It has been determined that the consistent pattern in each of the fraudulent DD Form 214(s) was to type the document over, and only a single typewritten document was used. In addition, different information was added to the fraudulent DD Form 214 documents than found in Exhibit K-1." With regard to Exhibit Q-5, the FLR states that this document has "several problems," to include the lack of a form number, contrasting light and dark ink in various places, and a very light signature in contrast to the typed letters. The FLR states that in most cases the darkness of the signature would be about the same as the typed entries. With regard to the other copy of this document (Exhibit Q-9), it was noted to have uneven darkness of toner, and a darker signature than Exhibit Q-5. With regard to Exhibits Q-6, and Q- 14, the FLR notes that these documents have the same irregularities that were noted with regard to Q-5, to include an irregular lightness of the signature. With regard to Exhibit Q-7, the FLR states that there were remarkable irregularities in the darkness of the ink that were not characteristic of a genuine document, that the signature was very feint (in contrast to the typed name underneath), and concludes that "the letter is probably fraudulent." Finally, with regard to Exhibit Q-13 (the service personnel file (DA Form 20)), the FLR states that there are "a number of problems with this document," and notes that it has uneven darkness of the ink, that it could not be determined to be a genuine document, and that it would be very easy to alter a copy by adding additional information on a copy. Exhibit Q-8 was also noted to have uneven darkness of ink. Finally, with regard to Exhibit Q-15, the FLR states that, "the problem of this document having been created like the DD Form 214 should not be above question, it would be easy to alter by typing information onto it, copying it several times to lose the detail of the typewriter, and the seal, and that "it would be very easy to go to a firm and order a seal to be manufactured." The FLR indicates that additional evidence would be needed for further analysis of Exhibits Q-5, Q-6, Q-8, Q-9, Q-13, Q-14, and Q-15. In a letter, dated in October 2004, the NPRC indicated that they had verified the veteran's entitlement to a number of awards, including the Purple Heart with Oak Leaf Cluster (signifying two awards), Good Conduct Medal, Presidential Unit Citation, and Combat Infantryman Badge 1st Award. See also, NPRC letter to the veteran, dated in May 2005. The claims files include a number of responses from the NPRC to VA concerning multiple inquiries, summarized as follows: in December 2001, August 2002, March 2005, December 2005, and March 2006, the NPRC stated that there were no records for the veteran in 12th Evacuation Hospital reports; in December 2001, the NPRC stated that there were no records for the veteran in 93rd Evacuation Hospital reports (see also August 2002 VAF 119 (report of contact)); in December 2001, August 2002, and March 2005 the NPRC stated that Morning Reports showed that the veteran was assigned to the 543rd Transportation Company between January 1, 1968 and November 23, 1968, when he was reassigned to the 1st S&T Battalion, A Company; in August 2002 and December 2005, the NPRC reported that their records did not show that the veteran had been awarded the Purple Heart. In December 2001, August 2002, and March 2006, the NPRC noted that the RO had requested a search of Morning Reports for the 543rd Transportation Company, 48th GP "Rifle Security" unit, and Company A, 1st S&T Battalion "Jump Team" Reaction Force, and indicated that the relevant MR's had been sent (as discussed infra, the MR's do not show that he was assigned to either a 48th Group "Rifle Security" Unit, or a 1st S&T Battalion "Jump Team" reaction force). A letter from the NPRC to the veteran, dated in June 2006, states that they are correcting erroneous information previously sent to him in May 2005. The NPRC states: We have since determined that your military record contains what appear to be improperly altered copies of DD Form 214, Report of Transfer or Discharge. Since some of the medals verified were based on entries in the DD Form 214, we conducted a thorough review of your military record and organizational records on file at this Center. Based on that review, you are eligible for the following awards: National Defense Service Medal Vietnam Service Medal with 3 bronze service stars Meritorious Unit Citation Republic of Vietnam Campaign Ribbon with device 1960 Republic of Vietnam Gallantry Cross with Palm Unit Citation Republic of Vietnam Civil Actions Unit Citation Expert Badge with AutoRifle Bar Sharpshooter Badge with Rifle Bar We are not able to verify your entitlement to the Purple Heart, Combat Infantryman Badge, Presidential Unit Citation, or Good Conduct Medal. Since these medals have already been sent to you, please note that you are not authorized to wear them or display them, and you should return them to the U.S. Army Tank Automotive and Armament Command in Philadelphia, or destroy them. In response to requests to the NPRC, Morning Reports (MR's) and other documents were received. MR's for the 543rd Transportation Company (TC), are dated January 8th, May 14th, August 8th, August 14th, November 23rd (all 1968). These MR's show that the veteran was a member of that unit, and that his rank was no higher that E4. A DA 305-3, dated October 31, 1968, from the 543rd TC, shows that the veteran's MOS was 64A10. Unit Orders, dated July 25, 1968, also list the veteran as a member of the 543rd TC. MR's were also received for Company A, Motor Transportation, 1st S&T Battalion, dated in 1969, which show that he was a member of that unit. Specifically, MR's were received dated January 8th (also indicating his MOS was 64A10); May 8th, June 29th, July 4th, August 21st, August 22nd, September 11th, September 12th, September 17th, September 20th, and October 21st. The MR's indicate that the veteran's rank was no higher than E3. The August 21st MR indicates that he was attached to the 93rd Evacuation Hospital, and the August 22nd MR indicates that he returned the next day; the September 11th MR indicates he was attached to the 93rd Evacuation Hospital, and the September 12th MR indicates that he returned the next day; the September 17th MR indicates he was attached to the 93rd Evacuation Hospital, and the September 20th MR indicates that he returned three days later. In July 2007, VA received copies of the veteran's service records from the National Archives and Records Administration (NARA), that were certified as true and correct copies. These documents were divided into two bound sets, with the bottom set containing a cover note stating that the attached documents included documents that had been altered or added to the veteran's file (OMPF) (hereinafter "the second set"). The second set of documents includes the aforementioned evidence indicating that the veteran was awarded of the Purple Heart, and a CIB, that the veteran served with infantry units in Vietnam, and that the veteran was wounded in action. The first set of documents includes service records which show the following: as of January 10, 1968, the veteran was assigned to the 543rd TC with an MOS of 64A10; as of September 23, 1968, he was assigned to Company B, 7th Support Battalion, 199th Light Infantry Brigade with an MOS of 64A10; as of October 26, 1968, he was back with the 543rd TC, with an MOS of 64A10; as of May 26, 1969, he was assigned to Company A, 1st S&T Battalion (A/S&T), with an MOS of 64A10; a servicemen's group life insurance election, dated January 11, 1969, indicates that the veteran's unit was A/S&T; on April 14, 1969, the veteran received a nonjudicial punishment while a member of A/S&T; an August 18, 1968 service medical record indicates that the veteran was assigned to the 543rd TC, with an MOS of 64A10; a service medical record contains entries for August 18, 1968, and October 6, 1968, and indicates that the veteran's unit is the 543rd TC. A "statement of personal history," dated in April 1967, indicates that the veteran did not graduate from high school, and does not show that he had any college credits. II. Analysis Having summarized the history of the claims and the evidence, the Board will now address the credibility issues. A. Credibility of Evidence Given the evidence discussed in Part I, the Board has determined that the copy of the veteran's DD Form 214 that was registered by the veteran in Wisconsin just two days after his separation from service in 1969, is genuine and authentic. The Board points out that its conclusion is in conformance with the conclusions in the FLR and observes that no question has ever been raised concerning the authenticity of the DD Form 214 that was registered by the veteran in Wisconsin after his separation from service in 1969. The service medical records that were received in January 1970, in association with the veteran's 1969 claims for service connection for a hernia and low back disability, are also considered genuine and authentic. The Morning Reports and associated documents that have been received from the NPRC are also considered genuine and authentic. Finally, the first set of bound documents, received from NARA in July 2006, are considered genuine and authentic. The Board further finds that the following evidence, which is not corroborated or consistent with the aforementioned evidence, is not shown to be genuine, and is not considered probative: all versions of the veteran's DD Form 214's that are inconsistent with the 1969 version; the March 1968 TDY order (indicating that the veteran was "reassigned" to A Company, 3d Battalion, 7th Infantry Regiment, 199th Light Infantry Brigade); the January 31, 1969 "Extract" (indicating that the veteran's MOS was 11B20, and that he was to be attached to Company A, 2d Battalion, 28th Infantry); the September 14, 1969 "order" (indicating that the veteran was placed under the operational control of A Company, 1st Battalion, 16th Infantry (M), 1st Infantry Division, and that he was awarded the Purple Heart Medal for an incident on September 6, 1969); and the September 1969 service medical report (which indicates that the veteran was wounded in action). With regard to the September 1969 service medical report, the notation indicating that the veteran sustained fragmentation wounds is on the bottom half a sheet. The top half of the sheet contains entries showing treatment in August and October of 1968 for symptoms that are not in issue. However, the September 1969 notation of fragmentation wounds does not appear in the copy of the service medical record as certified by NARA. The NARA-certified record shows that the bottom half of the sheet is blank, and the Board cannot conceive of any logical reason to explain the disappearance of an entry in a service medical record. In reaching this decision, the Board has considered the appellant's representative's arguments, particularly those set forth in a submission dated in June 2007. He argues inter alia that the veteran and his spouse deny ever having altered or created any documents, and that the September 1969 service medical record indicating that he sustained shell fragment wounds to the right foot, and the DD Form 214's indicating that he received the Purple Heart and CIB, are probative evidence. He further argues that the MR's which show that the veteran was treated several times at the 93rd Evacuation Hospital between August and September of 1969, are "consistent with" his claim of treatment for shell fragment wounds in September 1969. However, the veteran claims that he was hospitalized for anywhere from 11/2 to five weeks for these alleged wounds. As previously discussed, the MR's and service medical records that have been determined to be genuine and authentic show that between June and September of 1969 he was treated on several occasions for testicular pain on an outpatient basis. The representative also implies that the DD Form 214's which indicate receipt of the Purple Heart and the CIB, and the September 1969 service medical record indicating treatment for shell fragment wounds are probative of the claims because they "were obtained from NARA." However, as previously noted, this evidence is contained within the second set of documents received from NARA in July 2006, i.e., the set containing a cover note stating that the attached documents included documents that had been altered or added to the veteran's file (OMPF). This evidence is not contained within the first set of documents. Any evidence obtained from NARA prior to July 2006 is subject to NARA's July 2006 determination, which is the final and most recent decision of that agency. Given the foregoing analysis, the representative's arguments are unpersuasive. B. Veteran's Credibility The Board finds that the veteran is not credible. On October 28, 1969, just two days after separation from service, the veteran registered his DD Form 214 in Wisconsin. This DD Form 214 is considered genuine and authentic, and it does not show receipt of the Purple Heart or a CIB. It indicates his last duty assignment was A/S&T. A few days later, on October 31, 1969, the veteran filed a claim for service connection for a hernia, and a low back disability. Although he now asserts that he has shell fragment wounds of the face, buttocks, and right lower extremity, to include a missing small toe, as a result of injuries sustained in combat, at the time of his 1969 claim he made no mention of such injuries, nor does the January 1970 VA examination report contain reports or findings indicating such injuries existed. Contrary to his oral and written testimony, this report notes that the veteran stated that he was not hospitalized in the service. Twenty-six years later, in 1996, the veteran filed six claims for service connection, to include a claim for PTSD. In support of his claims, he submitted DD Form 214's which indicated that he received awards that are considered to be presumptive evidence of combat. Specifically, these discharges indicated receipt of the Purple Heart with Oak Leaf Cluster, and the CIB. He also submitted what he asserts were orders sending him to two infantry units, and a service medical record and another document indicating that he was wounded in action and had been awarded two Purple Hearts. Finally, he submitted a DA Form 20 containing handwritten notations noting the award of the Purple Heart with Oak Leaf Cluster, and the CIB. However, the evidence shows that the veteran had physically entered the Army Reference Branch (ARB) office several times, and reviewed his records, and that the ARB was concerned that he could have removed or amended records while he was there. See statement of the Chief, Army Reference Branch, dated in September 1997. There is also other evidence indicating that the veteran, "or someone associated with him," improperly handled evidence. Specifically, a memorandum from the RO, dated in September 1998, shows that the RO determined that the Medical Center had allowed the veteran, "or someone associated with him," to obtain access to a July 1998 VA examination report. The memorandum concludes that, "The veteran or someone associated with him improperly removed the originals of the veteran's photographs from Medical Center custody." In addition, the July 2000 Forensic Laboratory Report clearly shows that the laboratory's experts determined that the veteran has submitted altered and fraudulent documents in support of his claims. The June 2006 statement from the NPRC shows that, despite previous letters indicating otherwise, the NPRC determined that the veteran's record contained "improperly altered copies" of his DD Form 214, and that it was not able to verify his entitlement to the Purple Heart, the Combat Infantryman Badge, the Presidential Unit Citation, or the Good Conduct Medal. Furthermore, the veteran's claimed unit assignments, and claimed MOS of 11B10, are not corroborated by the credible evidence of record. In this regard, as noted in the Board's April 2001 Remand, the veteran claims to have been assigned, on both permanent and temporary duty bases, to units not listed in his DA 20, and to have performed duties as an infantryman. His claimed assignments were discussed in Part I of this decision. However, the aforementioned reports from NARA and the NPRC show that he was not a member of the claimed units, and that his MOS was 64A10 or 64B20 at all relevant times. Service medical records also indicate that he was not a member of these infantry units. To the extent that the veteran claims that he was treated for multiple shrapnel wounds for anywhere from 11/2 to five weeks, in three different hospitals, after being wounded in combat on September 6, 1969, the MR's and service medical records dated after that day are consistent with each other, and they contradict his claim. This evidence shows that he was treated for right testicular pain on four occasions between September 12th and 20th of 1969, and that he was assigned to A/S&T at the time. The MR's indicate that his treatment required two overnight stays, and one stay of about three days, at the 93rd Evacuation Hospital. See also service medical records, dated September 17th and 19th (indicating that he was to board overnight at the 90th Replacement Battalion, and return for additional treatment in the morning). The sole possibly supportive record is a notation dated October 26, 1969, which indicates that his last duty station was Company A, 1st Battalion, 1st Infantry Division (A/1/1). However, the service records indicate that the veteran's units during the time period in issue, i.e., the 543rd TC and A/S&T, supported the infantry units he claims to have served with, and that the parent unit for both of these organizations was the 1st Infantry Division. Furthermore, this record is merely an extract, it indicates that his MOS was 64B20 (heavy truck driver), it could reasonably be read to be an imprecise notation of his shown duty with A/S&T (see e.g., last duty assignment as listed in the authentic DD Form 214 ("UASRV CO A 1ST ST BN 1ST INF DIV"), and it is dated on the last day of the veteran's service. In fact, the previously discussed evidence, to include the highly probative DA 20 and MR's, shows that he did not serve with A/1/1 in Vietnam. In reaching this decision, the Board notes that the veteran has not provided an explanation as to a number of issues pertaining to his credibility, and the authenticity of the service records in issue, to include: why, during his claimed periods of service with infantry units, the MR's for the 543rd TC and A/S&T show him as members of these units; how he could have been hospitalized for 11/2 to five weeks for shrapnel wounds beginning September 6, 1969, when numerous MR's and service medical records show that between September 11th and 20th, he received at least five outpatient treatments for testicular pain (four of these were at the 93rd Evacuation Hospital) (these are essentially continuations of treatment for symptoms that began in June 1969), and that he was a member of A/S&T during that time; why he denied being hospitalized during service during his January 1970 VA examination; why there is no credible medical evidence of retained metallic fragments anywhere in his body; why there is no evidence to show that a "Tet Unit Citation" ever officially existed; why the DD Form 214's he submitted include a notation of 15 credit hours of "college CLEP" when there is no evidence in his service records that he ever took such classes; and why his submitted discharges indicate that he was an E5, when even the versions of his DA 20 that have been determined to have been altered do not show that he ever attained this rank. In this regard, the veteran has denied fabricating documents or adding evidence. He has repeatedly alleged that VA personnel are somehow responsible for the evidence that is inconsistent with his claims, and that they have removed evidence that is favorable to his claims. See e.g., veteran's letter, received in March 1998, and letters, dated in February and June of 1998, June 1999, and January 2001. These allegations are completely unsupported and are not reasonably plausible. Furthermore, even if the veteran and his spouse deny ever having altered or created any documents, the veteran is still at this date standing behind the documentary evidence associated with the claims file since 1996 that purports to demonstrate that he engaged in combat with the enemy, documents that have been found not to be authentic or genuine. In summary, the Board finds the veteran has been determined to have submitted fraudulent evidence, and to have altered and added evidence to the record in order to misrepresent material facts. Furthermore, his statements are uncorroborated or contradicted by the service records and service medical records which have been found to be authentic and reliable, to such a degree that the Board finds that he is not a credible historian. See Wilson v. Derwinski, 2 Vet. App. 16, 19-20 (1991); Cohen v. Brown, 10 Vet. App. 128, 146 (1997). In reaching this decision, the Board has considered an affidavit from Lieutenant Colonel (Ret'd) K.G.C., dated in April 2006. Lt. Col. K.C.G. is the officer who assertedly signed the September 14, 1969 document indicating that the veteran was awarded the Purple Heart Medal for an incident on September 6, 1969. In this affidavit, Lt. Col. K.C.G. indicated that the veteran had approached him at a military reunion. Lt. Col. K.C.G. asserted that the veteran had served under his command, in the 1st Battalion, 16th Infantry in September 1969, and that although he did not personally witness it, the veteran was wounded in action, and he was personally responsible for putting the veteran in for receipt of the Purple Heart. The affidavit is accompanied by a copy of Lt. Col. K.C.G.'s discharge. However, this affidavit, based on the author's memory of an incident occurring about 25 years before, is simply too attenuated when weighed together with the other evidence of record to warrant a favorable determination. Briefly stated, the veteran's assertions that he had duty as an infantryman with several infantry units, that he was twice wounded in combat, that he received the Purple Heart and the CIB, and that he received up to five weeks of treatment for fragment wounds, are clearly contradicted by the authentic and probative evidence of record. The Board therefore finds that he is not a credible historian. III. New and Material The veteran asserts that new and material evidence has been submitted to reopen a claim for service connection for a low back disability. The Board's determination of what evidence is authentic and reliable in Part I is incorporated herein. In March 1970, the RO denied a claim for low back strain. The RO notified the veteran of this denial of his claim in a letter dated March 17, 1970. There was no appeal, and the RO's decision became final. See 38 U.S.C.A. § 7105(c); 38 C.F.R. § 20.1103 (2007). In September 1996, the veteran filed to reopen his claim, and in a December 1998 rating decision, the RO denied the claim. The veteran has appealed this decision. Rating actions from which an appeal is not perfected become final. 38 U.S.C.A. § 7105; 38 C.F.R. § 20.1103. The governing regulations provide that an appeal consists of a timely filed Notice of Disagreement in writing and, after a Statement of the Case has been furnished, a timely filed Substantive Appeal. 38 C.F.R. § 20.200. A final decision cannot be reopened unless new and material evidence is presented. Pursuant to 38 U.S.C.A. § 5108, the Secretary must reopen a finally disallowed claim when new and material evidence is presented or secured with respect to that claim. Knightly v. Brown, 6 Vet. App. 200 (1994). The veteran's claim to reopen were received at the RO prior to August 29, 2001. Under the applicable version of 38 C.F.R. § 3.156, when presented with a claim to reopen a previously finally denied claim, the VA must determine if new and material evidence has been submitted. For the purpose of this claim, new and material evidence is defined as follows: [E]vidence not previously submitted to agency decisionmakers 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 (2001). The definition of "new and material evidence" was revised, but the revision applies to claims for benefits received by VA on or after August 29, 2001. 66 Fed. Reg. 45620, 45629 (August 29, 2001). As the appellant's claim was received before that date, the new definition does not apply in this case. The most recent and final denial of this claim was in March 1970. Therefore, the Board must determine if new and material evidence has been submitted since that time. See 38 U.S.C.A. § 5108. When determining whether the evidence is new and material, the specified basis for the last final disallowance must be considered. See Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). The evidence of record at the time of the RO's March 1970 decision included the veteran's service medical records, which include a report, dated September 11, 1969, indicating that he received treatment for a sore testicle and lower back symptoms. None of the subsequently dated service medical reports show treatment for, or a diagnosis of, a low back disorder. In an October 1969 "Report of Medical History" accompanying his separation examination report, the veteran denied a history of "back trouble of any kind." As for the post-service medical evidence, it consisted of a VA examination report, dated in January 1970. This report shows that he reported that he had fallen off of a truck in late May or early July of 1969, and that he was treated at the dispensary about 7 to 14 days later. An X-ray of the lumbar spine was negative. The "diagnosis" noted that he did not have an orthopedic condition on examination. At the time of the RO's March 1970 rating decision, there was no competent evidence to show that the veteran had a low back disability, or that a low back disability was related to his service. Evidence received since the RO's March 1970 rating decision consists of VA and non-VA reports, dated between 1996 and 2006. This evidence is summarized as follows: VA progress notes, dated in 1998, show that the veteran complained of low back pain, with occasional tingling in the extremities and low back, that he was using a Transcutaneous Electrical Nerve Stimulation (TENS) unit, and that he received multiple sessions of physical therapy to improve flexibility of his extremities. His assessments included low back pain. A VA X-ray report for the low back, dated in April 1998, contains an impression noting evidence of subluxation of L5, no evidence of spondylosis, and normal alignment of the lumbar spine. A VA examination report, dated in July 1998, notes that a July 1998 CT (computerized tomography) scan was normal, and it contains a diagnosis noting that "the only definable variation in this man's spine is a sharply angled lumbosacral articulation. This is not ordinarily a cause of symptom. In other respects, the bone structure was normal, and the facet joints did not appear unusual." A report from Dr. L.V., dated in December 1998, notes that the veteran complained of chronic low back pain since his service. This evidence that was not of record at the time of the March 1970 decision, is not cumulative, and is "new" within the meaning of 38 C.F.R. § 3.156. However, the Board finds that this evidence is not material. In this case, although the submitted evidence contains notations of low back pain, there does not appear to be an underlying pathology or disease process, and it is not entirely clear that the veteran has a low back disorder. See Sanchez-Benitez v. West, 259 F.3d 1356 (Fed. Cir. 2001). In any event, even assuming arguendo that a low back disorder is shown, none of the submitted evidence is dated prior to 1996, which is about 25 years after separation from service. Furthermore, although the veteran's reports of low back trauma during service and/or participation in combat have been reiterated by him in the medical reports, these notations are "by history" only. To the extent that he has submitted evidence in support of his assertions of participation in combat, the credibility of this evidence was discussed in Part II of this decision. Briefly stated, the genuine and authentic evidence of record does not show that the veteran participated in combat. In this regard, the Board will normally presume that newly submitted evidence is credible. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). However, the Board is not prohibited from establishing the authenticity and veracity of the submitted service records and service medical records prior to its new and material analysis. The evidence received subsequent to the last final decision is not presumed to be credible for purposes of reopening the claim if it is untrue. See Duran v. Brown, 7 Vet. App. 216, 220 (1995); Justus v. Principi, 3 Vet. App. 510, 513 (1992); Robinette v. Brown, 8 Vet. App. 68, 75-76 (1995). The Board further points out that in its discussion of the veteran's PTSD claim, infra, the Board has determined that the veteran did not participate in combat. The Board therefore finds that the submitted evidence is not so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156 (2001). Accordingly, new and material evidence has not been presented, and the March 1970 RO decision is final. The appellant's claim of entitlement to service connection for a low back disability is not reopened. In reaching this decision, the Board has considered an August 2002 report from a social worker, B.J.W., MSW, which contains Axis III diagnoses noting a back injury, a foot/ankle wound, and an injury below the left eye, "secondary to war injuries." She indicated that she had conducted a "thorough review of all this veteran's records." However, she did not cite to clinical findings during service, or thereafter, in support of these notations, or otherwise provide a rationalized basis for these notations. Furthermore, given the Board's determinations that the veteran did not participate in combat, that there are no verified stressors, that he is not shown to have sustained shell fragment wounds during service, and that he is not credible, there is no factual basis for these notations, and they are not considered probative. Id. The Board's finding as to this evidence extends to its analysis of the claims for residuals of shell fragment wounds of the face, and right foot, infra. The only other pertinent evidence received since the Board's March 1970 decision consists of oral and written testimony from the appellant. However, the appellant has been found not to be credible, and as a layperson, he is not competent to give a medical opinion as to a diagnosis or causation. Therefore, as the appellant has not submitted competent medical evidence showing that he has a low back disorder that is related to service, these statements are not new and material evidence, and are insufficient to reopen the claim. See Hickson v. West, 11 Vet. App. 374 (1998) (lay assertions of medical causation cannot suffice as new and material evidence to reopen a claim); Savage v. Gober, 10 Vet. App. 488 (1997); Moray v. Brown, 5 Vet. App. 211 (1993). Because the appellant has not fulfilled his threshold burden of submitting new and material evidence to reopen his finally disallowed claim, the benefit-of- the-doubt doctrine is inapplicable. Annoni v. Brown, 5 Vet. App. 463, 467 (1993). IV. Service Connection The veteran asserts that he is entitlement to service connection for residuals of shell fragment wounds of the right foot, residuals of shell fragment wounds of the face and buttocks, peripheral neuropathy (including claimed as secondary to herbicide exposure), "other psychiatric disability, including chronic mental dysfunction impairment," a heart disorder, erectile dysfunction, and post-traumatic stress disorder (PTSD). The claim for PTSD will be discussed separately, infra. Applicable law provides that service connection may be granted for disability resulting from disease or injury incurred or aggravated during active service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted on the basis of a post-service initial diagnosis of a disease, when "all of the evidence, including that pertinent to service, establishes that the disease was incurred during service." See 38 C.F.R. § 3.303(d). In addition, certain chronic diseases, including hypertension, and organic diseases of the nervous system, may be presumed to have been incurred 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, 1113; 38 C.F.R. §§ 3.307, 3.309. Service connection may be granted, on a secondary basis, for a disability, which is proximately due to, or the result of an established service-connected disorder. 38 C.F.R. § 3.310 (2007). Similarly, any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. Allen v. Brown, 7 Vet. App. 439 (1995). In the latter instance, the nonservice- connected disease or injury is said to have been aggravated by the service-connected disease or injury. 38 C.F.R. § 3.310. In cases of aggravation of a veteran's nonservice-connected disability by a service- connected disability, such veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.322 (2007). Effective October 10, 2006, VA amended 38 C.F.R. § 3.310 to implement the Veterans Claims Court's decision in Allen v. Principi, 7 Vet. App. 439 (1995), which addressed the subject of the granting of service connection for the aggravation of a nonservice-connected condition by a service-connected condition. See 71 Fed. Reg. 52,744-47 (Sept. 7, 2006). The existing provision at 38 C.F.R. § 3.310(b) was moved to sub- section (c). Under the revised section 3.310(b), the regulation provides that: Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. The rating activity will determine the baseline and current levels of severity under the Schedule for Rating Disabilities (38 C.F.R. part 4) and determine the extent of aggravation by deducting the baseline level of severity, as well as any increase in severity due to the natural progress of the disease, from the current level. 71 Fed. Reg. 52,744 (2006) (codified at 38 C.F.R. § 3.310(b)). As this claim was filed prior to the effective date of the revised regulation (October 10, 2006), the Board has considered whether this change in law may be given retroactive effect, or whether the old law, i.e., the Allen decision itself, is for application. See generally, Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003); VAOPGCPREC 7-2003, 69 Fed. Reg. 25179 (2004). However, as service connection is not currently in effect for any disabilities, the Board finds no prejudice to the veteran in evaluating the secondary service connection claim under either the old or new criteria. For all service connection claims, the Board's determination of what evidence is authentic and reliable in Part I is incorporated herein. The Board notes that the medical reports show that the veteran has repeatedly told health care providers that he participated in combat, and/or that he was wounded in combat, to include sustaining shell fragment wounds to his lower right extremity, face, and coccyx/low back. In addition, as previously discussed, the Board has determined that the veteran is not credible. Furthermore, as discussed in the analysis of his PTSD claim, infra, the Board has determined that he did not participate in combat, and that there is no verified stressor upon which a PTSD diagnosis may be accepted for VA purposes. None of these notations are shown to have been based on a review of the veteran's claims file. Given the foregoing, these notations are clearly "by history" only and are afforded no probative value, and will not be further discussed except as noted. The veteran's service medical records were discussed in Part I. Briefly stated, the service medical records which have been determined to be authentic and credible do not show treatment for, or a diagnosis of, shell fragment wounds of the right foot, face, or buttocks, peripheral neuropathy, psychiatric symptoms, a heart disorder, or erectile dysfunction. The veteran's October 1969 "Report of Medical History" accompanying his separation examination report shows that the veteran denied any relevant symptoms, to include a "history of broken bones," "loss of arm, leg, finger, or toe," "foot trouble," "frequent trouble sleeping," "depression or excessive worry," or nervous trouble of any sort." As for the post-service medical evidence, it consists of VA and non-VA evidence, dated between 1970 and 2006. The evidence includes a January 1970 VA examination report which notes that there were no normal neurological or circulatory findings, and which contains a "diagnosis" of "no orthopedic condition noted this examination." The next medical evidence consists of VA and non-VA reports dated 26 years later, in September 1996. A VA X-ray report for the right foot contains an impression of surgical deformity of the fifth metatarsal bone. The report specifically stated, "No radiopaque foreign body is seen." A VA psychiatric assessment, dated in October 1996, shows that the veteran reported a history of "probable peripheral neuropathy, chronic pain syndrome secondary to partial loss of right foot in VN [Vietnam]", and "excision of shrapnel lateral to coccyx (pvt. physician) 1970." The report contains diagnoses of PTSD, major depression, anxiety disorder, and dissociative disorder, with the latter three conditions all secondary to PTSD. See also reports from private social worker, B.J.W., LCSW, dated in May 2000 and April 2002 (noting several psychiatric disorders as secondary to PTSD). A VA examination report, dated in February 1997, contains a diagnosis of status post wound, loss of fifth right toe and musculature, also partial function of the right foot. Associated photographs of the veteran's right foot show that his right little toe is missing. A VA Agent Orange protocol examination report, dated in October 1996, contains diagnoses that note "tingling hands & feet." A VA peripheral nerve examination report, dated in July 1998, contains a diagnosis noting that, "This patient does not present convincing evidence of peripheral neuropathy." The diagnosis further notes that the areas of sensory impairment are inconsistent with known anatomic patterns. He did have features suggestive of bilateral carpal tunnel syndrome." The examiner stated that an electromyogram (EMG) was scheduled, and indicated that even if peripheral neuropathy were shown, there is nothing in his history which would establish a cause for it except for the possibility of alcohol abuse. The report goes on to say (seemingly inconsistently), "He does have peripheral neuropathy. It cannot be a reasonable cause for disability as it is trivial at best." With regard to the veteran's claim for his right foot, the diagnosis notes that there was no indication of it in the health record or the examinations which were conducted approximate to his discharge. He stated, "The configuration of the injury looks much more like that of a lawn mower or axe- inflicted wound, rather than a grenade, fragmentation or crushing wound." An addendum to the report, dated in August 1998, states that an EMG had been reviewed, and that the results were consistent with minimal carpal tunnel syndrome, and it notes "minimal peripheral neuropathy." A VA EMG report, dated in July 1998, is associated with the examination report, as are pictures of the veteran's right foot. VA progress notes, dated between 1996 and 2005, include reports dated between September and November of 1996, which note "possible peripheral neuropathy," and a history of peripheral neuropathy. Beginning in 1997, he received a number of treatments for right foot pain. An August 2005 report notes neuropathy, and amputee, toe, right foot, and a number of other reports note a missing right little toe. Reports from St. Anthony's Medical Center, dated in 1999, contain diagnoses that include hypertension. A VA PTSD examination report, dated in October 2006, contains an Axis I diagnosis of PTSD, chronic with secondary depression and anxiety. The examiner noted that the PTSD score was two standard deviations above the average, that symptoms appeared to be overstated, and that the veteran may be exaggerating symptoms. The examiner stopped short of giving a diagnosis of malingering, however, and he stated that the exacerbation of the veteran's presentation can be attributed to a personality disorder. Finally, the examiner stated, "At issue, of course is the presence of a stressor and that cannot be ascertained within the clinical interview. The diagnosis given of PTSD assumes that the stressors were present even in the light of the falsified documents." A letter from the Social Security Administration (SSA), dated in July 2000, states that the veteran has a continuing disability. Associated documentation indicates that the veteran claimed to be disabled due to psychiatric symptoms which he asserted were related to PTSD. A. Residuals, Shell Fragment Wounds, Right Foot With regard to the claim for residuals of shell fragment wounds of the right foot, the Board has previously determined that the only service medical record supporting this claim, dated in September 1969, is not authentic or reliable, and it is not considered genuine or probative. Although the veteran claims to have sustained a shrapnel wound "through his ankle," as well as a loss of the right little toe, the authentic service medical records do not contain any indication that the veteran was wounded in combat, or that he sustained shrapnel wounds to areas that included his right lower extremity. In this regard, the veteran's October 1969 separation examination report contains a PULHES profile showing that his lower extremities ("L") were rated as a "1", which indicates a high level of fitness. The accompanying "Report of Medical History" does not contain any indication of his claimed shrapnel wounds, and shows that he denied a "history of broken bones," "loss of arm, leg, finger, or toe," or "foot trouble." Furthermore, there is no evidence of retained metallic fragments in the right lower extremity, and the earliest medical evidence of a right foot injury is dated no earlier than 1996, which is about 25 years after separation from service. This evidence indicates that he has a missing right little toe. The July 1998 VA examiner stated that his injury looks much more like that of a lawn mower or axe- inflicted wound than a grenade, fragmentation or crushing wound. As such, there is no medical evidence of record which suggests or offers an opinion that any currently diagnosed right foot disorder is in any way related to service. In any event, as the Board has determined that there is no credible, probative evidence that this claimed injury was incurred during service, service connection must be denied. B. Residuals, Shell Fragment Wounds, Face and Buttocks The Board initially notes that with regard to the claim for residuals of shell fragment wounds to the face, a review of the veteran's oral and written testimony shows that he has not asserted that these wounds affected his eyesight. See e.g., December 1999 hearing transcript. Under 38 U.S.C.A. § 1110, an appellant must submit proof of a presently existing disability resulting from service in order to merit an award of compensation. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). In this regard, the veteran's October 1969 separation examination report contains a PULHES profile showing that his eyes ("E") were rated as a "1", which indicates a high level of fitness. In this case, the veteran has frequently asserted to health care providers that he sustained shrapnel wounds in Vietnam, to include near his left eye, and coccyx. In at least one case, he gave a history of having fragments removed near his coccyx by a private physician in 1970 (there is no medical evidence to support this, nor has the veteran ever identified this health care provider). However, service medical records do not show any treatment for shell fragment wounds. He apparently had some sutures removed near his eye in May 1969, however, there is no indication that this injury involved combat or was a result of hostile fire, that it involved a metallic fragment, that it was otherwise associated with a shrapnel wound, or that it is productive of a current disability. Although there are several "by history" notations in the claims file a shrapnel wound to the face or left eye, as the Board has determined that the veteran is not credible, and that the claimed disorder was not incurred during service, these notations do not have a factual basis and are not probative of the claim. The Board therefore finds that the preponderance of the evidence is against the claim, and that the claim must be denied. C. Peripheral Neuropathy The veteran's service medical records do not show that he was treated for peripheral neuropathy during service. Therefore, a chronic condition is not shown during service. See 38 C.F.R. § 3.303. Furthermore, it is less than clear that he currently has this condition. See e.g., December 1998 report of Dr. L.V. (noting that a diagnosis of peripheral neuropathy was not supported by EMG tests). However, even assuming that this condition is shown, the first post-service medical evidence of this condition is dated in 1996. This is approximately 25 years after separation from service. This lengthy period without treatment is evidence that there has not been a continuity of symptomatology, and it weighs against the claim. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Furthermore, there is no competent evidence showing that the veteran has peripheral neuropathy that is related to his service, nor is there any evidence that an organic disease of the nervous system was manifest to a compensable degree within one year of service. See 38 C.F.R. §§ 3.307, 3.309. The veteran has also asserted that he has peripheral neuropathy due to exposure to Agent Orange. If a veteran was exposed to an herbicide agent during active military, naval, or air service, the following diseases shall be service connected if the requirements of 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied: Chloracne or other acneform disease consistent with chloracne; Type 2 Diabetes; Hodgkin's disease; 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 sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). 38 C.F.R. § 3.309(e) (emphasis added). For purposes of this section, the term "acute and subacute peripheral neuropathy" means transient peripheral neuropathy that appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset. 38 C.F.R. § 3.309(e), and Note 2. The diseases listed at 38 C.F.R. § 3.309(e) 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 C.F.R. § 3.307(a)(6)(ii). The veteran had active service in the Republic of Vietnam during the Vietnam era, and thus he is presumed to have been exposed to herbicides. See 38 C.F.R. § 3.307(a)(6). However, the veteran is not shown to have "acute or subacute peripheral neuropathy" that manifest to a degree of 10 percent or more within one year of service in the Republic of Vietnam. Therefore, service connection under the presumptive provisions of 38 C.F.R. §§ 3.307 and 3.309 is not warranted. See also 59 Fed. Reg. 341 (Jan. 4, 1994); 61 Fed. Reg. 41442 (Aug. 8, 1996) (The Secretary of VA has formally announced that a presumption of service connection based on exposure to herbicide exposure in Vietnam is not warranted for certain conditions including leukemia or "any . . . condition for which the Secretary has not specifically determined a presumption of service connection is warranted."). Finally, there is no competent medical evidence of record suggesting a causal link between the veteran's service, to include any in-service herbicide exposure, and the subsequent development of peripheral neuropathy. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Board therefore finds that the preponderance of the evidence is against the claim, and that the claim must be denied. D. Acquired Psychiatric Disorder (other than PTSD) The veteran's service medical records do not show that he was treated for psychiatric symptoms during service. The veteran's October 1969 separation examination report contains a PULHES profile showing that his psychiatric condition ("S") was rated as a "1", which indicates a high level of fitness. A "Report of Medical History" accompanying his October 1969 separation examination report shows that the veteran denied a history of "frequent or terrifying nightmares," "depression or excessive worry," or "nervous trouble of any sort." Therefore, a chronic condition is not shown during service. See 38 C.F.R. § 3.303. The first post-service medical evidence of an acquired psychiatric disorder is dated in 1996. This is approximately 25 years after separation from service. This lengthy period without treatment is evidence that there has not been a continuity of symptomatology, and it weighs against the claim. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Furthermore, there is no competent evidence showing that the veteran has an acquired psychiatric disorder (other than PTSD) that is related to his service. To the extent that a number of reports indicate that the veteran has acquired psychiatric disorders other than PTSD that are secondary to PTSD, as the Board has determined that service connection for the underlying disability (PTSD) is not warranted, infra, this evidence does not provide a basis for a grant of the benefit sought on appeal. See 38 C.F.R. § 3.310. Furthermore, to the extent that a VA examiner has attributed his psychiatric symptoms to a personality disorder, personality disorders are not compensable diseases or injuries within the meaning of veterans' benefits law. 38 C.F.R. 3.303(c), 4.9; Winn v. Brown, 8 Vet. App. 510, 516 (1996); Beno v. Principi, 3 Vet. App. 439 (1992). In reaching this decision, the Board has considered two statements from R.M.P., D.O., dated in January 2001 and June 2004. In January 2001, he stated that the veteran's "mental and physical conditions treated in this office are related one hundred percent to his serving in Vietnam." In June 2004, he stated that the veteran is "totally and permanently disabled and unemployable due to his Vietnam War Service to his Country." However, the Board has determined that service connection is not warranted for any of the claimed disabilities, and service connection is not in currently in effect for any disabilities. It appears that these opinions are based on the veteran's assertions of combat, and the Board has determined that the veteran is not credible. In addition, no specific disabilities were identified in either statement, and neither of these statements are shown to have been based on a review of the veteran's claims files. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion.). Furthermore, when these opinions are read in context with other reports from this same health care provider, which repeatedly note treatment for PTSD, it appears that PTSD is the underlying psychiatric disorder being referred to (the veteran's claim for service connection for PTSD has been denied, infra). The Board therefore finds that the preponderance of the evidence is against the claim, and that the claim must be denied. To the extent that it may be argued that this evidence is probative of any of the other claims, the Board's further finds that its discussion of this evidence is applicable to all claims on appeal which could be construed to be within the scope of its language. E. Heart Disorder The veteran asserts that service connection is warranted for a heart disorder. In his Notice of Disagreement, received in February 2005, and his Substantive Appeal, received in October 2005, he asserted that he has a heart disorder secondary to PTSD, which he also argues should be service-connected. The veteran's service medical records do not show treatment for heart symptoms, or a diagnosis of a heart disorder. His separation examination report, dated in October 1969, shows that his blood pressure was 132/78. In the accompanying "Report of Medical History," he denied a history of "pain or pressure in chest," "palpitation or pounding heart," or "high or low blood pressure." The earliest medical evidence of a heart condition (in this case, hypertension) is found in a private treatment report dated in 1999. A VA electrocardiogram (EKG), dated in February 2004, was abnormal. Although VA progress notes, dated in 2004, show that the veteran began receiving treatment for symptoms such as chest pain, it does not appear that he has been diagnosed with a heart disorder other than hypertension. A June 2004 report from Dr. R.M.P. notes a possible history of heart attack. In any event, the earliest evidence of hypertension and/or treatment for heart symptoms comes approximately 28 years after separation from service, and this lengthy period without treatment is evidence that there has not been a continuity of symptomatology, and it weighs heavily against the claim. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). In addition, there is no competent evidence showing that the veteran has a heart disorder, to include hypertension, that is related to his service. There is no medical evidence to show that hypertension was manifest to a compensable degree within one year of separation from service. See 38 C.F.R. §§ 3.307, 3.309. Finally, to the extent that the veteran argues that service connection for a heart disorder is warranted as secondary to PTSD, as the Board has determined that service connection is not warranted for PTSD, infra, and as service connection is not in effect for any disability, let alone a disability that is shown to be related to a heart disorder, service connection for a heart disorder is not warranted under 38 C.F.R. § 3.310. Accordingly, the Board finds that the preponderance of the evidence is against the claim, and that the claim must be denied. F. Erectile Dysfunction The veteran argues that service connection is warranted for erectile dysfunction. In his Notice of Disagreement, received in February 2005, and his Substantive Appeal, received in October 2005, he asserted that he has erectile dysfunction due to medications prescribed by VA. The Board notes that neither the veteran nor his representative has asserted that the veteran's erectile dysfunction is an injury or aggravation of an injury that was sustained as a result of VA hospitalization or medical or surgical treatment which resulted in additional disability, and that it does not appear that a claim for compensation has been raised under 38 U.S.C.A. § 1151. The veteran's service medical records do not show treatment for erectile dysfunction. As noted in Part I, he received treatment for complaints of "drip" or painful urination in June 1969, and treatments for a sore testicle between June and September of 1969. The "Report of Medical History" accompanying his October 1969 separation examination report does not contain any relevant findings or history, other than to show that he indicated that he had a history of "VD syphilis, gonorrhea, etc." The earliest medical evidence of erectile dysfunction is found in VA progress notes, dated in 2004, which contains "problem lists" noting impotence. See also June 2004 report of Dr. R.M.P. This evidence comes approximately 33 years after separation from service, and this lengthy period without treatment is evidence that there has not been a continuity of symptomatology, and it weighs heavily against the claim. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). In addition, there is no competent evidence showing that the veteran has erectile dysfunction that is related to his service. Finally, to the extent that the veteran argues that he has erectile dysfunction as a result of medications provided to him by VA, the veteran is shown to be taking a considerable number of medications for a variety of conditions. The claims files also contain a number of reports in which VA and non-VA care providers expressed concern about the number and effect of medications being provided to the veteran. See e.g., letters from Dr. R.M.P., dated in May 1998 and April 2000; December 1998 report of Dr. L.V.; August 2005 VA progress note. However, the claims files do not appear to contain competent evidence to show that he has erectile dysfunction as a result of his medications, and in any event, as service connection is not currently in effect for any disabilities, there is no basis for a grant of service connection under 38 C.F.R. §§ 3.303 or 3.310. Accordingly, the Board finds that the preponderance of the evidence is against the claim, and that the claim must be denied. G. PTSD The veteran asserts that he has PTSD due to combat in Vietnam. Applicable regulations provide that 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. See 38 C.F.R. § 3.304(f). The evidence, the veteran's credibility, the credibility of the evidence, and the veteran's claims of service with several infantry units while in Vietnam were discussed in Parts I and II. The Board's discussion is incorporated herein. Briefly, stated, other than a two-day period (January 9th and 10th, 1968, spent with the 120th Transportation Company), the veteran is shown to have served with two support units while he was in Vietnam, i.e., the 543rd TC, and A/S&T (there is one report indicating service with a third support unit, i.e., Company B, 7th Support Battalion, 199th Light Infantry Brigade, between September 23, 1968 and October 26, 1968). The veteran has been found not to be a credible historian, and there is no credible, probative evidence to show that he was wounded in action, that he served with the claimed infantry units, or that he was awarded the Purple Heart, or CIB. All future references to "the evidence," unless otherwise noted, are intended to refer only to that evidence that the Board has determined is genuine, reliable, and probative. The Board finds that the evidence does not show that the veteran participated in combat. He is not shown to have received commendations or awards that warrant the conclusion that he participated in combat. See VAOPGCPREC 12-99 at 12; 65 Fed. Reg. 6256-6258 (2000); VBA's Adjudication Procedure Manual, M21-1MR (hereinafter "M21- 1MR"), Part III.iv.4.H.29.b., c. In this regard, although the veteran's personnel file lists three campaigns ( the Vietnam Counteroffensive Phase III, Tet Counteroffensive, and "Un-Named"), the nature and extent of the veteran's participation in these campaigns is not specifically described, and the Board declines to afford these entries the same weight as the commendations or awards evincing combat. Id. To the extent these entries indicate that the veteran was present in a combat zone, the U.S. Court of Appeals for Veterans Claims has previously held that it is the distressing event, rather than the mere presence in a "combat zone," which may constitute a valid stressor for purposes of supporting a diagnosis of PTSD. Moran v. Peake, No. 2007-7163 (Fed. Cir. May 2, 2008); Zarycki v. Brown, 6 Vet. App. 91, 98 (1993); see also Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (noting that serving in a combat zone is not the same as serving in combat). Based on the foregoing, the Board finds that the evidence in favor of a claim of a finding of participation in combat is of less weight than the evidence against such a finding. The Board therefore finds that the veteran did not participate in combat. See Cohen v. Brown, 10 Vet. App. 128, 145 (1997). In reaching this determination, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against a finding of participation in combat, the doctrine is not for application. See 38 U.S.C.A. § 5107(b); VAOPGCPREC 12- 99. Furthermore, to the extent that medical examiners may have concluded that the veteran has PTSD due to combat, these were based on an oral history as provided by the veteran, and are otherwise lacking in a factual basis so as to outweigh the information in the veteran's service records and the service documents. See Cohen, 10 Vet. App. at 140; West v. Brown, 7 Vet. App. 70, 77 (1994); see also M21-1MR, Part III.iv.4.H.29.i. As it is not shown the veteran engaged in combat, his assertions of service stressors are not sufficient to establish the occurrence of such events. Rather, his alleged service stressors must be established by official service records or other credible supporting evidence. 38 C.F.R. § 3.304(f); Pentecost v. Principi, 16 Vet. App. 124 (2002); Fossie v. West, 12 Vet. App. 1 (1998); Cohen v. Brown, 10 Vet. App. 128 (1997); Doran v. Brown, 6 Vet. App. 283 (1994); see also M21-1MR, Part III.iv.4.H.29.a, i. The Board further finds that there is no verified stressor to serve as a basis for granting the veteran's PTSD claim. In this regard, he has submitted voluminous amounts of evidence in support of his claim, to include unit histories, staff journals, operational reports/lessons learned from the infantry units that he argues that he served with in Vietnam. He has also written many letters to VA, some of which list many names of soldiers whom he asserts he saw killed or wounded in action. However, all his claimed stressors, and all of his claims of participation in combat, are based on his assertions that he was assigned to three different infantry units while in Vietnam, and the Board has determined that the credible and probative evidence of record does not show that he served with these units. In this regard, he has also claimed that he served with a 48th Group "Rifle Security" unit, and a 1st S&T Battalion "Jump Team" reaction force, for short periods of time. However, he is not shown to have served with either of these units, and in fact, these units are not shown to have existed. As the Board has determined that the veteran is not shown to have served with any of the claimed units, the stressors, all of which he asserts that he witnessed as a member of those units, may not be accepted. See M21- 1MR, Part III.iv.4.H.29.d. ("Credible supporting evidence that an in-service stressor actually occurred includes not only evidence that specifically documents the veteran's personal participation in the event, but evidence that indicates the veteran served in the immediate area and at the particular time in which the stressful event is alleged to have occurred, and supports the description of the event); see also M21- 1MR, Part III.iv.4.H.29.e (discussing evidentiary requirements to show a "claimant's personal participation" and "the veteran's personal exposure to the event"). The Board therefore finds that there is no verified stressor upon which a grant of service connection for PTSD may be based. Id. The Board therefore finds that the preponderance of the evidence is against the claim, and that the claim must be denied. The veteran's claim for service connection for PTSD fails on the basis that the veteran is not shown to have participated in combat; there is no verified stressor; and that all elements required for such a showing have not been met. The Board therefore finds that the preponderance of the evidence is against the veteran's claim for entitlement to service connection for PTSD. Accordingly, service connection for PTSD must be denied. H. Conclusion In reaching this decision, the Board has considered the appellant's representative's arguments, particularly those set forth in submissions dated in July 2006 and June 2007, in which he asserts that the veteran's participation in combat is established, and that the provisions for combat veterans at 38 U.S.C.A. § 1154(b) are applicable. In July 2006, he argued that service connection is warranted under Collette v. Brown, 82 F.3d, 389, 393 (Fed. Cir. 1996) and Dambach v. Gober, 223 F.3d 1376 (Fed. Cir. 2000). However, Collette and Dambach make clear that 38 U.S.C.A. § 1154(b) is applicable only to veterans who have established participation in combat. In this case, the Board has determined that the veteran did not participate in combat. Accordingly, these arguments do not warrant a grant of any of the benefits sought. In reaching these decisions, the Board has considered the doctrine of reasonable doubt, however, as is stated above, the preponderance of the evidence is against the appellant's claims, and the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). With respect to the veteran's own contentions, a layperson is generally not capable of opining on matters requiring medical knowledge. Bostain v. West, 11 Vet. App. 124, 127 (1998) citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992) (a layperson without the appropriate medical training and expertise is not competent to provide a probative opinion on a medical matter, to include a diagnosis of a specific disability and a determination of the origins of a specific disorder). Lay testimony is competent, however, to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994). When a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh that testimony and to make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The issues on appeal are based on the contention that a low back disorder, residuals of shell fragment wounds of the right foot, residuals of shell fragment wounds of the face and buttocks, peripheral neuropathy, an acquired psychiatric disorder (other than PTSD), a heart disorder, erectile dysfunction, and PTSD, were caused by service, with the claim for peripheral neuropathy to include as due to exposure to Agent Orange, or some other herbicide, during service, and with a heart disorder claimed as secondary to PTSD. In this case, when the veteran's service records, service medical records, and post-service medical records are considered (which indicate that he did not participate in combat, that there are no verified stressors, that he is not credible, that he did not sustain any shell fragment wounds during service, that the claimed conditions began at least 25 years after separation service, which do not contain competent and probative evidence of a nexus between any of the claimed conditions and the veteran's service, and which do not show that service connection is warranted for PTSD), the Board finds that the medical evidence outweighs the veteran's contentions that he has the claimed conditions that are related to his service. V. VCAA The Board finds that VA has satisfied its duties to the veteran under the Veterans Claims Assistance Act of 2000 (VCAA). A VCAA notice consistent with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) must: (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; (3) inform the claimant about the information and evidence the claimant is expected to provide; and (4) request or tell the claimant to provide any evidence in the claimant's possession that pertains to the claim, or something to the effect that the claimant should "give us everything you've got pertaining to your claim(s)." This "fourth element" of the notice requirement comes from the language of 38 C.F.R. § 3.159(b)(1). Pelegrini v. Principi (Pelegrini II), 18 Vet. App. 112 (2004). VA has made all reasonable efforts to assist the veteran in the development of his claims, has notified him of the information and evidence necessary to substantiate the claims, and has fully disclosed the government's duties to assist him. In letters, dated in August 2002 (claims for a low back disorder, residuals of shell fragment wounds of the right foot, residuals of shell fragment wounds of the face and buttocks, peripheral neuropathy, an acquired psychiatric disorder (other than PTSD), and PTSD), and May 2004 (claims for a heart disorder, and erectile dysfunction), the veteran was notified of the information and evidence needed to substantiate and complete the claims. The May 2004 VCAA notice preceded the adjudication of the claims for a heart disorder, and erectile dysfunction. With regard to the August 2002 VCAA notice, it did not comply with the requirement that the notice must precede the adjudication. However, the RO's October 1997 and December 1998 decisions were decided prior to the enactment of the VCAA. In such cases, there is no error in not providing notice specifically complying with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)(1) because an initial RO adjudication had already occurred. Rather, the appellant is to be given proper subsequent VA process, and the Board is to make findings on the completeness of the record or on other facts permitting the Court to make a conclusion of lack of prejudice from improper notice. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The August 2002 VCAA letter was provided by the RO prior to the transfer and certification of the appellant's case to the Board. In addition, after the August 2002 letter was sent, the case was readjudicated and in January 2007 a Supplemental Statement of the Case was provided to the appellant. The veteran was scheduled for a hearing in April 2008. However, he failed to report for his hearing. In summary, the claimant has been provided with every opportunity to submit evidence and argument in support of his claims, and to respond to VA notice. With regard to the application to reopen a claim for service connection for a low back disability, in Kent v. Nicholson, 20 Vet. App. 1 (2006), the Court stated that 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 this case, it does not appear that the veteran received notice in accordance with Kent. With regard to the lack of notice under Kent, and to the extent that it may be argued that either of the VCAA letters were not in compliance with current law, in Sanders v. Nicholson, 487 F.3d 881 (Fed. Cir. 2007), the United States Court of Appeals for the Federal Circuit (Federal Circuit) held that any error by VA in providing the notice required by 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b)(1) is presumed prejudicial, and that once an error is identified as to any of the four notice elements the burden shifts to VA to demonstrate that the error was not prejudicial to the appellant. The Federal Circuit stated that requiring an appellant to demonstrate prejudice as a result of any notice error is inconsistent with the purposes of both the VCAA and VA's uniquely pro-claimant benefits system. Instead, the Federal Circuit held in Sanders that all VCAA notice errors are presumed prejudicial and require reversal unless VA can show that the error did not affect the essential fairness of the adjudication. To do this, VA must show that the purpose of the notice was not frustrated, such as by demonstrating: (1) that any defect was cured by actual knowledge on the part of the claimant; (2) that a reasonable person could be expected to understand from the notice what was needed; or (3) that a benefit could not have been awarded as a matter of law. Although not specifically discussed by the Federal Circuit, some other possible circumstances that could demonstrate that VA error did not prejudice the claimant include where the claimant has stated that he or she has no further evidence to submit, or where the record reflects that VA has obtained all relevant evidence. In this case, there was no notice under Kent, and even assuming arguendo that the VCAA letters were not in compliance, the Board finds that any VCAA notice errors did not affect the essential fairness of the adjudication as VA has obtained all relevant evidence, and as the appellant has demonstrated actual knowledge of what was necessary to substantiate the claims. Id. Specifically, a review of the appellant's submissions, and those of his representative, received subsequent to the VCAA letters, discussed the alleged circumstances of the veteran's service, and the applicable law, to such a degree that they indicate actual knowledge of the right to submit additional evidence and of the availability of additional process. See e.g., appellant's submissions, dated in April and November of 2005; representative's submissions, dated in July 2006 and June 2007. As both actual knowledge of the veteran's procedural rights, and the evidence necessary to substantiate the claims, have been demonstrated and he, or those acting on his behalf, have had a meaningful opportunity to participate in the development of his claims, the Board finds that no prejudice to the veteran will result from proceeding with adjudication without additional notice or process. Furthermore, as discussed below, it appears that VA has obtained all relevant evidence. Id. During the pendency of this appeal, the Court further redefined the requirements of the VCAA to include notice that a disability rating and an effective date for award of benefits would be assigned if service connection is awarded. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). No further notice is needed as to any disability rating or effective date matters. The veteran was afforded sufficient notice in January 2007 (Supplemental Statement of the Case), and March 2007, and in any event, as the claims have been denied, any questions as to the disability rating or the appropriate effective date to be assigned are moot. Therefore, VA's duty to notify the appellant has been satisfied, and no prejudice to the veteran in proceeding with the issuance of a final decision. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993) (where the Board addresses a question that has not been addressed by the agency of original jurisdiction, the Board must consider whether the veteran has been prejudiced thereby). The Board further finds that VA has complied with the VCAA's duty to assist by aiding the veteran in obtaining evidence. It appears that all known and available records relevant to the issues on appeal have been obtained and are associated with the veteran's claims files. The RO has obtained the veteran's service records, to include Morning Reports, and service medical records, as well as VA and non-VA medical records, and records from the Social Security Administration. With regard to the claim for a low back disability, as the Board has determined that new and material evidence has not been presented, a remand for an examination and/or an etiological opinion is not required to decide the claim. See 38 U.S.C.A. § 5103A(f). The veteran was afforded physical and PTSD examinations in 1997, another physical examination in 1998, and another PTSD examination in October 2006. As he is not shown to have participated in combat, to have a verified stressor, or to have sustained shell fragment wounds during service, etiological opinions are not required for the claims for residuals of shell fragment wounds of the right foot, residuals of shell fragment wounds of the face and buttocks, or PTSD. See 38 C.F.R. § 3.159(d). With regard to the claims for peripheral neuropathy, an acquired psychiatric disorder other than PTSD, a heart disorder, and erectile dysfunction, he has not been afforded examinations and/or etiological opinions have not been obtained. Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in disability compensation (service connection) claims, the VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. In this case, the service medical records do not show treatment for peripheral neuropathy, psychiatric symptoms, cardiovascular conditions (to include hypertension), or erectile dysfunction, or a diagnosis of peripheral neuropathy, an acquired psychiatric disorder, a heart disorder, or erectile dysfunction. As previously discussed, the earliest evidence of any of the claimed conditions is dated no earlier than 25 years after separation from active duty. Finally, there is no competent evidence of record which shows that peripheral neuropathy, a heart disorder, or erectile dysfunction, is related to the veteran's service, to include peripheral neuropathy as due to exposure to Agent Orange, or some other herbicide, that acute or subacute peripheral neuropathy was manifested in accordance with 38 C.F.R. §§ 3.307(a)(5)(ii) and 3.309(e), Note 2, or that hypertension was manifest to a compensable degree within one year of separation from service. With regard to the claim for PTSD, the Board has determined that the veteran did not participate in combat, and that there is no verified stressor upon which a claim for PTSD may be based. Given the foregoing, the Board finds that the standards of McLendon have not been met. See also 38 C.F.R. § 3.159(c)(4); Wells v. Principi, 327 F. 3d 1339, 1341 (Fed. Cir. 2002). Simply stated, the Board finds that the service records, service medical records, and post service medical record provides evidence against these claims. The Board concludes, therefore, that decisions on the merits at this time do not violate the VCAA, nor prejudice the appellant under Bernard v. Brown, 4 Vet. App. 384 (1993). Further, the Board finds sufficient competent medical evidence on file for the VA to make a decision on the case. The service and post-service medical record is complete and the Board finds no basis for a VA medical examiner to find a connection between service and the disorders at issue in light of the record. Based on the foregoing, the Board finds that the veteran has not been prejudiced by a failure of VA in its duty to assist, and that any violation of the duty to assist could be no more than harmless error. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). ORDER Service connection for a low back disability is denied. Service connection for residuals of shell fragment wounds of the right foot is denied. Service connection for residuals of shell fragment wounds of the face and buttocks is denied. Service connection for peripheral neuropathy is denied. Service connection for other psychiatric disability, including chronic mental dysfunction impairment, is denied. Service connection for a heart disorder is denied. Service connection for erectile dysfunction is denied. Service connection for PTSD is denied. ____________________________________________ RAYMOND F. FERNER Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs