Citation Nr: 1304065 Decision Date: 02/05/13 Archive Date: 02/08/13 DOCKET NO. 06-25 116A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Whether new and material evidence has been received sufficient to reopen a claim of entitlement to service connection for temporomandibular joint disease (TMJ) and, if so, whether service connection is warranted. 2. Whether new and material evidence has been received to reopen a claim for entitlement to service connection for left knee degenerative joint disease. 3. Entitlement to service connection for diabetes mellitus. 4. Entitlement to service connection for prostate cancer. 5. Entitlement to service connection for a kidney disorder. 6. Entitlement to service connection for right knee strain. 7. Entitlement to service connection for right elbow traumatic arthritis. 8. Entitlement to service connection for a rectal disorder. 9. Entitlement to service connection for an anxiety disorder, to include posttraumatic stress disorder (PTSD). 10. Entitlement to an initial compensable rating for allergic rhinitis and sinusitis with sinus headaches. 11. Entitlement to a 10 percent rating based on multiple noncompensable service-connected disabilities. 12. Entitlement to special monthly pension. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD J.M. Rutkin, Associate Counsel INTRODUCTION The Veteran served on active duty from July 1972 to July 1976. This matter comes before the Board of Veterans' Appeals (Board) on appeal from November 2005 and July 2007 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. This case was previously before the Board in April 2009, at which time the issues on appeal were service connection for diabetes mellitus, prostate cancer, and a kidney disorder, as well as whether a timely appeal was perfected concerning the denial of the other issues listed on the first page of this decision. These four issues were remanded to the agency of original jurisdiction (AOJ) for further development. Upon remand, the AOJ determined that the appeal was timely received and issued a Supplemental Statement of the Case (SSOC) addressing those other issues in June 2011. The Board found in a November 2011 remand that the timeliness of the appeal is no longer at issue, and that the underlying claims are properly on appeal before the Board. The Veteran testified at a hearing before the Board in January 2009, and a transcript of the hearing is in the claims file. Because the Veterans Law Judge (VLJ) who presided over that hearing is no longer employed at the Board, this case was remanded by the Board in November 2011 to afford the Veteran an opportunity to testify at a new hearing before another VLJ in accordance with 38 C.F.R. §§ 20.707, 20.717 (2012). Moreover, in his September 2008 substantive appeal (VA Form 9), the Veteran had requested to testify at a Board hearing with respect to the other issues on appeal which were not addressed in the January 2009 Board hearing. Thus, in June 2012, the Veteran testified at a hearing before the undersigned at the St. Petersburg RO with respect to all the issues on appeal. A transcript of this hearing is in the claims file. At the June 2012 Board hearing, the Veteran withdrew his appeal of the denial of special monthly pension. Thus, this claim is no longer on appeal, as discussed below. The Board has characterized the Veteran's service connection claim for PTSD more broadly to include any anxiety disorder. In this regard, an October 2006 VA treatment record and other VA treatment records show a diagnosis of anxiety disorder NOS (not otherwise specified), as well as 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 acquired psychiatric disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. The Veteran stated at the June 2012 Board hearing and elsewhere that he experienced and was treated for anxiety in service, and his service treatment records confirm this testimony, as discussed in more detail below. Thus, the Veteran's claim encompasses both PTSD and any other anxiety disorder. See 38 C.F.R. § 4.130 (2012) (classifying PTSD as an anxiety disorder). In September 2012 the Veteran submitted VA treatment records dated in June 2012 and September 2012 which were not considered by the RO, as well as copies of service personnel records. He waived his right to initial consideration of this evidence by the agency of original jurisdiction (AOJ) in a September 2012 statement. See 38 C.F.R. § 20.1304(c) (2012) (providing that any pertinent evidence accepted directly at the Board must be referred to the AOJ for initial review unless this procedural right is waived by the appellant). Accordingly, the Board may proceed with appellate review. The petition to reopen the service connection claim for a left knee disability, the claims of entitlement to service connection for diabetes, a right knee disability, TMJ, a kidney disorder, PTSD and/or another anxiety disorder, right elbow traumatic arthritis, the appeal of the initial compensable rating for allergic rhinitis and sinusitis with sinus headaches, and the issue of whether a10 percent rating is warranted based on multiple noncompensable service-connected disabilities 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. A July 2004 rating decision last denied the claim of entitlement to service connection for TMJ; the Veteran was properly notified of the adverse outcome and his appellate rights in a July 2004 letter and did not appeal. 2. Additional evidence received since the July 2004 rating decision is neither cumulative nor redundant and raises a reasonable possibility of substantiating the Veteran's service connection claim for TMJ. 3. The Veteran has not had prostate cancer during the pendency of this claim. 4. A rectal disorder did not manifest during active military service and has not been shown to be related to a disease, injury, or event during active service. 5. The Veteran withdrew his appeal of the claim for special monthly pension at the June 2012 Board hearing. CONCLUSIONS OF LAW 1. The July 2004 rating decision, denying service connection for TMJ, is final. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. § 20.1103 (2012). 2. The claim of entitlement to service connection for TMJ is reopened with the submission of new and material evidence. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156(a) (2012). 3. The criteria for service connection for prostate cancer have not been met on a direct or presumptive basis . 38 U.S.C.A. §§ 1110, 1112, 1113, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2012). 4. The criteria for service connection for a rectal disorder have not been met. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 5. The criteria for withdrawal of a substantive appeal with regard to the special monthly pension claim have been met. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. § 20.204 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board has thoroughly reviewed all the evidence in the claims file, and has an obligation to provide an adequate statement of reasons or bases supporting its decision. See 38 U.S.C.A. § 7104 (West 2002); Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). While the Board must review the entire record, it need not discuss each piece of evidence. See id. The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the claimant). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Caluza v. Brown, 7 Vet. App. 498, 506 (1995). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. When the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must weigh against a claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). I. Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000) (codified as amended at 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107 (West 2002 & Supp. 2012), sets forth VA's duty to notify and assist claimants in substantiating a claim for VA benefits. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Because the service connection claim for TMJ has been reopened, any VCAA notice error with regard to this issue is nonprejudicial. See 38 U.S.C. §§ 5103, 5103A; 38 C.F.R. § 3.159; see also Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004); Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The duty to notify and assist has been satisfied with regard to the service connection claims for prostate cancer and a rectal disorder, as discussed below. Under the VCAA, when VA receives a complete or substantially complete application for benefits, it is required to notify the claimant and his representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). In order to satisfy its duty to notify the claimant under the VCAA, the United States Court of Appeals for Veterans Claims (Court) held that VA 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. Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). All notice under the VCAA should generally be provided prior to an initial decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004) (Pelegrini II). However, the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as an SOC or SSOC, is sufficient to cure any delay in timing and thereby render it nonprejudicial. See Mayfield v. Nicholson, 499 F.3d 1317, 1323 (Fed. Cir. 2007); Prickett v. Nicholson, 20 Vet. App. 370 (2006). In Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 484 (2006), the Court held that a claim of entitlement to service connection consists of five elements: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date. Notifying the claimant of what evidence is necessary to substantiate the claim requires notice of these five elements. Id. at 486;38 U.S.C.A. § 5103(a); see also Quartuccio, 16 Vet. App. at 187. Here, prior to the initial rating decision in this matter, letters dated in August 2005 and July 2006 notified the Veteran of the elements that must be met in order to establish entitlement to service connection, gave examples of the types of evidence he could submit to support his claims, and informed the Veteran of his and VA's respective responsibilities for obtaining relevant Federal records, private treatment records, and other evidence on his behalf, as well as VA's responsibility for providing a VA examination or obtaining a VA medical opinion when deemed necessary to decide the claim. While the July 2006 letter also informed the Veteran of how VA determines the degree of disability and the effective date of service connection, the August 2005 letter did not inform him of these two elements with respect to the prostate cancer claim. Nevertheless, because service connection cannot be established for prostate cancer, the application of these last two "downstream" elements to his claim is moot, as they only pertain to granted claims. Lack of notice with regard to these elements did not affect the outcome of the claim or the essential fairness of the adjudication. Therefore, this notice error was nonprejudicial and further notice is not required. See Mayfield, 19 Vet. App. at 115-16. Accordingly, the duty to notify has been satisfied. See id. VA's duty to assist under the VCAA includes helping the claimant to obtain service treatment records and other pertinent records, as well as providing an examination or obtaining a medical opinion when such is necessary to make a decision on the claim. See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). The duty to assist has been satisfied. The Veteran's service treatment records and VA medical records are in the file. Private medical records identified by the Veteran have been obtained to the extent possible. The Veteran has not identified any other outstanding records that he wanted VA to obtain or that he felt were relevant to the present claims. Although the Veteran had indicated that he was in receipt of disability benefits from the Social Security Administration (SSA), he clarified at the June 2012 hearing that he was actually referring to nonservice-connected VA pension benefits. Moreover, the RO attempted to obtain the Veteran's SSA records and received a negative response from SSA in October 2008. The Veteran was notified of this fact in an October 2008 letter, which also informed him that he could submit these records himself or identify their location. Thereafter, the RO issued a November 2008 memorandum for the record making a formal finding of unavailability with respect to the Veteran's SSA records. The formal finding sets forth the efforts that had been made to obtain the Veteran's SSA records and SSA's October 2008 response that such records could not be located, and concludes that further efforts to obtain these records would be futile. See 38 C.F.R. § 3.156(c)(2) (providing that VA will end its efforts to obtain records from a Federal department or agency only if VA concludes that the records sought do not exist or that further efforts to obtain those would be futile; cases in which VA may conclude that no further efforts are required include those in which the Federal department or agency advises VA that the requested records do not exist or that the custodian does not have them). Therefore, further efforts to obtain any SSA records are not warranted. Accordingly, the duty to assist has been satisfied with respect to obtaining relevant records on the Veteran's behalf. See 38 C.F.R. § 3.159(c). The duty to assist also includes providing a medical examination or obtaining a medical opinion when such is necessary to make a decision on the claim, as defined by law. See 38 U.S.C.A. § 5103A; 38 C.F.R. §§ 3.159(c)(4), 3.326(a); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Here, the Veteran was seen for a VA examination in April 2010 with respect to his prostate cancer claim, as well as other claims not addressed in this decision. The examiner reviewed the claims file and obtained a reported history from the Veteran. The Veteran stated that he had never been diagnosed with prostate cancer and that a recent biopsy of his prostate was negative for cancer. The examiner's review of the medical records also did not show diagnoses or indication of prostate cancer. In this regard, the examiner noted that the Veteran had elevated PSA levels, but did not find that they indicated cancer of the prostate. The examiner's conclusion that the Veteran did not have prostate cancer is borne out by other evidence of record, to include the Veteran's testimony at the June 2012 hearing, which confirms that he has never been diagnosed with prostate cancer. The examiner therefore concluded that an examination was not required, and did not provide a nexus opinion. In light of the fact that the Veteran has never been diagnosed with prostate cancer, the Board finds that an actual examination of the Veteran or a nexus opinion was not required, as service connection can only be granted for current disabilities. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Accordingly, the April 2012 VA examination report is adequate for the purpose of making a decision on this claim. See Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (holding that an examination is adequate when it is based on consideration of the claimant's medical history and describes the disability in sufficient detail so that the Board's evaluation of the disability will be a fully informed one). A VA examination has not been provided with regard to the Veteran's service connection claim for a rectal disorder, and the Board finds that such an examination is not required. In McLendon, 20 Vet. App. at 83, the Court held that an examination is required when (1) there is evidence of a current disability, (2) evidence establishing an "in-service event, injury or disease," or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. Here, the Veteran argues that his current disorder, which according to his testimony at the June 2012 hearing is manifested primarily by diarrhea and diverticulitis, has been present ever since active service. As explained below, the Board finds that the Veteran did not have ongoing digestive or bowel problems during active service. Apart from two episodes of gastroenteritis, there is no mention of gastrointestinal or rectal problems in the service treatment records, and both the June 1976 separation examination report and a June 1979 service examination report (dated about two years after the Veteran's period of active service) are negative for bowel, digestive, or rectal problems. The earliest evidence of diarrhea, irritable bowel syndrome, and colon polyps are VA treatment records dated in 2006, which simply note a past history of intermittent diarrhea. These records are dated about thirty years after the Veteran's separation from service in July 1976. Thus, as discussed in more detail below, the Board does not find it credible that the Veteran has had ongoing symptoms of diarrhea or other rectal or bowel problems ever since active service. Therefore, there is no indication that any current rectal disorder or bowel disorder may be related to the Veteran's two episodes of gastroenteritis during active service or otherwise related to an in-service disease, injury, or event. Accordingly, a VA examination is not warranted. See id; see also 38 U.S.C.A. § 5103A(a)(2) (West 2002) (the Secretary is not required to provide assistance "if no reasonable possibility exists that such assistance would aid in substantiating the claim"); Dela Cruz v. Principi, 15 Vet. App. 143, 149 (2001). In sum, VA's duty to assist with respect to obtaining a VA examination or opinion has been met. See 38 C.F.R. §§ 3.159(c)(4); 3.326(a); McLendon, 20 Vet. App. at 83; Barr, 21 Vet. App. at 312. As shown in the above discussion, the duty to notify and assist under the VCAA has been satisfied. As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of the claims addressed in this decision, any such failure is harmless. See Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004); see also Mayfield, 19 Vet. App. at 115. II. New and Material Evidence The Veteran petitions to reopen the previously denied claim of entitlement to service connection for TMJ. For the following reasons, the Board finds that reopening is warranted. The Veteran initially submitted a claim of entitlement to service connection for TMJ in February 1998, which was denied in a June 1998 rating decision. The Veteran did not appeal this decision and it became final. See 38 U.S.C.A. § 7105(c); 38 C.F.R. § 20.1103. The Veteran petitioned to reopen this claim in April 2004. The RO denied the petition in a July 2004 rating decision, finding that new and material evidence had not been submitted to reopen the claim. The Veteran was notified of this decision and his appellate rights in a July 2004 letter in accordance with 38 C.F.R. § 19.25 (2012). He did not submit a notice of disagreement (NOD). See 38 C.F.R. § 20.200 (2012) (providing, in pertinent part, that an appeal consists of a timely filed NOD in writing); see also 38 C.F.R. §§ 20.201 (2012) (required contents of a NOD); 20.302(a) (2012) (time limits for submitting a NOD). Further, no new evidence pertaining to TMJ was received within one year of this decision. See 38 C.F.R. § 3.156(b). Consequently, the decision became final. See 38 U.S.C.A. § 7105(c); 38 C.F.R. § 20.1103. The July 2004 rating decision constitutes the last final adjudication of this claim. Under 38 U.S.C.A. § 5108 (West 2002), VA may reopen a previously and finally disallowed claim when "new and material" evidence is presented or secured with respect to that claim. "New evidence" means evidence not previously submitted to agency decision makers, and "material evidence" means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. 38 C.F.R. § 3.156(a). The 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. Id. In addition, new and material evidence submitted within one year of the appeal period, or prior to the appellate decision if a timely appeal has been filed, will be considered to have been filed in connection with the claim that was pending at the beginning of the appeal period, thereby rendering that claim still pending. See 38 C.F.R. § 3.156(b). The provisions of 38 U.S.C.A. § 5108 require a review of all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. See Evans v. Brown, 9 Vet. App. 273, 282-3 (1996). For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed, unless it is inherently false or untrue or, if it is in the nature of a statement or other assertion, it is beyond the competence of the person making the assertion. Duran v. Brown, 7 Vet. App. 216, 220 (1994); Justus v. Principi, 3 Vet. App. 510, 513 (1992). Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110. 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. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Id. Service connection may be granted for any disease diagnosed after discharge, when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection, there must be competent evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). In addition, where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, service connection for certain chronic disabilities, including arthritis, may be established on a presumptive basis by showing that the disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307; 3.309(a). This presumption is rebuttable by affirmative evidence to the contrary. 38 C.F.R. § 3.307(d). This claim was initially denied in the June 1998 rating decision because the RO found that there was no evidence showing TMJ. At the time of the July 2004 rating decision, the VA treatment records and other post-service medical evidence did not reflect diagnoses, treatment, or complaints of TMJ or any jaw problems, and therefore the claim was not reopened. Thus, in order to reopen this claim, there must be new evidence supporting a finding that the Veteran has TMJ which raises a reasonable possibility of substantiating the claim. Since the July 2004 rating decision was issued, a July 2007 VA treatment record reflects the results of a CT scan showing degenerative changes of both temporomandibular joint spaces. An April 1999 VA treatment record has also been associated with the file showing a diagnosis of TMJ. Objective clinical evidence of a TMJ disorder was not previously of record and therefore this evidence pertains to an unestablished fact, namely the existence of a current disability. Moreover, the Veteran gave testimony at the June 2012 Board hearing describing the circumstances in which he believes his TMJ was incurred. These alleged circumstances were not previously of record and are presumed to be credible for the purpose of determining whether new and material evidence has been submitted. See Duran, 7 Vet. App. at 220. Because the service treatment records reflect that the Veteran reported TMJ pain in May 1974, there is at least an indication that his current degenerative changes of the temporomandibular joint spaces are related to the TMJ pain he had during active service. See McLendon, 20 Vet. App. at 83 (providing that a VA examination is required when there is at least an indication that a current disability may be related to an in-service disease, injury, or event); see also Shade v. Shinseki, 24 Vet. App. 110, 121 (2010) (holding that new and material evidence need not pertain to all unestablished elements in order to reopen a claim, and that reopening is warranted when, for example, the newly associated evidence would trigger VA's duty to provide an examination under the VCAA when considered in light of the evidence previously of record). Thus, the newly associated evidence also raises a reasonable possibility of substantiating the claim. Accordingly, new and material evidence has been submitted to reopen the claim of entitlement to service connection for TMJ. See 38 C.F.R. § 3.156(a). III. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110. 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. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Id. Service connection may be granted for any disease diagnosed after discharge, when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection on a direct basis, there must be competent evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). In addition, where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, service connection for certain chronic disabilities, including arthritis, may be established on a presumptive basis by showing that the disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307; 3.309(a). This presumption is rebuttable by affirmative evidence to the contrary. 38 C.F.R. § 3.307(d). A. Prostate Cancer The Veteran claims entitlement to service connection for prostate cancer, which he argues is related to alleged herbicide exposure while serving in Okinawa, Japan. For the following reasons, the Board finds that service connection is not warranted. The first element in a service connection claim, namely evidence that the Veteran has the claimed disability, is not established. See Shedden, 381 F.3d at 1166-67. Specifically, at the June 2012 Board hearing, the Veteran acknowledged that he had not been diagnosed with prostate cancer but rather had elevated PSA levels which could make him prone to developing prostate cancer in the future. VA treatment records dated in August 2000, September 2003, and June 2007, among others, show diagnoses of prostatitis, begin prostatic hypertrophy, and elevated PSA levels, but do not reflect diagnoses of prostate cancer, either in the past or during the pendency of this claim. An August 2000 VA biopsy report shows findings of benign prostatic tissue and benign squamous mucosa, and does not reflect a diagnosis of cancer. The April 2010 VA examination report likewise reflects that the Veteran did not have prostate cancer. The examiner took note of the Veteran's elevated PSA levels, but did not conclude that this finding indicated the presence of cancer. Thus, a careful review of the relevant evidence of record, as outlined above, does not show the presence of prostate cancer. In order to establish entitlement to service connection for a claimed disorder, there must be competent evidence that the Veteran has had the disorder during the pendency of the claim. See Shedden, 381 F.3d at 1166-67 (service connection requires, in pertinent part, evidence of a current disability); see also Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of 38 U.S.C.A. § 1110 and §§ 1131 as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). The mere tendency to develop a disability at some future time does not itself constitute a current disability for which service connection may be established. Further, laboratory test results, such as the Veteran's elevated PSA levels, are not in and of themselves disabilities subject to compensation. Cf. 61 Fed. Reg. 20440, 20,445 (May 7, 1996) (supplementary information preceding Final Rule amending the criteria for evaluating endocrine system disabilities indicates that diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are actually laboratory test results, and are not, in and of themselves, disabilities). Because the Veteran has not been diagnosed with prostate cancer during the pendency of this appeal, the issue of whether he was exposed to herbicides during active service is moot with regard to this claim. Thus, further consideration of this issue is not warranted. The Veteran has not at any point indicated that he seeks compensation for his prostatitis or benign prostatic hypertrophy, but rather has consistently claimed service connection for prostate cancer due to his elevated PSA levels. Thus, whether service connection may be warranted for another prostate disorder is not on appeal. Accordingly, in the absence of a current disability, the preponderance of the evidence is against the Veteran's claim. Consequently, the benefit-of-the-doubt rule does not apply, and service connection for prostate cancer must be denied. See 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. B. Rectal Disorder The Veteran claims entitlement to service connection for a rectal disorder, which he described at the June 2012 Board hearing as being manifested primarily by diarrhea and diverticulitis. He stated that he was treated a number of times during service for his symptoms, and was told then that he had a "stomach problem." He further testified that these symptoms had been present ever since active service. For the following reasons, the Board finds that service connection is not warranted. The Veteran's service treatment records do not show ongoing rectal or stomach problems, but rather only two transitory episodes of gastrointestinal symptoms. Specifically, in February 1973 the Veteran was seen for stomach cramps which had been present for two days, with mild nausea but no vomiting. He was diagnosed with mild gastroenteritis. Almost three years later, in January 1976, the Veteran reported a "sudden onset" of headaches, malaise, nausea, vomiting, stomach cramping, and some diarrhea. He was diagnosed with mild gastroenteritis. The service treatment records do not otherwise reflect treatment or complaints of gastrointestinal problems, and are negative for any symptoms or diagnoses specific to the rectum. The June 1976 separation examination report indicates that the Veteran's anus and rectum were found to be normal on clinical evaluation, as well as his abdomen and viscera. After the Veteran's July 1976 separation from active service, he underwent a June 1979 enlistment examination for a second period of active service, although he did not actually reenter active service at this time. This examination report shows that the Veteran's anus and rectum, as well as his abdomen and viscera, were found to be normal on clinical evaluation. In the accompanying Report of Medical History, the Veteran denied a history of stomach or intestinal trouble or piles or rectal disease, although he indicated having a history of certain other medical conditions. The fact that he endorsed a history of some medical conditions but not others indicates that he gave this form attention and thought as to whether or not he had a history of any of the medical conditions listed in the form. This form thus constitutes credible and probative evidence that the Veteran did not have a history of recurrent rectal or stomach problems in the roughly three years that elapsed between his July 1976 separation and the June 1979 date of this form. The earliest evidence of the Veteran's current rectal or stomach problems are VA treatment records reflecting that the Veteran was diagnosed with duodenitis in 2004. He also underwent a colonoscopy in 2005, at which time a polyp was removed, and was diagnosed with diverticulitis and rectal bleeding. According to a May 2006 VA treatment record, the Veteran had intermittent abdominal pain and reported intermittent chronic diarrhea in the past. He stated that he had previously been diagnosed with irritable bowel syndrome. There is no mention of rectal or ongoing stomach or intestine problems in previous VA treatment records. The Board has considered the Veteran's contention that his rectal or stomach problems manifested during service and had been present off and on ever since active service. In this regard, the Veteran is competent to report subjective symptoms such as diarrhea and stomach pain, and to state that these symptoms have been present ever since active service. See, e.g., Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (holding that lay evidence can be competent with respect to both the diagnosis and the etiology of a disability); Jandreau v. Nicholson, 492 F. 3d 1372, 1377 & n4 (Fed. Cir. 2007) (setting forth circumstances in which lay evidence can be competent); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (holding that appellant was competent to testify as to factual matters of which he had first-hand knowledge). The competency of evidence differs, however, from the weight and credibility assigned to the evidence. As explained by the Court, "the former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination that addresses the probative value of the evidence to be made after the evidence has been admitted." Layno v. Brown, 6 Vet. App. 465, 469 (1994); accord Rucker v. Brown, 10 Vet. App. 67, 74 1997); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (stating that "although interest may affect the credibility of testimony, it does not affect competency to testify."). In determining whether statements submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. at 711. Further, the United States Court of Appeals for the Federal Circuit has held that while the absence of contemporaneous medical records does not, in and of itself, render lay testimony not credible, the Board may weigh the absence of contemporaneous records when assessing the credibility of lay evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006) ("Nor do we hold that the Board cannot weigh the absence of contemporaneous medical evidence against the lay evidence of record."). Moreover, the Court has held that although the Board cannot reject a claimant's statements merely because he is an interested party, the claimant's interest may affect the credibility of his testimony. See Cartright, 2 Vet. App. at 25; accord Buchanan, 451 F.3d at 1337 (holding that "the Board, as fact finder, is obligated to, and fully justified in, determining whether lay evidence is credible in and of itself, i.e., because of possible bias . . . ."). In this case, because the Veteran's statements are inconsistent with more probative evidence of record, the Board finds that they are not credible with regard to the alleged history of his rectal or stomach problems. Specifically, not only are the service treatment records devoid of any mention of rectal bleeding, diverticulitis, or ongoing diarrhea or stomach pain, but they show that the Veteran was only seen twice for stomach problems. These occasions were spaced about three years apart, and the stomach problems in question were accompanied by other symptoms such as nausea, headaches, and malaise. Indeed, when the Veteran was seen for a second time in January 1976 for these symptoms, he reported that they had a "sudden onset," which further weighs against a finding that they had been ongoing or recurrent in nature. Moreover, they were found to be part of a general viral process diagnosed as viral gastroenteritis as opposed to manifestations of a pathology of the rectum, stomach, or intestines. Most significantly, no such problems were noted at separation, and in fact the Veteran's rectum, anus, and abdomen were found to be normal on clinical evaluation. Three years after separation, the Veteran denied a history of stomach or intestinal trouble or rectal disease in the June 1979 Report of Medical History, and his anus and rectum were found to be normal on clinical evaluation. As explained above, these records constitute highly probative evidence that the Veteran did not have ongoing or intermittent gastrointestinal or rectal problems after separation from service. Rather, the probative evidence indicates that the February 1973 and January 1976 episodes of gastroenteritis were acute and transitory in nature, and that each such episode completely resolved without further symptoms. Thus, these episodes were not manifestations of a chronic or ongoing disorder. Finally, the fact that there is no mention of recurring rectal or stomach problems in the post-service medical records until around 2004-although they date since 1995 and reflect treatment for other medical condition-further weighs against a finding that the Veteran has had a continuity of symptoms ever since his period of active service. Indeed, the Veteran's post-service treatment records indicate that his rectal and stomach problems did not manifest until many years after service. Accordingly, the Board finds that the Veteran's statements are not only unaccompanied by contemporaneous evidence, but are inconsistent with more probative evidence of record, including his service treatment records and post-service treatment records, as explained in the preceding paragraphs. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the claimant); see also Caluza, 7 Vet. App. at 511 (holding that when determining whether lay evidence is satisfactory, the Board may properly consider, among other things, its consistency with other evidence submitted on behalf of the Veteran); Buchanan, 451 F.3d at 1336-37 (holding that while the absence of contemporaneous medical evidence cannot categorically lead to a finding that the lay statements in question are not credible, this factor can be weighed against such lay evidence, in conjunction with other factors). Thus, based on the totality of the factors having a negative bearing on the credibility of the statements at issue, the Board finds that these statements are not credible. See Caluza, 7 Vet. App. at 506 (the Board must assess the weight and credibility of the evidence). Consequently, the Veteran's assertion that recurrent rectal and stomach problems, including diarrhea and diverticulitis, have been present ever since active service is not entitled to any weight and is outweighed by the evidence showing that such problems did not manifested until many years after separation from service. See Washington, 19 Vet. App. at 368 (noting that the witness's credibility affects the weight to be given to his testimony). In sum, there is no credible evidence of a chronic or ongoing disorder during service or a continuity of symptoms after service. Rather, the Veteran's current rectal or stomach problems did not manifest until decades after his separation from service, which weighs against a finding that they are related to an in-service disease, injury, or event, to include the two episodes of gastroenteritis. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that a proper consideration for the trier of fact is the amount of time that has elapsed since military service, and that evidence of a prolonged period without medical complaint can be considered, along with other factors concerning the Veteran's health and medical treatment during and after military service, as evidence of whether a condition was incurred in service). Finally, there is no competent evidence of record otherwise supporting a relationship between the Veteran's current disorder and his period of active service, to include the two episodes of gastroenteritis. Whether such a relationship is possible is a medical determination that is too complex to be made based on lay observation alone, given the amount of time that has elapsed since the Veteran's separation from service in July 1976. The Veteran, as a lay person, does not have the medical expertise or training to render a competent opinion in this regard. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007)(observing that a layperson can be competent to identify conditions that are simple, such as a broken leg, but is not competent to identify more complex conditions such as a form of cancer); Barr v, 21 Vet. App. at 309 (holding that lay testimony is competent as to matters capable of lay observation, but not with respect to determinations that are "medical in nature"). His contention therefore lacks probative value and is outweighed by the probative evidence against a relationship between his current rectal or stomach problems and his period of service, as discussed above. See King v. Shinseki (Fed. Cir. 2012) (upholding the Court's finding that the probative value of lay evidence was properly discounted by the Board as not competent, noting that there is a statutory requirement under 38 U.S.C.A. § 5107(b) that lay evidence "demonstrate some competence"); see also Layno, 6 Vet. App. at 469-71 (holding that in order for testimony to be probative of any fact, the witness must be competent to testify as to the facts under consideration, and that lay testimony is not competent to prove that which would require specialized knowledge, training, or medical expertise). In sum, a careful review of the evidence of record does not show a relationship between the Veteran's current rectal or stomach problems and his period of service, to include the two episodes of gastroenteritis. See Shedden, 381 F.3d at 1166-67 (holding, in pertinent part, that in order to establish entitlement to service connection, there must be evidence of a relationship to service). Accordingly, the preponderance of the evidence is against the Veteran's claim. Consequently, the benefit-of-the-doubt rule does not apply, and service connection for a rectal disorder must be denied. See 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. III. Withdrawal of Appeal The Veteran withdrew his appeal of the denial of special monthly pension at the June 2012 Board hearing. Under 38 C.F.R. § 20.204(b), appeal withdrawals must be in writing, must include the name of the Veteran, the applicable claim number, and a statement that the appeal is withdrawn, and must be received by the Board prior to issuance of a decision on the issue being withdrawn. In this case, the Board hearing has been reduced to writing via a transcript which includes the Veteran's name, claim number, and a statement that his claim for special monthly pension is withdrawn. When the Board received the Veteran's withdrawal at the hearing, it had not yet issued a decision on this claim. Therefore, the Board finds that the criteria for withdrawal of an appeal with regard to this claim have been met. See id. When pending appeals are withdrawn, there is no longer an allegation of error of fact or law with respect to the determinations that had been previously appealed. Consequently, in such an instance, dismissal of the pending appeal is appropriate. See 38 U.S.C.A. § 7105(d). Accordingly, further action by the Board on the special monthly pension claim is not appropriate and the Veteran's appeal should be dismissed. Id. ORDER New and material evidence has been received to reopen the claim of service connection for TMJ; the appeal is granted to this extent only. Entitlement to service connection for prostate cancer is denied. Entitlement to service connection for a rectal disorder is denied. Entitlement to special monthly pension is dismissed. REMAND While the Board regrets the delay, further action on the remaining claims is required before they are ready for appellate review. With regard to the service connection claim for diabetes, the RO did not complete all the steps mandated by the Adjudication Procedure Manual to determine whether a veteran was exposed to herbicides outside of Vietnam or the Korean DMZ. Specifically, when a veteran provides the approximate dates of the alleged exposure, as well as the location and nature of such exposure, this information is to be furnished to the Compensation Service via e-mail at VAVBAWAS/CO/211/AGENTORANGE. The Compensation Service is then to review an inventory compiled by the Department of Defense (DOD) of herbicide operations to determine whether herbicides were used as alleged. If a review of the inventory does not confirm that herbicides were used as alleged, then the information is to be submitted to the Joint Services Records Research Center (JSRRC) to determine whether such exposure can be verified. See Adjudication Procedure Manual, M21-1, IV, ii.2.C.10.o. In this case, the Veteran has provided a time range in which the alleged exposure occurred, the location of the exposure and the unit he was in at the time, and the circumstances of the exposure. Specifically, the Veteran has stated that he was exposed to herbicides when they were sprayed overhead by a plane during the time period from January 1973 to February 1973 or from March to May 1973 while stationed at Camp Hansen, Okinawa, where he was serving with the 3d Marine Division, Cape Marine Force, 3rd Dental Company. This information was properly furnished to the Compensation Service, which reviewed the DOD inventory list and could not find confirmation that herbicides where used in that location. A copy of this finding is in the file. However, the RO did not then submit the information to the JSRRC to attempt verification of the alleged exposure through this channel, as directed by the Compensation Service in its findings, and by the provisions of the Adjudication Procedure Manual discussed in the preceding paragraph. Thus, on remand, the RO/AMC should complete this last step in attempting to verify the Veteran's alleged exposure. With regard to the Veteran's service connection claims for a kidney disorder, a disability of the right elbow, and a disability of the right knee, he stated at the January 2009 and June 2012 Board hearings that he was treated for these disorders as a VA employee at the James A. Haley VA hospital in Florida in the first few years following separation from active service. In its April 2009 remand directive, the Board instructed the agency of original jurisdiction (AOJ) to make efforts to obtain the Veteran's VA treatment records from the Tampa VA Medical Center (VAMC) in 1976. The RO did request the Veteran's clinical records from the Bay Pines VAMC from July 1976 to December 1996. In this regard, a penciled-in notation on a copy of the Board's remand in the claims file states that as an employee at the Tampa VAMC, the Veteran would have been sent to the Bay Pines VAMC and not to the Tampa VAMC. Nevertheless, as the Veteran has stated that he was treated at the Tampa VAMC, and specifically at the James A. Haley hospital, VA must make every effort to obtain records from this facility. See 38 C.F.R. § 3.156(c)(2). There is no indication in the claims file that such efforts have yet been undertaken. Thus, on remand, the RO/AMC should request the Veteran's VA treatment records for the period from 1976 to 1980 from the James A. Haley VA hospital and associated outpatient clinics. A request to the Tampa VAMC may be made instead if such a request encompasses records generated by these facilities. With regard to the Veteran's petition to reopen the service connection claim for a left knee disability, the Board finds that proper notice under the VCAA has not been sent. Specifically, in Kent v. Nicholson, 20 Vet. App. 1 (2006), the Court held that the VCAA requires VA to notify claimants of the general requirements to reopen a claim, and the specific grounds of the previous denial. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). Explaining the reasons for the prior denial clarifies what further evidence would be necessary to substantiate the element or elements required to establish service connection that were found insufficient in the previous denial. Here, the VCAA notice letter sent in July 2006 informed the Veteran that his claim for a left knee disability had last been denied in a July 2004 rating decision, and that new and material evidence was required to open it. It also explained the terms "new" and "material" evidence. However, while the letter correctly informed the Veteran that his claim had been denied in the July 2004 rating decision because new and material evidence had not been submitted at that time, it did not explain the actual basis of the denial on the merits. Notifying the Veteran that he must submit new and material evidence, and then stating that his claim had been previously denied because new and material evidence had not been submitted, is a tautology that does not meaningfully inform the Veteran of what evidence is required to reopen the claim, which contravenes VA's duty to notify under the VCAA as defined in Kent. On remand, the Veteran should be sent a new VCAA notice letter that provides all required notice under the VCAA with regard to petitions to reopen previously denied claims, and explains the actual basis for the previous denial on the merits, which can be found in the June 1997 rating decision. Although the basis for the denial on the merits is stated in the June 1997 rating decision, the Veteran must still be informed that the last prior denial of his claim is the July 2004 rating decision. With regard to the Veteran's service connection claim for TMJ, there is sufficient evidence to trigger VA's duty to provide an examination and obtain a nexus opinion under the VCAA. See 38 U.S.C.A. § 5103A; 38 C.F.R. §§ 3.159(c)(4), 3.326(a); McLendon, 20 Vet. App. at 83. Specifically, the service treatment records show that the Veteran had TMJ pain in July 1974. The Veteran testified at the June 2012 Board hearing that he woke up with TMJ pain in service, and believed he had been punched in the face. He is currently diagnosed with degenerative changes of the temporomandibular joint spaces, and states that he has had TMJ pain ever since active service. Thus, there is at least an indication that the Veteran's current TMJ degenerative changes are related to the TMJ pain he reported during active service. The Board is not able to make such a medical determination itself. See Colvin v. Derwinski, Vet. App. 171, 175 (1991) (holding that the Board is not competent to substitute its own opinion for that of a medical expert). Therefore, a VA examination is warranted to address the likelihood that the Veteran's TMJ degenerative changes are related to service. See McLendon, 20 Vet. App. at 83 (holding that a VA examination is required when there is an indication that a current disability is related to an in-service disease, injury, or event, and insufficient evidence to decide the claim). With regard to the service connection claim for a right knee disability, a VA joints examination was provided in April 2007. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In this case, the examiner concluded that an opinion could not be made without resorting to speculation, but did not adequately explain the basis for this conclusion. In this regard, the examiner stated that there was no documentation of ongoing right knee problems in the service treatment records and no right knee problem found in the separation examination report. However, the examiner did not explain how these findings precluded a nonspeculative opinion. On remand, a new VA joints examination should be performed. The examiner must either provide an opinion as to the likelihood that the Veteran's right knee disability is related to service, or provide a more complete explanation as to why such a relationship cannot be determined without resorting to speculation. For example, the examiner should explain whether a definitive opinion cannot be provided because required information is missing or because current medical knowledge yields multiple possible etiologies with none more likely than not the cause of the claimed disability. The examiner should note that the service treatment records reflect several complaints of right knee pain in 1973, but thereafter are negative for right knee problems in the remaining three years of service. In a January 1973 service treatment record, the Veteran reported having torn cartilage in the right knee, and that he had sustained a previous injury three years earlier. His separation examination report shows that his lower extremities were found to be normal on clinical evaluation, and the Veteran denied knee problems in a June 1979 Report of Medical History three years after his discharge. His post-service VA treatment records generally show treatment for a left knee disorder but not for the right knee. This information should be considered in addressing the likelihood that the Veteran's right knee disability is related to service. With regard to the Veteran's service connection claim for a kidney disorder, the examiner's opinion in an April 2010 VA examination report is not adequate for decision-making purposes. See Barr, 21 Vet. App. at 312. Specifically, the examiner stated that the Veteran had chronic renal insufficiency, but that it did not develop until years after the Veteran's separation from active service. However, the examiner did not address whether a kidney disorder may be related to the Veteran's difficulty urinating, kidney pain, and prostatitis noted in the January 1973 service treatment record. Notably, the VA treatment records show that the Veteran has had difficulty urinating-which is diagnosed as urethral stricture-and prostatitis during the pendency of this claim, which is similar to the in-service findings, although it is not clear to the Board whether these conditions are related to the Veteran's kidney stones or another kidney disorder. Thus, because the April 2010 VA opinion did not address this evidence, it is not adequate as it does not provide enough information to make a fully informed decision. See Barr, 21 Vet. App. at 312; Stefl, 21 Vet. App. at 123. On remand, a new VA genitourinary or kidney examination should be performed and the examiner must specifically address in the examination report the likelihood that any current kidney disorder is related to the prostatitis, kidney pain, and difficulty urinating documented in the service treatment records and for which the Veteran has been treated more recently at VA during the pendency of this claim. With regard to the Veteran's service connection claim for an anxiety disorder, to include PTSD, a VA examination is warranted to determine whether the Veteran has a current anxiety disorder related to active service. Specifically, the service treatment records show that in January 1973 the Veteran was seen for a psychological consultation due to difficulty adjusting to the military. He denied being a "deadbeat or hippie" prior to service, but stated he "was a drug abuser." No diagnosis was rendered, but the Veteran was prescribed Thorazine at this time. Three years after separation from service, in the June 1979 Report of Medical History, the Veteran checked the "yes" box for "nervous trouble of any sort." He explained on the back of the form that he had been treated for anxiety once and was told he was overworked and needed some rest. A doctor or nurse's notation further states that the Veteran had experienced an "anxiety reaction" seven months earlier and was prescribed valium. A December 1998 VA treatment record shows that the Veteran reported a history of anxiety attacks and feelings of severe anxiety. This record notes that the Veteran had been treated with valium and Thorazine in the past. A January 2000 VA treatment record reflects a diagnosis of anxiety and states that the Veteran was in an anxiety management program, which included deep breathing and removal from anxiety-producing situations. An October 2006 VA treatment record reflects a diagnosis of anxiety NOS (not otherwise specified). Thus, based on the evidence discussed in the preceding paragraph, there is at least an indication that the Veteran has an anxiety disorder related to the treatment he received in January 1973, at which time he was prescribed medication for psychiatric symptoms. Accordingly, a VA examination is warranted. See McLendon, 20 Vet. App. at 83. On remand, a VA psychiatric examination should be provided and the examiner should render an opinion as to whether the Veteran has an anxiety disorder apart from PTSD related to his treatment during service in January 1973. With regard to the Veteran's appeal of the initial noncompensable rating assigned his service-connected rhinitis and sinusitis with headaches, a new examination is warranted to assess the current level of severity of this disorder. In this regard, a VA examination of this condition was last performed in April 2007 and is now almost six years old. Where the evidence of record does not reflect the current state of a claimant's disability, a new VA examination must be conducted. See 38 C.F.R. § 3.327(a) (2012); Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Finally, the determination of whether a 10 percent rating is warranted for multiple noncompensable service-connected disabilities is dependent on the resolution of the claims being remanded. Therefore, the Board will defer consideration of this issue at the present time. See Harris v. Derwinski, 1 Vet. App 180, 183 (1991) (two issues are "inextricably intertwined" when a decision on one issue would have a "significant impact" on the resolution of the second issue). Accordingly, the case is REMANDED for the following actions: 1. Appropriate efforts should be made to obtain the Veteran's VA treatment records from the James A. Haley VA hospital and associated outpatient clinics from July 1976 to January 1980. A single request may be made to the Tampa VAMC if deemed sufficient to include these facilities. If the RO/AMC is unable to obtain these records after making as many requests as are necessary, and concludes that they do not exist or that further efforts to obtain them would be futile, the AOJ should make a formal finding of unavailability. A copy of the formal finding should be associated with the claims file. The RO/AMC must also notify the Veteran that it was unable to obtain these records. The notice should: (a) identify the specific records VA is unable to obtain; (b) briefly explain the efforts that VA made to obtain those records; (c) describe any further action to be taken by VA with respect to the claim; and (d) notify him that he is ultimately responsible for providing the evidence. 38 U.S.C.A. § 5103A(b)(2); 38 C.F.R. § 3.159(e)(1). 2. In accordance with Kent, a new VCAA letter should be sent to the Veteran explaining the basis of the prior denial on the merits of his service connection claim for a left knee disability, namely that the service treatment records did not show treatment for a left knee disability, according to the June 1997 rating decision. The Veteran must still be notified that the claim was last denied in the July 2004 rating decision. The letter should comply with all current, controlling legal guidance with respect to VCAA notice letters, and include the elements of new and material evidence and the elements of service connection. 3. The Veteran's alleged herbicide exposure for the periods between January 1973 and May 1973, at Camp Hansen in Okinawa, Japan while serving in the 3d Marine Division, Cape Marine Force, 3rd Dental Company should be submitted to the JSRRC for attempted verification. If the JSRRC is only able to conduct a search for a three-month time period, then separate inquiries should be made for the January-to-March 1973 and April-to-May 1973 time periods. 4. The Veteran should be scheduled for a VA examination to assess the nature and likely etiology of his TMJ disorder. The entire claims file and a copy of this REMAND must be made available to the examiner prior to the examination. The examiner must note in the examination report that the evidence in the claims file has been reviewed. After reviewing the file and examining the Veteran, the examiner should render an opinion as to whether the Veteran's degenerative changes of the temporomandibular spaces are at least as likely as not (i.e., to at least a 50:50 degree of probability) related to the TMJ pain noted in the May 1974 service treatment record or otherwise related to service, or whether such a relationship is unlikely (i.e., less than a 50:50 degree of probability). The term "at least as likely as not" does not mean "within the realm of medical possibility." Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of that conclusion as it is to find against it. The examiner should provide a complete rationale for any opinion provided. The RO/AMC should ensure that an adequate rationale has been provided before returning this case to the Board. 5. The Veteran should be scheduled for a VA examination to assess the nature and likely etiology of his right knee disability. The examination and opinion should comply with the guidelines set forth in the preceding instruction, to include review of the claims file and notation of this fact in the examination report. The examiner must provide an opinion as to whether it is at least as likely as not that the Veteran has a current right knee disability related to the right knee problems documented in the service treatment records, including the diagnosis of chondromalacia patella in the August 1973 service treatment record. If the examiner is not able to provide an opinion without resorting to speculation, the examiner must state the reasons why such an opinion cannot be rendered. In this regard, the examiner should state whether a definitive opinion cannot be provided because required information is missing, or because current medical knowledge yields multiple possible etiologies with none more likely than not the cause of the claimed disability. The examiner should be as specific as possible. 6. The Veteran should be scheduled for a VA genitourinary or kidney examination to assess the nature and etiology of any kidney disorder during the pendency of this claim. The examination should follow the guidelines set forth in instruction # 4. After examining the Veteran and reviewing the claims file and medical history, the examiner should render an opinion as to whether it is at least as likely as not that any current kidney disorder may be related to the prostatitis, kidney pain, and difficulty urinating documented in the service treatment records, and for which the Veteran has been treated more recently at VA, or whether such a relationship is unlikely. 7. The Veteran should be scheduled for a VA psychiatric examination to assess the nature and etiology of any current anxiety disorder. After reviewing the claims file and medical history and examining the Veteran, the examiner should render an opinion as to whether it is at least as likely as not that the Veteran has an anxiety disorder related to active service, and in particular to the Veteran's psychiatric consultation in January 1973, at which time he was prescribed Thorazine. The examiner must note in the examination report that the claims file has been reviewed, and the opinion must follow the guidelines set forth in instruction #4. If any of the Veteran's alleged in-service stressors have been verified, the examiner should also render an opinion as to whether the Veteran has PTSD as a result of a verified stressor. 8. The Veteran should be scheduled for a VA examination to assess the current level of severity of his rhinitis and sinusitis with headaches. The entire claims file and a copy of this REMAND must be made available to the examiner prior to the examination. The examiner must note in the examination report that the evidence in the claims file has been reviewed. All tests and studies deemed helpful by the examiner should be conducted and all clinical findings reported in detail. The examiner must discuss the functional impairment resulting from the Veteran's rhinitis and sinusitis with headaches, and in particular how it would affect his ability to work, irrespective of whether he is currently employed. 9. The RO/AMC should review the examination reports obtained as a result of this remand and ensure that they comply with the Board's remand directives and are otherwise adequate before returning this case to the Board. 10. After the above development is completed, and any other development that may be warranted based on any additional information or evidence received, the RO/AMC should readjudicate the claims on the merits. If the benefits sought are not granted, the Veteran and his representative should be furnished a supplemental statement of the case (SSOC) and afforded a reasonable opportunity to respond before the record is returned to the Board for further review. The Veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). No action is required of the Veteran until further notice. However, the Board takes this opportunity to advise the Veteran that the conduct of the efforts as directed in this remand, as well as any other development deemed necessary, is needed for a comprehensive and correct adjudication of his claims. His cooperation in VA's efforts to develop his claims, including reporting for any scheduled VA examination, is both critical and appreciated. The Veteran is also advised that failure to report for any scheduled examination may result in the denial of a claim. 38 C.F.R. § 3.655 (2012). 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. 2012). ______________________________________________ JOHN Z. JONES Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs