Citation Nr: 0836021 Decision Date: 10/21/08 Archive Date: 10/27/08 DOCKET NO. 07-02 888 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for residuals of a head injury, claimed as a seizure disorder. 2. Entitlement to service connection for cold injury residuals to the feet. 3. Entitlement to service connection for post-traumatic stress disorder (PTSD) REPRESENTATION Appellant represented by: Jeany Mark, Esq. of Lieberman & Mark WITNESSES AT HEARINGS ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD Jeanne Schlegel, Counsel INTRODUCTION The veteran served on active duty from July 1951 to October 1953 (United States Air Force) and from September 1960 to March 1961 (United States Army). This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2005 (PTSD) and April 2006 (seizure disorder and cold injury residuals) rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In January 2003, a video conference hearing was held before a Veterans Law Judge of the Board who had since retired. Subsequently, a hearing was held at the RO in December 2007 and thereafter, the veteran and his spouse presented testimony at a travel Board hearing held before the undersigned Veterans Law Judge in June 2008. Transcripts of all of the aforementioned hearings are of record. It is not clear whether an actual VA Form 9, substantive appeal, was filed in this case as to the claims involving the residuals of a head injury and cold injuries to the feet. A Supplemental Statement of the Case dated in March 2008 references a substantive appeal received on January 18, 2007, but this document does not appear to be in the file. In any event, the Board finds that the veteran's hearing testimony, as contained in the written transcript of the December 2007 hearing before a Decision Review Officer at the RO, meets the requirements necessary for a Substantive Appeal. Cf. Sondel v. Brown, 6 Vet. App. 218, 220 (1994); Tomlin v. Brown, 5 Vet. App. 355, 357 (1993). Moreover, accepting the veteran's December 2007 hearing testimony in lieu of a VA Form 9 is in keeping with the long-standing recognition of the nonadversarial, uniquely pro-veteran claims process within VA. Cf. Barrett v. Nicholson, 466 F.3d 1038, 1044 (Fed. Cir. 2006) (noting that "the importance of systemic fairness and the appearance of fairness carries great weight" within the nonadversarial veterans benefits system and that "[t]he [G]overnment's interest in veterans cases is not that it shall win, but rather that justice shall be done."). For these reasons, the Board finds that the issues on appeal are as set forth on the cover page of this remand. In addition, in a rating decision issued in October 2007, the RO denied an evaluation in excess of 30 percent for a disability of the cervical spine. The veteran filed a Notice of Disagreement (NOD) in October 2007, expressing disagreement with the rating assigned. In response to the NOD, the RO issued a Statement of the Case (SOC) in August 2008 addressing only the increased rating claim. To date, the veteran has not filed a substantive appeal as to this claim and accordingly it is not in appellate status before the Board at this time. 38 C.F.R. § 20.302. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2007). 38 U.S.C.A. § 7107(a)(2) (West 2002). As set forth in more detail below, the Board has determined that new and material evidence has been received to reopen the service connection claim for residuals of a head injury, claimed as a seizure disorder. However, additional action is necessary prior to further appellate consideration. The issues of entitlement to service connection for residuals of a head injury, claimed as a seizure disorder, and for PTSD being remanded are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. In a final decision issued in July 2003, the Board determined that no new and material evidence had been submitted to reopen a claim of entitlement to service connection for a seizure disorder; the evidence submitted since the July 2003 Board decision is not cumulative or redundant of evidence that was already submitted, relates to an unestablished fact, and raises a reasonable possibility of substantiating the claim. 2. The competent evidence fails to establish that claimed cold injury residuals to the feet, to include neuropathy initially diagnosed decades after the veteran's discharge from service, are related to either period of the veteran's active duty service. CONCLUSIONS OF LAW 1. The Board's July 2003 decision, which determined that no new and material evidence had been submitted to reopen a claim of entitlement to service connection for a seizure disorder, is final. 38 U.S.C.A. §§ 7103, 7104 (West 2002); 38 C.F.R. §§ 20.1100, 20.1104 (2007). 2. Evidence received subsequent to the July 2003 Board decision is new and material, and the service connection claim for residuals of a head injury, claimed as a seizure disorder, is reopened. 38 U.S.C.A. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. §§ 3.156, 20.1105 (2007). 3. Cold injury residuals to the feet were not incurred in or aggravated by the veteran's active duty service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSION Veterans Claims Assistance Act of 2000 Upon receipt of a substantially complete application for benefits, VA must notify the claimant what information or evidence is needed in order to substantiate the claim and it must assist the claimant by making reasonable efforts to get the evidence needed. 38 U.S.C.A. §§ 5103(a), 5103A; 38 C.F.R. § 3.159(b); see Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The notice required must be provided to the claimant before the initial unfavorable decision on a claim for VA benefits, and it 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 that pertains to the claim. 38 C.F.R. § 3.159, as amended, 73 Fed. Reg. 23353-56 (Apr. 30, 2008); see Pelegrini v. Principi, 18 Vet. App. 112, 120- 21 (2004) (Pelegrini II). This notice must be provided prior to an initial unfavorable decision by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini II, 18 Vet. App. at 119. In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the U.S. Court of Appeals for Veterans Claims held that, upon receipt of an application for a service-connection claim, 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating, or is necessary to substantiate, each of the five elements of the claim, including notice of what is required to establish service connection and that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. With respect to the issue of whether new and material evidence has been submitted to reopen a service connection claim for residuals of a head injury, claimed as a seizure disorder, the RO also has a duty to notify an appellant of what information or evidence is needed in order reopen a claim. See Kent v. Nicholson, 20 Vet. App. 1 (2006). However, the law specifically provides that nothing in amended section 5103A, pertaining to the duty to assist claimants, shall be construed to require VA to reopen a claim that has been disallowed except when new and material evidence is presented or secured. 38 U.S.C.A. § 5103A(f). In the decision rendered herein, the Board has determined that new and material evidence has been presented to reopen the veteran's service connection claim for residuals of a head injury, claimed as a seizure disorder. Therefore, regardless of whether the duty to notify and assist requirements have been met in this case, no harm or prejudice to the appellant has resulted. Therefore, the Board concludes that the current laws and regulations have been complied with, and a defect, if any, in providing notice and assistance to the veteran was at worst harmless error in that it did not affect the essential fairness of the adjudication. Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004); Pelegrini v. Principi, 18 Vet. App. 112, 119-120 (2004); Bernard v. Brown, 4 Vet. App. 384 (1993); VAOPGCPREC 16-92. The Board notes that it is expected that when the claim is returned to the RO for further development and appellate consideration of the claim on the merits, the RO will properly conduct all necessary VCAA notice and development in accordance with its review of the underlying claim. With respect to the service connection claim for cold injury residuals to the feet, the VCAA duty to notify was satisfied by way of a letter sent to the veteran dated in February 2006 that fully addressed all notice elements of Quartuccio v. Principi, 16 Vet. App. 183 (2002). Here, the duty to notify was satisfied prior to the initial unfavorable decision on the claim (April 2006) by the AOJ. Moreover, such notice errors may instead be cured by issuance of a fully compliant notice, followed by readjudication of the claim. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006) (where notice was not provided prior to the AOJ's initial adjudication, this timing problem can be cured by the Board remanding for the issuance of a VCAA notice followed by readjudication of the claim by the AOJ) see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as an SOC or SSOC, is sufficient to cure a timing defect). In this case, not only has the appellant been afforded a meaningful opportunity to participate effectively in the processing of his claim and given ample time to respond, but the AOJ also readjudicated the case by way of a supplemental statement of the case (SSOC) issued in March 2008 after the notice was provided. For these reasons, it is not prejudicial to the appellant for the Board to proceed to finally decide this appeal. In addition, although the notice provided did not address either the rating criteria or effective date provisions that are pertinent to the veteran's claim, such error is harmless given that service connection for cold injury residuals to the feet is being denied in this case and hence no rating or effective date will be assigned with respect to this claimed condition(s). 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). VA has a duty to assist the veteran in the development of the claim. This duty includes assisting the veteran in the procurement of STRs and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the appellant. See Bernard v. Brown, 4 Vet. App. 384 (1993). The RO has obtained the service treatment records, VA outpatient treatment records and private medical records. The veteran provided hearing testimony in 2007 and 2008 and in August 2008, additional evidence was added to the file which was accompanied by a waiver. While VA has not afforded the veteran a comprehensive medical examination relating to his claim of service connection for cold injury residuals to the feet, the Board finds that such an examination is not necessary to render a decision under the circumstances of this case. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C.A. § 5103A(d)(2), 38 C.F.R. § 3.159(c)(4)(i) (2007). Although the evidence reflects that the veteran has currently diagnosed foot disabilities, the STRs do not show any abnormality of the feet on examinations dated from 1951 to 1961 and more than 40 years have elapsed since the veteran was discharged following his second period of service without any record of complaints, treatment, or diagnosis of any foot problems or reference to a cold injury in service. The Board finds that any medical opinion linking a currently diagnosed foot disability to service would be speculative at best. Thus, as procuring such an examination provides not reasonable possibility that such assistance would aid in substantiating the veteran's claim, VA has no further duty to assist in this regard. 38 U.S.C.A. § 5103A(a)(2). Significantly, neither the veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. Hence, no further notice or assistance to the appellant is required to fulfill VA's duty to assist the appellant in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Legal Analysis The Board has thoroughly reviewed all the evidence in the veteran's claims folders. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the evidence submitted by the appellant or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). The analysis herein focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims. The appellant must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the veteran). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). A. New and Material The veteran maintains that his currently claimed residuals of a head injury, primarily described as a seizure disorder, are etiologically related to a blow to the head sustained in 1960. The veteran does not maintain that he suffered from any head trauma during his first period of service or that the currently claimed residuals of a head injury/seizure disorder are in any way related to his first period of service. The Board observes that the veteran's service connection claim for residuals of a head injury, claimed as a seizure disorder, was previously considered and denied by the Board in a decision issued in July 2003. The veteran was provided a copy of that decision, and the Board's decision in the matter is final. See 38 U.S.C.A. §§ 7103, 7104(b); 38 C.F.R. § 20.1100. In January 2006, the veteran requested that the claim be reopened. The April 2006 rating decision currently on appeal determined that new and material evidence was presented, reopened the claim for service connection and adjudicated the claim on the merits, denying it. As will be explained herein, the Board believes that the RO's adjudication regarding reopening the veteran's claim for service connection is ultimately correct. However, regardless of what the RO has done in cases such as this, "the Board does not have jurisdiction to consider a claim which it previously adjudicated unless new and material evidence is presented, and before the Board may reopen such a claim, it must so find." Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996); 38 U.S.C.A. §§ 5108, 7104(b). Therefore, the Board is required to review whether new and material evidence has been submitted to reopen the claim. Thus, the Board has characterized the issue on appeal as whether the appellant has submitted new and material evidence to reopen the previously denied claim for service connection for residuals of a head injury, claimed as a seizure disorder. In order to reopen a claim which has been denied by a final decision, the claimant must present new and material evidence. 38 U.S.C.A. § 5108. For applications to reopen filed after August 29, 2001, as was the application to reopen the claim in this case, new and material evidence means evidence not previously submitted to agency decisionmakers; which relates, either by itself or when considered with previous evidence of record, to an unestablished fact necessary to substantiate the claim; which is neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and which raises a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). To reopen a previously disallowed claim, new and material evidence must be presented or secured since the last final disallowance of the claim on any basis, including on the basis that there was no new and material evidence to reopen the claim since a prior final disallowance. See Evans v. Brown, 9 Vet. App. 273, 285 (1996). For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992) (in determining whether evidence is new and material, "credibility" of newly presented evidence is to be presumed unless evidence is inherently incredible or beyond competence of witness). As noted herein, in a decision issued in July 2003, the Board determined that new and material had not been presented with which to reopen the service connection claim residuals of a head injury. In that decision, the Board acknowledged that the veteran had a currently diagnosed seizure disorder, but determined that no competent evidence had been added to the record which related the veteran's claimed seizures to either of his periods of service, or to any specific incident therein. The evidence before the Board in 2003 included service treatment records (STRs) for the first period of service and an enlistment examination in September 1960 which were devoid of complaints, treatment or findings indicating a head injury. An entry dated in November 1960 reflected the veteran's complaint that he had fallen and hit his head four days previously. On subsequent examination in November 1960, he reported having epilepsy for which he had been treated by his hometown physician. Three types of spells, which began a year previously, were described and included absence spells lasting several minutes, some loss of muscle tone with dropping to the knees, and spells of paralysis at night. A neurological examination was within normal limits. The examiner doubted the existence of epilepsy, and indicated that the episodes described resembled some aspects of narcolepsy syndrome. In late November 1960, vague, diffuse symptoms were described, and the veteran wondered if the symptoms could be caused by brain tumor or snake bite. On hospitalization in January 1961, the veteran complained of "spells," headaches and a feeling like "eggs frying" on the right side of his head. Clinical data revealed a report from his local doctor dated in June 1960 with an opinion that the veteran should undergo an electroencephalogram and that his attacks were possibly functional. During the January 1961 hospitalization, the veteran reported that burning sensations in the back of his head began after he was hit on the head with a helmet by a second lieutenant during basic training in September 1960. He also reported having had spells of nervousness for several years. A physical examination and neurological evaluation were within normal limits. The final diagnosis was passive-aggressive reaction characterized by difficulties in handling hostility in the service, some history of difficulty in handling hostility in the past, poor school history and fair work history. The March 1961 separation examination report revealed that clinical evaluation of the head was normal as was a neurological evaluation. Passive-aggressive reaction was shown on the veteran's psychiatric evaluation. The veteran gave a history of frequent or severe headaches, dizziness or fainting spells, and loss of memory or amnesia, and complaints were made of pain in the back of the head. He did not identify symptoms of epilepsy or fits. A report of private hospitalization in December 1960, during which time the veteran was attended to by primary physician Dr. F., revealed complaints of drowsiness and difficulty in maintaining thought continuity. A history was given of being struck in the face and head while in boot training about three months prior to hospitalization and of having experienced discomfort in the back of the head and between the shoulders since that time. After examination and treatment, the diagnoses were acute bacterial infection of the tonsils and adjacent nodes and acute infection probably due to bacterial organisms involving the tonsils, pharynx and adjacent regional nodes. An April 1972 report of examination by Dr. W., showed complaints of intermittent dizziness for the previous 18 months. The veteran reported having been hit in the face with a helmet while in service approximately 11 years previously. He complained of numerous symptoms, was seen in numerous places, and ultimately recovered. Various diagnostic studies were reported to have been normal. After examination, the impression was history suggestive of true vertigo, and he was referred to another physician to rule out acoustic neuroma. A progress note dated in July 1972 indicates that another private physician's neurological examination had been unremarkable. On a VA examination in May 1972, blackouts starting in about 1970 and an old head injury in about 1962 were reported. An examination of the musculoskeletal system and neurological examination were normal. The diagnoses were no neurological disease found, no medical disease found, and X-ray of the skull negative for pathology. Dr. H. submitted a summary of private hospitalization in July 1972, when the veteran was hospitalized with a history of "feeling crazy," bouts of loss of consciousness, and sensations of twirling and confusion. X-ray studies of the skull and cervical spine were normal, except for osteoarthropathy. Arteriography was within normal limits. The diagnosis was vestibular derangement of undetermined etiology. Service comrades, including the veteran's brother, stated in 1972 that the veteran had been struck on the head while in training. They did not actually see the blow but noticed that his face was cut and his head swollen afterwards. On a VA examination in March 1973, the veteran reported that the blow on his head in service "numbed his head" and that he had had a pressure sensation in the vertex of the calvarium for the previous 12 years. A neurological evaluation was normal, except for slight tremor of the extended fingers. Neuropsychological testing conducted in April 1973 indicated no significant organic impairment of cortical functioning. The clinical psychologist summarized that the veteran's somatic complaints probably were the result of his emotional disorder rather than an organic impairment. The neuropsychiatrist concluded that the veteran was an emotionally disturbed person and that the helmet accident resulted in no damage of any significance. The diagnosis was conversion reaction. VA outpatient treatment reports dated in 1975 and 1976 showed various complaints, including those of "spells," pressure in the head, sense of twirling, confusion, falling, "seizures," loss of consciousness and bizarre complaints of pinched nerve in the head and hardening of the arteries in head. Diagnoses included possible carotid insufficiency and organic brain syndrome. After psychiatric testing in July 1975, the examiner felt that there was some impairment of an organic nature in the veteran's cortical functioning. An electroencephalogram in July 1975 was abnormal with mild swelling of basic frequencies and possible right hemisphere swelling that was felt to be of questionable import. A brain scan in February 1976 was within normal limits. A history was given of having been hit on the head in service. On state hospitalization from October to December 1975 because of bad temper, history of head injury, and seizures and emotional problems, the psychiatric diagnosis was convulsive disorder secondary to head injury and signs of organicity. Outpatient treatment records from 1976 included a psychiatric examiner's opinion that the veteran was paranoid. Dr. T., reported in July 1978 that the veteran was his patient in the autumn of 1960, at which time he had received head injuries in a fall and that he referred the veteran to Dr. F. in LaGrange, Georgia, for treatment and follow up of the injuries. A medical report from Dr. H., dated in November 1982, indicates that the veteran was first seen in July 1979 and that his overlying major medical problem was a problem with a seizure disorder. Dr. H. reported that the seizure disorder was not present prior to his entrance into military service and was present at the time of his discharge from military service. Dr. H. reported that a head injury that occurred during service "may well be the etiology of the [veteran's] present seizure disorder." She said that there was nothing else in his medical history to explain the onset of the seizures. Dr. H. further reported that a neurologic work-up showed no etiology for the seizure disorder of a correctable nature, that is, showed no brain tumors, metabolic disorders or vascular disorders. The veteran testified at a hearing before the Board in January 1984 to the effect that the STRs reporting a history of nervousness prior to service were not correct. It was reported that the veteran had no seizures prior to service but that the seizures began after he was hit in the head by a helmet resulting in a severe head injury. It was contended that the seizure disorder was a manifestation of, and due to an acquired psychiatric disorder that began during service as a result of the head injury. Reports of private medical treatment from 1986 are of record and show that a report of electroencephalographic studies the veteran had in June 1986 revealed no evidence of epileptogenic activity, or of focal, lateralizing or diffuse abnormalities. According to the report of a brain scan in June 1986, the findings were normal. In the statements submitted by a private physician in 1986, it was noted that the veteran had been treated for headaches in 1962. Private hospital reports dated in 1989 reflected a long history of seizure disorder questionably related to head trauma that the veteran sustained while in the Armed Forces. A statement dated in October 1989 from Dr. W., a specialist in family practice, indicated that he had been treating the veteran for the previous four years and that the veteran had been suffering from recurrent cervical pain for years. The initial onset of his cervical problems had been due to an accident during military service when he suffered a blow to his head. Dr. W. said that the veteran had been diagnosed as having osteoarthritis involving the cervical spine. Private hospital reports from 1990 show that the veteran was hospitalized with a chief complaint of left leg weakness. His history included a history of seizure disorder. He also gave a history of head trauma in his 20's, when he was in service. Since then, he had complaints of headaches off and on and vague cervical pain. The head trauma was apparently complicated by what were described as a "vague seizure disorder" that seemed to have been partial complex epilepsy. The impressions included a seizure disorder, which appeared to be partial complex epilepsy and post traumatic in origin. A private medical consultation in July 1992 noted that the veteran had had some previous episodes of left sided weakness and history of transient ischemic attack. It was also reported that he had had some ill defined seizures that he maintained were due to a service related injury. A cranial CT scan in July 1992 was normal. The examiner's impression was left-sided hemiparesis of unclear etiology. The examiner said that this could questionably be epileptiform but that this was not clear cut. The file also contains a January 1994 statement of Dr. C, a chiropractor, who treated the veteran in 1993. The report stated that the veteran reported having a history of seizures and that had been told by a doctor that he had nerve damage in the neck and head due to the blow to his head in 1960. A disability of the cervical spine was diagnosed at that time, but a seizure disorder was not. A VA medical report dated in July 2000 indicates that the veteran gave a 40 to 50 year history of a seizure disorder. Evaluation revealed no specific neurological findings and atypical seizure disorder was diagnosed. Service connection for a disability of the cervical spine was granted by rating action of February 2001, as it was determined this was etiologically related to a head injury sustained in service. A period of observation and evaluation at a VA medical center in May 2001 culminated in a final diagnosis of seizures based on at least four witnessed spells during the hospitalization. The hospital report shows that a history elicited on admission reflected risk factors for seizures that included a blow to the head in 1960 or 1961 while in basic training with no loss of consciousness. An electroencephalogram during the spells showed no change electrographically, but it was reported that computerized spike and seizure recognition programs were not in operation at the time. The veteran provided testimony at a Board video conference hearing conducted in January 2003. He testified that while in basic training at Fort Jackson, South Carolina, in about November 1960, he was hit in the head with a helmet causing injury, which in turn caused bleeding. He said that the lieutenant took him to a service dispensary the following morning. The veteran testified that he saw a doctor from Newton, Georgia, who told him that his face was cut. He testified that his first sergeant later gave him a pass to see his doctor and that he went home to see Dr. T. and Dr. T. then sent the veteran to Dr. F., who hospitalized the veteran for 12 days. The veteran further testified that he had never sustained another head injury before, during, or after service. He said that Dr. H. "could have been" the first physician to mention seizures to him in about 1972. The veteran indicated that his condition worsened between 1961 and 1972. In a decision issued in July 2003, the Board determined that new and material evidence had not been presented with which to reopen the service connection claim for residuals of a head injury/seizure disorder. Subsequent to the July 2003 Board decision additional evidence has been added to the file which includes a private medical statement of Dr. W. dated in August 2004. Dr. W. stated that he had been treating the veteran for 17 years for a recurrent seizure disorder confirmed by EEG. A second medical opinion was offered by Dr. W. in November 2005. Dr. W. stated that he had treated the veteran since 1985 for symptoms including recurrent episodes of dizziness, headaches, enuresis and cervical pain. Dr. W. observed that in 1975 a diagnosis of partial seizures was made following an abnormal EEG. The doctor noted that veteran head injury sustained in 1960 and observed that prior to that time the veteran had not had any neurological or cervical complaints and that after the head injury he chronically experienced both types of problems. Dr. W. stated that more than one neurologist had diagnosed a seizure disorder. Dr. W. opined that the veteran had suffered from a cervical disability and a seizure disorder recurrently and chronically for several decades which were the result of an injury sustained in October 1960 when the veteran was struck in the head with a helmet. A third medical opinion was offered by Dr. W. in May 2006 which was based upon review of the veteran's pertinent medical evidence and clinical records. Again, Dr. W. opined that the veteran had suffered from a cervical disability and a seizure disorder recurrently and chronically for several decades which were the result of an injury sustained in October 1960 when the veteran was struck in the head with a helmet. VA records dated from 2005 to 2008 document episodic seizures. In this case, the Board finds that the opinions of Dr. W. provided in 2005 and 2006 to the effect that an etiological relationship exists between a head injury sustained in 1960 and the subsequent development of a chronic seizure disorder constitute new and material evidence. Because this evidence was received subsequent to the July 2003 Board decision and was not previously of record, it is clearly new. Moreover, the aforementioned evidence pertains to the critical issue before the Board, namely addressing an etiological relationship to service and suggesting that such a relationship exists. In essence, this evidence presented since the July 2003 final Board decision is not cumulative or redundant of evidence that was already submitted, relates to an unestablished fact, and raises a reasonable possibility of substantiating the veteran's claim. Accordingly, the Board concludes that these opinions constitute new and material evidence within the meaning of 38 C.F.R. § 3.156, and the claim is reopened. To the extent that the record before the Board at the time of the July 2003 decision contained medical evidence/opinion associating the veteran's seizures with service, this evidence was discounted by the Board and was not deemed to constitute new and material evidence by virtue of being based on history provided by the veteran which had been previously rejected. See Elkins v. Brown, 5 Vet. App. 474, 478 (1993) (doctor's opinion does not constitute competent medical evidence where based upon veteran's "own account of his medical history and service background, recitations which have already been rejected by the RO and BVA"); Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (doctor's opinion is not competent medical evidence to the extent it is based upon ostensible facts that have been rejected as inaccurate or untrue in VA adjudication). In contrast, the opinions of Dr. W. provided in 2005 and 2006 were not based solely on a history provided by the veteran. In fact, the 2006 opinion was clearly based on a longitudinal review of pertinent medical/clinical evidence and the veteran's medical history which was specifically referenced in the body of that opinion. Moreover, since the issuance of the Board decision in 2003, the Court has held that VA cannot reject a medical opinion simply because it is based on a history supplied by the veteran and that the critical question is whether that history is accurate. See Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) (the Board may not disregard a medical opinion solely on the rationale that the medical opinion was based on a history provided by the veteran, and instead must evaluate the credibility and weight of the history upon which the opinion is predicated); Coburn v. Nicholson, 19 Vet. App. 427, 432 (2006) (reliance on a veteran's statement renders a medical report incredible only if the Board rejects the statements of the veteran). Here, the critical facts which have been reported by the veteran to Dr. W. were as follows: (1) that he sustained a head injury during service in 1960 (from whatever cause); and (2) that he has suffered from chronic symptomatology thereafter which at various intervals has been diagnosed as a seizure disorder. These facts are accurate and are well documented by the evidence on file; accordingly the opinions offered by Dr. W. which are based in part upon these facts constitute competent evidence which is both new and material. Therefore, the Board finds that new and material evidence has been presented to reopen the veteran's previously denied service connection claim for residuals of a head injury, claimed as a seizure disorder. However, as will be explained below, the Board is of the opinion that further development is necessary before the merits of the claim can be addressed. B. Service Connection - Cold Injury Residuals to the Feet The veteran generally contends that cold weather and temperatures to which he was exposed while serving in Korea in 1952 (or thereabouts) caused the currently claimed cold injury residuals to the feet. The veteran does not maintain that he incurred or sustained any foot problems during his second period of service from 1960 to 1961. Initially, the Board notes that the file includes a DD 214 Form which reflects that the veteran had service in the United States Air Force from July 1951 to October 1953 with a primary MOS of vehicle operator in a transport unit. His awards include a Korean Service Medal and as such service in Korea is established. The veteran maintains that he had combat service in Korea. For injuries or disease which are alleged to have been incurred in combat, 38 U.S.C.A. § 1154(b) provides a relaxed evidentiary standard of proof to determine service connection. Collette v. Brown, 82 F.3d 389 (Fed. Cir. 1996); Gregory v. Brown, 8 Vet. App. 563 (1996). However, in this case, no evidence of record, including the DD Form 214, reflects that the veteran received a CIB or otherwise establishes that the veteran engaged in combat during his period of active duty service from 1951 to 1953, to include service in Korea. Accordingly, the provisions of 38 U.S.C.A. § 1154(b), are not applicable in this case. In order to establish direct service connection for a claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). A brief summary of the facts reveals that the STRs include an enlistment examination report dated in July 1951 which reflects that clinical evaluation of the feet was normal. An entry dated in August 1953 reveals that the veteran was seen for complaints of tingling on the plantar surface of both feet assessed as a possible fungal infection. The October 1953 discharge examination shows that clinical evaluation of the feet was normal. An examination report dated in 1958 also revealed that the clinical evaluation of the veteran's feet was normal. STRs from the veteran's second period of service include a September 1960 enlistment examination and a March 1961 discharge examination both of which reflect that clinical examination of the veteran's feet was normal. The veteran filed a service connection claim for a bilateral foot condition claimed as due to cold weather exposure in January 2006. VA records reflect that the veteran was seen for a podiatry consultation in July 2004. He reported that he sustained a cold injury to the feet during service in Korea and complained of painful calluses on the soles of the feet and numbness of the toes. Assessments of: a cold injury to the feet by history; neuropathy by history related to a cold injury of the feet; tylomas and onychomycosis were made. In February 2005, the veteran was seen by podiatry with complaints of painful feet and an ingrown toenail. Assessments of onychomycosis, onychocryptosis and metatarsalgia were made. In March 2005, the veteran underwent nail matrixectomy of the right 4th toe, following complaints that the toenail had been hurting for years. The veteran presented testimony at a hearing held at the RO in December 2007. He testified that he sustained cold injuries to the feet while serving in a combat zone driving in a vehicle with only a canvas top and a windshield and without doors or heaters during the coldest part of the day. The veteran indicated that he was never treated for foot problems while serving in Korea. The veteran also presented testimony at a Board hearing held in June 2008 stating that he had been exposed to extremely cold temperatures while serving in Korea. He stated that his current foot symptomatology consisted of soreness and burning and indicated that peripheral neuropathy had been diagnosed and had been associated by a doctor to a service-related cold injury. Additional evidence was received in August 2008 which was accompanied by a waiver. This evidence includes entries dated in February and April 2008 showing that the veteran was seen by VA podiatry with complaints of discomfort in both feet and a reported history of foot problems since been exposed to cold temperatures while serving in Korea. Assessments of metataralgia, neuropathy and porokeratosis were made. At the outset, the Board notes that the effects of a cold injury may not become apparent for many years and that VA has taken a number of steps to assist claimants and to enhance the adjudication of claims for residuals of cold injury. They include: revision and expansion of the criteria for rating residuals of cold injury; the addition of a section on cold injury in the adjudication procedures manual; and development of a cold injury examination protocol. See VA Adjudication Procedure Manual M21-1, Part VI, par. 11.20. There is no question in this case that the veteran has a current diagnosis relating to the feet, primarily assessed as metataralgia and neuropathy. Assessments of a cold injury to the feet by history and neuropathy by history related to a cold injury of the feet were also made in 2004. After a review of the evidence of record, the Board also finds that the veteran has provided credible testimony regarding exposure to cold temperatures while serving in Korea in the early 1950's. While the veteran is competent to describe being exposed to cold temperatures, he is not competent to render an opinion on matters of a medical diagnosis of a diagnosed disorder. Barr v. Nicholson, 21 Vet. App. 303 (2007); Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The critical inquiry is whether a currently manifested foot condition is in any way etiologically related to service, specifically to cold temperatures sustained in or around 1952 during service in Korea. The available STRs dated during the veteran's first period of service contain a sole documented entry made in August 1953 related to the feet without mention of any cold-related complaints or symptoms and assessed only as a possible fungal infection. Even presuming that a cold injury occurred during service as reported, the record must also include competent medical evidence to substantiate that this injury resulted in a currently manifested and/or chronically existing disability. See Hickson, 12 Vet. App. at 253. In this case, subsequent examinations conducted in 1953, 1958, 1960 or 1961 revealed no abnormalities of the feet. Post-service, it was not until 2004, about 50 years after the veteran was discharged from his first period of service, that medical records initially document the veteran's report of a cold injury in service and complaints relating to the feet. Prior to that time, there does not appear to be any mention any cold injury in service or any symptomatology of the feet reportedly related thereto. While the evidence in this case does include diagnoses of a cold injury to the feet by history and neuropathy by history related to a cold injury of the feet which were made in 2004, these diagnoses are essentially bare conclusions, unsupported by facts or evidence. The Court has held that a medical opinion is inadequate when it unsupported by medical evidence. Black v. Brown, 5 Vet. App. 177, 180 (1995). See also, Miller v. West, 11 Vet. App. 345, 358 (1998); Knightly v. Brown, 6 Vet. App. 200 (1994). As to the diagnoses made in 2004 there is no indication that any prior medical records were reviewed in conjunction with rendering these diagnoses. Subsequent diagnoses of metataralgia, neuropathy and porokeratosis made in 2008 were not etiologically related to service. In this case, no probative or competent evidence has been presented which establishes that the veteran's post-service foot symptomatology, manifested by neuropathy and other foot conditions, is etiologically related to service or has chronically existed since service. Supporting medical evidence is required in the circumstances presented in this case. See Voerth v. West, 13 Vet. App. 117, 120-1 (1999) (holding that there must be medical evidence on file demonstrating a relationship between the veteran's current disability and the claimed continuous symptomatology, unless such a relationship is one as to which a lay person's observation is competent). A prolonged period without medical complaint can be considered, along with other factors concerning a claimant's health and medical treatment during and after military service, as evidence of whether an injury a disease was incurred in service which resulted in any chronic or persistent disability. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Concerning this evidentiary gap between active service and the earliest mention of any cold injury in service shown in 2004, more than 5 decades after the veteran's discharge from his first period of service, the Board notes that the absence of evidence constitutes negative evidence tending to disprove the claim that the veteran sustained a cold injury in service which resulted in chronic disability or persistent symptoms thereafter. See Forshey v. West, 12 Vet. App. 71, 74 (1998), 38 U.S.C.A. § , 284 F.3d 1335, 1358 (Fed. Cir. 2002) (noting that the definition of evidence encompasses "negative evidence" which tends to disprove the existence of an alleged fact); see also 38 C.F.R. § 3.102 (noting that reasonable doubt exists because of an approximate balance of positive and "negative" evidence). Thus, the lack of any objective evidence of continuing complaints, symptoms, or findings related to the feet for decades after service is itself evidence which tends to show that a disorder of the feet did not have its onset in service or for many years thereafter. Additionally, the veteran did not report having residuals of a cold injury either to the Veterans Benefits Administration (VBA) or to his health care providers until 2004 and did not file his initial claim until 2006, more than four decades after discharge from even his second period of service. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the veteran). Not only may the veteran's memory be dimmed with time, but self interest may play a role in the more recent statements. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (interest may affect the credibility of testimony); cf. Pond v. West, 12 Vet. App. 341, 346 (1999). Thus, with consideration of the veteran's STRs, to include examination reports dated from 1951 to 1961 all of which are negative for any clinical abnormality of the feet and which failed to mention any treatment for a cold injury; the length of time following service prior to any reference to a cold injury in service and recorded complaints allegedly related thereto, and the absence of any competent and probative medical opinion establishing a causal link between currently manifested foot disorders and the veteran's service, the Board finds that the preponderance of the evidence is against the veteran's claim of service connection for cold injury residuals to the feet. Consequently, the benefit-of-the- doubt rule does not apply, and the claim must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). ORDER New and material evidence having been presented, the veteran's service connection claim for residuals of a head injury, claimed as a seizure disorder, is reopened and the appeal is granted to this extent only. Entitlement to service connection for cold injury residuals to the feet is denied. REMAND After a thorough review of the claims file the Board finds that additional development is necessary before a decision on the merits of the claim of entitlement to service connection residuals of a head injury, claimed as a seizure disorder, can be reached. Additional development is also required as to the service connection claim for PTSD. With respect to the claimed residuals of a head injury, primarily described as a seizure disorder, the veteran has reported during hearings held in 2007 and 2008 that he was in receipt of disability benefits from the Social Security Administration (SSA) from 1973 forward due to his residuals of a head injury/seizure disorder. It does not appear that the RO has attempted to obtain such claimed SSA records, and no such records are on file. Therefore, on Remand, the claimed evidence from the SSA will be requested. The Board observes that the medical history involving the veteran's claimed residuals of a head injury is both long and complex and it appears that questions remain regarding whether in fact the veteran has an actual clinically manifested seizure disorder and if so whether it is at least as likely as not that this condition is etiologically related to service, specifically a head injury sustained in 1960. Moreover, the Board recognizes the possibility that a theory of entitlement on a secondary basis exists in this case and notes in this regard that service connection is currently in effect for a disability of the cervical spine and that the original grant of service connection was made based on a determination that an etiological relationship exists between the head injury sustained in 1960 and the subsequent development of a disorder of the cervical spine. In Roebuck v. Nicholson, 20 Vet. App. 307 (2006), the Court held that although there may be multiple theories or means of establishing entitlement to a benefit for a disability, if the theories all pertain to the same benefit for the same disability, they constitute the same claim. Consequently, a remand is necessary in order for the agency of original jurisdiction to adjudicate the veteran's claim under both direct and secondary theories of entitlement. The veteran also maintains that service connection is warranted for PTSD and it appears that he is advancing two theories of entitlement in this regard. He has maintained that he had combat service in Korea during his first period of service with the United States Air Force extending from July 1951 to October 1953 and experienced stressors occurring during that period of service. It also appears that he maintains that he incurred PTSD during his second period of service with the United States Army from September 1960 to March 1961 based on personal assault resulting from a head injury sustained in 1960. Additional development is required under both theories of entitlement. Initially, the Board notes that under 38 C.F.R. § 3.304(f) a diagnosis of PTSD must be rendered in accordance with 38 C.F.R. § 4.125(a) (2007), which incorporates the provisions of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). That file includes VA outpatient records which reflect that PTSD was diagnosed in 2004 and that a diagnosis of PTSD was made by a private doctor in August 2004. It is not entirely clear that any current diagnosis of PTSD on file was made in accordance with the provision of with 38 C.F.R. § 4.125(a) (2007). As such, a VA PTSD examination will be furnished in order to establish whether or not such a diagnosis is warranted in this case. Should a diagnosis of PTSD be rendered in accordance with 38 C.F.R. § 4.125(a) (2007), additional stressor development would also be warranted in this case. The veteran provided an account of stressors experienced while serving in Korea (1952) in a document dated in September 2004. Additional information was provided in a January 2007 statement (in which the veteran named a military comrade whom he saw "blown up") and during the course of hearing testimony provided in 2007 and 2008. It also appears that he is claiming as a stressor a flight line accident (8th Bomber Squadron) which occurred on December 16, 1952, at Kunsan Airbase in Korea. To this point, it does not appear that verification of the veteran's reported stressors has been attempted and it appears that the RO has found the stressor information provided by the veteran inadequate and/or insufficiently detailed to verify and establish his alleged stressors. See VBA's Adjudication Procedure Manual, M21-1MR (hereinafter "M21- 1MR"), Part IV.ii.1.D.15.a (attempt at corroboration not required where stressors are not capable of being documented), and 14.d. (noting that claimants must provide, at a minimum, a stressor that can be documented). Accordingly, the veteran should be given an opportunity to provide additional detailed stressor information and should the stressor information which has been (cumulatively) provided be sufficiently detailed, an attempt at stressor verification should be undertaken through the appropriate sources. In addition, although the veteran's service personnel records are on file, his actual service dates in Korea are unclear. This matter should be clarified on Remand, particularly as this may impact verification of one the aforementioned stressors. As a related matter, the Board observes that the veteran was not provided notice in any VCAA notification letters which includes reference to 38 C.F.R. § 3.304(f)(3) which pertains to claims for PTSD based on allegations of personal assault in service. 38 C.F.R. § 3.304(f)(3) ("VA will not deny a PTSD claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than the veteran's service records or evidence of behavior changes may constitute credible supporting evidence of the stressor and allowing him or her the opportunity to furnish this type of evidence or advise VA of potential sources of such evidence."). The case must be remanded to cure this defect in due process. There is an enhanced duty to assist the veteran with the development of his claim for service connection for PTSD as a result of a personal assault. Specifically, the RO must consider all of the special provisions of VA Adjudication Procedure Manual M21-1MR (M21-1MR), Part IV, regarding personal assault. M21-1MR notes that personal assault is an event of human design that threatens or inflicts harm. Examples of this are rape, physical assault, domestic battering, robbery, mugging, stalking, and harassment. M21- 1MR, Part IV, Subpart ii, 1.D.17.a. M21-1MR identifies alternative sources for developing evidence of personal assault, including private medical records, civilian police reports, reports from crisis intervention centers, testimonial statements from confidants such as family members, roommates, fellow service members, or clergy, and personal diaries or journals. M21-1MR, Part IV, Subpart ii, 1.D.17.g. When there is no indication in the military record that a personal assault occurred, alternative evidence, such as behavior changes that occurred at the time of the incident, might still establish that an in-service stressor incident occurred. Examples of behavior changes that might indicate a stressor include: a request to be transferred to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. 38 C.F.R. § 3.304(f)(3) (2007); see Patton v. West, 12 Vet. App. 272 (1999) (holding that certain special M21 manual evidentiary procedures apply in PTSD personal assault cases). VA will not deny a post- traumatic stress disorder claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than the veteran's service records or evidence of behavior changes may constitute credible supporting evidence of the stressor and allowing him or her the opportunity to furnish this type of evidence or advise VA of potential sources of such evidence. See 67 Fed. Reg. 10330-10332 (March 7, 2002). VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. 38 C.F.R. § 3.304(f)(3) (2007). Accordingly, a remand is also required to provide the veteran and his representative a letter that advises them as required by 38 C.F.R. § 3.304(f)(3) and allow them the opportunity to furnish this type of evidence or to advise VA of potential sources of such evidence. Finally, the Board also points out that in Dingess v. Nicholson, 19 Vet. App. 473 (2006), the U.S. Court of Appeals for Veterans Claims held that, upon receipt of an application for a service-connection claim, 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating, or is necessary to substantiate, each of the five elements of the claim, including notice of what is required to establish service connection and that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. This specific notice is not currently on file and accordingly on Remand the RO will be requested to provide the veteran with such notification. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2007). Expedited handling is requested.) 1. Pursuant to the pending service connection claims for PTSD and residuals of a head injury, claimed as a seizure disorder, the RO should send a duty-to- assist notice to the veteran pursuant to Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The notice letter must provide information about the type of evidence necessary to establish a disability rating and an effective date for the disability on appeal. 2. The RO or the AMC should attempt to obtain the claimed SSA records pertinent to the veteran's award of Social Security disability benefits, including the administrative decision and the medical records relied upon concerning that claim. 3. The veteran should be scheduled for a VA examination to determine the nature and etiology of the claimed residuals of a head injury, primarily described as a seizure disorder. After reviewing the pertinent evidence in the claims folders, the examiner is initially requested to provide a diagnosis of any currently manifested residual of a head injury, other than the service-connected cervical spine disorder. and it is specifically requested that the examiner address whether or not the veteran has a currently manifested seizure disorder. Thereafter, the examiner is requested to provide the following information and opinions, with supporting rationale, as to whether it is at least as likely as not (whether there is 50 percent of more probability) that: a. the veteran has a currently manifested seizure disorder, which is related to either of the veteran's periods of active military service or any incident therein (specifically claimed as due to a head injury sustained in 1960). b. the veteran's service-connected disability of the cervical spine caused or aggravated any currently manifested residuals of a head injury to include a seizure disorder. c. If it is determined that aggravation beyond the natural progress of the claimed seizure disorder exists, the examiner should be asked to identify the baseline level of severity of the symptoms prior to aggravation and the level of severity of symptoms due to service connected aggravation. The veteran is hereby notified that it is his responsibility to report for the examination and to cooperate in the development of the case, and that the consequences of failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158 and 3.655 (2007). 4. As the RO/AMC has not, to date, developed the veteran's claim regarding military personal assault, the RO/AMC should send him a letter in connection with asking him to help corroborate his reported experience of personal assault in service, pursuant to M21-1. The veteran should be specifically advised that he may provide corroborating evidence of his alleged assault in service from alternate sources of information. The RO/AMC should review the evidence of record and ensure that it has fully complied with the provisions of VA Adjudication Manual M21- 1, Part III, 5.14 (c) (April 30, 1999). 5. The veteran should be requested to provide specific details pertaining to his claimed in-service stressful events, such as dates, places, detailed descriptions of events, and identifying information concerning any other individuals involved, including their names, ranks, units of assignment, and any other identifying details. The veteran should be advised that this information is vitally necessary, and that he must be as specific as possible, because without such detailed information, an adequate search for verifying data cannot be conducted. In conjunction with this development, the RO is requested to clarify the veteran's actual service dates and assignments in Korea for inclusion in the record. 6. After this information is collected but prior to undertaking any further stressor development with the appropriate stressor research agencies, the RO should schedule the veteran for a VA psychiatric examination to determine the diagnosis of any current mental disorder. The veteran's claims file must be provided to the examiner for review. All appropriate PTSD psychological testing should be performed. The examiner should provide an opinion as to whether the veteran has a mental disorder that meets the DSM-IV criteria for a diagnosis of PTSD. The examiner should explain why the veteran's symptoms do or do not meet the criteria for a diagnosis of PTSD. If the examiner finds that the veteran has PTSD, the examiner should indicate whether the current PTSD is linked to the traumatic experiences during service in Korea that the veteran has reported. In this regard, pre-service, inservice, and post-service stressors should be considered and discussed. The veteran has also alleged that he has PTSD based on a personal assault/head injury claimed to have occurred in 1960. If possible, the examiner should specifically identify the stressor(s) which is (are) responsible for PTSD, if diagnosed. A rationale for any opinion expressed should be provided. ** Action 7, below, need only be undertaken if a DSM-IV diagnosis of PTSD is made upon the aforementioned VA examination. 7. The RO should then review the record and determine whether there is sufficient information to attempt verification of any claimed stressor. If so, the appropriate steps should be taken to attempt verification of the veteran's stressor(s). 8. After undertaking any other development deemed appropriate, the RO is requested to adjudicate the claims on appeal. Pursuant to the adjudication of the PTSD claim, the RO is requested to discuss whether the veteran was exposed to a verified stressor, or stressors, in service, and, if so, the nature of the specific verified stressor or stressors established by the record which supports a PTSD diagnosis and whether there is any indication that the veteran participated in combat at some point during service. With respect to the claimed residuals of a head injury/seizure disorder, the RO is requested to discuss both direct and secondary theories of entitlement. If the benefits sought are not granted, the veteran should be furnished with a supplemental statement of the case and afforded an opportunity to respond before the record is returned to the Board for further review. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2008). ______________________________________________ JONATHAN B. KRAMER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs