Citation Nr: 1031874 Decision Date: 08/25/10 Archive Date: 09/01/10 DOCKET NO. 07-30 897A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for glaucoma. 3. Entitlement to service connection for chest pain. 4. Entitlement to service connection for a heart condition, claimed as an irregular heartbeat. 5. Entitlement to service connection for tinea pedis/tinea curis of the feet, groin, chest and back. 6. Entitlement to service connection for pseudofolliculitis barbae. 7. Entitlement to service connection for impotency. 8. Entitlement to service connection for chronic fatigue syndrome. 9. Entitlement to an increased disability rating for migraine headaches, to include a disability rating in excess of 10 percent prior to August 29, 2008, and a disability rating in excess of 30 percent as of August 29, 2008. ATTORNEY FOR THE BOARD B. R. Mullins, Associate Counsel INTRODUCTION The Veteran had active service from November 1988 to May 1993, January 2003 to September 2003, and from June 2004 to August 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2006 rating decision of the Department of Veterans Affairs Regional Office (RO) in Jackson, Mississippi, granting service connection for migraine headaches and assigning a 10 percent disability rating, and denying the remaining claims on appeal. In an April 2010 rating decision, the RO assigned a 30 percent disability rating to migraine headaches, effective August 29, 2008. Although an increased rating has been granted, the issue remains in appellate status, as the maximum schedular rating has not been assigned and such rating was not assigned during the entire appeal period. AB v. Brown, 6 Vet. App. 35 (1993). The Veteran has claimed entitlement to service connection for PTSD. Construing the claim liberally, however, the Board finds that it should be characterized as one of service connection for a psychiatric disorder, to include PTSD. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (per curiam order) (it is the responsibility of the Board to consider alternate current conditions within the scope of the claim). The issue is thus restated on the title page of this decision. The issue of entitlement to service connection for tinea pedis/tinea curis of the feet, groin, chest and back is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the Veteran if any further action is required on his part. FINDINGS OF FACT 1. The Veteran's psychiatric disabilities, to include anxiety and depression, manifested as a result of active military service. 2. Clear and unmistakable evidence demonstrates that the Veteran's glaucoma preexisted a period of active duty, and it was not aggravated beyond the natural progression of the disease due to active service. 3. The Veteran has not been diagnosed with an underlying disability manifested by his complaints of chest pain. 4. The Veteran has not been diagnosed with an underlying disability manifested by his complaints of an irregular heartbeat. 5. The evidence of record does not indicate that the Veteran has a diagnosis of pseudofolliculitis barbae. 6. The Veteran's impotency was an acute disorder that has resolved. 7. The Veteran does not have a current diagnosis of chronic fatigue syndrome. 8. Prior to August 29, 2008, the Veteran's migraines were manifested by headaches once every month or two with incapacitating episodes averaging one every three months. 9. As of August 29, 2008, the Veteran's migraines have been manifested by headaches occurring two to three times per week with incapacitating episodes averaging once per month. CONCLUSIONS OF LAW 1. The criteria necessary for establishing entitlement to service connection for a psychiatric disorder have been met. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2009). 2. The criteria necessary for establishing entitlement to service connection for glaucoma have not been met. 38 U.S.C.A. §§ 1110, 1111, 1131, 1153 (West 2002); 38 C.F.R. § 3.303 (2009). 3. The criteria necessary for establishing entitlement to service connection for chest pain have not been met. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2009). 4. The criteria necessary for establishing entitlement to service connection for a heart condition, claimed as an irregular heartbeat, have not been met. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2009). 5. The criteria necessary for establishing entitlement to service connection for pseudofolliculitis barbae have not been met. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2009). 6. The criteria necessary for establishing entitlement to service connection for impotency have not been met. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2009). 7. The criteria necessary for establishing entitlement to service connection for chronic fatigue syndrome have not been met. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2009). 8. The criteria necessary for establishing entitlement to an increased disability rating for migraine headaches, to include a disability rating in excess of 10 percent prior to August 29, 2008, and a disability rating in excess of 30 percent as of August 29, 2008, have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A (West 2002); 38 C.F.R. §§ 3.159, 4.124a, Diagnostic Code 8100 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duty to Notify VA has a duty to notify and assist veterans in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). Proper notice from VA must inform the Veteran of any information and medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the Veteran is expected to provide in accordance with 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In addition, the notice requirements apply to all five elements of a service-connection claim, including: (1) veteran status; (2) existence of a disability; (3) a connection between a veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. Previously, the United States Court of Appeals for the Federal Circuit (Federal Circuit) held that the failure to provide pre- adjudicative notice of any of the necessary duty to notify elements was presumed to create prejudicial error. Sanders v. Nicholson, 487 F.3d 881 (2007). VA was required to show that that the error did not affect the essential fairness of the adjudication, and that to make such a showing the VA had to demonstrate that the defect was cured by actual knowledge on the claimant's part or that a benefit could not have been awarded as a matter of law. Id. However, the United States Supreme Court (Supreme Court) recently held this framework to be inconsistent with the statutory requirement that the CAVC take "due account of the rule of prejudicial error" under 38 U.S.C.A. § 7261(b)(2). Shinseki v. Sanders, 129 S. Ct. 1696 (2009). In reversing the Federal Circuit's decision, the Supreme Court held that the burden is on the claimant to show that prejudice resulted from the error, rather than on VA to rebut a presumed prejudice. Id. Regarding the Veteran's claims of entitlement to service connection, letters sent to the Veteran in January 2006, August 2006 and May 2007 addressed all notice elements listed under 3.159(b)(1). The January 2006 and August 2006 letters were sent prior to the initial RO decision in this matter. The letters informed him of what evidence was required to substantiate the claims and of his and VA's respective duties for obtaining evidence. Even though the Veteran was not provided with the Dingess requirements (specifically, how disability ratings and effective dates are assigned) until after the initial adjudication of the claims in the May 2007 letter, the claims were subsequently readjudicated, no prejudice has been alleged, and none is apparent from the record. See Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant notification followed by readjudication of the claim, such as a statement of the case or supplemental statement of the case, is sufficient to cure a timing defect). Regarding the Veteran's claim of entitlement to an increased disability rating for his migraines, this claim arises from his disagreement with the initial evaluation following the grant of service connection. Courts have held that once service connection is granted the claim is substantiated, additional notice is not required and any defect in the notice is not prejudicial. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007), Goodwin v. Peake, 22 Vet. App. 128, 134 (2008), Dunlap v. Nicholson, 21 Vet. App. 112 (2007). Therefore, no further notice is required for these claims. Under these circumstances, the Board finds that the notification requirements have been satisfied as to both timing and content. Adequate notice was provided to the Veteran prior to the transfer and certification of his case to the Board that complied with the requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b). Duty to Assist Next, VA has a duty to assist the Veteran in the development of the claim. This duty includes assisting him in the procurement of service medical records 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). VA obtained a large number of the Veteran's service treatment records. However, VA learned in November 2006 that no records were available for the Veteran's period of active duty from June 2004 to August 2005. Nonetheless, the Veteran has submitted copies of some of his treatment records from this period. Due, however, to the missing service treatment records, the Board recognizes its heightened obligation to explain its findings and conclusions and to consider carefully the benefit of the doubt rule. See O'Hare v. Derwinski, 1 Vet. App. 365 (1991). This duty includes a search for alternate medical records, as well as a heightened obligation on the Board's part to explain its findings and conclusions, and carefully consider the benefit-of-the-doubt rule. See Cromer v. Nicholson, 19 Vet. App. 215 (2005). The Veteran underwent VA medical examinations in February 2006, March 2006, October 2006, November 2006, December 2006 and August 2008, and VA has obtained these records as well as the records of the Veteran's outpatient treatment with VA. Significantly, the Veteran has not identified any additional existing evidence that is necessary for a fair adjudication of the claim that has not yet been obtained. Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist him 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). Service Connection Claims Relevant Laws and Regulations Service connection will be granted if it is shown that the Veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service. Watson v. Brown, 4 Vet. App. 309, 314 (1993); see also Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). To establish service connection, there must be: (1) a medical diagnosis of a current disability; (2) medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 252 (1999) (citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996)). Where a veteran has served for 90 days or more during a period of war, or during peacetime service after January 1, 1947, and a chronic disorder, such as psychoses, becomes manifest to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Also, 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. See 38 C.F.R. § 3.310(b); Libertine v. Brown, 9 Vet. App. 521, 522 (1996); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). An appellant's own conclusion, stated in support of his claim, that his present disability is secondary to his service-connected disability is not competent evidence as to the issue of medical causation. See 38 C.F.R. § 3.159 (2009); see also Grivois v. Brown, 6 Vet. App. 136 (1994). A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997); see also 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)). Psychiatric Disorder, to Include PTSD The Veteran contends that he is entitled to service connection for PTSD. However, as discussed below, the Veteran does not have a confirmed diagnosis of PTSD. Nonetheless, the Veteran has been diagnosed with anxiety and depressive disorder due to his military service. Therefore, when affording the Veteran the benefit of the doubt in this case, the evidence demonstrates that he is entitled to service connection for a psychiatric disorder. Establishment of service connection for PTSD requires: (1) medical evidence diagnosing PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). See also Cohen v. Brown, 10 Vet. App. 128 (1997). A "clear" diagnosis of PTSD is no longer required. Rather, a diagnosis of PTSD must be established in accordance with 38 C.F.R. § 4.125(a), which simply mandates that, for VA purposes, all mental disorder diagnoses must conform to the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-IV). See 38 C.F.R. § 3.304(f). The United States Court of Appeals for Veterans Claims (Court) has taken judicial notice of the mental health profession's adoption of the DSM-IV as well as its more liberalizing standards to establish a diagnosis of PTSD. The Court acknowledged the change from an objective "would evoke ... in almost anyone" standard in assessing whether a stressor is sufficient to trigger PTSD to a subjective standard (e.g., whether a person's exposure to a traumatic event and response involved intense fear, helplessness, or horror). Thus, as noted by the Court, a more susceptible person could have PTSD under the DSM-IV criteria given his or her exposure to a traumatic event that would not necessarily have the same effect on "almost everyone." Cohen, 10 Vet. App. 128 at 140-41. The record contains a VA outpatient treatment record from April 2006. The Veteran was diagnosed with an anxiety disorder not otherwise specified. He was noted to have symptoms indicative of PTSD and panic, but no actual diagnosis of PTSD was assigned at this time. This diagnosis was within one year of the Veteran's separation from active duty in August 2005. The Veteran underwent a VA PTSD examination in November 2006. The examiner concluded that the Veteran did not meet the DSM-IV criteria for a diagnosis of PTSD. However, the examiner concluded that the Veteran met the DSM-IV criteria for a diagnosis of an anxiety disorder, not otherwise specified. The examiner concluded that the Veteran's experiences in Iraq were a contributing factor to his current symptoms. In an addendum, the examiner noted that the Veteran met the DSM-IV criteria for both an anxiety disorder not otherwise specified and a depressive disorder not otherwise specified. The examiner opined that the Veteran's anxiety disorder was related to his military experiences and that his depression was intrinsically related to this anxiety disorder. The record also contains a February 2009 VA treatment record in which the Veteran was noted to have a negative PTSD screening. A subsequent PTSD evaluation from September 2009 indicates that the Veteran described traumatic events in service and that he continued to experience significant distress related to these events. However, the record does not demonstrate that a diagnosis of PTSD was in fact assigned at this time. Subsequent mental health records also fail to demonstrate a confirmed diagnosis of PTSD. Nonetheless, having afforded the Veteran the full benefit of the doubt in this case, the Board finds that he is entitled to service connection for a psychiatric disorder - specifically, an anxiety disorder and a depressive disorder. See 38 U.S.C. § 5107(b). The evidence of record demonstrates that the Veteran was diagnosed with an anxiety disorder within one year of his separation from active duty, and according to the November 2006 VA examiner, this disorder was related to the Veteran's military service. The Veteran's claim of entitlement to service connection for a psychiatric disorder is granted. Glaucoma The Veteran contends that he is entitled to service connection for glaucoma. Specifically, the Veteran contends that he was first treated for glaucoma during his period of military service from 1988 to 1993. However, the preponderance of the evidence demonstrates that the Veteran's glaucoma did not manifest during this period of active duty, nor was it aggravated by any subsequent period of active duty. As such, service connection is not warranted. A review of the Veteran's service treatment records from November 1988 to May 1993 demonstrates that the Veteran was not diagnosed with glaucoma during this period of active duty. The records are silent regarding any treatment for glaucoma or visual impairment. The Board recognizes that the Veteran testified to being treated for glaucoma during this period of active duty in his December 2007 appeal to the Board, and as a lay person, the Veteran is competent to testify about disorders he was treated for. Lay assertions may serve to support a claim for service connection when they relate to the occurrence of events that are observable as a lay person or the presence of a disability or symptoms of a disability that are subject to lay observation. 38 U.S.C.A. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support the existence of a disability even when not corroborated by contemporaneous medical evidence). However, the Board does not find this testimony to be credible. According to the Veteran's April 1993 separation examination, the Veteran had a visual acuity of 20/20 bilaterally and his eyes were found to be normal. Furthermore, the Veteran himself specifically denied having, or ever having had, eye trouble. The Board finds the Veteran's explicit denial during active duty to be more reliable than the Veteran's recollection more than 10 years later. As such, the preponderance of the evidence demonstrates that the Veteran did not suffer from glaucoma during his period of active duty from November 1988 to May 1993. The first evidence of glaucoma is an August 2003 in-service treatment record. According to this record, the Veteran was seen with complaints of blurred vision in his left eye for about 2 years. The Veteran was diagnosed with possible primary open angle glaucoma. A follow-up treatment record from the following day notes that early glaucoma was detected and that the Veteran was now receiving treatment. Therefore, the evidence of record does establish that the Veteran was diagnosed with glaucoma during his period of active duty from January 2003 to September 2003. Glaucoma was not mentioned during the Veteran's January 2003 enlistment examination. For purposes of basic entitlement to service-connection, 38 U.S.C.A. § 1111 provides that every Veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. The Veteran was afforded a VA eye examination in February 2006. The examiner noted that the Veteran was diagnosed with glaucoma in both eyes in August 2003. The Veteran reported that the left eye vision was already affected by the glaucoma at that point in time. The examiner diagnosed the Veteran with chronic open-angle glaucoma, of mild to moderate severity in the right eye and advanced in the left eye. The examiner concluded that the Veteran's glaucoma condition preexisted his January 2003 entry into active duty. The examiner noted that the August 2003 in- service treatment record indicated that the vision in the Veteran's left eye was already decreased to the 20/30 level. The examiner stated that this indicated that the Veteran's central visual acuity was already being affected by the glaucoma and that this was only usually affected at the end stage of the optic nerve damage. The examiner opined that this indicated a relatively longstanding condition and that this much damage would typically take a number of years to occur. The Veteran's right eye visual acuity was still 20/20 at the time of the August 2003 treatment, but the examiner noted that the Veteran continued to suffer no visual impairment as a result of his right eye glaucoma during the examination. Based on the above evidence, the Board concludes that there is clear and unmistakable evidence indicating that the Veteran's glaucoma preexisted his second period of active military service (January 2003 to September 2003). The examiner noted that the level of ocular degeneration exhibited by the Veteran would typically take several years, and the Veteran himself reported left eye symptomatology that had existed for approximately 2 years. Therefore, the evidence demonstrates that this condition existed prior to enlistment into active duty in January 2003. Since the evidence demonstrates that the Veteran's glaucoma preexisted his military service, the Board must determine whether it was permanently aggravated as a result of active duty. For service connection claims involving a preexisting injury or disease, 38 U.S.C.A. § 1153 provides that a preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. An addendum to the February 2006 VA examination was provided in October 2006. The examiner noted reviewing the Veteran's partial claims file, including the previous VA examination report. The examiner concurred with the previous examiner's findings that the Veteran suffered from a chronic open-angle glaucoma of mild to moderate severity in the right eye and advanced in the left eye. The examiner opined that the Veteran's preexisting glaucoma was not aggravated beyond the normal progression expected by glaucoma, and that the progression of his change in visual acuity in the left eye would be anticipated as the normal progression of this disease and not aggravated by active duty service. Based on the above evidence, the Board concludes that the Veteran is not entitled to service connection for glaucoma. The evidence of record demonstrates that this condition was not diagnosed during the Veteran's period of active duty from November 1988 to May 1993. Also, there is clear and unmistakable evidence demonstrating that the Veteran's glaucoma preexisted his period of active duty from January 2003 to September 2003, and the October 2006 VA examiner concluded that this preexisting condition was not aggravated beyond the normal progression of the disease due to active military service. As such, the Veteran is not entitled to service connection for glaucoma, to include aggravation of a preexisting disability. Since the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran's claim of entitlement to service connection for glaucoma must be denied. Chest Pain The Veteran contends that he is entitled to service connection for chest pain. Specifically, the Veteran contends that he suffers from a disability manifested by chest pain that is secondary to his service-connected migraine headaches. However, as outlined below, the preponderance of the evidence of record demonstrates that the Veteran does not suffer from a current disability manifested by his complaints of chest pain. As such, service connection is not warranted. The Veteran's service treatment records demonstrate that the Veteran complained of chest pain during his active military service. According to an August 2003 in-service examination, the Veteran complained of intermittent pain and pressure in his chest. Also, according to an October 2004 service treatment record, the Veteran was noted to be experiencing chest pain. The Veteran was assigned to light duty for 48 hours with no pulling, pushing, or heavy lifting for 2 weeks. A July 2005 electrocardiogram (ECG) was also interpreted to be abnormal. However, the Veteran was not diagnosed with any specific underlying disability related to his complaints of pain. If there is no evidence of a chronic condition during service, or during an applicable presumptive period, then a showing of continuity of symptomatology after service is required to support the claim. See 38 C.F.R. § 3.303(b). Evidence of a chronic condition must be medical, unless it relates to a condition to which lay observation is competent. See Savage v. Gober, 10 Vet. App. 488, 495-98 (1997). However, medical evidence must relate this chronic symptomatology to the Veteran's present condition. See id. The Veteran's post-service treatment records demonstrate that the Veteran has not sought treatment for chest pain since his separation from active duty. The Veteran was afforded a general VA examination in October 2006. The Veteran reported a history of chest pain and irregular heartbeat. The Veteran believed he first noticed this in 2005 while he was serving in Iraq. The examiner noted that the Veteran was vague about the symptoms and frequency of these symptoms, but he reported having had at least two attacks in the past with other mild attacks from time to time. The Veteran was unable to describe what happened during these attacks or when his last one was. The examiner reviewed the Veteran's medical history, and concluded that the Veteran had no diagnosed disorder based on his reported symptomatology. The Veteran did not suffer from shortness of breath, cough, syncope, dizziness, paroxysmal nocturnal dyspnea (PND), orthopnea, or pedal edema. Examination revealed the Veteran to have a normal blood pressure and heart rhythm, with no murmur. The examiner did not diagnose the Veteran with a cardiac condition, but instead noted that the Veteran's vague symptoms related to chest pain were more consistent with musculoskeletal symptoms than anything else. The record contains no other medical evidence diagnosing the Veteran with a cardiac disorder manifested by chest pain. Based on the above evidence, the Board concludes that the Veteran is not entitled to service connection for chest pain. The evidence demonstrates that while the Veteran has reported chest pain in the past, he does not have a current diagnosis of a disorder associated with this chest pain. A veteran's belief that he is entitled to some sort of benefit simply because he had a disease or injury while on active service is mistaken, as Congress has specifically limited entitlement to service connection to cases where such incidents have resulted in a disability. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Moreover, there must be a current diagnosis of a disorder for service connection to be granted. Hickson v. West, 12 Vet. App. 247, 252 (1999). Without a medical diagnosis of a cardiac disorder, the Board must deny the Veteran's claim. See Degmetich v. Brown, 104 F.3d 1328, 1333 (1997) (holding that the existence of a current disability is the cornerstone of a claim for VA disability compensation). The Board has considered the Veteran's testimony regarding chest pain. According to his December 2007 appeal to the Board, the Veteran indicated that he suffered from chest pain that was secondary to his migraine headaches. While the Veteran is competent to testify to chest pain, he is not competent to offer a medical opinion linking these two disabilities. See Routen, 10 Vet. App. at 186; see also Bostain, 11 Vet. App. at 127 (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)). While the Veteran may notice chest pain while he is suffering a migraine headache, the fact that the Veteran occasionally experiences symptoms of pain is not sufficient to warrant service connection. Pain alone is not a disability for VA compensation purposes. See Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999). The October 2006 VA examination revealed a normal blood pressure and heart rhythm, and the examiner did not diagnose the Veteran with a cardiac disability. The examiner also noted that the Veteran had no previous diagnosis of a heart condition manifested by chest pain. As such, the Veteran's testimony does not demonstrate entitlement to service connection for chest pain. Since the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran's claim of entitlement to service connection for chest pain must be denied. Irregular Heart Beat The Veteran contends that he is entitled to service connection for an irregular heartbeat. Specifically, the Veteran contends that he suffers from an irregular heart beat that is secondary to his service-connected migraine headaches. However, as outlined below, the preponderance of the evidence of record demonstrates that the Veteran has not been diagnosed with a heart condition manifested by an irregular heartbeat. As such, service connection is not warranted. The Veteran's service treatment records do not demonstrate that he was diagnosed with a chronic heart condition during his active military service. According to an August 2003 in-service examination, the Veteran complained of intermittent pain and pressure in his chest. However, there was no finding of an irregular heartbeat at this time. Also, a July 2005 ECG was interpreted to be abnormal. However, the Veteran was not diagnosed with any specific underlying disability related to this. If there is no evidence of a chronic condition during service, or during an applicable presumptive period, then a showing of continuity of symptomatology after service is required to support the claim. See 38 C.F.R. § 3.303(b). Evidence of a chronic condition must be medical, unless it relates to a condition to which lay observation is competent. See Savage v. Gober, 10 Vet. App. 488, 495-98 (1997). However, medical evidence must relate this chronic symptomatology to the Veteran's present condition. See id. The Veteran's post-service treatment records demonstrate that the Veteran has not sought treatment for an irregular heart beat since his separation from active duty. The Veteran was afforded a general VA examination in October 2006. The Veteran reported a history of chest pain and irregular heartbeat. The Veteran believed he first noticed this in 2005 while he was serving in Iraq. The examiner reviewed the Veteran's medical history, and concluded that the Veteran had no diagnosed disorder based on his reported symptomatology. The Veteran did not suffer from shortness of breath, cough, syncope, dizziness, PND, orthopnea, or pedal edema. The Veteran was unable to report the last time he had an irregular heartbeat. He said he would just be sitting, and then he will have a momentary irregular heart beat that passes. It was not associated with any other symptomatology. Examination revealed the Veteran to have a normal blood pressure and heart rhythm, with no murmur. The examiner did not diagnose the Veteran with a heart condition or an irregular heartbeat. Based on the above evidence, the Board concludes that the Veteran is not entitled to service connection for a heart condition, claimed as an irregular heartbeat. The Veteran has not been diagnosed with a disability manifested by an irregular heartbeat, and according to the October 2006 VA examiner, the Veteran had a normal heart rhythm. There must be a current diagnosis of a disorder for service connection to be granted. Hickson v. West, 12 Vet. App. 247, 252 (1999). Without a medical diagnosis of a heart condition manifested by an irregular heartbeat, the Board must deny the Veteran's claim. See Degmetich, 104 F.3d at 1333 (holding that the existence of a current disability is the cornerstone of a claim for VA disability compensation). The Board has also considered the Veteran's testimony regarding an irregular heartbeat. According to his December 2007 appeal to the Board, the Veteran indicated that he suffered from an irregular heart beat that was secondary to his migraine headaches. While the Veteran is competent to testify to feeling like he has an abnormal heartbeat, he is not competent to offer a medical opinion linking the occurrence of this sensation to his migraine headaches. See Routen, 10 Vet. App. at 186; see also Bostain, 11 Vet. App. at 127 (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)). The Veteran has merely described a symptom he experiences, but he has not been diagnosed with any actual disability associated with this symptom. In fact, the October 2006 VA examiner specifically concluded that he had a normal heart rhythm. The examiner also noted that the Veteran had no previous diagnosis of a heart condition. As such, the Veteran's testimony does not demonstrate entitlement to service connection for a heart condition, claimed as an irregular heartbeat. Since the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran's claim of entitlement to service connection for a heart condition, claimed as an irregular heartbeat, must be denied. Pseudofolliculitis Barbae The Veteran contends that he is entitled to service connection for pseudofolliculitis barbae. However, the preponderance of the evidence demonstrates that the Veteran has not been diagnosed with this disability. As such, service connection is not warranted. The Veteran's service treatment records do not reflect that the Veteran was treated for pseudofolliculitis barbae during any period of active military service. According to an April 1993 separation examination, the Veteran's skin was normal and the Veteran denied a history of skin diseases. The Veteran's skin was also found to be normal upon examination in January 2003. There are no other records of a skin disease, including pseudofolliculitis barbae, during active duty. Nonetheless, the Veteran testified during his November 2006 VA examination that he was treated for pseudofolliculitis barbae during basic training. He also stated that he had suffered from this condition continuously and that he suffers from flare-ups 3 to 5 times a month. As a layperson, the Veteran is competent to testify to this matter. Lay assertions may serve to support a claim for service connection when they relate to the occurrence of events that are observable as a lay person or the presence of a disability or symptoms of a disability that are subject to lay observation. 38 U.S.C.A. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support the existence of a disability even when not corroborated by contemporaneous medical evidence). However, the Board does find the above testimony to be credible. The Veteran's skin was routinely found to be normal during active duty, and the Veteran himself denied a history of a skin disorder upon examination in 1993, calling into question his claim that this disability began during basic training. Furthermore, there was no evidence of this disorder upon VA examination in November 2006. The examiner concluded that the face and head were clean shaven and the skin was smooth without signs of infection, excoriation, or disfigurement. There was also no inflammation, edema or keloid formation, and there was no hyper or hypo pigmentation. The examiner concluded that the Veteran had normal skin of the face. The complete lack of evidence of any current skin disorder of the face undermines the credibility of the Veteran's testimony of a long-standing chronic disability. Furthermore, the record contains no medical evidence suggesting that the Veteran has ever been treated for pseudofolliculitis barbae. While this fact alone is not sufficient to call into question the credibility of the Veteran's statement, this complete absence of treatment does further undermine the Veteran's claim of a chronic disability that has existed since basic training. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); see also Forshey v. West, 12 Vet. App. 71, 74 (1998), aff'd sub nom. Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (the definition of evidence encompasses "negative evidence" which tends to disprove the existence of an alleged fact, i.e., the lack of evidence is itself evidence). Since the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran's claim of entitlement to service connection for pseudofolliculitis barbae must be denied. Impotency The Veteran contends that he is entitled to service connection for impotency. Specifically, the Veteran contends that this condition is secondary to medication used to treat his glaucoma. However, as determined hereinabove service connection has not been established for glaucoma, and as will be discussed below the preponderance of the evidence of record demonstrates that impotency is not a chronic disability. As such, service connection is not warranted. The Veteran's service treatment records are silent regarding complaints of, or treatment for, erectile dysfunction. The first evidence of this disorder is the Veteran's October 2005 claim. The Veteran was afforded a general VA examination in October 2006, where he reported having problems with erectile dysfunction some 6 to 8 months earlier. The Veteran felt this was a result of a new medication he was taking for his glaucoma. The Veteran also reported that his erectile dysfunction had resolved since stopping this medication. There is no evidence of record suggesting that the Veteran sought further treatment for this condition. Based on the above evidence, the Board concludes that the Veteran is not entitled to service connection for erectile dysfunction. The Veteran's service treatment records do not demonstrate that the Veteran suffered from erectile dysfunction during active military service. Furthermore, while the Veteran contends that his acute episode of erectile dysfunction was due to his glaucoma, service connection is not in effect for this disability, thus service connection under a secondary theory of entitlement would not be warranted. 38 C.F.R. § 3.310(a). Finally, the Veteran indicated that this condition had resolved. There must be a current diagnosis of a disorder for service connection to be granted. Hickson v. West, 12 Vet. App. 247, 252 (1999). Without a medical diagnosis chronic erectile dysfunction, the Board must deny the Veteran's claim. See Degmetich v. Brown, 104 F.3d 1328, 1333 (1997) (holding that the existence of a current disability is the cornerstone of a claim for VA disability compensation). The Board has also considered the statement provided by the Veteran during his December 2007 appeal to the Board. The Veteran indicated that he had been suffering from erectile dysfunction that he now believed was secondary to his migraine headaches and his associated medications. Service connection may be granted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). However, an appellant's own conclusion, stated in support of his claim, that his present disability is secondary to his service-connected disability is not competent evidence as to the issue of medical causation. See 38 C.F.R. § 3.159 (2009); see also Grivois v. Brown, 6 Vet. App. 136 (1994). In the present case, the record contains no competent evidence in support of the Veteran's claim, and the Veteran himself is not competent to offer a medical opinion linking erectile dysfunction to medication. See Routen, 10 Vet. App. at 186; see also Bostain, 11 Vet. App. at 127 (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)). Thus, such contention has no merit and is not supported by the medical evidence of record. Since the preponderance of the evidence is against the claim, the provisions of 38 U.S.C.A. § 5107(b) regarding reasonable doubt are not applicable. The Veteran's claim of entitlement to service connection for impotency must be denied. Chronic Fatigue Syndrome The Veteran contends that he is entitled to service connection for chronic fatigue syndrome. Specifically, according to the Veteran's December 2007 appeal to the Board, he contends that he suffers from this disability as secondary to his migraine headaches. However, the preponderance of the evidence of record demonstrates that the Veteran does not suffer from chronic fatigue syndrome. As such, service connection is not warranted. The Veteran's service treatment records are silent as to fatigue. The first evidence of such a disorder is the Veteran's October 2005 claim of entitlement to service connection. However, when questioned about fatigue during his October 2006 VA examination, the Veteran said he did not remember ever having any problems with physical fatigue. Rather, the Veteran felt he suffered from some mental fatigue as a result of PTSD. A review of the Veteran's November 2006 psychiatric examination reveals that no separate fatigue syndrome was diagnosed. The record contains no further evidence of a diagnosis of chronic fatigue syndrome or treatment for this condition. Therefore, the preponderance of the evidence of record demonstrates that the Veteran is not entitled to service connection for chronic fatigue syndrome. The Veteran's service treatment records do not suggest that he suffered from this disability during active duty. In fact, there is no evidence of record to suggest that the Veteran has ever been diagnosed with this disability. The Veteran himself denied a history of physical fatigue during his November 2006 VA examination. As already discussed, there must be a current diagnosis of a disorder for service connection to be granted. Hickson v. West, 12 Vet. App. 247, 252 (1999). Without a medical diagnosis of a fatigue syndrome, the Board must deny the Veteran's claim. See Degmetich, 104 F.3d at 1333 (holding that the existence of a current disability is the cornerstone of a claim for VA disability compensation). Finally, while the Veteran contends that his fatigue syndrome is secondary to his migraine headaches, he is not competent to offer a medical conclusion such as this. See Routen, 10 Vet. App. at 186; see also Bostain, 11 Vet. App. at 127 (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)). The Veteran does not have the expertise to diagnose himself with chronic fatigue syndrome and offer a medical nexus opinion linking it to his migraines. Since the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran's claim of entitlement to service connection for chronic fatigue syndrome must be denied. Increased Disability Rating for Migraine Headaches Relevant Laws and Regulations Disability evaluations are determined by the application of the Schedule For Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where, as in the instant case, the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). Diagnostic Code 8100 provides ratings for migraine headaches. Migraine headaches with less frequent attacks than the criteria for a 10 percent rating are rated as noncompensably (0 percent) disabling. Migraine headaches with characteristic prostrating attacks averaging one in 2 months over the last several months are rated 10 percent disabling. Migraine headaches with characteristic prostrating attacks occurring on an average once a month over last several months are rated 30 percent disabling. Migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability are rated 50 percent disabling. 38 C.F.R. § 4.124a. Facts and Analysis The Veteran contends that he is entitled to an increased disability rating for his migraine headaches. For historical purposes, the Veteran was granted service connection for this disability in an October 2006 rating decision. A disability rating of 10 percent was assigned under Diagnostic Code 8100, effective as of August 12, 2005. The Veteran submitted a notice of disagreement to this decision in March 2007, and the RO increased the Veteran's disability rating to 30 percent, effective as of August 29, 2008, in an April 2010 rating decision. The Board must decide whether the Veteran is entitled to a disability rating in excess of 10 percent prior to August 29, 2008, as well as whether he is entitled to a disability rating in excess of 30 percent as of August 29, 2008. The Board will first address whether the Veteran is entitled to a disability rating in excess of 10 percent prior to August 29, 2008. Upon filing his claim, the Veteran was afforded a VA examination for his migraines in March 2006. During the examination, the Veteran reported having migraines that occurred every month or two. The Veteran reported having two incapacitating episodes in the previous 6 months, and that he missed one day of work because of these headaches. The Veteran also described symptoms of photophobia and nausea, as well as atypical chest pain. The examiner diagnosed the Veteran with common migraines with a prostrating headache every month or two. A magnetic resonance image (MRI) was performed, revealing a normal brain except for the incidental finding of a pineal cyst. The record also contains a July 2008 VA outpatient treatment record in which the Veteran was noted to be suffering from 1 to 2 migraines per week. This record made no mention of prostrating attacks. However, it was noted that the Veteran's symptomatology tended to cease within 30 to 45 minutes upon taking a medication called Tramadol. It was also noted that the Veteran rarely required a second dose. The above evidence demonstrates that the Veteran is not entitled to a disability rating in excess of 10 percent for his migraine headaches prior to August 29, 2008. As already noted, migraine headaches with characteristic prostrating attacks averaging one in 2 months over the last several months are rated 10 percent disabling. 38 C.F.R. § 4.124a. The next- higher disability rating of 30 percent is warranted for migraine headaches with characteristic prostrating attacks occurring on an average once a month over the last several months. Id. The Veteran reported having migraines once every month or two during his March 2006 VA examination, with only 2 incapacitating episodes in the last 6 months. Subsequent VA outpatient treatment records do not suggest an increase in the Veteran's overall symptomatology. Therefore, the evidence demonstrates that the Veteran was not suffering from prostrating attacks on a monthly basis at this time. Likewise, the preponderance of the evidence demonstrates that the Veteran is not entitled to a disability rating in excess of 30 percent as of August 29, 2008. According to the Veteran's August 2008 VA examination, the Veteran reported getting headaches two to three times per week. He also estimated that in the past 6 months he had suffered 5 to 6 incapacitating headaches. This would average to approximately one incapacitating episode per month, which is represented by a 30 percent disability rating. Id. A higher disability rating of 50 percent is warranted for migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a. The evidence of record does not suggest that the Veteran suffers from "very frequent" completely prostrating attacks that result in severe economic inadaptability. Rather, the Veteran testified to suffering on average one incapacitating headache per month. As this number represents the specific criteria for a 30 percent disability rating, it is inherent that one incapacitating attack per month would not qualify as "very frequent," or 50 percent disabling. As such, the preponderance of the evidence of record demonstrates that the Veteran is not entitled to a disability rating in excess of 30 percent, as of August 29, 2008. The rating schedule represents as far as practicable, the average impairment of earning capacity. Ratings will generally be based on average impairment. 38 C.F.R. § 3.321(a), (b). To afford justice in exceptional situations, an extraschedular rating can be provided. 38 C.F.R. § 3.321(b). The Court has clarified the analytical steps necessary to determine whether referral for extraschedular consideration is warranted. See Thun v. Peake, 22 Vet. App. 111 (2008). First, the RO or the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that disability are inadequate. Second, if the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a Veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extraschedular rating. The Veteran's symptoms associated with his service-connected migraine headaches are several headaches per week with an average of one prostrating attack per month. However, such impairment is contemplated by the rating criteria. See 38 C.F.R. § 4.71a, Diagnostic Codes 5256-63. The Veteran has not alleged that he is unemployable as a result of his headaches, and there is no evidence of frequent periods of hospitalization. The rating criteria reasonably describe the Veteran's disability and referral for consideration of an extraschedular rating is, therefore, not warranted. Finally, the Board has considered whether a claim for a total disability rating based on individual unemployability (TDIU) has been raised by the record. See Rice v. Shinseki, 22 Vet. App. 447, 453 (2009) (finding that a claim to TDIU benefits is not a free-standing claim that must be pled with specificity; it is implicitly raised whenever a pro se Veteran, who presents cogent evidence of unemployability, seeks to obtain a higher disability rating). However, the Veteran has not alleged that he is unemployable as a result of this disability, so further consideration of TDIU is not warranted. Based upon the guidance of the Court in Fenderson v. West, 12 Vet. App. 119, 126 (1999), the Board has considered whether additional staged ratings would be appropriate. However, as discussed in detail above, the Veteran's migraine headaches were no more than 10 percent disabling prior to August 29, 2008, and no more than 30 percent disabling as of August 29, 2008. As such, staged ratings are not warranted. ORDER Entitlement to service connection for an acquired psychiatric disorder is granted. Entitlement to service connection for glaucoma is denied. Entitlement to service connection for chest pain is denied. Entitlement to service connection for a heart condition, claimed as an irregular heartbeat, is denied. Entitlement to service connection for pseudofolliculitis barbae is denied. Entitlement to service connection for impotency is denied. Entitlement to service connection for chronic fatigue syndrome is denied. Entitlement to an increased disability rating for migraines, to include a disability rating in excess of 10 percent prior to August 29, 2008 and a disability rating in excess of 30 percent as of August 29, 2008, is denied. REMAND Tinea Pedis/Tinea Curis of the Feet, Groin, Chest and Back The Veteran contends that he is entitled to service connection for tinea pedis/tinea curis of the feet, groin, chest and back (hereinafter a "skin disorder"). This claim was previously denied because there was no evidence of a skin disorder during active military service. However, additional evidentiary development is necessary before appellate review may proceed on this matter. The Veteran indicated during his November 2006 VA examination that he was treated for a rash of the feet and groin during his military service in Iraq. No opinion regarding etiology was provided as part of this examination. According to an October 2004 service treatment record, the Veteran had no history of a skin disease "except both feet." While it is not clear when the Veteran suffered from this skin disease of the feet, the Veteran has testified that it occurred during his active military service. As a lay person, the Veteran is competent to testify to being treated for a skin disease during service. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). A March 2006 VA outpatient treatment record notes that the Veteran suffered from tinea pedis and dermatitis, while the November 2006 VA skin examination confirmed that he suffered from tinea pedis. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the Veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). In the present case, the Veteran has testified to suffering from a skin disease of both feet during active duty, and an outpatient treatment record from October 2004 does support a prior history of skin disease. Also, the evidence demonstrates that the Veteran currently suffers from a skin disease of the feet. Therefore, the Veteran should be afforded a new VA examination so that an opinion regarding etiology may be provided. Accordingly, the case is REMANDED for the following action: 1. The Veteran should be afforded a VA examination for his claimed skin disability, to include tinea pedis/tinea curis of the feet, groin, back and chest, before an appropriate specialist(s) to determine the etiology of this disability. The Veteran's claims file and a copy of this remand must be made available for review by the examiner at the time of examination. The examiner is asked to indicate whether the Veteran currently suffers from any skin condition of the feet, groin, chest or back. If the examiner finds a skin disorder in any of these areas, an opinion should be offered as to whether it is at least as likely as not that this condition(s) had its onset during a period of active service (November 1988 to May 1993; January 16, 2003, to September 27, 2003; June 7, 2004, to August 11, 2005), or is otherwise related to a period of active service. A complete rationale must be provided for any opinion offered. Consideration should be given to the service treatment records, lay statements of the Veteran pertaining to a skin disorder, and post-service medical evidence of a skin disorder. 2. The AMC should then readjudicate the Veteran's claim. If the benefit sought on appeal remain denied, the Veteran should be provided with a SSOC, containing notice of all relevant actions taken on the claim, to include a summary of the evidence and applicable law and regulations considered pertinent to the issues currently on appeal. An appropriate period of time should be allowed for response. The Veteran has the right to submit additional evidence and argument on the matter 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. 2009). ______________________________________________ M.W. KREINDLER Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs