Citation Nr: 1025852 Decision Date: 07/12/10 Archive Date: 07/19/10 DOCKET NO. 07-26 149 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Diego, California THE ISSUES 1. Entitlement to service connection for a left eye disorder. 2. Entitlement to service connection for a heart disorder to include coronary artery disease. 3. Entitlement to service connection for a lung disorder to include as due to asbestos exposure. 4. Entitlement to service connection for a back disorder. 5. Entitlement to service connection for a neurological disorder of the upper extremities. 6. Entitlement to service connection for a neurological disorder of the lower extremities. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant's son ATTORNEY FOR THE BOARD G. A. Wasik, Counsel INTRODUCTION The Veteran had active duty service from June 1942 to October 1945. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2005 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran's son testified at a personal hearing at the Board in January 2009. The issues on appeal were previously before the Board in February 2009 when they were remanded for additional evidentiary development. Also before the Board in February 2009 were claims of entitlement to service connection for posttraumatic stress disorder (PTSD) and for hearing loss. These claims were also remanded in February 2009. In February 2010, the RO granted service connection for hearing loss and for PTSD. The issues are no longer in appellate status. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2009). 38 U.S.C.A. § 7107(a)(2) (West 2002). The issues of entitlement to service connection for a heart disorder to include coronary artery disease and entitlement to service connection for a lung disorder to include as due to asbestos exposure 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. VA will notify the appellant if additional action is required on his part. FINDINGS OF FACT 1. A left eye disorder was not present during active duty or for many years thereafter and the preponderance of the evidence is against finding that a left eye injury occurred during active duty. 2. A back disorder was not present during active duty or for many years thereafter and the preponderance of the evidence is against finding that a back injury occurred during active duty. 3. A neurological disorder of the upper extremities was not present during active duty or for many years thereafter and the preponderance of the evidence is against finding that a neurological disorder of the upper extremities occurred during active duty. 4. There is no competent evidence of the current existence of a neurological disorder of the lower extremities. CONCLUSIONS OF LAW 1. A left eye disorder was not incurred in or aggravated by the Veteran's military service. 38 U.S.C.A. §§ 1101, 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2009). 2. A back disorder was not incurred in or aggravated by the Veteran's military service. 38 U.S.C.A. §§ 1101, 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2009). 3. A neurological disorder of the upper extremities was not incurred in or aggravated by the Veteran's military service. 38 U.S.C.A. §§ 1101, 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2009). 4. A neurological disorder of the lower extremities was not incurred in or aggravated by the Veteran's military service. 38 U.S.C.A. §§ 1101, 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations set forth certain notice and assistance provisions. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R §§ 3.102, 3.156(a), 3.159 and 3.326(a). After reviewing the claims folder, the Board finds that the appellant has been notified of the applicable laws and regulations which set forth the criteria for entitlement to the benefits adjudicated by this decision. The discussion in a November 2004 VCAA letter has informed the appellant of the information and evidence necessary to warrant entitlement to service connection for his left eye, back, and upper and lower extremities claims. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). The requirements of 38 C.F.R. § 3.159(b)(1) have been met. The Board finds that all notice required by VCAA and implementing regulations was furnished to the appellant and that no useful purpose would be served by delaying appellate review to send out additional VCAA notice letters. In this case, the RO's decision came after complete notification of the Veteran's rights under the VCAA. The VCAA notice was timely. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). On March 3, 2006, the United States Court of Appeals for Veterans Claims (Court) issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), which held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: (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. The Court held that upon receipt of an application for a service-connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. See Dingess/Hartman, supra. In the present appeal, the Veteran was provided with notice of what types of information and evidence were needed to substantiate the issues adjudicated by this appeal, but he was not provided with notice of the types of evidence necessary to establish an effective dates for the disabilities on appeal. Despite the inadequate notice provided to the Veteran on this element, the Board finds no prejudice to the Veteran in proceeding with the issuance of a final decision. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993) (where the Board addresses a question that has not been addressed by the agency of original jurisdiction, the Board must consider whether the veteran has been prejudiced thereby). In that regard, as the Board concludes below that the preponderance of the evidence is against the appellant's claims of entitlement to service connection for a left eye disorder, for a back disorder and for neurological disorders of the upper and lower extremities, any questions as to the effective dates to be assigned are rendered moot. All the VCAA requires is that the duty to notify is satisfied, and that claimants are given the opportunity to submit information and evidence in support of their claims. Once this has been accomplished, all due process concerns have been satisfied. See Bernard v. Brown, 4 Vet. App. 384 (1993); Sutton v. Brown, 9 Vet. App. 553 (1996); see also 38 C.F.R. § 20.1102 (harmless error). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). With regard to the service connection claims adjudicated by this decision, the Board notes that the Veteran has not been afforded VA examinations. The Board finds no prejudice flows to the Veteran as a result of the failure to provide VA examinations. This is because, as set out below, the Board finds that the preponderance of the evidence is against finding that the Veteran experienced any injury to or disease of his left eye, back or upper or lower extremities while on active duty. Without evidence of an in-service injury or disease, any opinion attempting to link a current disorder to the Veteran's active duty service would be speculative, at best, and service connection cannot be granted based on speculative evidence. Accordingly, the Board finds that VA's duty to assist with respect to obtaining VA examinations or opinions concerning the issues on appeal has been met. 38 C.F.R. § 3.159(c) (4). No additional pertinent evidence has been identified by the appellant as relevant to the issues adjudicated by this decision. The claims file documents that the Veteran has reported receiving private treatment for some of the disabilities on appeal. Significantly, despite being requested, the Veteran has not indentified any outstanding private medical evidence which should be associated with the claims file. VA cannot attempt to obtain private medical evidence in support of the Veteran's claim without first being informed of the nature and location of the evidence and without having the Veteran sign an appropriate release. Attempts were made to obtain in-service hospitalization records reported to exist by the Veteran. However, all attempts to obtain this evidence were not fruitful. The Veteran was informed of VA's inability to obtain these records in December 2009. Under the circumstances of this particular case, no further action is necessary to assist the appellant. Competency and credibility The Veteran can attest to factual matters of which he had first- hand knowledge, e.g., experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). However, the Veteran as a lay person has not been shown to be capable of making medical conclusions; thus, his statements regarding causation are not competent. Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). Competent medical evidence means evidence provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements or opinions. See Duenas v. Principi, 18 Vet. App. 512, 520 (2004). A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997); see also Bostain v. West, 11 Vet. App. 124, 127 (1998). While the Veteran is competent to report what comes to him through his senses, he does not have medical expertise. See Layno v. Brown, 6 Vet. App. 465 (1994). However, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that lay evidence is one type of evidence that must be considered and competent lay evidence can be sufficient in and of itself. 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). This would include weighing the absence of contemporary medical evidence against lay statements. In Barr v. Nicholson, 21 Vet. App. 303 (2007), the Court indicated that varicose veins was a condition involving "veins that are unnaturally distended or abnormally swollen and tortuous." Such symptomatology, the Court concluded, was observable and identifiable by lay people. Because varicose veins "may be diagnosed by their unique and readily identifiable features, the presence of varicose veins was not a determination 'medical in nature' and was capable of lay observation." The Court found the veteran's lay testimony regarding varicose vein symptomatology in service represented competent evidence. In Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007), the Federal Circuit determined that 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 (noting that sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (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. The relevance of lay evidence is not limited to the third situation, but extends to the first two as well. Whether lay evidence is competent and sufficient in a particular case is a fact issue. Although the Veteran is competent in certain situations to provide a diagnosis of a simple condition such as varicose veins, the Veteran is not competent to provide evidence as to more complex medical questions. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (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")). See Barr. The issues on appeal do not involve simple diagnoses or medical assessments. See Jandreau; see also Woehlaert. The Veteran is not competent to provide a complex medical opinion regarding the etiology of a left eye disorder, a back disorder or neurological disorders of the upper or lower extremities. See Barr. The Board finds reason to question the Veteran's credibility. As further set out elsewhere in this decision, the Veteran has provided evidence which is contradicted by objective evidence of record and has also provided conflicting stories as to how he incurred some of the disabilities on appeal. One of the major incidents reported by Veteran and opined by him to be the genesis of several of his disabilities was an explosion which occurred at the Port of Chicago. He has reported in numerous statements that he was standing watch when he was nearly thrown overboard by a tremendous explosion which also almost knocked over his ship which was in dry dock. He has also informed a clinician that he was on the ship during the explosion and the ship almost sunk. Significantly, a deck log from the ship the Veteran was stationed on July 17, 1944 indicates that the ship was moored at that time (not dry docked) and that a loud explosion of undetermined origin was heard. Several hours later, a report was heard of an explosion at Port Chicago. There was no indication in the deck log that the ship was almost tipped over as a result of the blast. The Board can find no reason for such a misstatement of significant facts other than the Veteran was lying when advancing such a history in pursuit of material gains. The Board finds that, if the Veteran's ship was exposed to a blast so extensive that the ship was almost tipped over (in dry dock) and the Veteran was almost thrown overboard that such an event would have been recorded in the ship's log. The nature of the ship's log entry is such that the Board finds no significant explosion was experienced by the Veteran or his ship as a result of the accident at the Port of Chicago. People on board only heard the explosion without experiencing any other blast effects. This large discrepancy in the Veteran's alleged account of what happened versus the history as recorded in the ship's log leads the Board to place significantly reduced probative value on the Veteran's self-reported history. The Veteran alleged that, in August 1944, he was standing watch when a gas leak exploded. He alleged that a three story building next to the dock had its corner knocked off. Again, the ship's log does not reflect such activity. The Board finds that, if such an explosion actually occurred, there would have been some reference to this fact in the deck log. The absence of such evidence leads the Board to again find the Veteran is less than truthful when reporting his in-service history. The Veteran seemed to indicate, on a statement in support of claim which was received in September 2009 that, during a typhoon, he was at the helm of the ship. He wrote that "we" had two sailors handling the helm and ". . . it took all our strength to keep on course. We worked 4 hours shifts on the helm and then traded off to keep the men fresh." There is no indication in the service personnel records that the Veteran received any type of training in maneuvering a ship. The Board finds it highly unlikely that the Veteran would have been placed at the helm, during a typhoon, when he did not receive any training in conning a ship. This statement which is contradicted by objective evidence of record again leads the Board to find that the Veteran is less than truthful when reporting his in- service history. There are other issues where the Veteran's credibility is questioned by the Board. These are addressed below. Analysis The Board has thoroughly reviewed all the evidence in the Veteran's claims folder. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all of the evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the veteran). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. See 38 U.S.C.A. § 1110; 38 C.F.R. §§ 3.303(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. See 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247, 253 (1999). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran submitted the claims which initiated the current appeal in May 2004. By way of background, the service treatment records reveal that the Veteran was found to be without pertinent defects at the time of the July 1942 entrance examination. Vision was 20/20 bilaterally. There was no indication that there was any trouble with the spine or extremities. Examination conducted in October 1943 in connection with the Veteran's attending radar school indicated that vision was 20/15 in the right eye and 20/20 in the left. The Veteran was found to be without pertinent defects at the time of the separation examination which was conducted in October 1945. Vision was 20/20 bilaterally. The spine and extremities were normal. The service personnel records document that the Veteran served on the USS Pueblo from May 1944 to October 1945. Entitlement to service connection for a left eye disorder In his claim which was received in May 2004, the Veteran reported that he had had metal in his eye prior to active duty but was claiming that the injury was aggravated by active duty due to eye strain and vision problems. In January 2009, the Veteran's son testified that the Veteran was injured when he was hit in the eye by a piece of metal from a practice depth charge. It was alleged that the Veteran was treated at the Marine Hospital in San Francisco. There is competent evidence of record documenting the current existence of a left eye cataract and residuals (as well as a right eye cataract). The VA clinical records also indicate the Veteran had a history of primary open angle glaucoma. The Board finds that service connection is not warranted for a left eye disorder. The service treatment record were completely silent as to complaints of, diagnosis of or treatment for any eye disorders. The Veteran's vision was found to be 20/20 at the time of discharge. The only evidence of record which indicates that the Veteran injured his left eye during active duty is the Veteran's own allegations and those of his representative and son. Significantly, as set out above, the Board finds reason to place reduced probative value on the Veteran's reports of his in- service history. Furthermore, with regard to the left eye claim, there is an additional discrepancy. At the time of the Veteran's original application for compensation which was received in 2004, it was alleged that the Veteran had a pre-existing left eye disorder which was aggravated by the Veteran's active duty service. There was no report of any in-service eye injury when the claim was originally submitted. At the time of the January 2009 hearing conducted by the undersigned, it was alleged that the Veteran's left eye was injured when struck by part of a practice depth charge (hedgehog). There was no testimony regarding a pre-existing eye disorder or aggravation of a pre- existing eye disorder. It is not apparent to the Board why the Veteran's theory of injury had changed from 2004 to 2009. The Veteran and his representative have not provided any explanation for the discrepancy. Furthermore, there is no evidence of record indicating that the Veteran received any specialized training in the use of a "hedgehog." The Board finds it unlikely that the Veteran would be assigned to a weapon if he had no actual training on that particular weapon. Based on this discrepancy and others noted in this decision, the Board finds that significantly reduced probative value should be placed on the Veteran's self-reported history. The Board notes that attempts to obtain the medical records which reflect alleged eye treatment were unsuccessful and there is no indication that such records were actually created. The Board finds the objective evidence of record does not support a finding that the Veteran injured his left eye during active duty and the Veteran's subjective allegations have been discounted due to problems with the Veteran's veracity. There is no evidence of any continuity of symptomatology of a left eye disorder from active duty to the present. The clinical records do not reflect such a history and the Veteran has not alleged such a fact pattern. The Veteran was found to have 20/20 vision bilaterally at the time of his discharge. The first post service evidence of a left eye disability is dated many decades after the Veteran's discharge. The Veteran's son testified that the Veteran had complained of eye problems for a long time. The son did not indicate that the complaints had begun during active duty. A July 2007 VA clinical record indicates the Veteran reported that his vision watching television had become a little fuzzy ever since an aneurysm five weeks prior. There was no indication that the eye symptomatology had been long standing. This evidence weighs against a finding of continuity of symptomatology. The Board finds that the preponderance of the probative evidence of record is against finding that the Veteran experienced a left eye injury during active duty which resulted in the currently existing left eye disorder or that a left eye disorder was otherwise present during active duty. The only evidence of an in-service eye injury or aggravation of a pre-existing eye injury is the Veteran's testimony and allegations which the Board finds reason to discount due to inconsistencies with the objective evidence of record. Entitlement to service connection for a back disorder In his May 2004 claim, the Veteran wrote that he was missing one vertebrae from birth but he had a back problem which was aggravated by military service when he fell during a typhoon. In a stressor statement which was received in October 2004, the Veteran reported that his ship was caught in a typhoon. He did not indicate, in any way, that he experienced an injury during this storm. At the time of the January 2009 hearing, the Veteran's son alleged that the Veteran injured his back when he was almost thrown overboard as a result of an explosion at the Port of Chicago. It was also alleged that the Veteran injured his back handling heavy ammunition that would misfire. The Veteran's son indicated that the first time he remembered his father complaining of back problems was when the Veteran was 40 years old. (The Veteran was born in 1922.) There is competent evidence of the current existence of a back disorder. A July 2007 VA clinical record indicates that a lumbosacral spine X-ray was interpreted as revealing an old compression fracture of L1 which was probably from an old fall. This evidence does not link a current back disorder to the Veteran's active duty service. The Board finds that service connection is not warranted for a back disorder. The service treatment records were silent as to complaints of, diagnosis of or treatment for a back disorder. The only evidence of record which supports a finding that the Veteran injured his back is his own allegations and testimony and that of his son. As set out elsewhere in this decision, the Board finds reason to place significantly reduced probative value on the Veteran's self-reported history. With regard to the back claim, as set out above, the Veteran originally indicated that he had a pre-existing back disorder which was aggravated by a fall which occurred during a typhoon. In subsequent statements, when discussing the typhoon, the Veteran did not indicate that he had fallen in any way. Subsequently, it was advanced that the Veteran's back injury was the result of the explosion at the Port of Chicago. It is not apparent to the Board why these conflicting theories of injury were advanced if, in fact, any of them actually occurred. The Board finds the preponderance of the probative evidence of record does not support a finding that the Veteran injured his back during active duty. There is no continuity of symptomatology of a back disorder from the time of discharge to the present. As set out above, the service treatment record were silent as to complaints of, diagnosis of or treatment for back problems. The first medical evidence of problems with the Veteran's back is dated decades after his discharge. An October 2005 VA clinical record indicates the Veteran reported experiencing shooting sensations from the base of his spine to the occiput which resulted in him losing consciousness approximately once per year to once every two years. It was recorded that the Veteran believed this symptomatology was the result of a bad motor vehicle accident which occurred in the 1970's. There was no mention at all of a prior injury during active duty. This evidence weighs against a finding of continuity of symptomatology. The only evidence of record which indicates that the Veteran injured his back during active duty is the Veteran's own allegations and his son's testimony. As set out elsewhere, the Board finds reason to place reduced probative value on the Veteran's self-reported history. Furthermore, the fact that the Veteran originally alleged he injured his back while in a typhoon and then subsequently was silent as to such a fact pattern lends further probative weight to the Board's finding that the Veteran's self-reported history is not probative. Entitlement to service connection for a neurological disorder of the upper extremities In his May 2004 claim, the Veteran alleged that he had neurological damage as a result of a concussion. The service treatment records were silent as to complaints of, diagnosis of or treatment for any neurological problems to include problems with the upper extremities. There is some competent evidence of the current existence of neurological problems of the right upper extremity but this is dated many years after service. A January 2007 nerve conduction study performed on the right upper extremity was interpreted as revealing evidence of a right median neuropathy at or distal to the wrist which was severe in degree. Another January 2007 record indicates the Veteran had carpal-tunnel syndrome symptoms in the right hand with difficulty holding items. A February 2007 clinical record references carpal-tunnel syndrome. There is no competent evidence of record linking the currently existing right carpal-tunnel syndrome (or any other neurological disorder of the upper extremities) to the Veteran's active duty service. None of the clinical records which reference the disorder attribute it, in any way, to the Veteran's active duty service. The Veteran has opined that he currently experiences neurological problems as a result of being exposed to a blast during active duty. This opinion is non-persuasive for two reasons. As set out elsewhere in this decision, the Board has found reason to place significantly reduced probative value on the Veteran's self-reported history. Other than the Veteran's allegations, there is no indication that the Veteran was subjected to any blast or concussion during active duty. Nor was there any other evidence of an in-service injury which neurologically affected the upper extremities. Furthermore, as set out above, the Board finds that the Veteran is not competent to diagnose a currently existing neurological disorder and he is not competent to provide an opinion as to etiology of a currently existing neurological disorder. The Veteran's opinion as to the existence and etiology of a distinct neurological disorder of the upper extremities is without probative value. The Board finds the preponderance of the probative evidence of record does not support a finding that the Veteran neurologically injured his upper extremities during active duty. His allegation that he was exposed to blasts or concussions during active duty is not supported by any objective evidence of record and the Board places significantly reduced probative value on the Veteran's self-reported history due to the inaccuracies and inconsistencies previously discussed. There is no continuity of symptomatology of neurological problems of the upper extremities from the time of discharge to the present. The first medical evidence of the problem with the right upper extremity was dated many years after discharge and there is no medical evidence of problems with the left upper extremity. The Veteran has not alleged that he had had continuous problems with his upper extremities since discharge. As the preponderance of the evidence is against finding that the Veteran injured his upper extremities during active duty and as there is no competent evidence of record linking a currently existing neurological disorder of the upper extremities to the Veteran's active duty service on any basis, service connection is not warranted. Entitlement to service connection for a neurological disorder of the lower extremities In his May 2004 claim, the Veteran alleged that he had neurological damage as a result of a concussion. The service treatment records are silent as to complaints of, diagnosis of or treatment for problems with the Veteran's lower extremities including any neurological problems. Furthermore, the post-service medical evidence is devoid of any findings of a neurological disorder of the lower extremities. A VA clinical record dated in March 2007 reveals the Veteran reported pains in the lower back and associated leg pains. The pertinent assessment was low back pain which sounded like pseudo- claudication. This is the only medical evidence of record which indicates the Veteran had any problems with the lower extremities. This evidence does not indicate that the Veteran currently experiences neurological problems of the lower extremities. The symptomatology noted in March 2007 was attributed to the Veteran's back. A separate neurological disorder was not identified. There is no other medical evidence of record documenting the current existence of neurological problems with the lower extremities. The only evidence of record which indicates that the Veteran currently experiences a neurological disorder of the lower extremities is the Veteran's own allegations and testimony. As set out above, the Veteran is not competent to provide an opinion regarding the existence and etiology of a neurological disorder of the lower extremities. In the absence of evidence of current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board further notes there is no competent evidence of the presence of neuropathy of the lower extremities at any time during the appeal period. ORDER Entitlement to service connection for a left eye disorder is not warranted. The appeal is denied. Entitlement to service connection for a back disorder is not warranted. The appeal is denied. Entitlement to service connection for a neurological disorder of the upper extremities is not warranted. The appeal is denied. Entitlement to service connection for a neurological disorder of the lower extremities is not warranted. The appeal is denied. REMAND The Veteran has claimed entitlement to a heart disorder to include coronary artery disease. There is competent evidence of the current existence of a heart condition. In his May 2004 claim, the Veteran reported that he had cardiovascular disease and a defective heart which was due to a concussion. The Veteran has recently claimed in May 2010, however, that he has cardiovascular disease which was the result of his service- connected posttraumatic stress disorder (PTSD). The Veteran's representative submitted an extract of Cecil Textbook of Medicine, (22nd Edition, 2004) p. 253 which he indicates provides as follows: "Psychosocial factors, such as anger, anxiety, depression, hostility, type A behavior, and various measures of social support, have been associated with the occurrence and recurrence of [cardiovascular disease]. In addition, measures of cardiovascular physiologic reactivity have been correlated with [cardiovascular disease] outcomes." The appellant has argued that commonly accepted medical principles relate that psychiatric disorders are associated with the onset/worsening of cardiovascular disease. The Board is thus presented with evidence of a current cardiac disability and some evidence of a potential link between cardiovascular disability and the service- connected PTSD but no opinion has been obtained to determine if there is an etiologic link in the present case. The case of McLendon v. Nicholson, 20 Vet. App. 79 (2006), held that an examination is required when there is (1) evidence of a current disability, (2) evidence establishing an "in-service event, injury or disease," or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. In the current case, the requirement that there be an in-service injury or event is satisfied by the service-connected PTSD which is alleged to be the genesis of the cardiac disability. Based on the above, the Board finds the Veteran should be afforded a VA examination to determine if he currently experiences a cardiac disorder which was etiologically linked to the Veteran's service-connected PTSD. The Veteran has claimed that he currently experiences a pulmonary disorder which he alleges is the result of exposure to asbestos while on active duty. As to claims of service connection for asbestosis or other asbestos-related diseases, VA has issued a circular on asbestos- related diseases. This circular, DVB Circular 21- 88-8, Asbestos-Related Diseases (May 11, 1988) (DVB Circular), provides guidelines for considering compensation claims based on exposure to asbestos. The information and instructions from the DVB Circular were included in VA Adjudication Procedure Manual, M21-1 (M21- 1), Part VI, para. 7.68 (Sept. 21, 1992). Subsequently, the M2-1 provisions regarding asbestos exposure were amended. The new M21-1 guidelines were set forth at M21-1, Part VI, para. 7.21 (Oct. 3, 1997). The guidelines provide, in part, that the clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal disease; that VA is to develop any evidence of asbestos exposure before, during and after service; and that a determination must be made as to whether there is a relationship between asbestos exposure and the claimed disease, keeping in mind the latency period and exposure information. See Ashford v. Brown, 10 Vet. App. 120 (1997); McGinty v. Brown, 4 Vet. App. 428 (1993). The applicable section of Manual M21-1 also notes that some of the major occupations involving exposure to asbestos include mining, milling, work in shipyards, carpentry and construction, manufacture and servicing of friction products such as clutch facings and brake linings, manufacture and installation of roofing and flooring materials, asbestos cement and pipe products, military equipment, etc. High exposure to respirable asbestos and a high prevalence of disease have been noted in insulation and shipyard workers, and this is significant considering that, during World War II, U.S. Navy veterans were exposed to chrysotile, amosite, and crocidolite that were used extensively in military ship construction. Furthermore, it was revealed that many of these shipyard workers had only recently come to medical attention because the latent period for asbestos- related diseases varies from 10 to 45 or more years between first exposure and development of disease. Also of significance is that the exposure to asbestos may be brief (as little as a month or two) or indirect (bystander disease). See Department of Veterans Affairs, Veteran's Benefits Administration, Manual M21- 1, Part 6, Chapter 7, Subchapter IV, § 7.21 b. In Dyment v. West, 13 Vet. App. 141, 145 (1999), the Court found that provisions in former paragraph 7.68 (predecessor to paragraph 7.21) of VBA Manual M21-1, Part VI, did not create a presumption of exposure to asbestos. Medical nexus evidence is required in claims for asbestos related disease related to alleged asbestos exposure in service. VAOPGCPREC 4-00. In short, with respect to claims involving asbestos exposure, VA must determine whether or not military records demonstrate evidence of asbestos exposure during service, develop whether or not there was pre-service and/or post-service occupational or other asbestos exposure, and determine whether there is a relationship between asbestos exposure and the claimed disease. See M21-1, Part VI, 7.21; DVB Circular 21- 88-8, Asbestos-Related Diseases (May 11, 1988). The Veteran has alleged that he was exposed to large amounts of asbestos in May 1944 when the ship he was on was sprayed with the material while the men were still aboard. A review of the ship's log from May 1944 does not document this allegation. Furthermore, as set out elsewhere in this decision, the Board finds reason to place reduced probative value on the Veteran's self-reported history. The Board notes, however, that the RO has conceded that the Veteran had minimal exposure to asbestos. The Board further notes the Veteran was assigned to a Navy ship for a period of time and the pertinent regulations note that asbestos was present on ships. Based on the above, the Board finds that the Veteran had minimal exposure to asbestos. In response to a development letter which was sent in March 2009 asking, in part, about pre and post service employment, the Veteran responded that he had worked for a railroad prior to active duty and post-service worked in a steel mill and in woodshop. The Veteran's response does not indicate the type of work he performed or whether he was exposed to asbestos while performing the reported employment. This is significant, in that the development required for asbestos claims consists, in part, of making a determination as to the Veteran's exposure to asbestos prior to during and subsequent to active duty. The Board finds that additional development is required prior to adjudication of the Veteran's lung disorder claim. The Veteran must be contacted to determine the extent, if any, of his pre- service and post-service exposure to asbestos. Additionally, as exposure to asbestos is conceded, the Veteran should be provided with an examination to determine if a currently existing lung disorder was etiologically linked to exposure to asbestos. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2009). Expedited handling is requested.) 1. Obtain the names and addresses of all medical care providers who treated the Veteran for pulmonary disorders, PTSD, and cardiac disorders. After securing any necessary releases, obtain those records identified by the Veteran which have not been associated with the claims file to the extent possible. Regardless of the Veteran's response, obtain all outstanding VA medical records. 2. Contact the Veteran and request that he provide information as to his pre-service and post-service employment including the dates of such employment and whether the employment entailed any exposure to asbestos. 3. Schedule the Veteran for a VA heart examination by an appropriately qualified health care professional to determine whether the Veteran currently experiences a cardiac disorder which was etiologically linked to his PTSD. The claims file, to include a copy of this remand, must be made available to the examiner prior to completion of the examination report for review of pertinent documents therein. After reviewing the record, the VA examiner should answer the following question: Whether it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent), that the Veteran currently has a cardiac disorder which is etiologically linked to the service- connected PTSD, to include on an aggravation basis (i.e., whether the Veteran's cardiac disorder(s) permanently increased in severity beyond the natural progress due to the service-connected PTSD). The examiner must be informed that service connection is currently in effect for PTSD. A detailed rationale, including pertinent findings from the record, should be provided for all opinion(s) provided. If any opinion cannot be provided without resort to speculation, the examiner should so state and indicate why such an opinion would require speculation. Note: The term "at least as likely as not" does not mean merely within the realm of medical possibility, but rather that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of causation as it is to find against it. 4. Schedule the Veteran for a VA pulmonary examination by an appropriately qualified health care professional to determine whether the Veteran currently experiences an asbestosis-related disease or other lung disorder due to service, including asbestos exposure. The claims file, to include a copy of this remand, must be made available to the examiner prior to completion of the examination report for review of pertinent documents therein. After reviewing the record, the VA examiner should answer the following questions: (a) Whether it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent), that the Veteran has an asbestos-related disease, including asbestosis. (b) If yes, then whether it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent), that any current asbestos-related disease is related to in-service asbestos exposure. The examiner must be informed that the Veteran had minimal exposure to asbestos during the normal course of his duties on board the USS Pueblo. The examiner must also be informed of any pre-service and post- service exposure to asbestos indicated by the record. (c) For any lung disorder diagnosed, the examiner should also provide an opinion as to whether it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent), that any currently existing lung disorder was etiologically linked to the Veteran's active duty service including exposure to minimal asbestos while on active duty. Note: The term "at least as likely as not" does not mean merely within the realm of medical possibility, but rather that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of causation as it is to find against it. A detailed rationale, including pertinent findings from the record, should be provided for all opinion(s) provided. If any opinion cannot be provided without resort to speculation, the examiner should so state and indicate why such an opinion would require speculation. 5. After completing any additional development deemed necessary, readjudicate the claims. If any benefit requested on appeal is not fully granted, the Veteran and his representative should be furnished a Supplemental Statement of the Case, which addresses all of the evidence obtained after the issuance of the last supplemental statement of the case or statement of the case as the situation may require, and provided an opportunity to respond. The case should then be returned to the Board for further appellate consideration, if in order. By this remand, the Board intimates no opinion as to any final outcome warranted. The appellant and his representative have the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). ______________________________________________ BARBARA B. COPELAND Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs