Citation Nr: 1104168 Decision Date: 02/02/11 Archive Date: 02/14/11 DOCKET NO. 06-05 741 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Oakland, California THE ISSUES 1. Entitlement to service connection for diabetes mellitus, to include as due to exposure to herbicides. 2. Entitlement to service connection for a chronic skin condition, to include as due to exposure to herbicides and ionizing radiation. 3. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depression. 4. Entitlement to service connection for migraine headaches, to include as secondary to an acquired psychiatric disorder. 5. Entitlement to a compensable initial evaluation for service- connected bilateral hearing loss. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and Appellant's Spouse ATTORNEY FOR THE BOARD M. Sorisio, Counsel INTRODUCTION The Veteran served on active duty from January 1964 to October 1967. These matters are before the Board of Veterans' Appeals (Board) on appeal from December 2004 and June 2006 rating decisions of the Oakland, California Department of Veterans Affairs (VA) Regional Office (RO). In March 2009, a Travel Board hearing was held before the undersigned. A transcript of the hearing is of record. At the hearing, the Veteran submitted additional evidence with a waiver of RO initial consideration of such evidence. The Veteran was granted a 90-day abeyance period for the submission of additional evidence to support his claims and he submitted evidence during that period with a waiver of RO initial consideration of the evidence. Additionally, in January 2011, the Veteran submitted additional evidence without a waiver of RO initial consideration. The Board notes that the Veteran originally filed separate claims for service connection for an acquired psychiatric disorder, to include depression, and for service connection for PTSD. In Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the United States Court of Appeals for Veterans Claims (Court) held that the scope of a mental health disability claim includes any mental disorder that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and other information of record. To ensure that the full scope of the psychiatric claim is considered, the Board has recharacterized the issue as a single claim of service connection for an acquired psychiatric disorder, to include PTSD and depression. The Veteran is not prejudiced by this recharacterization, as it ensures that any mental disorder reasonably encompassed by his original claims will be considered. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action on his part is required. REMAND The Board has determined that before it can adjudicate the Veteran's claims, additional development is required, as described below. A. Veterans Claims Assistance Act of 2000 (VCAA) A VCAA notice letter consistent with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. The Veteran's claim for service connection for migraine headaches is, in part, based on a theory that migraine headaches are secondary to an acquired psychiatric disorder, for which he is also seeking service connection. A September 2008 VCAA notification letter substantially complied with VCAA notice requirements regarding a claim for direct service connection for migraine headaches; however, this letter did not specifically inform the Veteran of the requirements for proving a claim of secondary service connection. Hence, the Veteran must be given this notice on remand. B. VA and Private Treatment Records The Veteran has indicated that he receives ongoing VA treatment for several of his claimed conditions. The most recent VA records showing continuing treatment are from July 2005. In January 2011, the Veteran submitted VA Form 21-4142, Authorization and Consent to Release Information to VA, for records of treatment for diabetes with Dr. S.B. at the McClellan VA Outpatient Clinic. With regard to the Veteran's claim for an initial compensable rating for bilateral hearing loss, a July 2004 VA treatment record indicates that audio form 10-2464, Summary Report of Examination for Loss of Organic Hearing Acuity, was completed on July 29, 2004 by D.F., M.S. and was located on Vista imaging. A copy of this record has not been associated with the claims file. A December 2005 letter from VA physician E.C.H. indicates that he completed audiometry testing on the Veteran in December 2005. He also stated that he planned to perform serial audiograms to ensure that the Veteran did not have a tumor. The record does not contain records of such audiometry. As the above described VA records are constructively of record, they must be secured and associated with the claims file on remand. Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). In June 2006, the Veteran submitted a November 21, 2005 graphical report of audiometry. It is unclear whether the audiometry was completed by a VA or private treatment provider. Additionally, the audiometry findings are shown in a graphical format that is unclear; hence, the Board is unable to interpret them. This report also does not indicate whether speech discrimination testing using the Maryland CNC test was performed. As this information is factual, objective, and relevant to assessing the level of the Veteran's hearing loss during the appeal period, the Board has determined that further clarification of this report is necessary. See Savage v. Shinseki, No. 09-4406, 2011 WL 13796, at *10-12 (Jan. 4, 2011) (holding that in instances where "missing information is relevant, factual, and objective" and bears on the probative value of a medical report, VA must seek clarification from the examiner or explain why such clarification would be unreasonable). As the origin of the report is unclear, the Veteran must first be contacted and asked to identify who completed the audiometric testing on November 21, 2005, so the RO can then seek further clarification from that treatment provider. At the March 2009 hearing, the Veteran reported that he receives treatment for his skin condition and that his physician provides him with ointments for treatment. The evidence of record does not reveal such treatment and it is unclear from the hearing testimony whether the Veteran receives such treatment from a private or VA treatment provider. Thus, on remand, the Veteran must be asked to provide more information regarding the treatment he receives for his skin condition. C. Social Security Administration (SSA) Records A February 2004 letter from the Veteran's private physician, Dr. M.K.S., indicates that the Veteran was applying for SSA benefits. The letter states that Dr. M.K.S. supported the Veteran's application because the Veteran had heart disease that severely limited his activities. An October 2005 Vet Center treatment record indicates that the Veteran is in receipt of SSA disability benefits for multiple health problems. The claims file does not reflect that SSA records have been requested. Although Dr. M.K.S.'s letter suggests the Veteran may be receiving SSA benefits mainly based on nonservice-connected heart disease, the October 2005 Vet Center record indicates he could be receiving the benefits based on other disabilities. As SSA records are constructively of record and may be pertinent to the Veteran's claims, an attempt must be made to secure them on remand. 38 C.F.R. § 3.159(c)(2); see Golz v. Shinseki, 590 F.3d 1317, 1323 (Fed. Cir. 2010) (finding that if there is a reasonable possibility that SSA records are relevant to a claim, VA is required to assist the claimant in obtaining the identified records). D. Deck Logs As will be explained in detail below, the Board has determined that it is necessary to secure deck logs for the U.S.S. Benjamin Stoddert from December 1965 and January 1966 pursuant to the Veteran's claims of service connection for disabilities claimed to be a result of exposure to herbicides and for an acquired psychiatric disorder. 1. Herbicide Exposure The Veteran alleges that he has diabetes and a chronic skin condition as a result of exposure to herbicides in Vietnam. Absent affirmative evidence to the contrary, there is a presumption of exposure to herbicides (to include Agent Orange) for all veterans who served in Vietnam during the Vietnam Era (the period beginning on January 9, 1962, and ending on May 7, 1975). 38 U.S.C.A. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). "Service in Vietnam" for purposes of applying the herbicide presumption includes service in the waters offshore or service in other locations if the conditions of service involved duty or visitation to Vietnam from January 9, 1962 to May 7, 1975. 38 U.S.C.A. § 1116(a)(3); 38 C.F.R. §§ 3.307(a)(6)(iii); 3.313(a). In Haas v. Peake, 525 F.3d 1168, 1187-90 (Fed. Cir. 2008), the United States Court of Appeals for the Federal Circuit confirmed VA's interpretation of 38 C.F.R. § 3.307(a)(6)(iii) as requiring a service member's presence at some point on the landmass or inland waters of Vietnam in order to benefit from the regulation's presumption. A Veteran who never went ashore from a deep water naval vessel on which he served in Vietnamese coastal waters is not entitled to presumptive service connection due to alleged Agent Orange/herbicide exposure. Haas, 525 F.3d at 1193- 94; see VAOPGCPREC 27-97 (July 23, 1997). The record currently does not reflect that the Veteran was present on the landmass or inland waterways of Vietnam. The Veteran's service personnel records show that he served aboard the U.S.S. Benjamin Stoddert from September 1964 to October 1967. He has alleged that the Stoddert traveled in the inland waterways of Vietnam around Christmas of 1965. At the March 2009 hearing, he testified that the Stoddert went about 50 miles up the Mekong river in Vietnam. In the process of backing out of the river, the Stoddert got stuck on a sand bar for twenty-four hours. The Veteran has alleged that while the ship was stuck there, it was sprayed with Agent Orange and the ventilation system had to be closed down so the Agent Orange did not circulate throughout the vessel. The Veteran has also indicated that the ship had .761 caliber guns shooting at it while it was stuck on the sand bar and that there were holes on the side of the ship that needed to be repaired. He stated that the ship also was damaged from being stuck on the sand bar and had to head to Japan for repairs; because of the damage, it took eight days for the Stoddert to return to Japan. In May 2006, the National Personnel Records Center (NPRC) certified that the Stoddert sailed in the official waters of the Republic of Vietnam from December 5, 1965 to January 23, 1966. The Dictionary of American Naval Fighting Ships (Dictionary) shows that the Stoddert was a guided missile destroyer that arrived off the shore of Vietnam on December 16, 1965. The ship was then involved in the campaigns of Operation "Rolling Thunder" and Operation "Sea Dragon." In early January 1966, the Stoddert fired its 5-inch guns against Viet Cong targets ashore. On January 22, 1966, the Stoddert proceeded to Yokosuka, Japan, arriving there on January 28th. The destroyer spent a week in Japan to repair a broken steam blower. Although this history indicates that the ship was in official Vietnam waters and was damaged during the time period the Veteran alleges it was in the inland waterways of Vietnam, it does not provide sufficient evidence to conclude that the Stoddert sailed in inland Vietnam waterways. Therefore, the RO must request from the appropriate Federal custodian deck logs for the U.S.S. Benjamin Stoddert from December 5, 1965 to January 23, 1966 to investigate whether the Stoddert sailed in the inland waterways of Vietnam during that time frame. Review of these deck logs is crucial to determining whether the Veteran is presumed to have been exposed to herbicides. 2. Acquired Psychiatric Disorder Including PTSD and Depression The RO must also review the above requested deck logs to see if they contain credible supporting evidence of the Veteran's claimed in-service stressor event. The Veteran has contended that around December 1965 the Stoddert was traveling in the Tonkin Gulf doing shore bombardments when the spotter identified the wrong coordinates for the desired target and the Stoddert shot at an orphanage, killing many children. The captain had the intercom on throughout the ship so everyone, including the Veteran, could hear the announcement that the Stoddert had hit an orphanage. The regulations governing service connection for PTSD were recently amended to liberalize the evidentiary standard for establishing a required in-service stressor where a claimed stressor is related to fear of hostile military or terrorist activity. Stressor Determinations for Posttraumatic Stress Disorder, 75 Fed. Reg. 39,843 (July 13, 2010) (to be codified at 38 C.F.R. § 3.304(f)(3)), corrected by 75 Fed. Reg. 41,092 (July 15, 2010). These amendments are applicable to the Veteran's appeal. Id. at 39,843 (stating that the amendments are applicable to appeals currently before the Board that have not yet been decided). "Fear of hostile military or terrorist activity" is defined as where "a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror." Id. at 39,852. In the absence of clear and convincing evidence to the contrary, the Veteran's lay testimony alone may establish the occurrence of such a stressor if the claimed stressor is consistent with the places, types, and circumstances of the Veteran's service and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the Veteran's symptoms are related to the claimed stressor. Id. On July 2005 VA psychiatric examination, the examiner concluded the Veteran had Axis I diagnoses of major depressive disorder and PTSD. He opined that the Veteran had PTSD related to his work on a gunnery crew on a destroyer off the coast of Vietnam and his severe guilt over the fact that it was reported they had destroyed an orphanage killing numerous children and innocent people. Although the VA examiner related the diagnosis of PTSD to the Veteran's alleged stressor, the opinion appears to be at least partially based on an inaccurate factual premise - that the Veteran was a part of a gunnery crew that incorrectly hit an orphanage. Statements and testimony from the Veteran have indicated that he heard over the intercom that the ship's weapons had hit the orphanage, not that he was a part of the gunnery crew that actually engaged weapons against the orphanage. Additionally, the Veteran's service personnel records indicate that he was a Machinist Mate; there is no indication in these records that he worked with a gunnery crew. Thus, the July 2005 examination does not sufficiently confirm that the Veteran's alleged stressor is adequate to support a diagnosis of PTSD as it is based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (finding that a physician's opinion based on an inaccurate factual premise has no probative value). As the record currently stands, the evidence does not support that the Veteran's claimed stressor is consistent with the places, types, and circumstances of the Veteran's service. As noted above, the Dictionary shows that the Stoddert was involved in campaigns off the coast of Vietnam and that in early January 1966, the Stoddert fired its 5-inch guns against Viet Cong targets ashore. However, the evidence is vague and does not indicate that the Stoddert hit any wrong targets. The occurrence of such an event cannot be viewed as being consistent with the places, types, and circumstances of the Veteran's service as a Machinist's Mate. Therefore, the evidence is not sufficient for the Veteran's lay testimony alone to establish the occurrence of the alleged stressor. See 75 Fed. Reg. at 39,852. In light of the foregoing, however, the Board finds that more development regarding the alleged stressor is necessary. Since the Veteran contends the stressor event occurred around Christmas in 1965, the December 1965 and January 1966 deck logs requested above must also be reviewed on remand to determine if they provide credible evidence supporting the occurrence of the alleged stressor event. 38 C.F.R. § 3.304(f). E. Radiation Exposure The Veteran contends that he was exposed to ionizing radiation during service. Specifically, he has alleged that during 1965 or June or July of 1966 he was involved in an atomic bomb test when the Stoddert was stationed in the South Pacific Islands. In his February 2006 stressor statement, the Veteran raised the atomic bomb testing as one of his stressors. In statements received in June 2010 and January 2011, the Veteran contended that his skin condition was related to fallout from this nuclear bomb testing. Service connection for a condition that is claimed to be due to radiation exposure during service may be established in one of three different ways. First, certain diseases will be presumptively service connected under 38 C.F.R. § 3.309(d) if they become manifest in a "radiation-exposed" veteran, provided that the rebuttable presumption provisions of 38 C.F.R. § 3.307 are also satisfied. Second, service connection may be granted under 38 C.F.R. § 3.311 where the veteran develops a "radiogenic disease" after service and contends that such disease is due to radiation exposure during service. This provision does not provide for presumptive service connection but rather, requires that certain procedures be followed in the handling of such claims. Regardless of whether a claimed disability is recognized under the provisions pertaining to radiation exposure, a Veteran is not precluded from presenting competent evidence that a claimed disability was due to or the result of radiation exposure. See Ramey v. Brown, 9 Vet. App. 40, 44-45 (1996), aff'd, 120 F.3d. 1239 (Fed. Cir. 1997); see also Rucker v. Brown, 10 Vet. App. 67, 71-72 (1997); Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Currently, the evidence of record does not establish that the Veteran has skin cancer; hence, his skin condition does not appear to be included in the presumptive diseases listed under 38 C.F.R. § 3.309(d)(2) as due to radiation exposure or as radiogenic diseases in § 3.311(b)(2). As such, the Veteran must present competent evidence that a skin condition is a result of radiation exposure; he has not submitted such evidence. However, the Veteran has alleged that being involved in nuclear testing was a stressor event in conjunction with his claim of service connection for PTSD. Therefore, further development is required to determine if the Stoddert was involved in atomic bomb testing. A February 2006 statement from the Veteran's service comrade, D.B., reports that he remembers training in ABC warfare in the Pacific in July, August, or September of 1965. D.B. stated that all of the sailors were issued pocket dosimeters and were ordered to wear them at all times. He recalled an incident where the Stoddert was hit by an over pressurization wave that caused the entire ship to jump. He believed this occurred because of a nuclear test. For the time periods raised by the Veteran regarding when he believes nuclear testing occurred, the Dictionary shows that the Stoddert was stationed in Pearl Harbor from May to July 1965 and that the ship underwent shakedown training and operational evolutions until it joined the Pacific Fleet in August 1965. It then conducted local operations in Hawaiian waters until October 1965. In May 1966, the Stoddert arrived at Pearl Harbor and conducted several antisubmarine exercises in Hawaiian waters until August 1966. The Stoddert divided the remainder of 1966 between various service inspections and local operations out of Pearl Harbor, including shore bombardments, carrier screening, and antisubmarine warfare exercises. It is unclear from the Dictionary whether any of these operations included nuclear testing and the record does not reflect that development has been completed to determine whether the Stoddert was actually involved in any nuclear testing while the Veteran was serving aboard the Stoddert. Additionally, the lay statement from D.B. indicates that service members aboard the Stoddert were provided with dosimeters. The Veteran's service personnel and medical records do not contain a DD Form 1141, Record of Occupational Exposure to Ionizing Radiation; however, there is no indication that the RO has requested DD Form 1141. Therefore, such development must be completed on remand. F. VA Examinations 1. Initial Evaluation for Bilateral Hearing Loss A December 2004 rating decision granted service connection for bilateral hearing loss, rated noncompensable, effective May 4, 2004. The noncompensable rating was assigned based on an October 2004 VA examiner's interpretation of April 2004 audiometry findings. It appears from the VA examination report that the Veteran was not seen for examination in October 2004 and the record does not indicate that he has since been seen for a VA examination to evaluate the current nature and severity of his bilateral hearing loss. Also, the Court has held that VA audiological examiners must not only report their objective findings but also fully describe the functional effects caused by hearing loss disability in the final examination report. Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). The October 2004 VA examination report does not sufficiently address the functional effects caused by hearing loss disability. Therefore, the examination is inadequate for rating purposes and remand for a current, sufficient examination is necessary. 2. Acquired Psychiatric Disorder As noted above, the July 2005 VA psychiatric examination was based on inaccurate factual premises and is thus inadequate for rating purposes. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (finding that once VA provides an examination, it must ensure that it is adequate for rating purposes). Hence, if any of the development requested above corroborates an alleged stressor event, then a VA examination should be scheduled to adequately address the etiology of the Veteran's acquired psychiatric disorder. 3. Migraine Headaches The Veteran has alleged that his migraine headaches are secondary to PTSD or depression. Consequently, consideration of the claim must be deferred pending a final decision on the claim seeking service connection for an acquired psychiatric disorder. However, a VA examination is required before the claim can be adequately adjudicated. Although the Veteran has mainly raised a theory of secondary service connection for migraine headaches, the record indicates the Veteran was treated for a headache during service in February 1964. This evidence raises a theory of direct service connection and the December 2004 rating decision denied his claim based on this theory. The Veteran was afforded a VA examination in June 2005 to assess the etiology of migraine headaches; however, this examination was inadequate. See Barr, 21 Vet. App. at 312. After reviewing the claims file, the June 2005 examiner noted that the available information did not allow him to determine the etiology of the headaches. He believed the Veteran needed a medical workup with a neurologist that included imaging of his brain. The examiner also indicated that an eye examination would help determine whether glaucoma was causing his pain. He felt these medical workups might provide enough information so a more conclusive opinion could be obtained regarding the etiology of the headaches. He also noted that the Veteran appeared to have an undiagnosed psychiatric disorder and that further psychiatric evaluation might help to determine whether or not the headaches were related to a psychiatric diagnosis. Recently, in the case of Jones v. Shinseki, 23 Vet. App. 382, 390 (2010), the Court found that the Board can only rely on a statement that an opinion cannot be reached "without resort to speculation" if the examiner has explained the basis for the conclusion or the Board's review of the evidence otherwise makes the basis apparent. Id. The examiner's rationale must clearly show that he or she obtained and considered all tests and records that could help illuminate any pertinent medical question and the examiner may have a duty to conduct further medical research. Id. The Court noted that such research may be necessary because use of the term "without resort to speculation" should reflect limitations of knowledge in the greater medical community, not just limitations of knowledge of a single examiner. Id. If the record does not indicate that all tests and records have been secured, then the Board must remand the claim for further development. Id. Here, the June 2005 VA examiner clearly explained that he was unable to reach a conclusion regarding the etiology of the Veteran's migraine headaches because further testing and evaluation was required; however, the record does not reflect that all of the indicated evaluations have been completed. Thus, the June 2005 VA examination is inadequate and a remand to secure a more thorough examination that addresses the questions raised by the June 2005 VA examiner is necessary. 4. Chronic Skin Condition As explained in detail below, the Board finds that if the development requested in section D.1 establishes presumed or actual exposure to herbicides, a VA examination for the Veteran's skin condition will be warranted. Under 38 C.F.R. § 3.159(c)(4)(i), a VA medical examination or opinion is necessary if the evidence of record: (A) contains competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of disability; and (B) establishes that the Veteran suffered an event, injury or disease in service; (C) indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service or with another service-connected disability, but (D) does not contain sufficient medical evidence for the Secretary to make a decision on the claim. At the March 2009 hearing, the Veteran reported that his skin gets flaky and that he has loose skin all over his face. The undersigned Veterans Law Judge observed that the Veteran's complexion was a little red and that he had visible red spots on his hands. The Veteran's representative noted that when he has seen the Veteran on other occasions he has observed similar skin irregularities. These lay statements are considered competent, as they provide evidence regarding knowledge of facts or circumstances that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2); see Layno v. Brown, 6 Vet. App. 465, 469 (1994) (noting a lay person is competent to report observable symptoms because this requires only personal knowledge, not medical expertise, as it comes through the senses). There is also no reason to doubt the credibility of these lay statements. Thus, the record contains competent and credible evidence that the Veteran has had recurrent symptoms of a skin condition during the pendency of his claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (finding that the requirement of having a current disability is met "when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim"). The Veteran also testified in March 2009 that his skin condition is chronic and began six months after his service. He reported that he receives treatment for his skin condition and that his physician provides him with ointments for treatment. An October 2004 statement from the Veteran's spouse indicates that he often breaks out in skin rashes. These lay statements are also competent and appear to be credible regarding the continuity of the Veteran's observable symptoms of a skin condition since shortly after service. The record currently does not provide evidence that establishes the Veteran suffered an event, injury, or disease in service relevant to his skin condition. See Bardwell v. Shinseki, 24 Vet. App. 36, 39 (2010) (finding that § 3.159(c)(4)(i)(B) does "not qualify the quality of evidence needed to meet its threshold: the evidence must establish that there was a disease, injury, or event in service"). The Veteran has not indicated nor does the record reflect that a skin condition began during service. He has, in part, alleged that his chronic skin condition is related to exposure to herbicides in service. As such, if the development requested in section D.1 reveals presumed or actual exposure to herbicides, then the evidence would establish an in service event and the elements of § 3.159(c)(4)(i) would be satisfied. Consequently, a VA examination to obtain a medical opinion would be necessary. Accordingly, the case is REMANDED for the following actions: 1. Send the Veteran a letter providing him the notice required under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) for a claim of secondary service connection for migraine headaches. 2. Ask the Veteran to provide the names, addresses, and approximate dates of treatment for all private and/or VA health care providers, who have treated him for his skin condition. After securing any necessary releases, request any identified records that are not duplicates of those contained in the claims file. Ask the Veteran to identify the treatment provider who completed audiometry testing on him on November 21, 2005. If the Veteran provides this information, and after securing any necessary releases, send a letter to the identified treatment provider asking him or her to provide the November 21, 2005 test results in a numerical format and to identify whether Maryland CNC speech discrimination testing was completed, and if so, to identify the results of that testing. 3. Obtain all relevant ongoing VA treatment records dated since July 2005. Secure a copy of VA audio form 10-2464, completed on July 29, 2004 by D.F., M.S. 4. Obtain from SSA copies of any decision regarding a claim for SSA disability benefits and copies of the record upon which any such claim was decided. 5. Request from the appropriate Federal custodian the deck logs for the U.S.S. Benjamin Stoddert from December 5, 1965 to January 23, 1966. 6. Contact the appropriate facility(ies) to determine whether the U.S.S. Benjamin Stoddert was involved in any nuclear testing from November 1964 to October 1967. 7. Request from the service department (United States Navy) all records relating to the Veteran's claimed in-service exposure to radiation including, but not limited to, a DD Form 1141. 8. If any of the records requested in items 2 through 7 above are unavailable, clearly document the claims file to that effect and notify the Veteran of any inability to obtain these records, in accordance with 38 C.F.R. § 3.159(e). 9. If deck logs or other records are secured pursuant to item 5, review those records to determine whether the U.S.S. Benjamin Stoddert sailed in the inland waterways of Vietnam and whether the records provide corroboration for the Veteran's alleged stressor event of the Stoddert shooting at an orphanage and killing innocent people. Notify the Veteran of any determination made on these questions. 10. If the development requested in items 6 and/or 7 indicates that the Veteran was exposed to ionizing radiation, then complete any further development necessary for claims based on exposure to ionizing radiation, such as securing a dose estimate or scheduling the Veteran for an appropriate VA examination. 11. Schedule the Veteran for a VA audiological examination (with audiometric studies and Maryland CNC speech discrimination testing) to ascertain the current severity of his bilateral hearing loss. The examiner must review the Veteran's claims file in conjunction with the examination. The examiner should comment on the nature and extent of any impairment of social and/or occupational functioning due to hearing loss that would be expected given the degree of severity of the disability found. The examiner must provide a rationale for all opinions expressed. 12. If any of the development requested above corroborates an alleged stressor event, then schedule the Veteran for a VA mental disorder examination to determine the etiology of any diagnosed psychiatric disorder. The examiner must review the Veteran's claims file and must explain the complete rationale for all opinions expressed and conclusions reached. After examining the Veteran and reviewing his claims file, the examiner must identify all current psychiatric disorders. The examiner is asked to provide opinions responding to the following questions: (A) Is it at least as likely as not (a 50% or greater probability) that any diagnosed psychiatric disorder is causally related to the Veteran's period of active duty service? (B) (1) If PTSD is diagnosed (under DSM-IV criteria), then identify the specific stressor(s) upon which the diagnosis is based. Explain whether the claimed stressor(s) is/are related to the Veteran's fear of in-service hostile military or terrorist activity. (2) If PTSD is not diagnosed, then explain why the Veteran does not meet the criteria for the diagnosis. 13. Schedule the Veteran for an appropriate VA examination to assess the etiology of his migraine headaches. The examination must include any necessary consultations, including referral for an eye examination and neurological evaluation, as suggested by the June 2005 VA examiner. The examiner must review the Veteran's claims folder in conjunction with the examination. The examiner must explain the rationale for all opinions provided. The examiner is asked to provide an opinion responding to the following question(s): A) Is it at least as likely as not (a 50% or greater probability) that the Veteran's migraine headaches are related to an event or injury incurred during service?; B) If it has been determined that service connection for an acquired psychiatric disorder is warranted, then is it at least as likely as not (a 50% or greater probability) that the Veteran's migraine headaches were either (i) caused or (ii) aggravated by (increased in severity due to) the service-connected acquired psychiatric disorder. 14. If the development requested in item 5 reveals that the Veteran had presumed or actual exposure to herbicides, then schedule him for an appropriate examination to assess the etiology of any chronic skin condition. The examination should include any testing or evaluation necessary to determine the nature and diagnosis of any chronic skin condition. The examiner must review the Veteran's claims file in conjunction with the examination. The examiner must explain the rationale for all opinions given. The examiner should express an opinion on the following question: Is it at least as likely as not (a 50% or greater probability) that any diagnosed chronic skin condition is causally related to exposure to herbicides during service or otherwise related to the Veteran's service? 15. Thereafter, readjudicate the claims (specifically including initial consideration of additional argument and evidence received in January 2011 without a waiver of RO review). If any claim remains denied, issue an appropriate supplemental statement of the case and give the Veteran and his representative the opportunity to respond. The case should then be returned to the Board, if in order, for further review. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board for additional development or other appropriate action must be handled in an expeditious manner. 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2010). _________________________________________________ Steven L. Keller Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2010).