Citation Nr: 1032230 Decision Date: 08/26/10 Archive Date: 09/01/10 DOCKET NO. 97-31 495 ) DATE ) MERGED APPEAL ) ) On appeal from the Department of Veterans Affairs Regional Office in Seattle, Washington THE ISSUES 1. Entitlement to service connection for type II diabetes mellitus, claimed as due to Agent Orange exposure. 2. Entitlement to service connection for a psychiatric disorder, to include schizophrenia and posttraumatic stress disorder (PTSD). 3. Entitlement to service connection for a bilateral hand and wrist disorder, to include a rash and/or an orthopedic disability. 4. Whether new and material evidence has been submitted to reopen a claim for service connection for a skin condition of the feet. 5. Entitlement to an effective date prior to July 23, 1997, for the award of service connection for acne keloidalis nuchae of the scalp. 6. Entitlement to an effective date prior to March 3, 1999, for the award of nonservice-connected pension benefits. 7. Entitlement to an initial rating higher than 50 percent for acne keloidalis nuchae of the scalp prior to August 30, 2002. 8. Entitlement to a rating higher than 80 percent for acne keloidalis nuchae of the scalp since August 30, 2002. 9. Entitlement to specially adapted housing assistance or a special home adaptation grant. 10. Entitlement to a total disability rating based on individual unemployability (TDIU). REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Douglas Massey, Counsel INTRODUCTION The Veteran served on active duty from June 1987 to August 1987, from June 1988 to August 1988, and from February 1991 to July 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from various rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. In December 2010, the Veteran testified at a hearing at the RO before the undersigned Veterans Law Judge of the Board, also commonly referred to as a Travel Board hearing. The issue of whether new and material evidence has been submitted to reopen a claim for service connection for a skin condition of the feet, as well as the issue of entitlement to a TDIU, 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. Type II diabetes mellitus is included in the list of diseases presumptively associated with exposure to herbicides (Agent Orange) in Vietnam; however, the Veteran did not serve in the Republic of Vietnam during the Vietnam era, and no evidence shows that he was ever exposed to herbicides while on active duty. 2. The Veteran's type II diabetes mellitus was first diagnosed many years after his military service ended and has not been etiologically linked by competent medical evidence to his service. 3. The Veteran has not been diagnosed with PTSD, and his diagnosis of schizophrenia was first diagnosed many years after his separation from active duty and has not been linked by competent medical evidence to service. 4. The Veteran does not have an orthopedic disability involving either hand or wrist. 5. A rash on the Veteran's wrist was first identified many years after service and has not been linked by competent medical evidence to service. 6. On July 23, 1997, the RO received the Veteran's claim for service connection for a skin disorder involving his scalp; prior to this date, however, the Veteran did not file an informal or formal claim pertaining to a skin disorder of the scalp. 7. An unappealed April 1996 rating decision denied the Veteran's claim for nonservice-connected pension benefits. 8. On March 3, 1999, the RO received another claim for nonservice-connected pension benefits, which was ultimately granted effective from the date of claim on March 3, 1999. 9. The Veteran is receiving the maximum schedular ratings for his service-connected acne keloidalis nuchae of the scalp, which is rated 50 percent prior to August 30, 2002, and 80 percent since. 10. There is no evidence that the Veteran's acne keloidalis nuchae of the scalp has independently cause marked interference with employment or required frequent periods of hospitalization. 11. The Veteran does not have a service-connected disability that results in the loss of use of both lower extremities, the loss of use of a lower and a upper extremity, or the loss of use of a lower extremity which so affects the functions of balance or propulsion as to preclude locomotion without the aid of a wheelchair. 12. The Veteran is not blind, and does not have permanent impairment of vision of both eyes, ankylosis of one or both knees or one or both hips, or loss of use of either hand or either foot as a result of a service-connected disability. CONCLUSIONS OF LAW 1. Type II diabetes mellitus was not incurred in or aggravated by service and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1110, 1131, 1116 (West & Supp. 2009); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). 2. A psychiatric disorder, to include schizophrenia and PTSD, was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.304 (2009). 3. A bilateral hand and wrist disorder, to include a rash and/or orthopedic disability, was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.304 (2009). 4. The criteria are not met for an effective date prior to July 23, 1997, for the grant of service connection for acne keloidalis nuchae of the scalp. 38 U.S.C.A. § 5110 (West Supp. 2005); 38 C.F.R. §§ 3.1, 3.155, 3.159, 3.157, 3.400 (2009). 5. The criteria are not met for an effective date prior to March 3, 1999, for the award of nonservice-connected pension benefits. 38 U.S.C.A. § 5110 (West Supp. 2005); 38 C.F.R. §§ 3.1, 3.155, 3.159, 3.157, 3.400 (2009). 6. The criteria are not met for an initial rating higher than 50 percent for acne keloidalis nuchae of the scalp prior to August 30, 2002. 38 U.S.C.A. § 1155 (West Supp. 2005); 38 C.F.R. §§ 3.321(b)(1), 4.1-4.14 (2009), 4.118, Diagnostic Code 7800 (prior to August 30, 2002). 7. The criteria are not met for a disability rating higher than 80 percent for acne keloidalis nuchae of the scalp since August 30, 2002. 38 U.S.C.A. § 1155 (West Supp. 2005); 38 C.F.R. §§ 3.321(b)(1), 4.1-4.14, 4.118, Diagnostic Code 7800 (2009). 8. The criteria for specially adapted housing assistance or a special home adaptation grant have not been met. 38 U.S.C.A. §§ 2101(a), 5107 (West Supp. 2005); 38 C.F.R. § 3.809 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In the interest of clarity, the Board will initially discuss whether the claims have been properly developed for appellate review. The Board will then address the claims on their merits, providing relevant statutes, VA regulations, and case law, the relevant factual background, and an analysis of its decision. I. The Duties to Notify and Assist As provided by the Veterans Claims Assistance Act of 2000 (VCAA), VA has duties to notify and assist a claimant in substantiating a claim for VA benefits. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2009). Proper notice from VA must inform the claimant of any information and medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will obtain; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1). Quartuccio v. Principi, 16 Vet. App. 183 (2002). These VCAA notice requirements apply to all five elements of a service-connection claim: (1) Veteran status; (2) existence of a disability; (3) a connection between the Veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (2007). This notice must include information that a downstream disability rating and an effective date for the award of benefits will be assigned if service connection is granted. Id. at 486. The Veteran was provided VCAA notice in response to his claims in numerous letters dated in March 1999, June 2000, May 2004, July 2004, September 2004, November 2005, March 2006, April 2006, August 2006, October 2006, February 2008, and April 2009. Overall these letters indicated the type of information and evidence needed to substantiate the claims, and explained the division of responsibility between him and VA in obtaining this supporting evidence, including lay evidence and private and VA medical treatment records. The Veteran did not received full VCAA notice concerning all the claims prior to their initial adjudication by the RO. But after providing all required VCAA notice, the claims were readjudicated by the RO and/or AMC, the most recent of which were in two supplemental statements of the case (SSOCs) in January 2010 and February 2010. This is important to point out because the United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that a SSOC can constitute a "readjudication decision" that complies with all applicable due process and notification requirements if adequate VCAA notice is provided prior to the SSOC. See Mayfield v. Nicholson, 499 F.3d 1317, 1323 (Fed. Cir. 2007). As a matter of law, the provision of adequate VCAA notice prior to a readjudication "cures" any timing problem associated with inadequate notice or the lack of notice prior to an initial adjudication. See also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). With respect to the ratings assigned for his service-connected acne of the scalp, the appeal arise from the initial rating assigned by the RO after granting service connection for this condition. The Federal Circuit and the U.S. Court of Appeals for Veteran's Claims (Court) have held that where the underlying claim for service connection has been granted and there is disagreement as to downstream questions, such as an initial rating, the claim has been substantiated and there is no need to provide additional VCAA notice. 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). The Courts' reasoning in Hartman and Dunlap leads to the conclusion that further VCAA notice is not required in this case. In sum, the duty to notify has been satisfied. VA also fulfilled its duty to assist the Veteran by obtaining all relevant evidence in support of these claims. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The RO obtained all pertinent records that he and his representative identified as relevant to these claims. These records include VA and private treatment records, as well as records pertaining to his award of Social Security Administration (SSA) benefits. 38 C.F.R. § 3.159(c)(1) and (c)(2). In addition, he was afforded several VA compensation examinations to determine the nature and severity of his service- connected acne of the scalp, which has been assigned the highest schedular ratings both prior to and since August 30, 2002. Moreover, none of these reports indicates that the Veteran's acne renders him unable to secure or maintain gainful employment. 38 C.F.R. §§ 3.327, 4.2. See also Caffrey v. Brown, 6 Vet. App. 377 (1994). The Board notes that the Veteran has not been afforded VA examinations concerning his claims for service connection for (i) type II diabetes mellitus; (ii) a psychiatric disorder, to include schizophrenia and PTSD; or (iii) a bilateral hand and wrist disorder, to include a rash and/or orthopedic disability. However, VA examinations are not warranted because the standards set forth in McLendon v. Nicholson, 20 Vet. App. 79 (2006), have not been met. In McLendon, the Court held that a medical examination is necessary in a service-connection claim when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for VA to make a decision on the claim. Id., at 81. See also 38 U.S.C.A. § 5103A(d) and 38 C.F.R. § 3.159(c)(4). In this case, however, there is no confirmed evidence of a current disability involving PTSD or a disability involving his hands and wrists. In addition, although diagnosed with type II diabetes mellitus and a psychiatric disorder involving schizophrenia, these disorders were first diagnosed many years after his military service ended and have not been etiologically linked by competent medical evidence to any period of military service. There is also no evidence that the Veteran was ever exposed to Agent Orange in service. Accordingly, the Board finds that no further development is needed to meet the requirements of the VCAA or Court. II. Service Connection for Diabetes Mellitus The Veteran was diagnosed with type II diabetes mellitus in 2001. He believes this condition was caused by his exposure to Agent Orange during tests performed at Fort Leonard Wood, MO, in 1987, and at Fort Sill, OK, in 1988. For the reasons set forth below, however, the Board finds no basis to grant his claim. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. See 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). In general, service connection requires: (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). Type II diabetes mellitus may be presumed to have been incurred in service if manifest to a compensable degree of at least 10 percent within one year of discharge from service. See 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. In addition to these provisions, a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era, and has a disease listed in 38 C.F.R. § 3.309(e), shall be presumed to have been exposed during such service to an herbicide agent, such as Agent Orange, unless there is affirmative evidence to establish that he or she was not exposed to any such agent during that service. See 38 C.F.R. § 3.307(a)(6)(iii). If a Veteran was exposed to Agent Orange during active military, naval, or air service, certain specified diseases shall be service-connected, if the requirements of 38 C.F.R. § 3.307(a) are met, even if there is no record of such disease during service. 38 C.F.R. § 3.309(e). The list of diseases includes type II diabetes mellitus. Id. Thus, service connection may be presumed for residuals of Agent Orange exposure by showing two elements. First, a Veteran must show that he served in the Republic of Vietnam during the Vietnam War era. See 38 U.S.C.A. § 1116; 38 C.F.R. § 3.307(a)(6). Second, the Veteran must be diagnosed with one of the specific diseases listed in 38 C.F.R. § 3.309(e). Brock v. Brown, 10 Vet. App. 155, 162 (1997). However, even if a Veteran is found not entitled to a regulatory presumption of service connection, the claim must still be reviewed to determine whether service connection may be established on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed Cir. 1994) The Board finds that presumptive service connection due to Agent Orange exposure is not warranted for the Veteran's type II diabetes mellitus. While type II diabetes mellitus is one of the specific diseases listed in 38 C.F.R. § 3.309(e), the Veteran's service personnel records do not show, nor has the Veteran alleged, that he served in the Republic of Vietnam. Also, no evidence suggests that he was ever exposed to herbicides in service. The Board has reviewed the Veteran's service personnel records, none of which mentions his participation or involvement in testing or handling any kind of herbicide such as Agent Orange. Service connection for type II diabetes mellitus, therefore, may only be established with proof of actual direct causation or by showing that it became manifest to a compensable degree within one year of service. See Combee, supra. See also McCartt v. West, 12 Vet. App. 164, 167 (1999) (wherein the Court held that the provisions set forth in Combee, which actually instead concerned radiation exposure, are nonetheless equally applicable in cases, as here, involving claimed Agent Orange exposure). And mere lay assertions of this purported cause-and-effect relationship do not constitute competent medical evidence with respect to the nexus requirement. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). No such medical nexus evidence has been submitted in this case. The Veteran's service treatment records make no reference to diabetes mellitus or laboratory findings which suggest increased blood sugar levels. See Struck v. Brown, 9 Vet. App. 145 (1996). Instead, the record shows the Veteran's type II diabetes mellitus was first diagnosed in October 2001, over ten years after his most recent period of military service had ended. This significant gap provides compelling evidence against the claim on both direct-incurrence and presumptive bases. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000) (ruling that a prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability). Also, none of the treatment records in the claims file includes a medical opinion concerning the etiology or date of onset of the Veteran's type II diabetes mellitus. Maggitt v. West, 202 F.3d 1370, 1375 (Fed. Cir. 2000). This evidentiary deficiency concerning the nexus element is fatal to the claim. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of 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."). See also D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000); and Collaro v. West, 136 F.3d 1304, 1308 (Fed. Cir. 1998). The only evidence in support of the Veteran's claim is his unsubstantiated lay opinion. As already explained, however, without any medical training and expertise, he simply is not qualified to render a medical opinion concerning the cause of his type II diabetes mellitus. His personal opinion, therefore, does not constitute competent medical evidence for consideration by the Board. See Grottveit, 5 Vet. App. at 93; Espiritu, 2 Vet. App. at 494-95 (laypersons are not competent to render medical opinions). For these reasons and bases, the Board finds that the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for type II diabetes mellitus, claimed as due to Agent Orange exposure. And as the preponderance of the evidence is against his claim, the doctrine of reasonable doubt is not for application. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53- 56 (1990). Accordingly, the appeal is denied. III. Service Connection for a Psychiatric Disorder, to Include Schizophrenia and PTSD The Veteran claims that he suffers from PTSD as a result of several sexual assaults while on active duty. But since the Veteran's psychiatric diagnosis involves schizophrenia, the Board will adjudicate the claim for service connection for a psychiatric disorder, to include schizophrenia and PTSD. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (per curiam) (holding that the scope of a mental health disability claim includes any mental disability that reasonably may be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record). Service connection for PTSD is somewhat different than a general claim involving other psychiatric disorders in that, at the time he filed his claim, it required: [1] a current diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM- IV, presumed to include the adequacy of the PTSD symptomatology and the sufficiency of a claimed in-service stressor); [2] credible supporting evidence that the claimed in-service stressor(s) actually occurred; and [3] medical evidence of a causal relationship between current symptomatology and the specific claimed in-service stressor(s). See 38 C.F.R. § 3.304(f) (2009); Cohen v. Brown, 10 Vet. App. 128 (1997). Recently, regulations governing PTSD claims were amended by liberalizing in some cases the evidentiary standard for establishing the required in-service stressor. See 75 Fed. Reg. 39843 (July 13, 2010). VA regulation also outlines the process of verifying stressors involving personal assault. See 38 C.F.R. § 3.304(f)(3). As discussed below, however, since the Veteran has not been diagnosed with PTSD, an analysis concerning his alleged stressors is not relevant to this appeal. Therefore, the Board finds that the Veteran is not prejudiced by the fact that he has not been notified of the recent amendments. 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 appellant has been prejudiced thereby). PTSD has never been diagnosed. Instead, the record shows that he has been diagnosed with various psychiatric disorders other than PTSD - namely, schizophrenia, a psychotic disorder (not otherwise specified), and polysubstance abuse (alcohol and cocaine). Indeed, a December 2005 VA compensation examination report lists a diagnosis of psychotic disorder, not otherwise specified, asymptomatic during the interview. Also significant is the fact that a PTSD screen performed by VA in December 2007 was negative. See Wray v. Brown, 7 Vet. App. 488, 493 (1995) (holding that the adoption of an expert medical opinion may satisfy the Board's statutory requirement of an adequate statement of reasons and bases if the expert fairly considered the material evidence seemingly supporting the veteran's position). Thus, since the Veteran does not have the required DSM-IV diagnosis of PTSD, this aspect of his claim must be denied. See Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000) and Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (indicating service connection presupposes a current diagnosis of the condition claimed, and that without this minimum level of proof, there is no valid claim). Although the Veteran believes he suffers from PTSD, he simply is not competent to attribute his psychiatric symptoms to a specific diagnosis of PTSD, which requires medical training and expertise. Grottveit, 5 Vet. App. at 93; Espiritu, 2 Vet. App. at 494-95 (laypersons are not competent to render medical opinions). And since there is no diagnosis of PTSD, the Board need not discuss whether the Veteran's alleged stressors involving personal assault and harassment can be verified according to 38 C.F.R. § 3.304(f)(3). In other words, the denial of the claim based on the absence of a diagnosis of PTSD renders 38 C.F.R. § 3.304(f)(3). inapplicable. However, the Board will consider the Veteran's alleged stressors when discussing the remaining aspect of his claim involving schizophrenia, although without the need for special development pursuant to 38 C.F.R. § 3.304(f)(3), since this only applies if there is a diagnosis of PTSD. The Veteran's diagnoses of schizophrenia and a psychotic disorder (not otherwise specified) involve psychosis. See 38 C.F.R. § 3.384. See also 71 Fed. Reg. 42,758-60 (July 28, 2006). This is significant because a psychosis will be presumed to have been incurred in service if manifested to a compensable degree (at least 10 percent disabling) within one year after service. This presumption is rebuttable by probative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In the present case, however, no evidence indicates that the Veteran's psychosis had its onset either in service or within one year of his separation from active duty in July 1991. Initially, it is worth mentioning that the Veteran was treated at Jackson Mental Health for drug dependency involving marijuana from March 1981 to July 1982, which is five years prior to his initial enlistment in June 1986. However, no other psychiatric disorder was identified at that time or at any time prior to service. In addition, each of his enlistment examinations made no reference to a psychiatric disorder. In other words, the Veteran entered service in sound condition with no preexisting psychiatric disability noted at entrance. 38 U.S.C.A. § 1111. His service treatment records make no reference to a chronic psychiatric disorder. In a June 1988 Report of Medical History, the Veteran checked the box for "Yes" next to "Frequent trouble sleeping." The examining physician elaborated that the Veteran reported an occasional sleeping problem due to worrying; however, a psychiatric evaluation at that time was normal. Moreover, when examined in June 1991, about a month before his separation from his final period of active duty, there was no reference to psychiatric problems, including trouble sleeping. So, in the absence of a psychiatric disorder in service, the service treatment records provide highly probative evidence against his claim. See Struck, supra. There is also no medical evidence that he developed a psychosis within one year of his separation from active duty in July 1991, thereby precluding service connection on a presumptive basis. 38 C.F.R. §§ 3.307, 3.309. In fact, the record shows that he was first diagnosed with a psychiatric disorder many years after his military service had ended. An August 2000 VA outpatient treatment report notes the Veteran's statement that he had an "emotional overload" a month ago and experienced "a change in his personality." He also related that he had seen a psychiatrist in 1996 and again in 1998 for auditory hallucinations. He then reported that both his mother and aunt had a history of schizophrenia. The diagnoses were substance induced mood disorder and adjustment disorder with depressive features. The Veteran's stressors at that time were identified as unemployment and erectile dysfunction due to a back disability. When treated in October 2000, the diagnoses were alcohol abuse, possible cocaine dependency, and substance induced mood disorder. It was further noted that malingering should be ruled out. Interesting, the Veteran specifically denied any history of physical or sexual abuse, which is the basis for his claim. When seen by VA in November 2004, the Veteran reported that he had been raped two weeks prior. He explained that the assailant initially placed him in a choke hold before placing him in handcuffs, throwing him to the ground, and sexually assaulting him. The clinician's assessment included (1) rectal discharge - questionable rape recently, per patient, and (2) visual hallucination before assault. But it was not until August 2005 that the Veteran was diagnosed with schizophrenia. Subsequent VA treatment records dated from 2005 to 2009 show continued treatment for schizophrenia, a psychotic disorder (not otherwise specified), and polysubstance abuse. However, none of these records indicates that any of these psychiatric disorders are related to service or that his psychosis developed within one year of his separation from active duty in July 1991. See Maggitt, Watson, D'Amico, all supra. In sum, the medical evidence indicates that the Veteran's psychiatric disorder, to include schizophrenia, did not have its onset either in service or during the one-year presumptive period after service. Rather, the evidence shows that it was first documented approximately ten years after his most recent period of military service ended. See Maxson, supra. In addition, the Veteran's statements in which he attributes his psychiatric disorder to having been sexually assaulted in service are not credible. With respect to the Veteran's statements, the Board acknowledges that lay evidence is one type of evidence that must be considered, see Washington v. Nicholson, 19 Vet. App. 362, 368 (2005), and that the Veteran is competent to report a sexual assault in service as well as experiencing psychiatric symptoms since service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Board retains the discretion to make credibility determinations and otherwise weigh the evidence submitted, including lay evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). See also Layno v. Brown, 6 Vet. App. 465 (1994). (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted")). The Veteran's credibility in this case is undermined by the fact that the only reference to a sexual assault is in November 2004, when the Veteran reported that he was raped two weeks prior, which is over a decade after his separation from active duty. In fact, he specifically denied any kind of sexual trauma when interviewed in connection with psychiatric treatment in October 2000 and October 2001. These inconsistent statements, combined with the fact that a psychiatric disorder was not identified until many years after the Veteran's separation from active duty, undermines his credibility concerning his allegations of sexual assault in service as well as his having experienced psychiatric symptoms since service. See Macarubbo v. Gober, 10 Vet. App. 388 (1997) (holding that the credibility of lay evidence can be affected and even impeached by inconsistent statements, internal inconsistency of statements, inconsistency with other evidence of record, facial implausibility, bad character, interest, bias, self-interest, malingering, desire for monetary gain, and witness demeanor). It is important to point out that the Board does not find that the Veteran's lay statements lack credibility merely because they are unaccompanied by contemporaneous medical evidence. See Davidson v. Shinseki, 2009 WL 2914339 (Fed. Cir.), quoting Buchanon, 451 F.3d at 1337 ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence."). Rather, the Veteran's statements are found to be incredible because they are inconsistent with the evidence of record, including his own statements. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a psychiatric disorder, to include schizophrenia and PTSD. Therefore, the doctrine of reasonable doubt is not for application. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 53-56. Accordingly, the appeal is denied. IV. Service Connection a Bilateral Hand and Wrist Disorder, to Include a Rash and/or an Orthopedic Disability The procedural history concerning this claim is complicated and requires a brief discussion. A November 2006 rating decision on appeal denied service connection for a "wrist condition," although it is unclear whether the disability referred to an orthopedic or a skin disorder. The RO noted there was no evidence of a wrist condition in service and no evidence of arthritis within one year of his separation from active duty. The RO then noted that a May 2006 VA treatment record documented that a rash was present on the Veteran's right wrist, with no opinion concerning the diagnosis or whether it was related to service. The RO therefore denied the claim. In a SOC issued in February 2008, the RO characterized the issue on appeal as a bilateral hand and wrist condition. In denying the claim, the RO focused on the fact that X-rays taken in December 2005 were normal, thereby precluding a finding that the Veteran has a current orthopedic disability involving either hand or wrist. However, the SOC made no reference to a potential skin disorder. A February 2010 SSOC, however, characterized the disability as a "wrist rash," with no reference to orthopedic disability. In light of these prior adjudications, the Board has characterized the disability on appeal as a bilateral hand and wrist disorder, to include a rash and/or an orthopedic disability. For the reasons set forth below, the Board will deny the claim because there is no evidence of a current orthopedic disability involving either hand or wrist, and no evidence of a nexus between a rash seen on his right wrist in 2006 and service. With respect to the orthopedic aspect of his claim, X-rays taken in December 2005 show that his hands and wrists were normal. Indeed, no medical evidence indicates that the Veteran has any kind of orthopedic disability involving either hand or wrist. Thus, this aspect of his claim must be denied on the basis that there is no competent medical evidence of a current orthopedic disability. See Boyer, 210 F.3d at 1353; Brammer, 3 Vet. App. at 225 (1992). And the Veteran is simply not competent to attribute any complaints of hand or wrist pain to a diagnosis, such as arthritis. See Grottveit, 5 Vet. App. at 93; Espiritu, 2 Vet. App. at 494-95. With respect to his alleged rash, the only reference to this problem is a May 2006 treatment record which notes the presence of a rash on the Veteran's right wrist. The fact that this rash was first identified approximately sixteen years after service provides compelling evidence against a finding that it had its onset in service. See Maxson, supra. Also significant is the fact that none of the medical records, including the May 2006 VA treatment record, includes a medical opinion concerning the etiology or date of onset of the rash on his right wrist. See Maggitt, supra. The lack medical evidence showing a nexus or link between the rash diagnosed in May 2006 and service is fatal to the claim. See Watson, 4 Vet. App. at 314 ("A determination of 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."). The Board thus finds that the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a bilateral hand and wrist disorder, to include a rash and/or an orthopedic disability. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 53-56. Moreover, the Veteran's statements in support of his claim lack credibility based on the fact that no skin disorder was ever identified until many years after his final separation from active duty. See Grottveit, 5 Vet. App. at 93; Espiritu, 2 Vet. App. at 494-95. Accordingly, the appeal is denied. V. Entitlement to an Effective Date Prior to July 23, 1997, for the Award of Service Connection for Acne Keloidalis Nuchae of the Scalp The Veteran is requesting an effective date earlier than July 23, 1997, for the award of service connection for acne keloidalis nuchae of the scalp. In various written statements, he argues that the effective date should go back to when he was separated from active duty in 1991. For the reasons set forth below, however, the Board finds no grounds to grant his earlier effective date claim. The statutory guidelines for the determination of an effective date of an award of disability compensation are set forth in 38 U.S.C.A. § 5110. Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after a final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. In cases involving direct service connection, the effective date will be the day following separation from active service or the date entitlement arose if the claim is received within one year after separation from service. Otherwise, the effective date will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2)(i). A specific claim in the form prescribed by the Secretary of VA must be filed in order for benefits to be paid to any individual under the laws administered by VA. 38 U.S.C.A. § 5101(a). Any communication or action indicating an intent to apply for one or more VA benefits may be considered an informal claim. 38 C.F.R. § 3.155. An informal claim must identify the benefit sought. The term "application" is used interchangeably with claim and is defined as a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. See 38 C.F.R. § 3.1(p) (2009); see also Rodriguez v. West, 189 F.3d. 1351 (Fed. Cir. 1999). The relevant facts of this case are not in dispute. The Veteran was separated from active duty in July 1991. On July 23, 1997, the RO received his claim for service connection for a skin disorder involving his scalp. The RO denied the claim in July 1997 and September 1997. After filing an appeal, the Board granted the claim in a February 1999 decision. The RO effectuated the Board's decision by assigning an effective from the date he filed his claim on July 23, 1997. The Veteran appealed that decision by requesting an effective date back to when he was separated from active duty in 1991. At no time has the Veteran alleged that he actually filed a claim for a skin disorder prior to July 23, 1997. And, unfortunately, according to 38 U.S.C.A. § 5110(a) and 38 C.F.R. § 3.400(b)(2)(i), since he admittedly did not file an actual claim prior to July 23, 1997, there is no legal basis for an earlier effective date. The Board has reviewed the record in its entirety but finds neither a formal nor an informal communication in writing that can be construed as a claim for service connection for a skin disorder prior to July 23, 1997. The Veteran's argument that he is entitled to an effective date back to 1991 because his skin disorder was present since service has no legal merit. VA is not required to anticipate any potential claim for a particular benefit where no intention to raise it was expressed with VA. See Brannon v. West, 12 Vet. App. 32, 35 (1998); Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). In short, there is no basis to grant an effective date prior to July 23, 1997, since there is no evidence the Veteran filed a claim for a skin disorder prior to that date. In conclusion, the Board finds that the preponderance of the evidence is against an effective date earlier than July 23, 1997, for the award of service connection for acne keloidalis nuchae of the scalp. See 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Hence, the appeal of this claim is denied. VI. Entitlement to an Effective Date Prior to March 3, 1999, For the Award of Nonservice-Connected Pension Benefits The Veteran was awarded nonservice-connected pension benefits, effective from March 3, 1999. He is now seeking an earlier effective date for that award. But the Board finds no basis to grant his claim. Thus, the effective date of March 3, 1999, for the award of nonservice-connected pension benefits is upheld. The effective date for pension claims received on or after October 1, 1984, is the date of receipt of the claim, unless, within one year from the date on which the Veteran became permanently and totally disabled, he files a claim for a retroactive award and establishes that a physical or mental disability, which was not the result of his own willful misconduct, was so incapacitating that it prevented him from filing a disability pension claim for at least the first 30 days immediately following the date on which he became permanently and totally disabled. See 38 C.F.R. § 3.400(b)(1)(ii)(A)-(B) (2009). In this case, the Veteran initially filed a claim for nonservice- connected pension benefits in November 1995. In April 1996, the RO notified the Veteran that his claim had been denied. Since the Veteran made no attempt to appeal that decision within one year of notification, the April 1996 decision became final. 38 U.S.C.A. § 7105 (West 2002). On March 3, 1999, the RO received the Veteran's VA Form 21-8940, wherein he claimed a total disability and provided information concerning his income. In a November 2004 letter, the RO notified the Veteran that it had awarded nonservice-connected pension benefits, but that it would continue to only pay VA compensation benefits since this was greater than a nonservice- connected pension award. The RO initially erred by issuing a rating decision notifying the Veteran that May 16, 2005, was the correct effective date for his award of nonservice-connected pension. In April 1999, however, the RO notified the Veteran that March 3, 1999, was the correct effective date of his pension award. The Veteran's only argument is that the effective date of his pension should go back to when he initially filed his claim in November 1995. Unfortunately, this type of argument has been considered and rejected by the Court in previous cases. The Court held that the rule of finality regarding an original claim implies that the date of that claim is not to be a factor in determining an effective date if the claim is later reopened. The Court held that the term "new claim," as it appears in 38 C.F.R. § 3.400(q)(1)(ii), means a claim to reopen a previously and finally denied claim. See Sears v. Principi, 16 Vet. App. 244, (2002); see also Livesay 15 Vet. App. at 172 (holding that the plain meaning of § 5110 to be that "the phrase 'application therefor' means the application which resulted in the award of disability compensation that it to be assigned an effective dated under section 5110."); Cook v. Principi, 258 F.3d 1311, 1314 (Fed. Cir. 2001) (affirming assignment of an effective date for a service- connection award based upon the reopened claim as the date on which the Veteran "first sought to reopen his claim"). Accordingly, the Veteran is not entitled to an effective date prior to March 3, 1999, for his award of nonservice-connected pension benefits. In reaching this conclusion, the Board finds no evidence that the Veteran was so incapacitated that he was unable to file a claim for pension for at least the first 30 days following the date on which he became totally disabled. See 38 C.F.R. § 3.400(b)(1)(ii)(A)-(B) (2008). Thus, assigning an effective date prior to March 3, 1999, on this basis is not warranted. The Board concludes that there is no legal basis to award the Veteran an effective date prior to March 3, 1999, for the award of nonservice-connected pension benefits. Hence, the appeal must be denied. VII. Entitlement to Increased Ratings for Acne Keloidalis Nuchae of the Scalp, Rated 50 Percent Prior to August 30, 2002, and 80 Percent Since The procedural history concerning this claim is complex and requires some discussion. In July 1997 and September 1997, the RO denied service connection for acne keloidalis. After the Veteran filed an administrative appeal, the Board issued a February 1999 decision in which it granted service connection for a skin disorder of the occipital region of the scalp, classified as acne keloidalis nuchae/acne keloid. The RO effectuated the Board's decision by assigning an initial 30 percent rating, effective July 23, 1997. The Veteran appealed that decision by requesting a higher initial rating. In an April 1999 decision, the RO assigned a higher 50 percent rating for the Veteran's acne. However, rather than granting this higher rating from July 23, 1997, the RO assigned an effective date of February 23, 1999, for that award. So at that time the Veteran's acne was rated as 30 percent disabling prior to February 23, 1999, and 50 percent disabling since. In January 2010, however, the RO assigned the 50 percent rating back to July 23, 1997, and assigned a higher 80 percent rating from August 30, 2002, which was the date VA changed its regulations for rating skin disabilities. Therefore, the issue on appeal is entitlement to higher ratings for acne keloidalis nuchae of the scalp, rated 50 percent prior to August 30, 2002, and 80 percent since. Since this claim arises from the Veteran's disagreement with the initial ratings assigned following the grant of service connection, separate ratings may be assigned for separate periods of time based on the facts found, a practice known as "staging," with equal consideration for the entire body of evidence. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999) (holding that, when a Veteran timely appeals an initial rating, VA must consider whether the rating should be "staged" to compensate the Veteran for times since the effective date of the award when the disability may have been more severe than at other times during the course of the appeal). Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule). Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. 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. See 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in the Veteran's favor. 38 C.F.R. § 4.3. At the time the Veteran filed his claim, disfigurement from a scar of the head, face or neck was rated under Diagnostic Code 7800. This code provided a maximum 50 for complete or exceptionally repugnant deformity of one side of the face or marked or repugnant bilateral disfigurement. A rating higher than 50 percent was not available under this code at that time. 38 C.F.R. § 4.118, DC 7800 (prior to August 30, 2002). As already mentioned, VA issued new regulations for rating skin disabilities under 38 C.F.R. § 4.118, which became effective August 30, 2002. See 67 Fed. Reg. 49590-49599 (July 31, 2002). The Board is required to consider the claim in light of both the former and revised schedular rating criteria to determine whether an increased rating for the Veteran's acne is warranted. See VAOPGCPREC 3-00; see also 38 U.S.C.A. § 5110(g). Under the revised criteria of DC 7800, a maximum 80 percent rating is warranted for disfigurement of the head, face, and neck, with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes [including eyelids], ears [auricles], cheeks, lips), or exhibit six or more characteristics of disfigurement. A rating higher than 80 percent is not available under this code. See 38 C.F.R. 4.118 (since august 30, 2002). It thus appears that the Veteran's acne keloidalis nuchae of the scalp has been assigned maximum schedular ratings of 50 percent prior to August 30, 2002, and 80 percent since that date. Therefore, there is no legal basis to assign higher schedular ratings for this disability at any time since the initial grant of service connection. Although a higher schedular rating for the Veteran's acne keloidalis nuchae of the scalp is not available, the Board must determine whether the claim should be referred to the Under Secretary for Benefits or to the Director of Compensation and Pension Service for consideration of "an extraschedular evaluation." See Smallwood v. Brown, 10 Vet. App. 93, 97-98 (1997) (when a Veteran is in receipt of the maximum combined schedular evaluation possible pursuant to the amputation rule of 38 C.F.R. § 4.68, consideration of entitlement to an extraschedular rating for the disability at issue is still appropriate). In exceptional cases where schedular evaluations are found to be inadequate, the RO may refer a claim to the Under Secretary for Benefits or to the Director of Compensation and Pension Service for consideration of "an extraschedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities." 38 C.F.R. § 3.321(b)(1). "The governing norm in these exceptional cases is a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards." Id. 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, there must be a determination of whether the evidence presents such an exceptional disability picture that the available schedular evaluation for that service-connected disability is inadequate. Second, if the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology and is found inadequate, there must be a determination of whether the Veteran'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 under 38 C.F.R. § 3.321(b)(1). In the present case, the Board finds that the Veteran's symptomatology and limitation of functioning concerning his acne keloidalis nuchae of the scalp are reasonably contemplated by the rating schedule under the first prong of the analysis. It is therefore unnecessary to reach the question of whether the disability causes marked interference with employment or frequent periods of hospitalization. But even assuming for the sake of argument that the second prong of Thun applies, there is still no evidence that his acne keloidalis nuchae of the scalp has independently caused marked interference with employment, meaning above and beyond that contemplated by his assigned ratings. There is no indication that the Veteran has been hospitalized because of his acne keloidalis nuchae of the scalp. Concerning his employment, the record shows that the Veteran stopped working in August 1995 due to a work-related back injury. In addition, records from the Social Security Administration (SSA) show that he was awarded disability benefits due to a primary diagnosis of paranoid schizophrenia and a secondary diagnosis of sprain and/or strain of all types, with no reference to his acne. In short, no medical evidence indicates that his acne keloidalis nuchae of the scalp has markedly interfered with his ability to work. According to 38 C.F.R. § 4.1, generally the degrees of disability specified in the Rating Schedule are considered adequate to compensate for considerable loss of time working from exacerbations or illnesses proportionate to the severity of the several grades of disability. This is to say, the Board is not disputing that his acne keloidalis nuchae of the scalp may impair his occupational functioning. But this alone is not tantamount to concluding there is marked interference with his employment - again, meaning above and beyond that contemplated by the assigned ratings of 50 and 80 percent. Indeed, in Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993), the Court reiterated that the disability rating, itself, is recognition that industrial capabilities are impaired. For these reasons and bases, the Board is not required to remand this case for extraschedular consideration. VAOPGCPREC 6-96. See also Bagwell v. Brown, 9 Vet. App. 237, 238-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); and Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). VIII. Certificate of Eligibility for Assistance In Acquiring Specially Adapted Housing A certificate of eligibility for assistance in acquiring specially adapted housing may be provided if, among other things, the Veteran is entitled to service-connected compensation for permanent and total disability due to: (1) The loss, or loss of use, of both lower extremities such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair, or (2) Blindness in both eyes, having only light perception, plus the anatomical loss or loss of use of one lower extremity, or (3) The loss or loss of use of one lower extremity together with residuals of organic disease or injury which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair, or (4) The loss or loss of use of one lower extremity together with the loss or loss of use of one upper extremity which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair. 38 U.S.C.A. § 2101(a)(1)(2)(3); 38 C.F.R. § 3.809(b)(1)(2)(3)(4). The term "loss of use" of a hand or foot is defined by 38 C.F.R. § 3.350(a)(2) as that condition where no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function, whether the acts of grasping, manipulation, etc. in the case of the hand, or balance, propulsion, etc., in the case of a foot, could be accomplished equally well by an amputation stump with prosthesis. Id. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to specially adapted housing. The Veteran's acne keloidalis nuchae of the scalp is his only service-connected disability, which, by its very nature, does not cause loss of use of an extremity as defined by VA regulations. In other words, no evidence shows that the Veteran's acne on his scalp has resulted in the absence of effective function in any extremity other than that which would be equally well served by an amputation stump at the site of election below the elbow or knee with use of a suitable prosthetic appliance. Thus, the Veteran does not have any of the qualifying disabilities for specially adapted housing. In summary, as the criteria of 38 U.S.C.A. § 2101(a) and 38 C.F.R. § 3.809(b) are controlling, entitlement to a certificate of eligibility for assistance in acquiring specially adapted housing cannot be granted, given the Veteran's service-connected disability status at this time. IX. Certificate of Eligibility for Assistance in Acquiring a Special Home Adaptation Grant In order for a Veteran to be entitled to a certificate of eligibility for assistance in acquiring special home adaptation, he or she must be entitled to compensation for permanent and total disability which (1) is due to blindness in both eyes with 5/200 visual acuity or less, or (2) includes the anatomical loss or loss of use of both hands. 38 U.S.C.A. § 2101(b); 38 C.F.R. § 3.809(a). As noted above, service connection has not been granted for blindness, nor is service connection in effect for any disability other than acne. Consequently, the Board finds that entitlement to benefits under the provisions of 38 U.S.C.A. § 2101(b); 38 C.F.R. § 3.809(a) cannot be granted. ORDER The claim of entitlement to service connection for type II diabetes mellitus, claimed as due to Agent Orange exposure, is denied. The claim of entitlement to service connection for a psychiatric disorder, to include schizophrenia and PTSD, is denied. The claim of entitlement to service connection for a bilateral hand and wrist disorder, to include a rash and/or an orthopedic disability, is denied. The claim of entitlement to an effective date prior to July 23, 1997, for the award of service connection for acne keloidalis nuchae of the scalp is denied. The claim of entitlement to an effective date prior to March 3, 1999, for the award of nonservice-connected pension benefits is denied. The claim of entitlement to an initial rating higher than 50 percent for acne keloidalis nuchae of the scalp prior to August 30, 2002, is denied. The claim of entitlement to a rating higher than 80 percent for acne keloidalis nuchae of the scalp since August 30, 2002, is denied. The claim of entitlement to specially adapted housing assistance or a special home adaptation grant is denied. REMAND A remand is warranted because additional VCAA notice is required concerning the Veteran's petition to reopen his previously denied claim for service connection for a skin condition of the feet on the basis of new and material evidence. As a result, the TDIU claim also must also be remanded. With respect to the claim of whether new and material evidence has been submitted to reopen a claim for service connection for a skin condition of the feet, none of the VCAA notice letters to the Veteran comply with Kent v. Nicholson, 20 Vet. App. 1 (2006), wherein the Court indicated that he must be (1) notified of the evidence and information necessary to reopen the claim, (i.e., describe what new and material evidence is); (2) notify him of the evidence and information necessary to substantiate each element of the underlying service connection claim; and (3) notify him of what specific evidence would be required to substantiate the element or elements needed for service connection that were found insufficient in the prior denial on the merits. See also VA Gen. Couns. Mem., para. 2, 3 (June 14, 2006), wherein VA's Office of General Counsel issued informal guidance interpreting Kent as requiring the notice to specifically identify the kind of evidence that would overcome the prior deficiency rather than simply stating the evidence must relate to the stated basis of the prior denial. With respect to the TDIU claim, the Board notes that this claim is inextricably intertwined with the above claim concerning service connection for a skin condition of the feet. Any potential grant of service connection for this alleged disability involving his feet may bear significantly on his TDIU claim. See Holland v. Brown, 6 Vet. App. 443, 446 (1994) (TDIU claim predicated on a particular service-connected condition is inextricably intertwined with an increased rating claim regarding the same condition). Therefore, the Veteran's TDIU claim must be referred back to the RO for adjudication after the requirements of this remand have been met. Accordingly, this case is REMANDED for the following action: 1. Send the Veteran a supplemental VCAA notice letter to comply with the Court's holding in Kent v. Nicholson, 20 Vet. App. 1 (2006). In particular, this letter must notify him of the specific reasons for the previous denial of his claim for service connection for a skin condition of the feet in March 2003; (2) apprise him of the type of evidence and information necessary to reopen this claim, i.e., explain what would constitute new and material evidence; and (3) explain what specific evidence is required to substantiate the elements needed to grant the underlying claim on the merits. 2. After giving the Veteran a sufficient time to respond, readjudicate the issue of whether new and material evidence has been submitted to reopen a claim for service connection for a skin condition of the feet, as well as the claim of entitlement to a TDIU. If either claim is not granted to the Veteran's satisfaction, send him and his representative another SSOC and give them an opportunity to respond to it before returning the file to the Board for further appellate consideration. The Veteran has the right to submit additional evidence and argument concerning the claims the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims 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). ______________________________________________ JOAQUIN AGUAYO-PERELES Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs