Citation Nr: 1306901 Decision Date: 02/28/13 Archive Date: 03/01/13 DOCKET NO. 98-08 158A ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Baltimore, Maryland THE ISSUES 1. Entitlement to an effective date earlier than August 30, 2002, for the award of a 50 percent rating for pseudofolliculitis barbae and keloids of the face, neck and scalp. 2. Whether new and material evidence has been received to reopen a claim for service connection for an acquired psychiatric disorder other than posttraumatic stress disorder (PTSD), claimed as depression. 3. Entitlement to service connection for PTSD. 4. Entitlement to service connection for hip complaints/degenerative disc disease of the hips, to include as due to undiagnosed illness or other qualifying chronic disability, pursuant to 38 U.S.C.A. § 1117. 5. Entitlement to service connection for multiple joint arthralgia/multiple joint aches, to include as due to undiagnosed illness or other qualifying chronic disability, pursuant to 38 U.S.C.A. § 1117. REPRESENTATION Veteran represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL Veteran ATTORNEY FOR THE BOARD Kristy L. Zadora, Counsel INTRODUCTION The Veteran had active duty service from July 1981 to January 1993, including service Southwest Asia during the Persian Gulf War from October 1990 to July 1991. This appeal to the Board of Veterans' Appeals (Board) initially arose from a February 1996 rating decision in which the RO denied the Veteran's claim for service connection for joint aches as due to an undiagnosed illness. In a June 1998 rating decision, the RO, inter alia, continued the previous denial of service connection for multiple joint arthralgias, as due to an undiagnosed illness, and denied service connection for degenerative changes of the hips. The Board notes that the RO recharacterized several issues in this June 1998 rating decision to comport with the Veteran's statements made during VA examinations conducted subsequent to the February 1996 rating decision. In January 1999, the Veteran testified during a Board hearing in Washington, DC. A hearing transcript of the hearing is associated with the claims file. In March 1999, the Board, inter alia, remanded the claims for service connection for degenerative disc disease of both hips and multiple joint arthralgias for further action, to include additional development of the evidence. In September 2002, the Veteran was notified that the Member of the Board (now, Veterans Law Judge (VLJ)) who conducted the January 1999 hearing was no longer employed by the Board and that he had a right to another hearing; the Veteran subsequently requested an additional Board hearing. In February 2003, the Veteran testified during a hearing before the undersigned VLJ in Washington, DC. A transcript of the hearing is associated with the claims file. In June 2003, the Board, inter alia, remanded the claims for service connection for degenerative disc disease of the hips and multiple joint arthralgias for further action, to include additional development of the evidence. In a June 2004 Decision Review Officer (DRO) decision, the RO, inter alia, granted the Veteran's claim for service connection for pseudofolliculitis barbae and keloids of the face, scalp and posterior neck, assigning an initial, 10 percent rating from May 1, 1997, and a 50 percent rating from August 30, 2002 In a September 2007 rating decision, the RO, inter alia, denied the Veteran's claim for service connection for PTSD. In January 2008, the Veteran testified during a Board hearing before the undersigned VLJ in Washington, DC. A transcript of the hearing is associated with the claims file. In April 2008, the Board, inter alia, remanded the claims for service connection for degenerative disc disease of the hips and multiple joint arthralgia as well as the claim for entitlement to an earlier effective date for the award of a 50 percent rating for pseudofolliculitis barbae and keloids of the face, neck and scalp for further action, to include additional development of the evidence. In August 2012, the Veteran again testified during a Board hearing before the undersigned VLJ in Washington, DC. A hearing transcript of the hearing is associated with the claims file. In November 2012, the Veteran's representative submitted additional evidence in support of these claims. This evidence was accompanied by a signed waiver of initial RO consideration of the evidence. See 38 C.F.R. §§ 20.800, 20.1304 (2012). The Board's decision on the claim for an earlier effective date is set forth below. The remaining claims on appeal are addressed in the remand following the order; these matters are being remanded to the RO, via the Appeals Management Center (AMC), in Washington, D.C. VA will notify the Veteran when further action, on his part, is required. FINDINGS OF FACT 1. All notification and development actions needed to fairly adjudicate the claim herein decided have been accomplished. 2. The date of a May 1, 1997 VA dermatology examination has been considered the date of claim for service connection for disability characterized as keloids of the posterior neck and scalp. 3. In June 2004, the RO awarded service connection for pseudofolliculitis barbae and keloids of the face, neck and scalp, assigning a 10 percent rating from May 1, 1997 through August 29, 2002; and assigning a 50 percent rating for the disability from the August 30, 2002 effective date of a change in the applicable rating criteria. 4. The rating criteria upon which the 50 percent award was based are not applicable prior to August 30, 2002, nor is there evidence from which it is factually ascertainable that an increase in disability-meeting the criteria for a 50 percent rating under the former criteria-occurred prior to August 30, 2002. CONCLUSION OF LAW The claim for an effective date earlier than August 30, 2002, for the award of a 50 percent rating for pseudofolliculitis barbae and keloids of the face, neck and scalp is without legal merit. 38 U.S.C.A. §§ 5101, 5110 (West 2002); 38 C.F.R. §§ 3.114, 3.151, 3.155, 3.157, 3.400 (2012), 4.118, Diagnostic Code 7800 (as in effect prior to and since August 30, 2002). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Due Process Considerations The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2012) includes enhanced duties to notify and assist claimants for VA benefits. VA regulations implementing the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). The Board notes that, in regard to the Veteran's earlier effective date claim, the Veteran and his representative have been notified of the reasons for the denial of the claim, and have been afforded opportunity to present evidence and argument with respect to the claim. The Board finds that these actions are sufficient to satisfy any duties to notify and assist owed the Veteran. As will be explained below, the claim lacks legal merit. As the law, and not the facts, is dispositive of the claims, the duties to notify and assist imposed by the VCAA are not applicable. See Mason v. Principi, 16 Vet. App. 129, 132 (2002). II. Earlier Effective Date Generally, the effective date of an evaluation and award of compensation based on a claim for increase will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C.A. § 5110 (a); 38 C.F.R. § 3.400. Specifically as regards claims for increased disability compensation, the pertinent legal authority provides that the effective date will be the earliest date as of which it is factually ascertainable that an increase in disability has occurred, if a claim is received by VA within one year after that date; otherwise the effective date will be the date of receipt of claim or date entitlement arose, whichever is later. 38 U.S.C.A. § 5110(b); 38 C.F.R. § 3.400(o)(2). A specific claim in the form prescribed by VA must be filed in order for benefits to be paid or furnished to any individual under the laws administered by VA. 38 U.S.C.A. § 5101(a); 38 C.F.R. § 3.151(a). Any communication or action, indicating intent to apply for one or more benefits under the laws administered by VA, from a claimant, his duly-authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui juris may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered as filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155(a). Where compensation is awarded or increased pursuant to a liberalizing law, or a liberalizing VA issue approved by the Secretary or by the Secretary's direction, the effective date of such award or increase shall be fixed in accordance with the facts found, but shall not be earlier than the effective date of the act or administrative issue. Where compensation is awarded or increased pursuant to a liberalizing law or VA issue which became effective on or after the date of its enactment or issuance, in order for a claimant to be eligible for a retroactive payment under the provisions of this paragraph the evidence must show that the claimant met all eligibility criteria for the liberalized benefit on the effective date of the liberalizing law or VA issue and that such eligibility existed continuously from that date to the date of claim or administrative determination of entitlement. 38 C.F.R. § 3.114(a). If a claim is reviewed at the request of the claimant more than one year after the effective date of the law or VA issue, benefits may be authorized for a period of one year prior to the date of receipt of such request. 38 C.F.R. § 3.114(a)(3). Under the rating criteria for rating disfiguring scars of the head, face, or neck that was in effect prior to August 30, 2002, a slight deformity warranted a 10 percent rating. Severe scaring, especially if producing a marked and unsightly deformity of the eyelids, lips or auricles (ears) warranted a 30 percent rating. Complete or exceptionally repugnant deformity of one side of the face or marked or repugnant bilateral disfigurement warranted a 50 percent rating. 38 C.F.R. § 4.118. Diagnostic Code 7800 (2001). The rating criteria for scars were revised, effective August 30, 2002. Under the revised criteria for disfiguring scars of the head, face or neck, visible or palpable tissue loss and either gross distortion or asymmetry of one feature of paired set of features (nose, chin, forehead, eyes, ears, cheeks or lips) or with two or three characteristics of disfigurement warrant a 30 percent rating. Such scaring with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired set of features or with four or five characteristics of disfigurement. Such scarring with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features or with six or more characteristics of disfigurement warrants a 80 percent rating. 38 C.F.R. § 4.118, Diagnostic Code 7800 (2012). A note following Diagnostic Code 7800 stipulates that the eight characteristics of disfigurement, for purposes of rating scars under the diagnostic code, include: (1) scar 5 or more inches (13 or more cm) in length; (2) scar at least one-quarter inch (0.6 cm) wide at widest part; (3) surface contour of scar elevated or depressed on palpation: (4) scar adherent to underlying tissue; (5) skin hypo-or hyper-pigmented in an area exceeding six square inches (39-sq. cm); (6) skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm); (7) underlying soft tissue missing in an area exceeding six square inches (39 sq. cm); (8) skin indurated and inflexible in an area exceeding six square inches (39 sq. cm). A further note provides that the adjudicator is required to take into consideration unretouched color photographs when evaluating scars under these criteria. 38 C.F.R. § 4.118 , Diagnostic Code 7800 (2012). A May 1996 private treatment summary notes that several keloids were on the Veteran's posterior scalp. The report of a May 1997 VA dermatology examination includes notations that large ice pick scars were found on the Veteran's face. Large keloids measuring 1.0 cm were also found on his left chin and right face. The examiner noted there were scars present on both sides of the Veteran's face and both sides of his chin. Accompanying color photographs document the keloids on the Veteran's chin as well as the scarring on his face, primarily on his cheeks. A June 1998 VA treatment note reflects the Veteran's report that his keloids had improved with the use of a topical medication and that there had been no hypopigmentation. Multiple firm cysts were noted to be on his cheeks and chin. In addition, a 3.5 cm keloid was noted to be on his face. An October 1998 VA treatment note documents that a keloid measuring 3.5 cm by 2 cm was noted to be on the Veteran's chin/beard area. The Veteran reported this keloid to be unchanged in size but decreased in height. On November 2003 VA examination, multiple keloids were found to be present on the back and top of the Veteran's head as well as on both of his cheeks. A December 2003 addendum to this examination report notes that these keloids varied in length from one cm to three cm and were hyperpigmented, elevated, somewhat tender, firm in texture and adherent to the underlying tissue. Accompanying color photographs documented these keloids, including the presence of a large keloid near the Veteran's right ear. The basic facts in this case are not in dispute. The Veteran is considered to have filed a claim for service connection for keloids of the posterior neck and scalp on May 1, 1997, the date of a VA dermatology examination. In a June 2004 DRO decision, the RO recharacterized the disability as pseudofolliculitis barbae and keloids of the face, scalp and posterior neck, and granted service connection for the disability from May 1, 1997, assigning a 10 percent rating prior to August 30, 2002, and a 50 percent rating from that date. In his July 2004 notice of disagreement (NOD), the Veteran argued that he is entitled to an effective date in May 1997 for the award of the 50 percent rating, though he did not provide any specific assertions as to why he believes that he is entitled to an effective date earlier than August 30, 2002. However, considering the record in light of the governing legal authority, the Board finds that no earlier effective date is assignable. The rating criteria which permitted the award of a 50 percent rating for this disability were revised, effective August 30, 2002. See 67 Fed. Reg. 49596-49599 (July 31, 2002). There is no indication that the revised criteria are intended to have retroactive effect and the Board has the duty to adjudicate the claim under the former criteria for any period prior to the effective date of the revised criteria, and to consider the revised criteria for the period beginning on the effective date of the new provisions. See Wanner v. Principi, 17 Vet. App. 4, 9 (2003); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). See also VAOPGCPREC 3-2000 (2000) and 7-2003 (2003). As such, consideration of the revised rating criteria prior to the effective date of August 30, 2002 is prohibited. In addition, the former rating criteria for disfiguring scars of the head, face or neck, provide no basis for assignment of an earlier effective date for the award a 50 percent rating for the disability. While the clinical record does demonstrate the presence of keloids and scarring on the Veteran's face, this scarring was not complete, as it did not encompass the majority of his face, nor was it severe, marked or repugnant. The scarring was primarily centered on his cheeks and chin, near his beard area, and there is no indication that such scarring affected his eyelids, lips or auricles. There is also no indication either in the clinical or photographic evidence that such scarring constituted severe, marked or repugnant disfigurement which would warrant a higher rating under the former criteria. In addition, while the former criteria allows an higher rating in circumstances were there is tissue loss, cicatrization (scar formation) and marked discoloration or color contrast, the Board notes that the clinical evidence does not establish that there was tissue loss in this case. In sum, the rating criteria upon which the 50 percent award was based are not applicable prior to August 30, 2002, nor is there evidence from which it is factually ascertainable that an increase in disability-meeting the criteria for a 50 percent rating under the former criteria-occurred prior to August 30, 2002. The Board again emphasizes that the pertinent legal authority governing effective dates is clear and specific, and the Board is bound by such authority. As, on these facts, no effective date for the award of 50 percent rating for pseudofolliculitis barbae and keloids of the face, neck and scalp earlier than August 30, 2002 is assignable, the claim on appeal must be denied as without legal merit. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). ORDER An effective date earlier than August 30, 2002, for the award of a 50 percent rating for pseudofolliculitis barbae and keloids of the face, neck and scalp is denied. REMAND The Board's review of the claims file reveals that further RO action on the claims for service connection for PTSD, degenerative disc disease of the hips and multiple joint arthralgia, as well as with respect to the request to reopen a claim for service connection for an acquired psychiatric disorder other than PTSD is warranted. First addressing the request to reopen, the Board notes that the VCAA requires, with respect to requests to reopen previously denied claims, that a claimant must be notified of both the criteria to reopen a claim for service connection-to include a discussion of the basis/es for the prior denial-as well as the criteria for establishing the underlying claim for service connection. See Kent v. Nicholson, 20 Vet. App. 1 (2006). As indicated above, the Board has recharacterized the Veteran's claim for service connection for PTSD to also include psychiatric disorders other than PTSD. The Veteran has been previously denied service connection for an acquired psychiatric disorder other than PTSD but has not been provided notice of the general requirements for reopening a previously denied claim. See 38 C.F.R. §20.1100; 38 C.F.R. §§ 3.104, 20.1100. As the Veteran has not been informed as to the evidence needed to reopen the claim, the Kent notice is found to be inadequate. As regards the claim involving PTSD, the Board notes that service connection for PTSD requires a medical diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). The evidence needed to establish the occurrence of a claimed in-service stressor is typically dependent upon whether a veteran engaged in combat with the enemy. See Gaines v. West, 11 Vet. App. 353, 359 (1998). If VA determines that a veteran engaged in combat with the enemy and his alleged stressor is combat-related, then his lay testimony or statement is accepted as conclusive evidence of the stressor's occurrence and no further development or corroborative evidence is required-provided that such testimony is found to be "satisfactory," i.e., credible and "consistent with circumstances, conditions or hardships of service." See 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(f)(1); Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). Under the legal authority in effect at the time the Veteran filed his claim in September 2006, if the alleged stressor was not combat related, then the Veteran's lay testimony, alone, would not be sufficient to establish the occurrence of the alleged stressor; rather, corroborating evidence would be needed to support the claim for service connection. See Cohen v. Brown, 10 Vet. App. 128, 147 (1997); Moreau v. Brown, 9 Vet. App. 389, 395 (1996). See also Zarycki, 6 Vet. App. at 98; Doran v. Brown, 6 Vet. App. 283, 289-290 (1994). The Board notes, however, that, on July 13, 2010, VA published a final rule that amended its adjudication regulations governing service connection for PTSD by, in part, liberalizing the evidentiary standard for establishing the occurrence of the required in-service stressor if that stressor is related to the Veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD. See 75 Fed. Reg. 39843 (July 13, 2010), and 75 Fed. Reg. 41092 (July 15, 2010) (correcting the effective and applicability dates from July 12, 2010 to July 13, 2010). The revisions apply to, among others, claims such as the Veteran's, which were appealed before July 13, 2010, but not yet decided by the Board. In this case, the evidence currently of record does not reflect that the Veteran engaged in combat. In this regard, the Veteran's Form DD-214 noted that the Veteran's military occupational specialties (MOS) included a motor transport operator and petrolatum heavy vehicle operator. Additionally, he did not receive any medals indicative of combat. However, the Veteran has alleged that he participated in combat operations in conjunction with Operations Desert Shield and Desert Storm during his deployment to Southwest Asia from October 1990 to July 1991. The Veteran's personnel records indicate that he participated in Operation Desert Shield and Operation Desert Storm in Saudi Arabia from October 1990 to July 1991. The records also reflect that the Veteran was assigned to the 267th Quartermaster Company. To date, there is no indication that the RO attempted to obtain the Veteran's unit histories or attempted to verify his reports of being subject to scud missile attacks while in Saudi Arabia. These records could potentially provide information concerning whether the Veteran's unit participated in any combat operations and/or whether members of the Veteran's unit were displaced to support combat operations. Accordingly, the RO should undertake any necessary development to attempt to verify the Veteran's alleged participation in combat during Operations Desert Shield and Desert Storm, to specifically include through the U.S. Army Joint Services and Records Research Center (JSRRC) and any other source(s), as appropriate. In particular, the RO should attempt to obtain histories for the Veteran's assigned unit in Saudi Arabia from October 1990 to July 1991. Any additional action necessary for independent verification of the Veteran's alleged combat service, or of any reported verifiable stressors, to include follow-up action requested by the contacted entity, should be accomplished. If the search for corroborating evidence leads to negative results, the RO should notify the Veteran of this fact, explaining the efforts taken, and describing further action (if any) to be taken. Additionally, the Board notes that an October 2012 private treatment summary reflects a diagnosis of PTSD and that the Veteran has asserted that this disability is the result of his in-service stressors. However, there is no clear medical indication to that effect of record. Hence, in the event that the RO determines that the record establishes that the Veteran had combat service, to which an identifiable stressor is related, or the occurrence of an in-service stressor is verified, the RO should arrange for the Veteran to undergo VA examination, by a psychiatrist or psychologist, at an appropriate VA medical facility, to obtain medical opinion as to whether he currently has PTSD as a result of any combat action/verified stressor. With regard to the Veteran's claims involving hips and multiple joint complaints, the Board notes that these claims were remanded in April 2008 for the Veteran to undergo VA Gulf War examination. Specifically, the examiner was to determine whether the Veteran's complaints of multiple joint arthralgia were attributable to a known clinical diagnosis. If so, the examiner was asked to provide an etiological opinion for each diagnosed condition. The examiner was specifically asked to address the Veteran's hip, knee and ankle symptoms. In May 2009, the Veteran underwent a VA orthopedic examination. The examiner, following a physical examination, issued a variety of diagnoses, including left hip degenerative disease and bilateral ankle sprain; no etiological opinion was provided for these disabilities. Any symptoms or disabilities related to the Veteran's right hip and/or knees were not addressed. In light of these deficiencies, it is unlikely that the May 2009 VA examination would withstand judicial scrutiny. A remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Under 38 U.S.C. § 1117(a)(1), compensation is warranted for a Persian Gulf Veteran who exhibits objective indications of a "qualifying chronic disability" that became manifest during service on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent during the presumptive period prescribed by the Secretary. Effective October 16, 2012, VA extended the presumptive period in 38 C.F.R. § 3.317(a)(1)(i) through December 31, 2016 (for qualifying chronic disabilities that become manifest to a degree of 10 percent or more after active duty in the Southwest Asia theater of operations). See 77 Fed. Reg. 63225 (2012). Furthermore, the chronic disability must not be attributed to any known clinical disease by history, physical examination, or laboratory tests. See 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317(a), (b). The Board notes that, during the pendency of this appeal, Congress revised 38 U.S.C.A. § 1117, effective March 1, 2002. In the revised statute, the term "chronic disability" was changed to "qualifying chronic disability," and the definition of "qualifying chronic disability" was expanded to include (a) undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms, or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. Effective June 10, 2003, VA promulgated revised regulations to, in part, implement these statutory changes. See 38 C.F.R. § 3.317(a)(2). Hence, the RO should arrange for the Veteran to undergo VA Gulf War examination, by an appropriate physician-as well as any specialist examination(s) deemed warranted-at a VA medical facility. The Veteran is hereby notified that failure to report to any scheduled examination(s), without good cause, may result in denial of the claim(s) for service connection (as the original claim(s) will be considered on the basis of the evidence of record). See 38 C.F.R. § 3.655. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant and death of an immediate family member. If the Veteran fails to report to any scheduled examination(s), the RO should obtain and associate with the claims file (a) copy(ies) of the notice(s) of the date and time of the examination(s) sent to him by the pertinent VA medical facility. To ensure that the record is complete, and that all due process requirements are met, the RO/AMC should also undertake appropriate action to ensure that all outstanding, pertinent records are associated with the claims file. As regards VA records, the claims file reflects that the Veteran has been receiving treatment for his disabilities from the VA Medical Center (VAMC) in Baltimore, Maryland, and records from that facility through August 2011 are associated with the file; however, more recent records may exist. The Board emphasizes that records generated by VA facilities that may have an impact on the adjudication of a claim are considered constructively in the possession of VA adjudicators during the consideration of a claim, regardless of whether those records are physically on file. See Dunn v. West, 11 Vet. App. 462, 466-67 (1998); Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). Hence, the RO/AMC should obtain all records of pertinent treatment from the Baltimore VAMC (since August 2011), following the current procedures prescribed in 38 C.F.R. § 3.159(c) with regard to requests for records from Federal facilities. The RO/AMC should also give the Veteran another opportunity to provide information and/or evidence pertinent to the claims on appeal. The RO/AMC's letter to the Veteran should explain that he has a full one-year period for response. See 38 U.S.C.A. § 5103(b)(1); but see also 38 U.S.C.A. § 5103(b)(3) (amending the relevant statute to clarify that VA may make a decision on a claim before the expiration of the one-year notice period). Thereafter, the RO/AMC should attempt to obtain any additional evidence for which the Veteran provides sufficient information, and, if needed, authorization, following the current procedures prescribed in 38 C.F.R. § 3.159. The actions identified herein are consistent with the duties imposed by the VCAA. See 38 U.S.C.A. §§ 5103, 5103A; 38 C.F.R. § 3.159. However, identification of specific actions requested on remand does not relieve the RO/AMC of the responsibility to ensure full compliance with the VCAA and its implementing regulations. Hence, in addition to the actions requested above, the RO/AMC should also undertake any other development and/or notification action deemed warranted by the VCAA prior to adjudicating the claims on appeal. Accordingly, these matters are hereby REMANDED for the following action: 1. The RO/AMC should, through VCAA-compliant notice sent the Veteran and his representative, give the Veteran another opportunity to provide information and, if necessary, authorization, to enable VA to obtain any additional records pertaining to the matters on appeal that are not currently of record. The RO/AMC's letter must explain what type of evidence is needed to reopen the claim for service connection for an acquired psychiatric disorder other than PTSD, providing notice as to the reason for the prior denial of the claim, and specifically and precisely addressing the element(s) required to establish service connection that was/were found insufficient in the previous denial of the claim, as required by Kent (cited above). The RO/AMC's letter should clearly explain to the Veteran that he has a full one-year period to respond (although VA may decide the claims within the one-year period). 2. If the Veteran responds, the RO/AMC should assist him in obtaining any additional evidence identified, following the current procedures set forth in 38 C.F.R. § 3.159. All records/responses received should be associated with the claims file. If any records sought are not obtained, the RO should notify the Veteran of the records that were not obtained, explain the efforts taken to obtain them, and describe further action to be taken. 3. The RO/AMC should obtain from the Baltimore VA Medical Center (VAMC) all outstanding, pertinent records of evaluation and/or treatment of the Veteran, dated since August 2011. The RO/AMC must follow the procedures set forth in 38 C.F.R. § 3.159(c) with regards to requesting records from Federal facilities. All records and/or responses received should be associated with the claims file. 4. The RO/AMC should undertake necessary action, to particularly include contact with the U.S. Army and Joint Services Records Research Center (JSRRC) (and other appropriate source(s)), to attempt to independently verify whether or not the Veteran participated in combat operations while serving with the 267th Quartermaster Company in Saudi Arabia from October 1990 to July 1991; and any other alleged stressors (including whether he was exposed to scud missile attacks) for which the expanded record contains sufficient information to allow for independent verification. Specifically, the RO should obtain the Veteran's unit histories for October 1990 to July 1991. Any additional action necessary to verify the Veteran's combat service, or to verify a reported in-service stressor, to include follow-up action requested by the contacted entity, should be accomplished. If the search for corroborating records leads to negative results, the RO/AMC should notify the Veteran and afford him the opportunity to respond. The RO/AMC should also follow up on any additional action suggested by JSRRC. 6. After associating with the claims file all available records and/or responses received from each contacted entity, the RO/AMC should prepare a report detailing whether the record establishes that the Veteran had combat service, to which an identifiable stressor is related, or establishes the occurrence of a specific reported in-service stressor. This report is then to be added to the Veteran's claims file. If the Veteran's participation in combat is not established, and the occurrence of no claimed in-service stressful experience(s) is/are established, then the RO/AMC should so state in its report, skip the development requested in paragraph 7, below, and proceed with paragraph 8. 7. If, and only if, the RO/AMC determines that the Veteran had combat service and after all records and/or responses received from each contacted entity have been associated with the claims file, the RO/AMC should arrange for the Veteran to undergo VA psychiatric examination, by an appropriate physician, at a VA medical facility. The entire claims file, to include a complete copy of this REMAND, must be made available to the physician designated to examine the Veteran, and the examination report should include discussion of the Veteran's documented medical history and assertions. All indicated tests and studies should be accomplished (with all results made available to the requesting physician prior to the completion of his or her report), and all clinical findings should be reported in detail. The physician should clearly indicate whether the Veteran currently suffers from PTSD. In rendering a determination as to whether the diagnostic criteria for PTSD are met, the physician is instructed that only identifiable stressor(s) related to established combat service, and/or non-combat stressor(s) that have been verified, may be considered for the purpose of determining whether exposure to such in-service event has resulted in PTSD. If a diagnosis of PTSD is deemed appropriate, the physician must identify the specific stressor(s) underlying the diagnosis, and should comment upon the link between the current symptomatology and the established stressor(s). In rendering the requested opinion, the physician should specifically consider and discuss the service treatment records and post-service treatment records, including the October 2012 private summary from Dr. T. T., as well as the Veteran's contentions. The physician should set forth all current examination findings, along with the complete rationale for the conclusions reached, in a printed (typewritten) report. 8. After all available records and/or responses from each contacted entity have been associated with the claims file, the RO/AMC should arrange for the Veteran to undergo VA Gulf War examination, by an appropriate physician, at a VA medical facility. This examination should conform to the guidelines for conducting Gulf War examinations set forth in the Under Secretary for Health's Information Letter, dated April 28, 1998 (IL 10-98- 010), at a VA medical facility. As indicated below, additional specialist examination(s) should be conducted as needed. The entire claims file, to include a complete copy of this REMAND, must be made available to each physician designated to examine the Veteran, and the examination report(s) should include discussion of the Veteran's documented medical history and assertions. Each physician should set forth all examination findings, along with the complete rationale for the conclusions reached (to include citation to specific evidence and/or medical authority, as appropriate) in a typewritten report a) The primary Gulf War examiner should note and detail all reported symptoms of multiple joint arthralgia. The examiner should conduct a comprehensive general medical examination, and provide details about the onset, frequency, duration, and severity of all symptoms of right hip and bilateral knee pain and state what precipitates and what relieves them. b) The examiner should list all diagnosed disabilities and state which symptoms of right hip and bilateral knee pain are associated with each disability. If all symptoms (such as joint pain) are associated with diagnosed condition(s), additional specialist examinations for diagnostic purposes are not needed. c) If any symptoms of multiple joint pain have not been determined to be associated with a known clinical diagnosis, further specialist examination(s) will be required to address these findings, and should be ordered by the primary examiner. d) If any specialist examination(s) is/are warranted, the primary examiner should provide the specialist with all examination reports and test results, specify the relevant symptoms that have not been attributed to a known clinical diagnosis and request that the specialist determine which of these, if any, can be attributed in this Veteran to a known clinical diagnosis and which, if any, cannot be attributed in this Veteran to a known clinical diagnosis. e) For each diagnosed disability, including left hip degenerative disease and a bilateral ankle sprain, the physician should render an opinion as to whether it is at least as likely as not (i.e., there is a 50 percent or greater probability) that the disability had its onset in or is otherwise medically related to service; or, if not, was caused or is aggravated by service-connected disability. If aggravation of a nonservice-connected condition by a service-connected disability is found, the examining physician should attempt to quantify the degree of additional disability resulting from such aggravation. If arthritis is diagnosed, the physician should state whether it was manifested to a compensable degree within one year of service discharge (i.e., January 1993). 9. To help avoid future remand, the RO/AMC must ensure that all requested actions have been accomplished (to the extent possible) in compliance with this REMAND. If any action is not undertaken, or is taken in a deficient manner, appropriate corrective action should be undertaken. Stegall v. West, 11 Vet. App. 268 (1998). 10. After completing the requested actions, and any additional notification and/or development deemed warranted, the RO/AMC should readjudicate the claims remaining on appeal in light of all pertinent evidence and legal authority. 11. If any benefit sought on appeal remains denied, the RO/AMC must furnish to the Veteran and his representative an appropriate SSOC that includes clear reasons and bases for all determinations, and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. The purpose of this REMAND is to afford due process and to accomplish additional development and adjudication; it is not the Board's intent to imply whether the benefits requested should be granted or denied. The Veteran need take no action until otherwise notified, but he may furnish additional evidence and/or argument during the appropriate time frame. See Kutscherousky v. West, 12 Vet. App. 369 (1999); Colon v. Brown, 9 Vet. App. 104, 108 (1996); Booth v. Brown, 8 Vet. App. 109 (1995); Quarles v. Derwinski, 3 Vet. App. 129, 141 (1992). This REMAND must be afforded expeditious treatment. The law requires that all claims 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). ______________________________________________ JACQUELINE E. MONROE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs