Citation Nr: 1044320 Decision Date: 11/24/10 Archive Date: 12/01/10 DOCKET NO. 05-18 993 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Seattle, Washington THE ISSUES 1. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for an ulcer disorder, and if so, whether the reopened claim should be granted. 2. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for psychiatric disability, to include posttraumatic stress disorder (PTSD), and if so, whether the reopened claim should be granted. 3. Entitlement to service connection for residuals of a traumatic brain injury (TBI). REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD K. Haddock, Associate Counsel INTRODUCTION The Veteran had active service in the United States Marine Corps from August 1969 to October 1969. This case comes before the Board of Veterans' Appeals (Board) on appeal from May 2004 and December 2008 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. In connection with this appeal the Veteran testified at a hearing before the undersigned Veterans Law Judge at the RO in August 2010. A transcript of the hearing is associated with the claims file. This case was previously before the Board in May 2010, at which time it was remanded for additional development. The case has now been returned to the Board for further appellate action. The issue of entitlement to service connection for a psychiatric disability, to include PTSD, is addressed in the REMAND following the order section of this decision. FINDINGS OF FACT 1. In an unappealed September 2001 rating decision, the RO denied the Veteran's claim of entitlement to service connection for an ulcer disorder. 2. The relevant evidence associated with the claims files subsequent to the September 2001 rating decision, is cumulative or redundant of the evidence previously of record or is not sufficient to establish a reasonable possibility of substantiating the claim. 3. In an unappealed September 2001 rating decision, the RO denied the Veteran's claim of entitlement to service connection for PTSD. 4. The evidence associated with the claims file subsequent to the September 2001 rating decision includes evidence that relates to an unestablished fact necessary to substantiate the claim, is neither cumulative nor redundant of evidence already of record, and raises a reasonable possibility of substantiating the claim of entitlement to service connection for a psychiatric disability, to include PTSD. 5. Residuals of a TBI are not etiologically related to the Veteran's active service. CONCLUSIONS OF LAW 1. New and material evidence has not been received to reopen a claim of entitlement to service connection for an ulcer disorder. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156(a) (2010). 2. New and material evidence has been received to reopen a claim of entitlement to service connection for a psychiatric disability, to include PTSD. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2010). 3. Residuals of a TBI were not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1111, 5107(b) (West 2002); 38 C.F.R. § 3.303 (2010). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), codified in pertinent part at 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2009), and the pertinent implementing regulation, codified at 38 C.F.R. § 3.159 (2009), provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. They also require VA to notify the claimant and the claimant's representative, if any, of any information, and any medical or lay evidence, not previously provided to the Secretary that is necessary to substantiate the claim. As part of the notice, VA is to specifically inform the claimant and the claimant's representative, if any, of which portion, if any, of the evidence is to be provided by the claimant and which part, if any, VA will attempt to obtain on behalf of the claimant. Although the regulation previously required VA to request that the claimant provide any evidence in the claimant's possession that pertains to the claim, the regulation has been amended to eliminate that requirement for claims pending before VA on or after May 30, 2008. The Board also notes that the United States Court of Appeals for Veterans Claims (Court) has held that the plain language of 38 U.S.C.A. § 5103(a) requires that notice to a claimant pursuant to the VCAA be provided "at the time" that, or "immediately after," VA receives a complete or substantially complete application for VA-administered benefits. Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). The timing requirement enunciated in Pelegrini applies equally to the initial-disability-rating and effective-date elements of a service-connection claim. Dingess v. Nicholson, 19 Vet. App. 473 (2006). Additionally, in March 2006, the Court held that because the terms "new" and "material" in a new and material evidence claim have specific, technical meanings that are not commonly known to VA claimants, when providing the notice required by the VCAA, it is necessary, in most cases, for VA to inform claimants seeking to reopen a previously and finally disallowed claim of the unique character of the evidence that must be presented. Kent v. Nicholson, 20 Vet. App. 1, 9-10 (2006) The record reflects that the Veteran was mailed letters in August 2003 and August 2008 advising him of what the evidence must show and of the respective duties of VA and the claimant in obtaining evidence. The August 2003 letter also informed the Veteran of the basis for the prior denials. In March 2006 and August 2008 letters, the Veteran was provided with appropriate notice with respect to the disability-rating and effective-date elements of his claim. Although the Veteran was not provided adequate notice until after the initial adjudication of the claim, the Board finds that there is no prejudice to the Veteran in proceeding with the issuance of a final decision. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). In this regard, the Board notes that following the provision of the required notice and the completion of all indicated development the claim was readjudicated. There is no indication or reason to believe that the ultimate decision on the merits of the claim would have been different had complete VCAA notice been provided at an earlier time. See Overton v. Nicholson, 20 Vet. App. 427, 437 (2006) (A timing error may be cured by a new VCAA notification followed by a readjudication of the claim). With regard to the claims of whether new and material evidence has been received to reopen a claim of entitlement to ulcer disorder and of entitlement to service connection for residuals of a TBI, the Board finds the Veteran has been afforded adequate assistance in response to his claim. The Veteran's service treatment records (STRs) and service personnel records (SPRs) are on file. VA Medical Center treatment records have been obtained. Private medical records are on file. Neither the Veteran, nor his representative has identified any outstanding evidence, to include medical records, which could be obtained to substantiate the claim. The Board is also unaware of any such evidence. The Board acknowledges that the Veteran has not been provided a VA examination in response to his claim to reopen a claim of entitlement to service connection for ulcers and that no VA medical opinion has been obtained in response to this claim, but notes that VA has no obligation to provide such an examination or obtain such an opinion if new and material evidence has not been presented. See 38 C.F.R. § 3.159 (c)(4). Additionally, the Board acknowledges that the Veteran has not been provided a VA examination in response to his claim of entitlement to service connection for residuals of a TBI. Additionally, no VA medical opinion has been obtained in response to this claim. VA is obliged to provide a VA examination or obtain a medical opinion when: (1) there is competent evidence that the Veteran has a current disability (or persistent or recurrent symptoms of a disability), (2) there is evidence establishing that the Veteran suffered an event, injury or disease in service or has a disease or symptoms of a disease within a specified presumptive period, (3) the evidence indicates that the current disability or symptoms may be associated with service or with another service-connected disability, and (4) there is not sufficient medical evidence to make a decision. See 38 C.F.R. § 3.159(c)(4); see also Charles v. Principi, 16 Vet. App. 370 (2002). In this regard, as discussed below, the evidence of record fails to indicate that the Veteran has residuals of a TBI which may be associated with service. Therefore, the Board finds that the medical evidence currently of record is sufficient to decide the claim and so, no VA examination or medical opinion is warranted. Accordingly, the Board will address the merits of the claim. Legal Criteria Claim to Reopen Generally, a claim that has been denied in an unappealed RO decision or an unappealed Board decision may not thereafter be reopened and allowed. 38 U.S.C.A. §§ 7104(b), 7105(c) (West 2002). The exception to this rule is 38 U.S.C.A. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence is defined as evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Burden of Proof Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Analysis Claim to Reopen Entitlement to Service Connection for Ulcer Disorder The Veteran originally filed his claim of entitlement to service connection for ulcers in June 1992. In an August 1992 rating decision, the RO denied the Veteran's claim based on a finding that there was no evidence that the Veteran had an ulcer disorder which had its onset during the Veteran's active service, near the time of his separation from active service, or within one year of his separation from active service. The Veteran did not appeal that decision. In September 2001, the Veteran was again denied entitlement to service connection for an ulcer disorder based on a finding that there was no evidence of peptic ulcer or any other digestive disorder while the Veteran was in active service. The Veteran did not appeal that decision. The evidence of record at the time of the September 2001 rating decision included the following: the Veteran's service treatment records (STRs); private treatment records from Annie Penn Memorial Hospital from December 1973 to June 1977, which should the Veteran periodically complained of abdominal pain and was diagnosed with a duodenal ulcer, alcoholic gastritis, and a possible peptic ulcer; a June 1989 treatment note from Annie Penn Memorial Hospital showing that the Veteran again complained of abdominal pain, at which time the impression was peptic ulcer disease v. gastritis; June 2000 private treatment records from Capital Medical Center which show that the Veteran was evaluated for recurrent abdominal pain/gastritis with findings consistent with current duodenal bulb ulceration; a statement received from the Veteran in December 2000, at which time the Veteran reported that his ulcer disorder had its onset in active service; and private treatment notes from Westcare Clinic from February 2000 to November 2000, which show that the Veteran was treated for a helicobacter pylori positive peptic ulcer. The evidence that has been received since the September 2001 rating decision includes the following: numerous statements from the Veteran in which he again reported that his ulcer disorder had its onset in active service and was due to the stress and anxiety he experienced during active service; a July 2003 treatment record from Occupational Medical Clinic of Tacoma, which shows that the Veteran reported hospital treatment for both ulcers and stress at that time; VA Medical Center treatment notes from July 2003 to February 2009, which show that the Veteran has periodically complained of and received treatment for GI pain and ulcers; and private treatment records from Providence St. Peter Hospital from January 2000 to October 2003, which show that the Veteran sought one time treatment for ulcer related problems. While the Veteran is competent to report when his symptoms first began and that they have continued since service; see Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991); this is evidence that was previously considered in the September 2001 rating decision which denied entitlement to service connection for ulcers. Additionally, the evidence of record showing that the Veteran has continued to receive treatment for an ulcer disability since 1973 does not relate to whether that ulcer disability is related to the Veteran's active service or was manifest to a compensable degree within one year of the Veteran's separation from active service. In sum, the evidence added to the record since the RO's September 2001 rating decision is cumulative and redundant in nature. In addition, it does not relate to the reason the claim was originally denied. Therefore, it is not sufficient to establish a reasonable possibility of substantiating the claim. Accordingly, reopening of the claim of entitlement to service connection for an ulcer disorder is not warranted. Claim to Reopen Entitlement to Service Connection for a Psychiatric Disability The Veteran originally filed his claim of entitlement to service connection for a nervous condition in June 1992. In an August 1992 rating decision, the RO denied the Veteran's claim based on a finding that there was no evidence that the Veteran had a nervous condition which had its onset during the Veteran's active service, near the time of his separation from active service, or within one year of his separation from active service. The Veteran did not appeal that decision. In September 2001, the Veteran was denied entitlement to service connection for PTSD based on a finding that there was no evidence that the Veteran was ever physically assaulted, as claimed, in active service. The Veteran did not appeal that decision. The evidence of record at the time of the September 2001 rating decision included the following: the Veteran's STRs; a May 1991 statement from the Veteran in which he claimed that his nerves caused him to act abnormal; private treatment records from Pinehurst Psychiatric Clinic showing sporadic psychiatric treatment from 1991-1992, and a statement received from the Veteran in December 2000, at which time he reported that he was subjected to harsh training practices at boot camp and became very nervous and afraid after he was physically attacked by a drill instructor and had his life threatened by several other people. The evidence that has been received since the September 2001 rating decision is voluminous and includes the following: numerous statements from the Veteran, in which he again reported that he had been subjected to unprecedented harsh training practices while in boot camp during which time he reported that other trainees died; a July 2003 treatment record from Occupational Medical Clinic of Tacoma, which shows that the Veteran reported hospital treatment for both ulcers and stress at that time; a September 2003 VA Medical Center psychiatric evaluation, at which time the Veteran was diagnosed with a myriad of psychiatric disorders, to include PTSD and personality disorder; VA Medical Center treatment notes from July 2003 to February 2009, which show that the Veteran has received both inpatient and outpatient mental health treatment at the VA Medical Center for a variety of mental health disabilities; private treatment records from Carolina Manor from March 1992 to April 1992, which show that the Veteran received inpatient treatment for alcohol dependence; a September 1968 newspaper article about drill instructor misconduct at Paris Island; the Veteran's statements indicating that he had a psychiatric disability which pre-existed, but was aggravated by his active service; a May 2004 private psychiatric evaluation showing a possible diagnosis of bipolar disorder; a May 2005 letter from the Veteran's doctor at the VA Medical Center indicating that the Veteran had sustained a head injury in July 2004 and was receiving treatment for such disability at the VA Medical Center; an April 2005 private psychiatric evaluation showing dementia, status post head injury, PTSD, and mood disorder; a March 2006 private psychiatric evaluation showing dementia, status post head injury, PTSD, mood disorder, and possible bipolar disorder; Social Security Administration (SSA) records showing both VA Medical Center and private mental health treatment for a variety of psychiatric disorders; a December 2008 psychiatric consultation from the Pinel Clinic, in which the Veteran's physician reported that the Veteran's descriptions of his experiences in boot camp could have contributed to PTSD, but that the events were unsubstantiated; a January 2009 statement from the Veteran's private physician in which Dr. J.K. reported that in his opinion, the Veteran's mental condition was a result of his TBI in 1955 and that it is more than likely that the condition was aggravated by active service; the Veteran's August 2010 Board testimony at which time he reported that his psychiatric disabilities were related to both his 1955 head injury and his active service; and a statement from Dr. J.K. received in October 2010 in which he reported that the Veteran did suffer from PTSD and it was Dr. J.K.'s opinion that if the PTSD was not caused by active service it certainly pre-existed and was exacerbated by the Veteran's active service. The Board finds that the medical opinion linking the Veteran's current psychiatric problems to his active service and in the alternative to a pre-existing condition that was aggravated by the Veteran's active service is new and material. In this regard the Board notes that it is not cumulative or redundant of the evidence previously of record. Moreover, it is sufficient to raise a reasonable possibility of substantiating the claim. Accordingly, reopening of the claim for entitlement to service connection for a psychiatric disability, to include PTSD, is in order. Entitlement to Service Connection for Residuals of Traumatic Brain Injury The Veteran has asserted that he sustained a head injury when he was approximately 5 years old. He reported that at that time, his father ran over him with a vehicle. A review of medical records on file shows that in 1955, the Veteran was admitted to the hospital for observation after he was run over by an automobile. However, it is noted, that at that time, the Veteran's condition was good. Additionally, when being treated for unrelated disabilities in the 1970s at Annie Penn Memorial Hospital, the Veteran again reported being run over by a car when he was five. At that time, the Veteran did not report any injury in service which aggravated his earlier head injury. A review of the Veteran's STRs shows that at his June 1989 enlistment examination the Veteran checked "no" when asked if he experienced frequent or severe headaches or dizziness or fainting spells. Additionally, the Veteran's head, face, neck, and throat were all found to be clinically normal upon examination. The Veteran's neurologic system was also found to be clinically normal upon physical examination at the time of his enlistment examination. Additionally, the Veteran did not report any sort of head injury or residuals of a head injury at the time of his enlistment into active service. The Board notes that a Veteran will be considered 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 the examination, acceptance, and enrollment, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. §§ 1111, 1137; 38 C.F.R. § 3.304 (b). The Board finds that the Veteran did not have residuals of a head injury that clearly and unmistakably existed prior to his active service. In this regard, the Board notes that the Veteran's 1955 head injury occurred many years prior to his 1969 enlistment into active service. Additionally, there is no evidence of record that the Veteran suffered from any sort of residuals from the 1955 head injury. The 1955 treatment note indicated that the Veteran was only admitted at that time for observation, but that his condition was good. Therefore, the Veteran was presumed to have been sound at the time of his entry into active service and the Board will limit its consideration to entitlement to service connection for residuals of a head injury on a direct basis. Further review of the Veteran's STRs is negative for any treatment for or diagnosis of a TBI while the Veteran was in active service. Also of record in the Veteran's STRs is an October 1969 statement in which it was reported that the Veteran did not have any physical or mental disability that warranted his discharge from active service by reason of that disability. Additionally, at the time of his separation examination in October 1969, the Veteran's head, face, neck, and throat were all found to be clinically normal upon physical examination and the Veteran's neurologic system was also clinically normal upon physical examination. There was no notation on the examination report indicating that the Veteran experienced any sort of head injury while in active service. A review of the Veteran's post-service medical records shows that the Veteran did not complain of any residuals of a head injury until July 2004. In July 2004, the Veteran was seen at a private hospital after being involved in a biking accident. Apparently, the Veteran was riding his bike and was struck by a vehicle. The accident was witnessed and after hitting his head on the pavement, the Veteran lost consciousness for approximately 3 minutes. After an examination and diagnostic tests were completed, he was diagnosed with a head injury, depressed skull fracture, subarachnoid hemorrhage, and cerebral contusion. Since his July 2004 head injury, the Veteran has been treated at both the VA Medical Center and at private facilities for residuals of the head injury, such as dementia, dizziness, and balance problems. The Board notes that prior to his July 2004 documented head injury, the Veteran was not treated for any residuals of a head injury. The evidence of residuals of a head injury prior to the July 2004 documented head injury well after the Veteran's separation from active service is limited to the Veteran's own statements. In relevant part, 38 U.S.C. § 1154(a) requires that the VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim to disability or death benefits. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed.Cir.2007) In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F .3d 1331, 1337 (Fed.Cir.2006). The Federal Circuit in Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed.Cir.2009), explicitly reiterated that it rejected the view that "competent medical evidence is required ... [when] the determinative issue involves either medical etiology or a medical diagnosis." Id. at 1316 . Federal Circuit held that, when considering evidence supporting a service-connection claim, the Board must consider, on a case-by-case basis, the competence and sufficiency of lay evidence offered to support a finding of service connection. Id. (reiterating that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. " Here, although the Veteran is certainly competent to report that he sustained a head injury while in training in service, the Board finds his account not to be credible. The medical evidence affirmatively shows that no evidence of residuals of a head injury was found on the examination for discharge from service. Moreover, the Veteran's claim for service connection for residuals of a head injury was filed almost 40 years following his discharge from service. His current recollections of when he first experienced symptoms of residuals of a head injury are not considered as probative as the contemporaneous medical evidence affirmatively indicating that there were no residuals of a head injury until the Veteran's July 2004 head injury many years after his separation from active service. Finally, the Board notes that the Veteran has provided no corroborating evidence of the presence of any residuals of a head injury in service or thereafter, until the July 2004 documented head injury. McLendon v. Nicholson, 20 Vet. App. 79 (2006), states, that in disability compensation (service connection) claims, VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. Simply stated, the standards of McLendon are not met in this case as there is nothing of record to suggest that the Veteran sustained a head injury in service or has any residuals of such an injury. Therefore, the Board must conclude that the preponderance of the evidence is against the claim and entitlement to service connection for residuals of a head injury is not warranted. ORDER The Board having determined that new and material evidence has not been presented, reopening of the claim for entitlement to service connection for an ulcer disorder is denied. The Board having determined that new and material evidence has been presented, reopening of the claim of entitlement to service connection for a psychiatric disability, to include PTSD, is granted. Entitlement to service connection for residuals of a TBI is denied. REMAND The Board finds that additional development is required before the Veteran's claim of entitlement to service connection for a psychiatric disability, to include PTSD, is decided. A review of the Veteran's STRs shows that he was discharged after approximately only 3 months of active service due to inaptitude, in that the Veteran was shown to be unmotivated towards becoming a marine and because he did not possess the minimum standards for graduation. The Veteran has reported that he was physically attacked by his drill instructor because he urinated in his pants in front of the platoon. He reported that following the incident he was transferred to Casual Company for evaluation and eventual discharge from active service. A review of the Veteran's post-service medical records shows that he has been diagnosed with a myriad of mental health disorders, to include PTSD, depression, bipolar disorder, personality disorder, and mood disorder. The Board notes that in Clemons v. Shinseki, 23 Vet. App. 1 (2009), the U. S. Court of Appeals for Veterans Claims found that an appellant's claim for service connection for posttraumatic stress disorder (PTSD) should have been construed more broadly by VA as a claim for service connection for any mental disability. The Court noted that the claimant was not competent to diagnose a particular psychiatric disability, such as PTSD, but that he was competent to describe his mental symptoms. Id. at 4-5, citing Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992) and Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Court also noted that the evidence submitted in support of the claim showed that the appellant had been diagnosed with psychiatric disabilities other than PTSD and that these disabilities arose "from the same symptoms for which he was seeking benefits." Id. at 9. The Court held that, in construing a claim, the Board must consider any disability, "that may reasonably be encompassed by several factors including: the claimant's description of the claim; the symptoms the claimant describes; and the information the claimant submits or that the Secretary obtains in support of the claim." Id. at 5. In light of the Court's decision and evidence of record showing that the Veteran has been diagnosed with multiple psychiatric disabilities, the Board will construe the Veteran's claim as one for entitlement to service connection for a psychiatric disorder, to include PTSD. Also of record is a letter from the Veteran's private physician, received by VA in October 2010. In the letter, Dr. J.K. reported that the Veteran did have PTSD and opined that if the PTSD was not caused by active service it certainly pre-existed and was exacerbated by the Veteran's active service. As noted above, a Veteran is presumed to have been sound upon entry into the military, except as to conditions noted at the time of the acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the condition existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. § 1111 (West 2002). Only such conditions as are recorded in physical examination reports are to be considered as "noted." The Veteran's reported history of the pre-service existence of a disease or injury does not constitute notation of such disease or injury, but is considered with all other evidence in determining if the disease or injury pre-existed service. Paulson v. Brown, 7 Vet. App. 466, 470 (1995). Therefore, the Board finds that the Veteran should be afforded a VA examination in order to determine the nature and etiology of any currently present psychiatric disability, to include whether it clearly and unmistakably existed prior to active service and underwent no increase in severity as a result of active service. Additionally, current treatment records should be obtained prior to a decision being rendered with regard to this issue. Accordingly, this case is remanded to the RO or the Appeals Management Center (AMC), in Washington, D.C., for the following actions: 1. The RO or the AMC should undertake appropriate development to obtain any outstanding, pertinent medical records. 2. The Veteran should be afforded a VA examination by a psychiatrist or a psychologist to determine the nature and etiology of any currently present psychiatric disorders, to include PTSD. The claims files must be made available to and reviewed by the examiner. Any indicated studies should be performed. Based upon the examination results and the review of the claims files, the examiner should provide an opinion with respect to any currently present psychiatric disorder, to include PTSD, as to whether there is a 50 percent or better probability that the disorder was present during service. If so, the examiner should provide an opinion as to whether the disorder clearly and unmistakably existed prior to the Veteran's active service and if so, whether it clearly and unmistakably underwent no permanent increase in severity as a result of the Veteran's active service. If the examiner is of the opinion that the Veteran did not develop the current psychiatric disorder, to include PTSD, until after his discharge from service, the examiner should provide an opinion as to whether there is a 50 percent or better probability that the disorder is etiologically related to the Veteran's active service. The supporting rationale for all opinions expressed must be provided. 3. The RO or the AMC should undertake any other development it determines to be warranted. 4. Then, the RO or the AMC should readjudicate the Veteran's claim of entitlement to service connection for a psychiatric disability, to include PTSD, based on a de novo review of the record. If the benefit sought on appeal is not granted to the Veteran's satisfaction, a Supplemental Statement of the Case should be furnished to the Veteran and his representative and they should be afforded the requisite opportunity to respond. Thereafter, if indicated, the case should be returned to the Board for further appellate action. By this remand, the Board intimates no opinion as to any final outcome warranted. The Veteran need take no action until he is otherwise notified, but he may furnish additional evidence and/or argument during the appropriate time frame. See Kutscherousky v. West, 12 Vet. App. 369 (1999). This REMAND must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or the Court for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2010). ______________________________________________ WAYNE M. BRAEUER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs