Citation Nr: 1106167 Decision Date: 02/15/11 Archive Date: 02/28/11 DOCKET NO. 09-22 926 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD) and anxiety. 2. Whether new and material evidence has been received to reopen service connection for a breathing disorder, to include as secondary to exposure to asbestos. 3. Entitlement to service connection for right ankle venous ulcer, to include as due to exposure to asbestos. REPRESENTATION Appellant represented by: Vietnam Veterans of America ATTORNEY FOR THE BOARD T. M. Gillett, Associate Counsel INTRODUCTION The Veteran, who is the Appellant, served on active duty from September 1961 to January 1966. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2008 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. Throughout the pendency of this appeal, one of the Veteran's claims has been adjudicated as service connection for PTSD; however, as the Veteran has been diagnosed with other psychiatric disorders, to include an anxiety disorder, the Board finds that the claim should be classified as one of service connection for a psychiatric disorder, to include PTSD and an anxiety disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (the scope of a health disability claim includes any disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record). The Veteran did not request a hearing before the Board. In January 2010, the Veteran submitted additional evidence, consisting of VA treatment records, along with a waiver of regional office review. The respective issues of service connection for a breathing disorder and a right ankle venous ulcer 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. The Veteran did not engage in combat with the enemy during service. 2. The Veteran was not personally assaulted in service. 3. The medical evidence of record does not contain a diagnosis of PTSD or any other disorder related to any actual occurrence in service . 4. The Veteran did not experience chronic symptomatology of a psychiatric disorder during service. 5. The Veteran did not experience continuous symptomatology of a psychiatric disorder after service. 6. In an August 2005 rating determination, the RO denied service connection for a breathing disorder, to include as due to asbestos exposure; the Veteran did not appeal to the Board within the required time period. 7. Evidence received since the July 2005 rating decision denying service connection for a breath disorder, to include as due to asbestos exposure, raises a reasonable possibility of substantiating the claim. CONCLUSIONS OF LAW 1. Service connection for a psychiatric disorder, to include PTSD and anxiety, is not warranted. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 4.125 (2010). 2. The August 2005 rating decision denying service connection for a breathing disorder, to include as due to asbestos exposure, became final. 38 U.S.C.A. § 7105 (c) (West 2002 & Supp. 2010); 38 C.F.R. §§ 20.302, 20.1103 (2010). 3. Evidence received since the August 2005 rating decision denying service connection for a breathing disorder, to include as due to asbestos exposure, is new and material, and the claim is reopened. 38 U.S.C.A. § 5108 (West 2002 & Supp. 2010); 38 C.F.R. § 3.156 (2010). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs (VA) has a duty to notify and assist Veterans in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2010). Because the determination below constitutes a grant of the application to reopen service connection for a breathing disorder, there is no reason to discuss the impact of the VCAA on that particular issue. For the claim for service connection for a psychiatric disorder, the Board will proceed to review compliance with the VCAA. VA has a duty to notify the claimant of any information and evidence needed to substantiate and complete a claim. 38 U.S.C.A. §§ 5102, 5103. In order to meet the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), VCAA notice must (1) inform the veteran about the information and evidence necessary to substantiate the claim; (2) inform the veteran about the information and evidence that VA will seek to provide; and (3) inform the veteran about the information and evidence the veteran is expected to provide. VCAA notice should be provided to a veteran before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). The United States Court of Appeals for Veterans Claims (Court) held in Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), 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) the veteran's status; (2) the existence of a disability; (3) a connection between the veteran's service and the disability; (4) the degree of disability; and (5) the 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 veteran 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. Id. at 486. This notice must also inform the veteran that a disability rating and an effective date for the award of benefits will be assigned if service connection is granted. Id. In this case, a VCAA notice letter sent in August 2007 substantially satisfied the provisions of 38 U.S.C.A. § 5103(a). In this letter, VA informed the Veteran about the information and evidence not of record that was necessary to substantiate the service connection claim; the information and evidence that VA would seek to provide; the information and evidence the Veteran was expected to provide; and information regarding disability rates and effective dates required by Dingess. The Board finds that all necessary assistance has been provided to the Veteran. VA has acquired the Veteran's service and VA treatment records to assist the Veteran with the claim. In March 2009, the Veteran was provided with a VA psychiatric examination to determine the nature and etiology of his claimed psychiatric disorder. The Board notes that the claims file, to include the service treatment records, were not provided to the March 2009 VA examiner. However, the Board finds that the examination was still adequate. First, the Board notes that the March 2009 VA examiner was able to review the Veteran's VA treatment records included in the electronic database and noted three such records in his report. Also, as will be explained more thoroughly following, the Veteran's service treatment records do not contain any notation indicating diagnosis or treatment for a psychiatric disorder during service, that is, there is no credible evidence of an in- service injury, disease, or event (including psychiatric symptoms) to which a purported nexus opinion could relate current psychiatric disability to service. Because there is no in- service injury or disease to which competent medical opinion could relate a current disability, there is no reasonable possibility that a VA examination or opinion could aid in substantiating the current claim for service connection for a psychiatric disorder. See 38 U.S.C.A. § 5103A(a)(2) (West 2002) (VA "is not required to provide assistance to a claimant . . . if no reasonable possibility exists that such assistance would aid in substantiating the claim"); 38 C.F.R. § 3.159(d) (VA to discontinue assistance where there is "no reasonable possibility that further assistance would substantiate the claim"). The Board has considered the decision in Charles v. Principi, 16 Vet. App. 370, 374-75 (2002); however, in the absence of evidence of an in-service disease or injury, referral of this case to obtain an examination and/or an opinion as to the etiology of the Veteran's claimed disability would in essence place the examining physician in the role of a fact finder, would suggest reliance on an inaccurate history of occurrence of an in-service injury or disease, and could only result in a speculative opinion or purported opinion of no probative value. In other words, any medical opinion which purported to provide a nexus between the Veteran's claimed disability and his military service would necessarily be based on an inaccurate history regarding what occurred in service, so would be of no probative value. The U.S. Court of Appeals for Veterans Claims (Court) has held on a number of occasions that a medical opinion premised upon an unsubstantiated account of a claimant is of no probative value. See, e.g., Swann v. Brown, 5 Vet. App. 229, 233 (1993) (generally observing that a medical opinion premised upon an unsubstantiated account is of no probative value, and does not serve to verify the occurrences described); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (the Board is not bound to accept a physician's opinion when it is based exclusively on the recitations of a claimant that have been previously rejected). The service treatment records also contain no notation indicating treatment or diagnosis for an alleged assault as suggested by the Veteran. The record indicates that the March 2009 VA examiner reviewed the history as provided by the Veteran and, having examined the Veteran, determined that he did not have PTSD or any other psychiatric disorder due to service. As the March 2009 VA psychiatric examination report was written after an interview with the Veteran and a review of the Veteran's VA treatment records, contained specific findings indicating the nature of the Veteran's claimed disability, and also contained an opinion, backed by clinical evidence, explaining why the Veteran did not have a service-related psychiatric disorder, there is no duty to provide an additional examination or medical opinion for this claim. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4). In view of the foregoing, the Board finds that VA has fulfilled its duty to notify and assist the Veteran in the service connection claim under consideration. Adjudication of the claim at this juncture, without directing or accomplishing any additional notification and/or development action, poses no risk of prejudice to the Veteran. Bernard v. Brown, 4 Vet. App. 384, 394 (1993). Service Connection Laws and Regulations Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. 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 prevail on the issue of service connection, generally, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f). If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of a veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 U.S.C.A. § 1154(b) (West 2002 & Supp. 2010); 38 C.F.R. § 3.304(f). Participation in combat, a determination that is to be made on a case-by-case basis, requires that a Veteran personally participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. See VAOPGCPREC 12-99; Moran v. Principi, 17 Vet. App. 149 (2003); see also Sizemore v. Principi, 18 Vet. App. 264, 273-74 (2004). If a veteran did not engage in combat with the enemy, or the claimed stressors are not related to combat, and the stressor is not related to "fear of hostile military or terrorist activity," then a veteran's testimony alone is not sufficient to establish the occurrence of the claimed stressors, and his testimony must be corroborated by credible supporting evidence. Cohen, 10 Vet. App. at 128; Moreau v. Brown, 9 Vet. App. 389 (1996); Dizoglio v. Brown, 9 Vet. App. 163 (1996). Furthermore, service department records must support, and not contradict, the claimant's testimony regarding non-combat stressors. Doran v. Brown, 6 Vet. App. 283 (1994). The question of whether a veteran was exposed to a stressor in service is a factual one, and VA adjudicators are not bound to accept uncorroborated accounts of stressors or medical opinions based upon such accounts. Wood v. Derwinski, 1 Vet. App. 190 (1991), aff'd on reconsideration, 1 Vet. App. 406 (1991). Hence, whether a stressor was of sufficient gravity to cause or support a diagnosis of posttraumatic stress disorder is a question of fact for medical professionals and whether the evidence establishes the occurrence of stressors is a question of fact for adjudicators. A PTSD claim based upon personal assault also involves different considerations. If a claim for service connection for PTSD is based on allegations of in-service personal assault, evidence from sources other than the Veteran's service records may corroborate the Veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor and such evidence include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. The regulation specifically provides that VA will not deny a PTSD claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than a veteran's service records or evidence of behavior changes may constitute credible supporting evidence of the stressor and allowing him or her the opportunity to furnish this type of evidence or advise VA of potential sources of such evidence. VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. 38 C.F.R. § 3.304(f)(3). It is the defined and consistently applied policy of the VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one that exists because of an approximate balance of positive and negative evidence, which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. See 38 C.F.R. § 3.102. Analysis of Service Connection for PTSD The Veteran essentially contends that he developed PTSD or an acquired psychiatric disorder due to stressors in service. Specifically, the Veteran claims that, at some point during service, he was attacked by three other service members. He indicated that, during this attack, the three men held him down and held a "K bar" to his neck. Having considered the evidence of record in light of the regulations noted above, the Board finds that a preponderance of the evidence is against service connection for PTSD or any other psychiatric disorder. First, the Board finds that the Veteran did not participate in combat with the enemy during service. Reviewing the evidence of record, in a service personnel record, specifically a Report of Transfer or Discharge (DD Form 214), the Veteran's military occupational specialty is listed as Reclamation and Salvage Man, which is not a combat-related occupation. Moreover, the DD Form 214 indicated that, during service, the Veteran was not awarded any decorations or medals indicating combat. Also, throughout the evidence of record, the Veteran has never claimed to have participated in combat. Therefore, the Board finds that the Veteran's claimed stressors must be corroborated by credible supporting evidence. Cohen, 10 Vet. App. at 128; Moreau, 9 Vet. App. at 389; Dizoglio, 9 Vet. App. at 163. The Board further finds that the Veteran's claimed in-service stressor, specifically an in-service assault, has not been corroborated by service records or other credible supporting evidence. The Board finds that the Veteran's accounts of an in- service assault are not credible and, as his accounts are the basic evidence regarding the assault's occurrence, that the Veteran was not assaulted during service. See Smith v. Derwinski, 1 Vet. App. 235, 237-38 (1991) (credibility is determined by the Board as fact finder). Reviewing the evidence, the Veteran's service treatment records do not include any notation or diagnosis for a psychiatric disorder, or chronic symptoms of psychiatric disorder in service. The Veteran's January 1966 service discharge medical examination indicated that the Veteran did not have any psychiatric disorders. The records also do not include any notations for wounds experienced during an assault. As will be explained below, the Veteran has given various dates for the supposed assault. In his most recent statements, the Veteran claimed that he was assaulted in either June or July 1963. Reviewing the service treatment records from that period, in June 1963 service treatment records, the Veteran was treated for acute urethritis due to gonococcus and nonspecific urethtritis. The Veteran stated that he was exposed in Okinawa and described onset of symptoms in June 1963. He was medically quarantined from June 24, 1963 through July 1, 1963. In a July 31, 1963 VA treatment record, the examiner stated that the Veteran was to be quarantined for 10 days due to urethritis acute. In a contemporaneous record, the Veteran stated that he noticed onset of symptoms on July 26, 1963. Therefore, the service treatment records, including those from June and July 1963, contain no mention of treatment for an assault or a resulting psychiatric disorder. Service personnel records also contain no reports of an assault. Reviewing the post-discharge treatment records and statements regarding the claimed stressor and its claimed effects, in an April 2006 VA treatment record, the Veteran stated that during basic training a drill instructor "busted" him in the mouth. He also stated that, after he had joined service and was still 17 years old, three individuals sat on top of him one night and held a "K bar" to his throat. He indicated that he was able to talk to them and they released him. He stated that he still woke up feeling a knife to his throat, but denied experiencing hallucinations. The Veteran stated that, for a while, he slept with a weapon under the bed. The Veteran indicated that he used to drink over the years in order to sleep soundly at night, but, since he had cut back drinking, he had started to experience anxiety again. The diagnoses were an anxiety disorder NOS and rule-out PTSD. Subsequently, in a May 2006 VA treatment record, the Veteran stated that he was mistrustful of blacks as black men had assaulted him during service. He indicated that he relived the incident and would ruminate on it. He now feared being around black men. He stated that he had been anxious since service, but never knew that it was a problem until he read of symptoms and realized that he had PTSD. In an August 2007 statement, the Veteran reported that, during service, he was assaulted by three people on Okinawa and that he woke up at night believing that someone was cutting off his head. The Veteran also stated that he refused to take any mind-altering drugs and wished only to undergo therapy for his disorder. In a December 2007 VA treatment record, Veteran denied any hypervigilance, hyperstartle response, or nightmares associated with the incident. However, he stated that he would wake up feeling that someone had a knife to his throat and that he tended to avoid large groups of people. The Veteran reported that he had experienced nocturnal anxiety episodes since service and, therefore, had self-treated with alcohol for many years. The examiner stated that, from the history supplied by the Veteran, it was likely that the Veteran was sufficiently symptomatic at discharge from service to warrant a diagnosis of PTSD which was not made at the time. At this time, the only remaining remnant of the original symptoms complex was bad dreams. The diagnosis was anxiety disorder. In an undated handwritten notation, written directly on the copy of the December 2007 VA treatment record included in the claims file, the Veteran wrote that he had been hypervigilant at certain times for 47 years. In a May 2008 VA treatment record, the Veteran indicated that he had awoken at night frequently for forty-seven years, feeling as if there was a knife to his throat. He indicated that the three men were black. However, he now felt afraid of white men as well. He stated that he felt more on guard around people. He also indicated that, sometimes, he would get a feeling that someone was after him and that, one day during the prior week, he saw a man standing by his bed. The diagnoses were anxiety disorder NOS and PTSD symptomatology. VA treatment records indicate that the Veteran was prescribed sertraline (Zoloft) in May 2008. In a May 2008 VA treatment record, the Veteran reported that he no longer felt on guard anymore. In a July 2008 VA treatment record, the Veteran recalled that the three individuals who assaulted him during service were fellow Marines from another unit. He recalled that he woke up to find one sitting on him, another sitting on his chest, and a third sitting on his legs. He remembered thinking that they were going to kill him. He told them to shine "the light" in his face because they had the wrong man. He indicated that he only saw the face of one of the men. He reported that, over the years, he thought he would see the persons who assaulted him by his bed. He indicated keeping a loaded pistol on his nightstand in case the person returned. He stated that he was now getting more rest than ever before. He also reported giving the gun in his nightstand to his wife. The diagnosis was PTSD. In an October 2008 statement, the Veteran indicated that on July 29, 1963, in Okinawa, he was attacked by three African-American Marines with a K-bar. He stated that the three individuals sat on his legs, stomach and chest, and put a knife to his throat, awakening him. He was told that they would cut his head off. He also indicated that they told him that they would be "back to finish the job." He stated that he had been on alert every day of his life since the incident. He recalled that he tried to get help from the sergeant in charge, but was told to simply watch for the perpetrators in his area. He said that he stayed up all night waiting for the men to return with a pistol and, as such, could not get up for his duties. He indicated that he would have flashbacks of the attack, to include waking up and feeling that the incident was happening again. He stated that he had slept with weapons ever since. He indicated that, since he started taking sertraline (Zoloft), his life had been livable again. While filing the above statement, the Veteran also submitted a copy of his in-service disciplinary proceedings, apparently as corroborating evidence regarding behavioral changes after the assault. In these documents, a notation dated July 31, 1963 indicates that the Veteran was punished for failing to go to his appointed place of duty at 5:30 A.M. He was awarded 14 days of restriction to the company area. On October 3, 1963, the Veteran was punished for again failing to leave his bunk despite being ordered to do so by a superior officer at 5:30 A.M. He was awarded 14 days of restriction to the company area and had to forfeit $20 per month. Finally, on February 5, 1964, the Veteran was noted to be absent without leave from 12:01 A.M. to 1:30 A.M. He was awarded one week of restriction to the dispensary, two hours of duty per days, and a monetary fine. In a March 2009 PTSD examination report, the VA examiner indicated that he did not have the claims file to review. In an interview, the Veteran stated that, during service, he lost rank due to numerous write-ups for insubordination, not reporting for duty, and for waiting up with guns for the individuals who assaulted him to return. He blamed the disciplinary actions on the assault and stated that he merely sought to protect himself from further attacks. The Veteran reported that the incident occurred in June 1963 in Okinawa. He indicated that he told his staff sergeant about the incident, but nothing was ever done about it and the individuals were never identified. He indicated that he had been hypervigilant ever since the incident. He stated that he slept with a loaded pistol, experienced nightmares in which the perpetrator of the incident came towards him, and occasionally saw a vision of the perpetrator beside his bed. In the March 2009 VA examination report, Veteran stated that he had alcohol problems over the years related to his PTSD which was related to the in-service assault. He worked for 38 years as a barber, running his own barbershop for many of those years. He stated that he had missed work at times because of his alcohol abuse. He also stated that the PTSD, caused by the single incident, caused his anger problems which led to the end of his first marriage. He indicated that he had quit using alcohol two years prior and that his anger problems went away after the use of Zoloft. Besides alcoholism, the Veteran could not name any particular occupational impairment caused by PTSD. As noted above, the March 2009 examiner did not have a copy of the claims file, to include the Veteran's service records; however, he did have access to the Veteran's computerized treatment records. He noted the May 2006 VA treatment record diagnosing alcohol abuse, a January 2009 VA treatment record indicating anxiety disorder, and a March 2009 VA treatment record diagnosing PTSD. In his report, the VA examiner noted that the Veteran seemed to contradict himself in stating that he saw the perpetrator at the foot of his bed as the perpetrator was never identified. Moreover, the examiner stated that the Veteran reported still experiencing symptoms of a psychiatric disorder, but then indicated that he had not experienced any symptoms since being prescribed Zoloft. Having reviewed the file, the March 2009 VA examiner assessed that the Veteran did not fit the criteria for a diagnosis of PTSD. This assessment was based on factually accurate assumptions that are consistent with the Board's findings in this decision, which include that the Veteran was not personally assaulted during service. The VA examiner did not believe that the Veteran had problems related to an assault during service. The examiner stated that, having conducted a mental status examination, he found that the Veteran had some mood instability and overall immaturity, but opined that these were derived from sources other than the alleged in-service assault. The VA examiner noted that psychometric testing, specifically that conducted using the Minnesota Multiphasic Personality Inventory- II, found that people with the Veteran's scores tended to be immature, egocentric, demanding, selfish with difficulty getting along with others, and tended to make physical complaints lacking in full substantiation by medical findings. Furthermore, the Veteran's scores were reflective of mood instability consistent with an undifferentiated somatoform disorder. The diagnoses based on the interview were an undifferentiated somatoform disorder and alcohol dependency. The examiner assessed that the Veteran did not have PTSD, and that the Veteran did not have a service-related mental disorder. Finally, in a September 2009 statement, the Veteran's wife indicated that she had been with her husband for 39 years. She reported noticing that he was irritable, and hypervigilant. She stated that she would wake up in the middle of the night, finding him with a pistol in his hand or checking to see if someone were outside their door. She also indicated that he would wake up in the middle of the night, gasping for air. She indicated that he also had nightmares and bad dreams throughout her marriage. She said that, from talking to her husband, his behavior was due to "3 black guys" attacking him "while in his Marine Corp (sic) barracks asleep in Okinawa, in 1963." She stated that once, in 1975, while in their home in Bedford, Texas, the Veteran was having a drink while attempting to fall asleep in their bedroom. He called her into the room and told her to take the gun, keep the kids in the room, and to shoot him in the leg if he came out of the room. The Veteran's wife stated that she called the police at that time and they stayed at the house for several hours. She indicated that her husband told the police that they he had experienced a nightmare and they left. Her husband later explained that he did this because he believed that he had been told by the voices of the men who jumped him that his family would die more horrible deaths than they could have imagined if he had killed the men. She reported leaving the Veteran on several occasions due to his behavior. She said she told him that she would come back if he got help. She stated that, in 2000, the Veteran went to the VA hospital and was prescribed Zoloft to change his mood. She indicated that he was doing better with his PTSD symptoms at this time. Having reviewed this lengthy evidence of record, the Board finds that the record does not contain evidence corroborating the Veteran's claimed stressors. First, the Board notes that, initially, the Veteran claimed that he was "busted" in the mouth by a drill instructor during basic training; however, the Veteran never mentioned this incident again in subsequent retellings of the alleged in-service stressful events, and never suggested that it resulted in any mental disorder. Regarding the incident involving an assault by three individuals, the Board finds that the Veteran's service treatment records do not contain any documentation corroborating the Veteran's account. As noted above, the service treatment and personnel records contains no notation indicating treatment for an assault. The Veteran's service treatment records indicate that the Veteran was never diagnosed as having any psychiatric disorder during service, or even complaining of psychiatric symptoms during service. While the absence of treatment in service alone is generally only one factor for consideration, and is not required to corroborate a veteran's assertion of in-service stressor, the absence of treatment entry in this Veteran's case is highly probative because the Veteran specifically represented that he was treated in service following the alleged assault. Also, despite the Veteran's statements made during the claim that he experienced anxiousness since the in-service incident, the Veteran's January 1966 service discharge examination report indicated that the Veteran did not have any psychiatric problems upon discharge. In the March 2009 VA PTSD examination report, the Veteran stated that he told his staff sergeant about the incident; however, the record contains no notation made by any of the Veteran's superiors about the incident. Moreover, in October 2009, the Veteran filed a copy of his in-service disciplinary proceedings, indicating punishment for either failing to be at his appointed station or being AWOL on July 31, 1963, October 3, 1963, and February 5, 1964, respectively. The record indicates that the Veteran sought medical treatment on July 31, 1963, the date of the first disciplinary action; however, instead of seeking help for anxiety or any other symptomatology related to an assault, service treatment records indicate that the Veteran instead sought treatment for urethrititis acute which had become symptomatic a few days earlier. Such evidence of treatment for unrelated disorders reflects an affirmative absence of complaints or treatment for the claimed assault, which is inconsistent with the Veteran's assertion of treatment following an assault. Moreover, the Veteran's service personnel evaluations never indicated any changes in performance or the quality of the Veteran's service. The Veteran's performance scores consistently indicated good performance. On May 11, 1963, the scores were 4.2, 4.5 and 4.5. On July 31, 1963, they were 4.2, 4.5, and 4.5. On November 2, 1963, they were 4.2, 3.9, and 4.3. On January 31, 1964, they were 4.2, ,4.4, and 4.4. For the rest of the Veteran's nearly two years in service, the Veteran's lowest performance rating was a 3.5 in January 1966 and, even in that month, his other scores were 4.0 and 4.0. Therefore, the record does not indicate a deterioration in work performance after the purported assault. In support of his claim, the Veteran submitted a letter from his wife; however, as the Veteran's wife has been with the Veteran for only 39 years, she admits that all knowledge she has of the incident comes from conversations with the Veteran. As the wife is not a witness to the events or behavioral changes soon after the alleged in-service events, her repetition of what the Veteran told her is no more probative value than the Veteran's own story of in-service assault. For this reason, the Board find that the Veteran's claimed in-service stressor involving an in-service assault by three fellow Marines has not been corroborated by the wife's statements. Moreover, as stated above, the Board finds that the Veteran's accounts of an in-service assault lack credibility. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (finding that the Board, as part of its duties, is required to assess the credibility, and therefore the probative value, of proffered evidence in the context of the record as a whole). First, the Board notes that the Veteran's statements indicating in-service behavior changes due to the assault and subsequent disciplinary actions are internally inconsistent and inconsistent with other evidence of record, so are not credible. As noted above, the Veteran stated that, after the incident, he was punished during service for missing his assigned duties as he was unable to awaken, having stayed up looking for the attackers. However, in later statements inconsistent with this one, the Veteran indicated that he was further disciplined for keeping guns and ammunitions at his bedside. Also, the Veteran stated that he lost ranks due to these behaviors and left service as a result of disciplinary actions. The e record indicates that the Veteran was disciplined three times, between July 31, 1963 and February 5, 1964. In the first disciplinary action, dated July 31, 1963, the Veteran was punished for failure to appear at his place of duty. However, the account of the second infraction, dated October 3, 1963, indicates that the Veteran was ordered by a superior officer to be out of his bunk and report to duty, and he refused to obey. This account, indicating a direct refusal to follow orders, contrasts with the Veteran's story of sleeping through his assignment due to a lack of sleep. The final infraction report, dated February 5, 1964, indicates that the Veteran violated Article 86 of the Uniform Code of Military Justice, indicating that he was AWOL from 0001 (12:01 A.M. to 0130 (1:30 A.M) on February 5, 1964. The Board notes that, considering the Veteran was AWOL in the middle of the night, this infraction does not support the Veteran's contention that he had trouble making his morning duty due to oversleeping. The Board notes that, after the last infraction, the Veteran continued to serve until January 1966 and that, during this nearly two-year span, he was never punished for any subsequent behavioral problems. Further, although the Veteran was punished for failing to report and going AWOL, the service personnel records contain no notation indicating punishment for keeping ammunition by his bedside, as claimed by the Veteran. Also, the service personal records contain no notation indicating that the Veteran lost ranks due to his post-assault behavior. In fact, the service personnel records indicate that the Veteran was promoted from a private first class to a lance corporal in January 1965. The record indicates no demotions of rank or other punishment after this promotion until the Veteran's honorable discharge in January 1966. As the contemporaneous service personnel records contradict the Veteran's accounts of disciplinary actions resulting from abnormal behavior caused by the in-service incident, the Board finds that his accounts of such behavior lack credibility. More importantly, the Board finds that the Veteran's accounts of the assault itself lack credibility. First, and most importantly, the Board notes that the Veteran's accounts of the assault are not internally consistent, as details constantly changed or were added. Initially, in an April 2006 VA treatment record, the Veteran stated that the assault occurred while he was still 17 years old. As the Veteran was born in March 1944, to be consistent, the incident would have had to have occurred in the period between March 1961 and March 1962. However, in later statements, the Veteran indicated the incident occurred on Okinawa. As the Veteran was stationed in Okinawa from February 1963 to February 1964, the record would suggest that the incident occurred between these dates. However, in a notation written on a VA treatment record, the Veteran stated that, as a result of the incident, he had been hypervigilant for the past 47 years. The Board notes that the file has been in the Board's care and custody since December 1963, so the Veteran must have written the notation at some time between December 2007 and December 2009. If 47 years had passed since the incident, as suggested in this record, the incident would have occurred in a period between 1960 and 1962. Yet, in an October 2008 statement, issued with a copy of the disciplinary proceedings indicating punishment on July 31, 1963, the Veteran stated that the incident definitely occurred on July 29, 1963. However, in the March 2009 PTSD examination report, the Veteran recalled that it occurred in June 1963. The Board notes that the Veteran essentially claims that this incident scarred him for life, causing symptomatology thereafter. Therefore, the Veteran's inability to recall a consistent date, to include the month or, at least, the year, undermines his credibility. Moreover, the Board notes that the details of the Veteran's accounts are inconsistent, with the Veteran changing and adding facts with each telling. Initially, in April 2006, the Veteran claimed that three individuals sat on top of him at night and held a "K bar" to his throat. He indicated that he was able to talk to them and they released him. In a May 2006 VA treatment record, the Veteran recalled that the individuals were African- American, a fact not previously specified. In July 2008, although the Veteran stated that he only saw the face of one man, and that the three men shone a light in his face to see who the Veteran was, indicating that it was too dark to discern anyone's face. However, despite being in the dark and being unable to see the faces of any man but one, the Veteran asserted that he was able to identify the three men as both African-Americans and as fellow Marines from another unit. Moreover, in his early accounts, the Veteran did not recount any instances in which the individuals said anything to him, such as any threats, and reported that they left after the Veteran talked to them. However, in an October 2008 statement, the Veteran stated that the men threatened to cut off his head and, upon leaving, despite finding out that they had the wrong individual, told him that they would be "back to finish the job." As the Veteran's story has changed so dramatically over the pendency of this appeal, contains many implausible details such as the ability to identify the individuals race and unit in a dark room, is not corroborated by the evidence in the service personnel and service treatment records, but is contradicted by service treatment and personnel records that reflect no complaints or treatment for assault and no corroborating behavioral changes, the Board finds that the Veteran's stressor story is not credible. Considering the treatment records indicating a normal psychiatric demeanor at discharge, continued promotion throughout service, and the lack of disciplinary proceedings claimed by the Veteran, the Board finds that the evidence affirmatively indicates that the assault did not occur. For these reasons, the Board finds that the weight of the evidence demonstrates that the Veteran was not personally assaulted in service. The question of whether the Veteran was exposed to a stressor in service is a factual one, and VA adjudicators are not bound to accept uncorroborated accounts of stressors or medical opinions based upon such accounts. See Wood, 1 Vet. App. at 190 (noting that the question of whether the Veteran was exposed to a stressor in service is a factual one to be determined by the adjudicator). Reviewing the medical evidence, the Board notes that the record contains many VA treatment records indicating a diagnosis PTSD or anxiety, due to the in-service assault. However, as the Board finds that the evidence indicates that the in-service assault did not occur, the Board finds that the examination findings of a mental disorder based on the alleged assault are based on an inaccurate factual premise, so are of no probative value. Id. (noting that the adjudicator is not bound to accept uncorroborated accounts of stressors or medical opinions based upon uncorroborated stressors). The Court has held on a number of occasions that a medical opinion premised upon an unsubstantiated account of a claimant is of no probative value. See, e.g., Swann v. Brown, 5 Vet. App. 229, 233 (1993) (generally observing that a medical opinion premised upon an unsubstantiated account is of no probative value, and does not serve to verify the occurrences described); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (the Board is not bound to accept a physician's opinion when it is based exclusively on the recitations of a claimant that have been previously rejected). The Board also notes that, in the March 2009 PTSD examination report, the examiner detailed reviewing the Veteran's recent VA treatment records, to include those diagnosing PTSD. He also interviewed the Veteran and performed a thorough examination, including the provision of a Minnesota Multiphasic Personality Inventory-II test. Based on the records, interview, and testing, the VA examiner diagnosed the Veteran with mood instability consistent with an undifferentiated somatoform disorder. The diagnoses based on the interview were an undifferentiated somatoform disorder and alcohol dependency, in remission. Considering the thoroughness of the examination and the rationale presented for the findings, the Board finds that the March 2009 PTSD examiner's findings have probative value in this matter. See Prejean v. West, 13 Vet. App. 444, 448 (2000) (indicating that the Board may determine the probative value of medical opinions based on their detail of their analysis). Finally, the Board notes that, in the informal hearing presentation, the Veteran's representative contended that the Veteran should be awarded service connection for a mental disorder because the evidence showed that he had a mental disorder during service, continuous symptomatology of a mental disorder after service, and a currently diagnosed mental disorder. See 38 C.F.R. § 3.304(f). As proof of an in-service mental disorder, the representative called attention to the December 2007 VA treatment record, in which a VA examiner wrote "from history supplied by the Veteran, it is likely that he was symptomatic at discharge from . . . service to warrant a diagnosis of PTSD which was not made at that time." The Board notes that the December 2007 VA examiner wrote this opinion, based entirely on the Veteran's factually inaccurate account of an in-service assault and symptomatology of a psychiatric disorder throughout service. As explained above, the Board finds that the assault did not occur and that the service treatment and personnel records contradict the Veteran's accounts of in-service symptomatology. As the December 2007 VA examiner's findings were based entirely on the Veteran's accounts of an in-service assault which did not occur, the Board does not accept its findings, which are of no probative value. See Wood, 1 Vet. App. at 190. The Veteran has stated that he has experienced symptomatology of a psychiatric disorder, in particular hypervigilance, since service. His wife also submitted a statement, indicating that the Veteran experienced symptomatology based on the in-service assault. However, the Board again notes that the accounts of the Veteran and his wife were based on symptomatology arising from memories of the in-service assault which the Board finds did not occur. Therefore, the Board finds them to lack credibility in this matter. Parenthetically, the Board also notes that the Veteran's accounts of post-service symptomatology are so inconsistent as to lack credibility. In the first record of treatment, dated April 2006, the Veteran stated that he had recently started to feel anxiety when he stopped drinking two years prior. He said that he woke up, feeling a knife at his throat, but specifically denied any hallucinations. Inconsistent with this assertion, in a July 2008 VA treatment record, the Veteran reported seeing a vision of a person who assaulted him by his bedside. In a December 2007 VA treatment record, the Veteran specifically denied being hypervigilant; however, in May 2008 during VA treatment, the Veteran claimed to have experienced hypervigilance for the past 47 years. Even the September 2009 statement, submitted by the Veteran's wife, is inconsistent with regard to the both the symptomatology reported by the Veteran and the history of the case as stated in the claims file. In this account, the Veteran's wife stated that, during one incident in 1975, the Veteran informed her that he had heard the voices of the three men who had assaulted him during service and that they were threatening to kill the Veteran's family if he tried to hurt these men; therefore, he gave her a gun and told her to shoot him in the leg if he left his bedroom. The Board notes that in this statement the Veteran's wife is claiming that the Veteran experienced auditory hallucinations, voices in his head, he thought were those of the three men. Throughout the treatment records included in the record, the Veteran claimed to have experienced visual hallucinations, but never mentioned experiencing auditory hallucinations. Moreover, the Veteran's wife stated that, due to his symptoms, she left the Veteran and did not return until he sought treatment at the VA and began taking Zoloft in 2000. Contradictory to this assertion, the record shows that the Veteran did not seek treatment until April 2006, and VA treatment records show that the Veteran was not prescribed Zoloft until May 2008. As the Veteran's wife essentially claims that the Veteran's treatment and use of medication had saved their marriage, one would expect that she would have a better memory of what year said treatment occurred. For these reasons, and other reasons previously cited, the Board finds the accounts of the Veteran and his wife are not credible because they are inconsistent with each other and inconsistent with the facts noted in other evidence of record. In conclusion, the Board finds as a fact that the Veteran was not assaulted during service. Consequently, all accounts of in- service assault, of chronic psychiatric symptoms in service or continuous post-service symptoms, are factually inaccurate. There is also no factual basis to support the purported medical findings that current psychiatric symptomatology is related to service, as there is no in-service injury or disease to which such currently diagnosed psychiatric disorders could be related. The evidence of record not only does not corroborate his non- combat stressor, but is affirmatively inconsistent with many of the reported details surrounding the in-service stressors and other in-service events claimed by the Veteran pursuant to his VA disability compensation claim. The treatment records do not contain a diagnosis of PTSD related to a confirmed stressor. Also, the evidence does not indicate a diagnosis for a service-related psychiatric disorder that is based upon a factually accurate history, that is, that is not based on the Veteran's accounts of symptoms associated with the claimed in-service assault. For these reasons, the Board finds that the preponderance of evidence weighs against the Veteran's claim for service connection for a psychiatric disorder, including PTSD and anxiety. As the preponderance of the evidence weighs against the Veteran's claim, the benefit of the doubt doctrine is not applicable, and the claim for service connection must be denied. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. New and Material Evidence Laws and Regulations Generally, a claim which has been denied may not thereafter be reopened and allowed based on the same record. 38 U.S.C.A. § 7105. However, pursuant to 38 C.F.R. § 5108, if new and material evidence is presented or secured with respect to a claim which has been disallowed, the VA Secretary shall reopen the claim and review the former disposition of the claim. New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence is defined as 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). In determining whether evidence is "new and material," the credibility of the new evidence must be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). Regardless of the RO's determination as to whether new and material evidence has been submitted, the Board has a jurisdictional responsibility to determine whether a claim previously denied by the RO is properly reopened. See Jackson v. Principi, 265 F.2d 1366 (Fed. Cir. 2001) (citing 38 U.S.C.A. §§ 5108, 7105(c)). Accordingly, the Board must initially determine whether there is new and material evidence to reopen the claim. Reopening Service Connection for a Breathing Disorder In an August 2005 rating decision, the RO denied the Veteran's claim for a breathing disorder, to include as due to exposure to asbestosis, finding that the evidence did not show that the Veteran has a current diagnosis of a breathing disorder. Because the Veteran did not appeal this decision to the Board, it became final. 38 U.S.C.A. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2010). Reviewing the evidence submitted since the August 2005 rating decision, in a June 2009 VA treatment record, an examiner diagnosed the Veteran as having chronic obstructive pulmonary disorder (COPD). In multiple statements and treatment records, the Veteran has contended that his breathing problems are related to in-service exposure to asbestos. The Board finds that the June 2009 VA treatment record indicates that the Veteran has a breathing disorder, specifically COPD, a diagnosed disability not in evidence at the time of the August 2005 rating decision. Therefore, the Board finds that the evidence received since the August 2005 rating decision regarding the Veteran's hypertension is new and material, as it relates to an unestablished fact of a current COPD diagnosis that is necessary to substantiate the claim for service connection, and raises a reasonable possibility of substantiating the claim. Accordingly, the evidence is new and material, and the claim for service connection for a breathing disorder will be reopened. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156. ORDER Service connection for a psychiatric disorder, to include PTSD and anxiety, is denied. Service connection for a breathing disorder, to include as secondary to asbestos exposure, is reopened. REMAND The Board finds that additional development is warranted to address the merits of the Veteran's respective claims for service connection for a breathing disorder and a right ankle venous ulcer, both to include as due to asbestos exposure. 38 C.F.R. § 19.9 (2010). VA must afford a veteran a medical examination or obtain a medical opinion when necessary to make a decision on a claim. See 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4) (West 2002 & Supp. 2010). The Court in McLendon v. Nicholson, 20 Vet. App. 79 (2006), provided further guidance, outlining that VA must provide a medical examination when there is: (1) competent evidence of a current disability or persistent recurrent symptoms of a disability; (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 Secretary to make a decision on the claim. With respect to the third factor above, the Court stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. The types of evidence that "indicate" that a current disability "may be associated" with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon, 20 Vet. App. at 83. Regarding service connection for a breathing disorder, as noted above, the Veteran has been diagnosed with a breathing disorder, specifically COPD. The Veteran has repeatedly insisted that the disorder was due to asbestos exposure during service. The Board notes that, as stated in the May 2009 Statement of the Case, VA recognizes that the Veteran experienced some degree of asbestos exposure during service. The Board further notes that, in an August 2009 VA treatment record, indicating a CT scan of the Veteran's chest, the examiner found no calcified or noncalcified pleural plaque formation evident at the time. Therefore, the examiner found no current, definitive CT evidence of prior asbestos exposure. Although the August 2009 VA treatment record weighs against the Veteran's claim, the Veteran was not provided with an examination to determine whether the Veteran's current breathing disorder, diagnosed as COPD, is related to any incident in service, to include the asbestos exposure. As the Veteran was diagnosed with COPD during the pendency of this appeal, was exposed to some asbestos during service, and is now contending that his COPD is related to an incident during service, specifically the in- service exposure to asbestos, the record contains sufficient evidence suggesting that a breathing disorder may be associated with active service so as to warrant a VA examination and medical opinion under the low threshold of McLendon. Likewise, regarding the claim for service connection for a right ankle venous ulcer, the Veteran has a current diagnosis for this disability. The Veteran contends that this disability is related to asbestos exposure during service. The Board also notes that, in a May 1965 service treatment record, the examiner noted that the Veteran had experienced an in-service traumatic injury to the right ankle due to a motor bike accident. As the Veteran has a diagnosed right ankle venous ulcer, experienced a right ankle injury during service, was exposed to some asbestos during service, and is now contending that his right ankle venous ulcer is related to an incident during service, specifically exposure to asbestos, the record contains sufficient evidence suggesting that right ankle venous ulcer may be associated with active service so as to warrant a VA examination and medical opinion under the low threshold of McLendon. Accordingly, the issues of service connection for a breathing disorder (COPD) and service connection for a right ankle venous ulcer are REMANDED for the following action: 1. Schedule the Veteran for appropriate VA medical examination(s), to include a pulmonary examination. The examiner should identify any current breathing or right ankle disorder. The relevant evidence from the claims file should be available for the examiner's review. The examination should include X-rays, CT scans, or any other necessary testing to determine exposure to asbestos. If X-rays are performed, the examiner is asked to identify any radiological changes attributable to exposure to asbestos. The examiner should also perform all necessary tests necessary regarding the Veteran's right ankle venous ulcer. The examiner(s) should then offer the following opinions: (a) Is it at least as likely as not (50 percent or greater probability) that any breathing disorder that is currently present, to include COPD, began during service or is causally linked to any incident of service, to include the in- service asbestos exposure? (b) Is it at least as likely as not (50 percent or greater probability) that that the Veteran's right ankle venous ulcer began during service or is causally linked to any incident of service, to include the in-service asbestos exposure or the May 1965 right ankle injury? The examiner is requested to answer the questions posed with use of the as likely, more likely, or less likely language. If the examiner must resort to speculation to answer the questions presented, it should be so stated in the examination report. In writing the opinions addressing the above-listed questions, the examiner should expressly indicate the bases for the opinions, including the clinical findings or other evidence of record that support the opinions. The examiner is advised that the term "as likely as not" does not mean within the realm of possibility. Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is medically sound to find in favor of causation as to find against causation. More likely and as likely support the contended onset date or causal relationship; less likely weighs against the claim. 2. After completion of the foregoing and all other necessary development, the AMC/RO should re-adjudicate the Veteran's respective claims for service connection for a breathing disorder and a right ankle venous ulcer, both including as secondary to in-service asbestos exposure. If the benefits sought remain denied, the Veteran and his representative should be furnished a Supplemental Statement of the Case (SSOC), and should be given an opportunity to submit written or other argument in response before the claims file is returned to the Board for further appellate consideration. The Veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). The Veteran is advised to appear and participate in any scheduled VA examination(s), as failure to do so may result in denial of the claim(s). See 38 C.F.R. § 3.655 (2010). 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. 2010). ______________________________________________ J. Parker Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs