Citation Nr: 1304558 Decision Date: 02/07/13 Archive Date: 02/19/13 DOCKET NO. 09-19 114 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for tinnitus/vertigo. 2. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for bilateral hearing loss. 3. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for chest pains. 4. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for headaches. 5. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for neck pain. 6. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a left knee disability. 7. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a left leg disability. 8. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a left ankle disability. REPRESENTATION Veteran represented by: Texas Veterans Commission WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD L. J. N. Driever INTRODUCTION The Veteran had active service from September 1991 to January 1998 and from April 1998 to April 2001 and subsequent service in the Army National Guard. These claims come before the Board of Veterans' Appeals (Board) on appeal of a September 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The Veteran testified at a hearing held at the RO before the undersigned Veterans Law Judge in April 2011. In September 2011, the Board remanded these claims to the RO for additional action. At that time, the appeal included claims to reopen previously denied claims of entitlement to service connection for low back and abdominal conditions. In a rating decision dated October 2012, the RO granted service connection for a low back disorder and an abdominal disorder. They are thus no longer before the Board for appellate review. A review of the Virtual VA paperless claims processing system reveals no additional pertinent documents for consideration in support of the claims being decided. The Board addresses the claims of entitlement to service connection for tinnitus/vertigo, chest pains and headaches in the REMAND section of this decision, below, and REMANDS those claims to the RO via the Appeals Management Center (AMC) in Washington, D.C. FINDINGS OF FACT 1. In a decision issued in June 2002, the RO denied the Veteran entitlement to service connection for tinnitus/vertigo, bilateral hearing loss, chest pains, headaches, neck pain, a left knee disability, a left leg disability and a left ankle disability. 2. The RO notified the Veteran of the decision and of his appellate rights with regard to the decision, but he did not appeal it. 3. The evidence received since June 2002 is neither cumulative, nor redundant of the evidence previously of record and, by itself or when considered with the evidence previously of record, relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for tinnitus/vertigo and raises a reasonable possibility of substantiating that claim. 4. The evidence received since June 2002 is neither cumulative, nor redundant of the evidence previously of record but, by itself or when considered with the evidence previously of record, does not relate to an unestablished fact necessary to substantiate the claim of entitlement to service connection for bilateral hearing loss or raise a reasonable possibility of substantiating that claim. 5. The evidence received since June 2002 is neither cumulative, nor redundant of the evidence previously of record but, by itself or when considered with the evidence previously of record, relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for chest pains and raises a reasonable possibility of substantiating that claim. 6. The evidence received since June 2002 is neither cumulative, nor redundant of the evidence previously of record but, by itself or when considered with the evidence previously of record, relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for headaches and raises a reasonable possibility of substantiating that claim. 7. The evidence received since June 2002 is neither cumulative, nor redundant of the evidence previously of record but, by itself or when considered with the evidence previously of record, does not relate to an unestablished fact necessary to substantiate the claim of entitlement to service connection for neck pain or raise a reasonable possibility of substantiating that claim. 8. The evidence received since June 2002 is neither cumulative, nor redundant of the evidence previously of record but, by itself or when considered with the evidence previously of record, does not relate to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a left knee disability or raise a reasonable possibility of substantiating that claim. 9. The evidence received since June 2002 is neither cumulative, nor redundant of the evidence previously of record but, by itself or when considered with the evidence previously of record, does not relate to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a left leg disability or raise a reasonable possibility of substantiating that claim. 10. The evidence received since June 2002 is neither cumulative, nor redundant of the evidence previously of record but, by itself or when considered with the evidence previously of record, does not relate to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a left ankle disability or raise a reasonable possibility of substantiating that claim. CONCLUSIONS OF LAW 1. The June 2002 rating decision, in which the RO denied the Veteran entitlement to service connection for tinnitus/vertigo, bilateral hearing loss, chest pains, headaches, neck pain, a left knee disability, a left leg disability and a left ankle disability, is final. 38 U.S.C.A. § 7105(c) (West 2002); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2002). 2. New and material evidence has been received to reopen a claim of entitlement to service connection for tinnitus/vertigo. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2012). 3. New and material evidence has not been received to reopen a claim of entitlement to service connection for bilateral hearing loss. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2012). 4. New and material evidence has been received to reopen a claim of entitlement to service connection for chest pains. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2012). 5. New and material evidence has been received to reopen a claim of entitlement to service connection for headaches. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2012). 6. New and material evidence has not been received to reopen a claim of entitlement to service connection for neck pain. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2012). 7. New and material evidence has not been received to reopen a claim of entitlement to service connection for a left knee disability. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2012). 8. New and material evidence has not been received to reopen a claim of entitlement to service connection for a left leg disability. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2012). 9. New and material evidence has not been received to reopen a claim of entitlement to service connection for a left ankle disability. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In this decision, the Board will discuss the relevant law that it is required to apply. This includes statutes enacted by Congress and published in Title 38, United States Code ("38 U.S.C.A."); regulations promulgated by VA under the law and published in the Title 38 of the Code of Federal Regulations ("38 C.F.R."); and the precedential rulings of the Court of Appeals for the Federal Circuit (as noted by citations to "Fed. Cir.") and the Court of Appeals for Veterans Claims (as noted by citations to "Vet.App."). The Board is bound by statute to set forth specifically the issue under appellate consideration and its decision must also include separately stated findings of fact and conclusions of law on all material issues of fact and law presented on the record, and the reasons or bases for those findings and conclusions. See 38 U.S.C.A. § 7104(d); see also 38 C.F.R. § 19.7 (implementing the cited statute); see also Vargas-Gonzalez v. West, 12 Vet.App. 321, 328 (1999); Gilbert v. Derwinski, 1 Vet.App. 49, 56-57 (1990) (the Board's statement of reasons and bases for its findings and conclusions on all material facts and law presented on the record must be sufficient to enable the claimant to understand the precise basis for the Board's decision, as well as to facilitate review of the decision by courts of competent appellate jurisdiction). The Board must also consider and discuss all applicable statutory and regulatory law as well as the controlling decisions of the appellate courts. VA's Duties to Notify and Assist Upon receipt and prior to consideration of most applications for VA benefits, VA must comply with the Veterans Claims Assistance Act of 2000 (VCAA) and its implementing regulations. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The United States Court of Appeals for Veterans Claims (Court) has mandated that VA ensure strict compliance with the provisions of the VCAA. Quartuccio v. Principi, 16 Vet. App. 183 (2002). The VCAA and its implementing regulations provide that VA is to notify a claimant and his representative, if any, of the information and medical or lay evidence not previously provided to the Secretary that is necessary to substantiate a claim. As part of the notice, VA is to specifically inform the claimant and his representative, if any, of which portion of the evidence the claimant is to provide and which portion of the evidence VA will attempt to obtain on the claimant's behalf. 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2012). These notice requirements apply to all five elements of a service connection claim, including: (1) veteran status; (2) existence of disability; (3) a connection between service and disability; (4) degree of disability; and (5) effective date of disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 484 (2006). In the context of a claim that has been previously denied, the notice must inform the claimant of the evidence and information necessary to reopen the claim and of the evidence and information necessary to establish entitlement to the underlying claim for the benefit sought by the claimant. Kent v. Nicholson, 20 Vet. App. 1, 9-10 (2006). In informing the claimant of what evidence would be considered new and material, VA must examine the basis for the denial in the prior decision and identify the evidence that would substantiate the element(s) of a service connection claim found lacking in the previous denial. Id. Notice under the VCAA must be provided a claimant prior to an initial unfavorable decision by the agency of original jurisdiction. Pelegrini v. Principi (Pelegrini II), 18 Vet. App. 112, 119-20 (2004). VA is also to assist a claimant in obtaining evidence necessary to substantiate a claim, but such assistance is not required if there is no reasonable possibility that it would aid in substantiating the claim. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159(c) (2012). In the context of a claim to reopen, VA's duty to assist is limited to the following: (1) making reasonable efforts to obtain non-Federal department or agency records; (2) obtaining records in the custody of a Federal department or agency; and (3) obtaining VA and military records. 38 C.F.R. § 3.159(c)(1), (2) and (3). Notice The RO provided the Veteran VCAA notice on his application to reopen his claims by letters dated July 2009, August 2009, November 2009, October 2011, December 2011 and May 2012. Although the RO sent these letters after initially deciding the Veteran's claims, it cured this timing defect later by readjudicating the claims in a supplemental statement of the case issued in October 2012. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The RO notified the Veteran of the evidence needed to substantiate his application to reopen his claims, identified the type of evidence that would best do so, notified him of VA's duty to assist and indicated that it was reviewing his petition to reopen his claims pursuant to that duty. The RO also notified the Veteran of the bases of the last denials of his claims. The RO identified the evidence it had requested and/or received and the evidence it was responsible for securing. The RO informed the Veteran that it had attempted to obtain his service treatment records from his first period of service on multiple occasions, but had learned that those records are unavailable. See Dixon v. Derwinski, 3 Vet. App. 261 (1992) (holding that, where a veteran's service medical records have been destroyed or lost, the Board is under a duty to advise the claimant to obtain other forms of evidence, such as lay testimony, to support his claim). In May 2012, the RO advised the Veteran that he could submit treatment records; statements from physicians, clinical studies, radiographic reports, physical therapy records and lay statements to support his claims. Any notice deficiency is harmless and non-prejudicial, not affecting the essential fairness of the adjudication. Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004); Pelegrini v. Principi, 18 Vet. App. 112, 119-120 (2004); Bernard v. Brown, 4 Vet. App. 384 (1993). As explained below, in each claim on appeal that the Board did not reopen, evidence pertaining to the current disability or nexus element of the claim is wanting. Therefore, even if the unavailable service treatment records were of record and showed in-service treatment for the claimed disabilities, the outcome would not change. When previously denying these claims, the RO conceded in-service incurrence. Assistance The RO also satisfied its duty to assist the Veteran in the development of his claims by attempting, albeit unsuccessfully in the case of the service treatment records mentioned, to secure and associate with the claims file all documents the Veteran identified as being pertinent to his claims. The Board further assisted the Veteran by affording him a VA hearing. The RO did not afford the Veteran VA examinations of the conditions at issue in this appeal; however, as previously indicated, given that these are claims to reopen, such action is not mandated. Analysis The Veteran seeks service connection for tinnitus/vertigo, bilateral hearing loss, chest pains, headaches, neck pain, a left knee disability, a left leg disability and a left ankle disability. He claims that the tinnitus/vertigo, chest pains and headaches initially manifested during his first period of active service and have continued to manifest since his discharge from that period of service. He claims that he developed hearing loss secondary to in-service noise exposure and neck, left knee, left leg and left ankle disabilities secondary to an in-service injury. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military, naval or air service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303(a) (2012). To prevail on the issue of service connection, there must be competent evidence of: (1) a current disability; (2) in-service occurrence or aggravation of a disease or injury; and (3) a nexus between the in-service injury or disease and the current disability. See generally Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Subsequent manifestations of a chronic disease in service, however remote, are to be service connected, unless clearly attributable to intercurrent causes. 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, as distinguished from merely isolated findings or diagnosis including the word "chronic." Continuity of symptomatology is required only where the condition noted during service is not, in fact, shown to be chronic or when the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (2012). To establish continuity after discharge, the evidence must demonstrate the following: (1) condition "noted" during service; (2) post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology. Id. at 498 (holding that, on the question of whether the veteran has a chronic condition since service, the evidence must be medical unless it relates to a condition as to which, under case law, lay observation is competent). Service connection may be granted for any disease diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2012). In a rating decision dated in June 2002, the RO denied the Veteran's claims of entitlement to service connection for tinnitus/vertigo, bilateral hearing loss, chest pains, headaches, neck pain, a left knee disability, a left leg disability and a left ankle disability. In deciding these claims, the RO considered the Veteran's treatment records from both of his periods of active service (he submitted copies of documents from the first period of service) and service in the National Guard, service personnel records, written statements, and VA examination reports. In the initial rating decision, the RO found the following: (1) The Veteran's tinnitus is periodic, not chronic; (2) The Veteran does not currently have hearing loss; (3) Although he received treatment for chest pains, headaches and neck pain during service, there is no evidence of chronic residuals of those conditions; and (4) Although he received treatment for left knee and ankle problems during service, he does not currently have a left knee, left leg or left ankle disability. Based on these findings, the Board concluded that all of the claimed conditions were not incurred in or aggravated by service. By letter dated the same month, the RO notified the Veteran of the rating decision and of his appellate rights with regard to that decision. Thereafter, however, the Veteran did not appeal the decision. The June 2002 rating decision is thus final. 38 U.S.C.A. § 7105(c) (West 2002); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2002). The Veteran attempted to reopen these claims by written statement received in July 2008. A claim that is the subject of a prior final denial may be reopened if new and material evidence is received with respect to that claim. Once a claim is reopened, the adjudicator must review it on a de novo basis, with consideration given to all of the evidence of record. 38 U.S.C.A. § 5108 (West 2002); Evans v. Brown, 9 Vet. App. 273 (1996). New evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with the previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative, nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a) (2012). As noted above, new and material evidence has not been received to reopen the claims of service connection for hearing loss, neck pain, and disorders of the left knee, left leg and left ankle. In its September 2008 rating decision, the RO found that the Veteran's claims were "considered reopened. However, regardless of the RO's actions, the Board has jurisdictional responsibility to determine whether a claim previously denied by the RO is properly reopened. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001) (citing 38 U.S.C.A. §§ 5108, 7105(c)); Barnett v. Brown, 83 F. 3d 1380 (Fed. Cir. 1996) and VAOPGCPREC 05-92. Accordingly, the Board must initially determine whether there is new and material evidence to reopen the back claim before proceeding to readjudicate the underlying merits of the claim. If the Board finds that no new and material evidence has been offered, that is where the analysis must end. The evidence that is considered to determine whether new and material evidence has been received is the evidence associated with the claims file since the last final disallowance of the appellant's claim on any basis. Evans, 9 Vet. App. at 273. This evidence is presumed credible for the purposes of reopening an appellant's claim, 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 (1995); Justus v. Principi, 3 Vet. App. 510 (1992). The evidence that has been associated with the claims file since the RO's June 2002 rating decision includes service personnel records, VA treatment records, and the Veteran's written statements and hearing testimony. This evidence is new. It is neither cumulative, nor redundant of the evidence previously of record. With regard to the claims of entitlement to service connection for tinnitus/vertigo, headaches and chest pain, this evidence is also material. By itself or when considered with the evidence previously of record, it relates to an unestablished fact necessary to substantiate those claims and raises a reasonable possibility of substantiating them. More specifically, the Veteran's hearing testimony includes his assertions that he has experienced tinnitus, chest pains and headaches continuously since service. In June 2002, the RO denied service connection for tinnitus because the most recent VA examination showed that the Veteran reported a "mild tinnitus of three to five minutes duration" which was not chronic. Similarly, the RO denied service connection for chest pains because although the Veteran had been treated for costochondritis between August and October 1998, the service treatment records did not reflect any other complaints or treatment "other than the one instance" where the Veteran complained of chest pain. Finally as to headaches, in June 2002, the RO denied the claim because there was no evidence that the Veteran had headaches, and STRs documented only a one time headache that was associated with a left ear canal inflammation. Given that these conditions are lay observable, such assertions represent competent evidence of continuity of symptomatology since service. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (layperson is competent to report lay-observable symptoms, but lacking in medical training and expertise, is not competent to diagnose a medical condition or provide an opinion on causation). The absence of this type of evidence, as a substitute for a showing of chronicity, formed the basis of the RO's previous denial of the claims of entitlement to service connection for tinnitus/vertigo, chest pains and headaches. Further, the Veteran's present reports of continuous symptoms are presumed credible for the limited purpose of determining whether new and material evidence has been submitted to reopen the claim. Justus, supra. Given the Veteran's competent assertions, and the limited presumption of credibility that attaches to his assertion for the purpose of reopening the claim, the Board will reopen and remand the claims for further development. With regard to the claims of entitlement to service connection for bilateral hearing loss, neck pain, a left knee disability, a left leg disability and a left ankle disability, this evidence is not material. The RO denied these claims in June 2002 because there was no evidence that the Veteran had incurred these disorders during his active military service. In particular, in a January 2001 Report of Medical History questionnaire, the Veteran then specifically denied then having, or ever having had hearing loss; arthritis, bursitis; bone, joint or other deformity, a "trick" or locked knee, and foot trouble. By itself or when considered with the evidence previously of record, any recently-submitted evidence does not relate to an unestablished fact necessary to substantiate those claims or raise a reasonable possibility of substantiating them. The new service personnel records show that the Veteran was discharged from the National Guard in April 2007 based on being medically unfit. The treatment records show that, since the last denial, the Veteran has received treatment for his left knee and ankle. There is no medical opinion in these records diagnosing hearing loss or etiologically relating a neck, left knee, left leg or left ankle disability to the Veteran's active service. See generally Morton v. Principi, 3 Vet. App. 508 (1992); Mingo v. Derwinski, 2 Vet. App. 51 (1992) (observing that evidence of a claimant's current condition is not generally relevant to the issue of service connection, absent some competent linkage to military service). The Veteran's statements reflect his belief that these disabilities are present and related to his active service, but given that the Veteran has no expertise in medical matters, his statements are not competent evidence of a diagnosis or nexus. Jandreau v. Nicholson, 492 F.3d at 1377. The element of a service connection claim that was previously missing - a nexus - therefore remains missing with regard to the claims of entitlement to service connection for bilateral hearing loss, neck pain, a left knee disability, a left leg disability and a left ankle disability. Having determined that new and material evidence has been received with regard to the claims of entitlement to service connection for tinnitus/vertigo, headaches and chest pain, the Board must reopen these claims. It may not proceed in adjudicating these claims, however, as further assistance is needed in the development thereof. Having determined that new and material evidence has not been received with regard to the claims of entitlement to service connection for bilateral hearing loss, neck pain, a left knee disability, a left leg disability and a left ankle disability, the Board may not reopen and must deny these claims. ORDER New and material evidence having been received, the claim of entitlement to service connection for tinnitus/vertigo is reopened and the appeal is granted to this extent only. New and material evidence not having been received, the claim of entitlement to service connection for bilateral hearing loss is denied. New and material evidence having been received, the claim of entitlement to service connection for chest pains is reopened and the appeal is granted to this extent only. New and material evidence having been received, the claim of entitlement to service connection for headaches is reopened and the appeal is granted to this extent only. New and material evidence not having been received, the claim of entitlement to service connection for neck pain is denied. New and material evidence not having been received, the claim of entitlement to service connection for a left knee disability is denied. New and material evidence not having been received, the claim of entitlement to service connection for a left leg disability is denied. New and material evidence not having been received, the claim of entitlement to service connection for a left ankle disability is denied. REMAND Prior to adjudicating the claims of entitlement to service connection for tinnitus/vertigo, chest pains and headaches, additional development is necessary. See 38 C.F.R. § 19.9 (2012). When the Board reopens a claim after the RO denied reopening the same claim, the matter generally must be returned to the RO for consideration of the merits of the claim. Hickson v. Shinseki, 23 Vet. App. 394, 399 (2010). This is so because the RO generally does not assess the credibility of the evidence or determine the need for a medical examination or opinion when reopening is denied. Id. at 403 (internal citations omitted). For the Board to then discuss the merits of the claim, it would be considering law that the RO had not already considered, possibly implicating 38 C.F.R. § 20.903(b). Id. In any event, the RO should consider the new evidence in the first instance and decide the claim on its merits so as to preserve for the Veteran the one review on appeal as provided by 38 U.S.C.A. § 7104 (West 2002). Id. at 399. In addition, during the course of this appeal, the RO did not afford the Veteran a VA examination in support of his claims for service connection for tinnitus/vertigo, chest pains and headaches (Veteran underwent VA examination in March 2002, years before filing these claims, but report of that examination is inadequate to decide these claims). Under 38 U.S.C.A. § 5103A (West 2002), VA's duty to assist includes providing a claimant a medical examination or obtaining a medical opinion when an examination or opinion is necessary to make a decision on a claim and the claims file contains competent evidence that the claimant has a current disability and indicates that the disability may be associated with the claimant's service. The types of evidence that indicate that a current disability may be associated with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Evidence of a link between a current disability and service must be sufficient and, depending on the nature thereof, may include an assertion by the Veteran linking the two. Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (holding that a conclusory, generalized statement relating an in-service illness to present medical problems is not sufficient to necessitate obtaining a VA examination and that medical examinations are not to be routinely and automatically provided to all veterans in disability cases involving nexus issues). The threshold for finding a link between a current disability and service is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon v. Nicholson, 20 Vet. App. at 83. In this case, examinations in support of the claims being remanded are necessary. Service treatment records establish that the Veteran reported tinnitus, chest pain and headaches during active duty. According to the Veteran, he has continued to experience these conditions since discharge. To date, no medical professional has offered an opinion on the etiology of these conditions, which contemplates the Veteran's assertions. Such an opinion is necessary as the assertions represent continuity of lay-observable symptomatology. The Board REMANDS these claims to the RO/AMC for the following action: 1. Ascertain if the Veteran has any further lay or medical evidence that is not presently in the claims file pertaining to the claims being remanded. Provide the Veteran with appropriate releases of information to obtain any evidence cited and advise him that he may submit such evidence on his own. 2. Afford the Veteran a VA examination in support of his claims for service connection for tinnitus/vertigo, chest pains and headaches. The following considerations will govern the examination: a. The claims folder and a copy of this remand will be reviewed by the examiner who will acknowledge this review in any report generated by the examination. The examiner's attention is called to the following: i. Service treatment records dated in December 1979, August 1999 and April 2000, noting the conditions at issue in this remand; ii. Report of VA examination conducted in March 2002, confirming the presence of these conditions; and iii. The Veteran's April 2011 hearing testimony asserting continuity of tinnitus, chest pains and headaches since service. b. Contemplating the Veteran's competent testimony, the examiner must express an opinion as to whether the Veteran has tinnitus, a disability manifested by chest pains, and/or a disability manifested by headaches, which is(are) related to his active service. THE EXAMINER MUST PROVIDE AN EXPLANATION FOR ANY CONCLUSIONS REACHED, BASED UPON HIS OR HER MEDICAL KNOWLEDGE, THE RESULTS OF THE EXAMINATION, AND THE EVIDENCE IN THE CLAIMS FOLDER. 3. The RO/AMC and the examiners are advised that the courts of appellate jurisdiction (i.e., those that review Board decisions) have imposed increasing requirements in the obtaining and review of medical opinion evidence. The courts have directed that when VA (either the RO or the Board) obtains a medical opinion, it must be fully explained with specific reference to both medically and factually relevant evidence in the record. The courts have generally focused on the following questions: Whether the examiner showed a knowledge of the claimant's correct medical history; Whether the examiner provided a fully reasoned explanation, as opposed to a summary conclusion - the latter not being legally sufficient; Whether the examiner used clinical data (e.g., previous and current objective and clinical test results, laboratory findings, blood tests, etc.) in explaining his or her findings; Whether the examiner responded to the Board or the RO's inquiry; Whether the examiner cited to, and discussed other medical opinions of record; Whether the examiner discussed, as opposed to merely cited, his or her own expertise; specializations if any, and clinical experience. 4. The RO/AMC will review the examination report to ensure that it includes all requested information and, if not, return it to the examiner for correction pursuant to 38 C.F.R. § 4.2. 5. The RO/AMC will then readjudicate the claims on appeal based on all of the evidence of record. If any benefit sought on appeal is not granted to the Veteran's satisfaction, issue a supplemental statement of the case. List the additional evidence the RO considered and identify the relevant actions the RO took and the evidence and applicable law and regulations it considered in support of the appeal. Allow an appropriate period of time for a response. Thereafter and subject to current appellate procedure, return this case to the Board for further consideration. The Board intimates no opinion as to the ultimate outcome in this case, but advises the Veteran that he has the right to submit additional evidence and argument on the remanded claims. Kutscherousky v. West, 12 Vet. App. 369, 372 (1999). These claims must be afforded expeditious treatment. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ____________________________________________ Vito A. Clementi Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs