Citation Nr: 1318207 Decision Date: 06/05/13 Archive Date: 06/11/13 DOCKET NO. 09-44 964 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Diego, California THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for an acquired psychiatric disorder other than PTSD, to include schizophrenia, psychosis not otherwise specified, and polysubstance induced psychotic disorder. 2. Whether new and material evidence has been submitted to reopen a claim of service connection for drug addiction and polysubstance abuse. 3. Entitlement to service connection for low back pain. 4. Entitlement to service connection for left lower extremity radiculopathy. 5. Entitlement to service connection for incorrect posture as secondary to venereal disease. 6. Entitlement to service connection for a heart condition. 7. Entitlement to an initial rating in excess of 30 percent for service-connected PTSD prior to March 22, 2011 and in excess of 50 percent thereafter. REPRESENTATION Veteran represented by: Virginia Girard-Brady, Attorney ATTORNEY FOR THE BOARD Catherine Cykowski, Counsel INTRODUCTION The Veteran had active duty service from January 1965 to January 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. The Board remanded this case in July 2009 for additional development, to include the provision of VCAA notice and the adjudication of his claim to reopen for an acquired psychiatric disorder pursuant to Clemons v. Shinseki, 23, Vet. App. 1 (2009). The Board finds that there has been substantial compliance with the remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). The claim for service connection for PTSD was previously before the Board. In an April 2011 rating decision, the RO granted service connection for PTSD. Accordingly, that issue is no longer before the Board, as the grant of service connection was a full grant of the benefit sought. See AB v. Brown, 6 Vet. App. 35 (1993). Although a claim for an increased rating for PTSD was not certified by the RO as on appeal, review of the record shows a statement of the case was issued on this claim in April 2012, with argument labeled "in lieu of Form 9" received from the Veteran's attorney in June 2012. In correspondence received in September 2012, the Veteran withdrew his request for a hearing in this matter. The issues of entitlement to service connection for a heart condition and entitlement to higher ratings for PTSD are addressed in the REMAND portion of the decision below and is REMANDED to the Department of Veterans Affairs Regional Office. FINDINGS OF FACT 1. An unappealed July 1987 rating decision denied claims for service connection for paranoid schizophrenia and drug addiction; the Veteran did not perfect an appeal or submit new and material evidence within the one year appeal period. 2. The evidence received since the July 1987 rating decision is neither cumulative nor redundant and is so significant that it must be considered in order to fairly decide the merits of the claim for service connection for an acquired psychiatric disorder other than PTSD. 3. The evidence received since the July 1987 rating decision is either cumulative or redundant and is not so significant that it must be considered in order to fairly decide the merits of the claims for service connection for drug addiction and polysubstance abuse. 4. The medical evidence indicates the Veteran's psychosis has been aggravated by the now service-connected PTSD. 5. There is no credible evidence of a back injury during service, and a low back condition is not related to service. 6. Left lower extremity radiculopathy is not related to service and is not proximately caused by or aggravated by a service-connected disability. 7. Incorrect posture is not related to service and is not proximately caused by or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The July 1987 rating decision is final. 38 U.S.C.A. § 7105(c) (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103 (2012). 2. New and material evidence has been received to reopen the claim for service connection for an acquired psychiatric disorder other than PTSD. 38 U.S.C.A. § 5108 (West 2002 & Supp. 2012); 38 C.F.R. § 3.156 (2001). 3. New and material evidence has not been received to reopen the claim for service connection for drug addiction and polysubstance abuse. 38 U.S.C.A. § 5108 (West 2002 & Supp. 2012); 38 C.F.R. § 3.156 (2001). 4. The criteria for secondary service connection for psychosis are met on the basis that it is aggravated by a service-connected disability. 38 U.S.C.A. § 1110 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.303, 3.310 (2012). 5. A low back condition was not incurred in or aggravated by service. §§ 1110, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303 (2012). 6. Lower extremity radiculopathy was not incurred in or aggravated by service, nor is it related to a service-connected disability. 38 U.S.C.A. §§ 1110, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102 , 3.303, 3.310 (2012). 7. Incorrect posture was not incurred in or aggravated by service, nor is it related to a service-connected disability. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102 , 3.303, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. VA's Duties to Notify and Assist On November 9, 2000, the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002), became law. Regulations implementing the VCAA were then published at 66 Fed. Reg. 45,620, 45,630-32 (August 29, 2001) and are now codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326 (2012). The VCAA and its implementing regulations are applicable to this appeal. The duty to notify under the VCAA requires VA to notify the claimant and the claimant's representative, if any, of the information and medical or lay evidence that is necessary to substantiate the claim. In Pelegrini v. Principi (Pelegrini II), 18 Vet. App. 112, 119-20 (2004), the Court specifically held that the VCAA requires VA to provide notice that informs the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim, (2) that VA will seek to provide, and (3) that the claimant is expected to provide. The Court has indicated that notice under the VCAA must be given prior to an initial unfavorable decision by the agency of original jurisdiction. Id. The VCAA and its implementing regulations provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim. Under these provisions, VA is required to obtain service medical records and relevant VA healthcare records and must make reasonable efforts to help the veteran obtain other relevant medical records. The duty to assist also requires VA to provide the claimant with a medical examination or a medical opinion when such an examination or opinion is necessary to make a decision on a claim. 38 U.S.C.A. § 5103A(d) (West 2002); 38 C.F.R § 3.159 (2012). The Court has mandated that VA ensure strict compliance with the provisions of the VCAA. Quartuccio v. Principi, 16 Vet. App. at 183 (2002). In Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), the Court held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 1) 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 of the disability. The Court held that upon receipt of an application for a service-connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. Dingess/Hartman at 488. Additionally, this notice must include notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. The Court has held that the VCAA requires additional notice when a claimant seeks to reopen a previously denied claim. In Kent v. Nicholson, 20 Vet. App. 1 (2006), the Court held that VA must examine the basis for a denial of a previously disallowed claim and provide the appellant with notice of the evidence of service connection found lacking in the previous denial. Kent at 9-10. May and July 2008 letters provided the Veteran with VCAA notice regarding his claims for service connection for degenerative disc disease, sciatic nerve damage and incorrect posture associated with herpes simplex. A July 2009 letter provided the Veteran with notice of the information required to reopen his previously denied claims for an acquired psychiatric disorder and polysubstance abuse. This letter informed the Veteran of the requirement of new and material evidence and advised the Veteran of the basis of the previous denial of his claims for service connection for an acquired psychiatric disability other than PTSD and polysubstance abuse. The 2008 and 2009 letters informed the Veteran of VA's duties for obtaining evidence. The letters also advised the Veteran of how disability ratings and effective dates are determined. Regarding the duty to assist, the RO made reasonable efforts to assist the Veteran with the development of the claims. The pertinent records identified by the Veteran have been obtained and associated with the claims file. The record includes the Veteran's service treatment records, post-service VA medical records and private medical records. Records were also obtained from the Social Security Administration. The Veteran has not identified any pertinent evidence that remains outstanding. The Veteran was examined by VA in March 2011 and an April 2012 addendum addressed an acquired psychiatric disorder, other than PTSD, and polysubstance abuse. 38 C.F.R. § 3.159(c)(4). 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). The Board finds that the March 2011 and April 2012 VA opinions obtained in this case are sufficient, as they were predicated on a full reading of the Veteran's service and post-service VA medical records. The VA examiner considered all of the pertinent evidence of record, the statements of the appellant, and provided an explanation for the opinions stated. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion with respect to the issues on appeal has been met. 38 C.F.R. § 3.159(c)(4). With respect to the claims for service connection for a low back condition, left lower extremity radiculopathy and incorrect posture, the Board acknowledges that the Veteran did not receive a VA examination for those claims. However, the Board finds that a VA examination is not necessary to decide those claims, as the standards of the Court's decision in McLendon v. Nicholson, 20 Vet. App. 79 (2006), have not been met. Under McLendon, VA must provide a medical examination in a service connection claim when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. Id. at 81. With respect to these claims, there is no credible evidence of an event or injury in-service that may be associated with the current disabilities. This is discussed in more detail below. Therefore, an examination is not necessary. For the foregoing reasons, the Board finds that VA has satisfied the duties to notify and assist with respect to the claims being decided, and appellate review may proceed without prejudice to the appellant. See Bernard v. Brown, 4 Vet. App. 384 (1993). II. Analysis of Claims Claims to Reopen The Veteran seeks to reopen a claim for service connection for an acquired psychiatric disorder other than PTSD, to include schizophrenia, psychosis not otherwise specified, and polysubstance induced psychotic disorder. The Veteran also seeks to reopen a previously denied claim for service connection for drug addiction and polysubstance abuse. A July 1987 rating decision denied service connection for a nervous condition and drug addiction. The decision found that the Veteran had a current Axis I diagnosis of chronic paranoid schizophrenia and mixed substance abuse. The decision also found that drug addiction could not be considered as a primary condition for service connection. The decision also found that chronic paranoid schizophrenia was not treated, diagnosed or found while the Veteran was on active duty or within the one-year presumptive period. In August 1987, the Veteran filed a Notice of Disagreement with the rating decision. An SOC was issued in February 1988. The Veteran did not perfect a timely substantive appeal and did not submit new evidence within one year of the rating decision. Therefore, the July 1987 rating decision is final. 38 U.S.C.A. § 7105; 38 C.F.R. § 3.156(b). In March 2000, the Veteran sought to reopen his claim for service connection for a psychiatric disorder. A claim that has been disallowed by the RO may not be reopened except upon the submission of new and material evidence. 38 U.S.C.A. § 5108(West 2002). 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). For claims filed prior to August 29, 2001, new and material evidence is defined as existing evidence not previously submitted to agency decisionmakers, which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant and which by itself or in connection with the evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of a claim. Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998); 38 C.F.R. § 3.156(a) (2001). The evidence that is considered to determine whether new and material evidence has been received is the evidence received since the last final disallowance of the appellant's claim on any basis. Evans, 9 Vet. App. 273 (1996). 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 Board has an obligation to make an independent determination of its jurisdiction regardless of findings or actions by the RO. Barnett v. Brown, 8 Vet. App. 1 (1995), aff'd, 83 F.3d 1380 (Fed. Cir. 1996). The United States Court of Appeals for Veterans Claims (Court) recently determined that the requirement of new and material evidence raising a reasonable possibility of substantiating the claim is a low threshold. Specifically, the Court interpreted the language of 38 C.F.R. § 3.156(a) as creating a low threshold, and viewed the phrase "raises a reasonable possibility of substantiating the claim" as "enabling rather than precluding reopening." See Shade v. Shinseki, 24 Vet. App 110 (2010). The evidence of record at the time of the July 1987 rating decision included: service treatment records, VA treatment reports dated in 1979 and VA inpatient records dated in April 1983, and a VA psychiatric evaluation dated in December 1986. The evidence received since the July 1987 rating decision includes: reports of VA psychiatric examinations dated in July 1999 and July 2000, VA outpatient treatment records, a report of VA examination dated in March 2011, private treatment records, records from the Social Security Administration (SSA) and written statements from the Veteran and his attorney. A report of a VA examination dated in July 1999 reflects that a physician diagnosed schizophrenia, chronic paranoid type; status post alcohol abuse, by history and status post polysubstance abuse, allegedly by history. The report of the July 2000 VA examination reflects that the Veteran was diagnosed with chronic paranoid schizophrenia and probable ongoing drug abuse. The report did not provide any medical opinions regarding the etiology of these disorders. VA treatment records dated in April 2007 noted a psychotic disorder thought to be related to chronic narcotics. Axis I diagnoses included psychosis not otherwise specified versus substance induced psychosis, cocaine dependence, in remission, heroin dependence, in remission. A report of a VA examination dated in March 2011 reflects a diagnosis of psychotic disorder, not otherwise specified, basically resolved. The report also reflects a diagnosis of a history of polysubstance dependence. With regard to whether polysubstance abuse is related to PTSD, the examiner noted that the Veteran reported that he was part of the anti-establishment culture. The examiner stated that he did not think that the Veteran was just "self medicating" for PTSD. The examiner concluded that the Veteran's drug abuse was not caused by PTSD. In an April 2012 addendum, the VA examiner addressed whether PTSD aggravated the Veteran's psychotic disorder. The VA examiner opined that PTSD likely aggravated the Veteran's psychosis permanently. The Board finds that new and material evidence has been received to reopen the claim of entitlement to service connection for an acquired psychiatric disorder other than PTSD, to include schizophrenia, psychosis not otherwise specified, and polysubstance induced psychotic disorder. The evidence submitted since the prior denial includes the 2011 VA medical opinion and addendum regarding the relationship between the Veteran's service-connected PTSD and a psychotic disorder. This evidence is both new and material, as it was not previously of record and relates to the basis of the prior final denial. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that compensation cannot be awarded pursuant to 38 U.S.C.A. §§ 1110 , 1131 and 38 C.F.R. § 105(a) either for a primary alcohol abuse disability incurred during service or for any secondary disability that resulted from primary alcohol abuse during service. Allen v. Principi, 237 F.3d 1368, 1376 (Fed. Cir. 2001). However, service connection may be granted for an alcohol or drug abuse disability acquired secondary to or as a symptom of service-connected disability. However, the Federal Circuit further stated that such compensation may be awarded only "where there is clear medical evidence establishing that alcohol or drug abuse is caused by a veteran's primary service-connected disability, and where the alcohol or drug abuse disability is not due to willful wrongdoing." Id. at 1381. The Board finds that new and material evidence has not been received to reopen the claim for service connection for drug addiction and polysubstance abuse. The claim for service connection for drug addiction was previously denied because drug addiction is not a primary disability for service connection. The evidence received since the prior final denial does not establish that the currently diagnosed polysubstance dependence is related to a service-connected disability. For the foregoing reasons, the Board finds that new and material evidence has been received to reopen the claim for service connection for an acquired psychiatric disorder other than PTSD, to include schizophrenia, psychosis not otherwise specified, and polysubstance induced psychotic disorder. The Board further finds that new and material evidence has not been received to reopen the claim for service connection for polysubstance abuse. Service Connection Laws and Regulations Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in active service. 38 U.S.C.A. § 1110. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Psychoses, arthritis and radiculopathy are "chronic diseases" listed under 38 C.F.R. § 3.309(a); therefore 38 C.F.R. § 3.303(b) is applicable to those claims. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may be presumed for certain diseases, including psychoses, arthritis and organic diseases of the nervous system, if it is shown that the veteran served continuously for 90 days or more during a period of war or during peacetime after December 31, 1946, such disease became manifest to a degree of 10 percent within one year from the date of discharge, and there is no evidence of record establishing otherwise. 38 U.S.C.A. §§ 1101, 1112(a), 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309(a) (2012). Presumptive periods are not intended to limit service connection to diseases so diagnosed when the evidence warrants direct service connection. 38 C.F.R. § 3.303(d). In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (2012). Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Acquired psychiatric disorder other than PTSD The Veteran seeks service connection for an acquired psychiatric disorder other than PTSD, to include schizophrenia, psychosis not otherwise specified, and polysubstance induced psychotic disorder. The Veteran had active duty service from January 1965 to January 1969. Service treatment records do not reflect any complaints or diagnoses of an acquired psychiatric disorder. The evidence of record does not show that an acquired psychiatric disorder other than PTSD manifested within one year of separation from service. The post-service medical evidence of record reflects diagnoses of various acquired psychiatric disorders other than PTSD, including anxiety, depression, paranoid schizophrenia and psychosis. A VA medical certificate dated in March 1981 reflects a diagnosis of anxiety. A report of a VA examination dated in December 1986 reflects that the VA examiner diagnosed paranoid schizophrenia and mixed substance abuse, by history. VA treatment records dated in November 1992 reflect that the Veteran was diagnosed with polysubstance dependence and organic mood syndrome. Private records dated in September 1992 reflect that the Veteran was diagnosed with substance use disorder and schizophrenia, paranoid type. A June 1998 VA treatment record reflects that a VA psychiatrist diagnosed substance induced mood disorder in a patient with heroin dependence and chronic pain. In June 1998, the Veteran was admitted to a VA hospital with a complaint of depression. A VA treatment record dated in March 2004 also noted a diagnosis of depression. A report of VA examination dated in July 1999 reflects that the VA examiner diagnosed schizophrenia, chronic paranoid type, status post alcohol abuse, by history, and status post polysubstance abuse. A report of a VA psychology consultation dated in April 2007 reflects a diagnosis of psychosis not otherwise specified versus substance induced psychosis. The Veteran had a VA examination in March 2011. The VA examiner indicated that the claims file was reviewed. The examiner noted, with regard to psychiatric history, that the Veteran had been variously diagnosed over the years. It was noted that he was treated for PTSD in the 1990's and at some point developed paranoid delusions that were thought to be drug related. He was treated for a diagnosis of a psychotic disorder, not otherwise specified, and the symptoms had basically gone away. The examiner noted a history of psychiatric hospitalizations for substance abuse, depression, suicidal ideation and psychosis. The VA examiner diagnosed psychotic disorder, not otherwise specified, basically resolved and a history of polysubstance dependence. The examiner noted that polysubstance dependence and symptoms of psychosis were basically resolved. In an addendum opinion dated in April 2012, the examiner stated that PTSD permanently aggravated the Veteran's non-service-connected psychotic disorder. The examiner explained that, given that PTSD is a chronic anxiety condition, it likely aggravated the Veteran's psychosis permanently. The Board finds that it has not been shown that an acquired psychiatric disorder other than PTSD was incurred in or aggravated by service. In this regard, an acquired psychiatric disorder other than PTSD is not shown to have been manifested in service or within a presumptive period after service. Further, there is no competent medical evidence linking a current acquired psychiatric disorder, other than PTSD, to service. The evidence of record does not show that an acquired psychiatric disorder other than PTSD is proximately caused by or due to a service-connected disability. There is no medical opinion indicating that the Veteran's PTSD has caused any of his other psychiatric disorders. Any lay statements from the Veteran alleging such are not competent, since the onset, diagnosis, and etiology of a psychiatric disorder is beyond the competence of a lay person. Therefore, service connection on a secondary basis for an acquired psychiatric disorder other than PTSD as caused by the PTSD is not warranted. However, the April 2012 VA medical opinion indicates that psychosis is aggravated by service-connected PTSD. Accordingly, the Board finds that service connection is warranted for psychosis on the basis that it is aggravated by service-connected PTSD. Low Back The Veteran asserts that a current low back disability is related to service. The Veteran had active duty service from January 1965 to January 1969. Service treatment records do not show complaints or treatment of a back condition. Upon separation examination in January 1969, a normal clinical evaluation of the back was noted. A VA examination dated in December 1986 noted that the Veteran's gait and posture were normal, and he had full range of motion in his joints. No back disabilities were diagnosed. Initial post-service complaints of a back disability are shown in medical records dated in 1991. A report of Occupational Injury or Illness from the State of California, dated in August 1991, shows that the Veteran reported acute low back pain after pulling a heavy electrical cable. The report noted acute tenderness at midline L4-5 and L5-S1. Medical records from the University of California San Diego Medical Center show that the Veteran was seen in August 1992 with a complaint of severe back pain radiating to both legs. The report noted a herniated disk seen at L5, L6 causing severe low back pain and radiculopathy for approximately one year, now worsening. It was noted that the Veteran first experienced symptoms about one year prior while lifting an electrical cable at a shipyard. The Veteran reported that the pain radiated to the lower buttocks as well as the left lower extremity and posterior thigh initially. The report shows that the Veteran was admitted to the hospital and underwent L5-6 laminectomy with diskectomy. A private medical record dated in May 1995 noted a history of severe pain in the back that occurred in June 1991, when the Veteran was pulling a wire which pulled him backwards. A VA record dated in April 1999 reflects that the Veteran reported low back pain since rupturing a disc in 1991 working in a shipyard. A VA outpatient treatment record dated in October 2000 reflects that the Veteran reported that his back pain started in 1991. Another VA treatment record dated in November 1996 reflects that the Veteran reported that he had pain in his back from his work as an electrician in 1992. Private medical records dated in July 2007 show that the Veteran underwent lumbar laminectomy. In written statements in support of his claim, the Veteran has indicated that degenerative disc disease is related to unloading and carrying ammunition cans in service. In statements in support of his claim the Veteran has described in-service injuries. In a May 2008 statement, the Veteran stated that he injured himself in service while unloading 200 pound cans of ammunition. The Veteran has not specifically stated that he had continuous symptoms since service; however, after a review of all the lay and medical evidence, the Board finds that the weight of the evidence demonstrates that the Veteran did not experience continuous symptoms of a low back disability after service separation. The Veteran is competent to report that he had back pain in service, as a veteran is competent to report symptoms that he experiences at any time because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. at 470; Barr v. Nicholson, 21 Vet. App. 303, 309 (2007) (when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation). Lay evidence can also be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (e.g., a broken leg), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The absence of contemporaneous medical evidence is a factor in determining credibility of lay evidence, but lay evidence does not lack credibility merely because it is unaccompanied by contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). In determining whether statements submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, consistency with other evidence, and statements made during treatment. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board does not find the Veteran's report of an in-service back injury credible, as his report of in-service injury conflicts with multiple post-service medical records which show a history of a back injury in 1991. There are voluminous medical records in his VA file and prior to his VA claim, they show a consistent history by him of back pain starting with the 1991 work-related injury, without ever giving a history of prior back injury in the military or prior recurrent back pain. Such histories reported by the Veteran for treatment purposes are of more probative value than the more recent assertions and histories given for VA disability compensation purposes. Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (lay statements found in medical records when medical treatment was being rendered may be afforded greater probative value; statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). It was only with the filing of his VA claim that he alleged a military injury, and although his statements are competent on such a point, they are simply not credible in light of the multiple statements he previously provided giving onset of back pain long after service. Further, the post-service medical evidence does not reflect complaints or treatment for a back disability for more than 20 years after service. The Board emphasizes the multi-year gap between discharge from active duty service and initial reported symptoms related to a low back disorder in approximately 1991. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (lengthy period of absence of medical complaints for condition can be considered as a factor in resolving claim); see also Mense v. Derwinski, 1 Vet. App. 354, 356 (1991). Although the VA file contains medical records back to the 1970s, there were no complaints of chronic low back pain prior to the 1991 work injury. Finally, the record does not contain any medical opinions relating the Veteran's current back disability to any event or injury in service. His statements alleging such are not competent since the etiology of a spinal disorder is not something observable by a lay person. In sum, there is no credible evidence of a back injury during service or of a relationship between the Veteran's current low back disorder and active military service, by either competent medical nexus opinion or continuity of symptoms since service separation. Accordingly, the Board concludes that a low back disability was not incurred in or aggravated by service. As there is a preponderance of the evidence against the claim for service connection for a low back disability, reasonable doubt may not be resolved in the Veteran's favor. 38 U.S.C.A. § 5107. Left lower extremity radiculopathy In a May 2008 statement, the Veteran indicated that he sustained an injury of his sciatic nerve during service when a hatch fell on his thigh. Service treatment records do not show any complaints or treatment for radiculopathy. The enlistment examination, dated in June 1965, noted a normal clinical evaluation of the lower extremities. The January 1969 separation examination also reflects a normal clinical evaluation of the lower extremities. A VA examination dated in December 1986 noted that the Veteran's gait and posture were normal, and he had full range of motion in his joints. No complaint or diagnosis of left lower extremity radiculopathy was noted. A report of Occupational Injury or Illness from the State of California, dated in August 1991, shows that the Veteran reported acute low back pain after pulling a heavy electrical cable. The report noted acute tenderness at midline L4-5 and L5-S1. Objective findings included left leg/ left hip numbness with reflexes in left lower extremity depressed. The Veteran was diagnosed with acute sciatica, left leg. Other private and VA medical records show complaints and treatment for leg weakness, but there is no medical evidence of a relationship between a current left leg disability and active duty service. A VA treatment record dated in May 2001 noted intermittent right leg numbness that was chronic. A VA treatment record dated in October 2002 noted a diagnosis of chronic low back pain with moderate radiculopathies of the bilateral lower extremities. The Board has considered the Veteran's 2008 statement, in which he indicated that he injured his sciatic nerve in service. The Board finds that continuity of symptomatology since service is not established with respect to radiculopathy of the left lower extremity. The report of VA examination in 1986 did not note any complaints of radiculopathy or sciatica. The initial post-service complaint of sciatica was noted in 1991, following a reported low back injury which occurred at work. The Veteran's history reported during his treatment in 1991 is more probative than the Veteran's later assertions of an in-service injury. Rucker, supra. Further, the gap of more than 20 years between the Veteran's service and his initial complaint of left lower extremity sciatica weighs against his claim. Maxson, supra.; Mense, supra. In sum, there is no credible evidence of a relationship between the Veteran's current left lower extremity radiculopathy and active military service, by either competent medical nexus opinion or continuity since service separation. Accordingly, the Board concludes that left lower extremity radiculopathy was not incurred in or aggravated by service. As there is a preponderance of the evidence against the claim, reasonable doubt may not be resolved in the Veteran's favor. 38 U.S.C.A. § 5107. Incorrect Posture The Veteran claims service connection for incorrect posture as secondary to service-connected genital herpes. Initially, the Board notes that the Veteran was not treated for any posture disability during service. The Board has also determined in this decision that service connection is not warranted for a low back disability. To prevail on the issue of secondary service causation, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). In this case, there is no evidence of a nexus between service-connected genital herpes and a current disability of incorrect posture. The Board has considered the Veteran's statements about his disability. Again, while the Veteran is competent to report the symptoms he experiences through his senses, the matter of the etiology of a diagnosed disorder requires medical expertise to determine. See Jandreau. Thus, as a lay person, the Veteran is not competent to offer an opinion regarding the etiology of his claimed incorrect posture disability. No other evidence of record relates either by causation or aggravation a posture disorder to service-connected genital herpes. The Board therefore finds that a preponderance of the evidence is against the claim of service connection for incorrect posture. As there is a preponderance of the evidence against the claim, reasonable doubt may not be resolved in the Veteran's favor. 38 U.S.C.A. § 5107. ORDER New and material evidence having been received, the claim for service connection for an acquired psychiatric disorder other than PTSD, to include schizophrenia, psychosis not otherwise specified, and polysubstance induced psychotic disorder, is reopened. New and material evidence not having been received, the claim for service connection for drug addiction and polysubstance abuse is not reopened. Service connection for psychosis as aggravated by PTSD is granted. Service connection for low back pain is denied. Service connection for left lower extremity radiculopathy is denied. Service connection for incorrect posture is denied. REMAND Increase for PTSD The evidence of record reveals psychiatric and drug treatment back to the 1970's. As noted above, the VA examiner opined that since PTSD is a chronic anxiety disorder, it likely aggravated the Veteran's psychosis, and secondary service connection based on aggravation is therefore warranted. To the extent the Veteran's PTSD has aggravated his psychosis, then the disability rating for his mental health disorders will include such additional symptoms or impairment. In other words, only that increase in the psychotic disorder likely attributable to PTSD is compensable. The VA examiner stated that the effects of the PTSD and the psychotic disorder are so intertwined as to preclude separating the symptoms and impairment due to each. This does not answer the question, however, as to the extent PTSD aggravated the psychotic disorder. It is necessary that a medical professional perform a retroactive review of the record and identify, if possible, the baseline symptoms of the Veteran's psychotic disorder and then opine as to what symptoms and/or impairment are likely attributable to aggravation from the Veteran's PTSD. Service Connection for Heart Condition Additional development is necessary with respect to the claims for service connection for a heart condition. The Veteran asserts that a heart condition is related to Agent Orange exposure during service. Applicable regulations provide that a Veteran who served on active duty in Vietnam during the Vietnam era (from January 9, 1962, through May 7, 1975) is presumed to have been exposed to Agent Orange or similar herbicide. 38 C.F.R. § 3.307(a)(1)(6)(iii). "Service in Vietnam" for purposes of applying the herbicide presumption includes service in the waters offshore or service in other locations if the conditions of service involved duty or visitation to Vietnam from January 9, 1962 to May 7, 1975. 38 U.S.C.A. § 1116 ; 38 C.F.R. §§ 3.307(a)(6)(iii); 3.313(a) (2012). If a veteran was exposed to an herbicide agent during active military service, certain diseases, including ischemic heart disease, shall be service-connected if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, even though there is no record of such disease during service. 38 C.F.R. § 3.309(e). With regard to inland waterways, qualifying service in the Republic of Vietnam includes service on the inland waterways, but does not include service on a deep-water naval vessel in the waters offshore under 38 C.F.R. § 3.307 (a)(6)(iii). See Haas, 525 F.3d at 1187-90; 66 Fed. Reg. 23166 (May 8, 2001); VAOPGCPREC 27-97. "Inland waterways" are not defined in VA regulations; however, the Board may refer to the VA Adjudication Procedure Manual (Manual) for interpretive guidance. Inland waterways include rivers, canals, estuaries, and delta areas, such as those on which the Vietnam "brown water" Navy operated. See M21-1MR, Part IV, Subpart ii, ch. 2, sec. C(10)(k) (2012). A deferred rating decision dated in January 2011 noted that the personnel records showed the Veteran was in brown waters in Vietnam. The Veteran had a VA examination for heart disorders in March 2011. The examiner diagnosed concentric LVH due to a combination of hypertensive heart disease and aortic insufficiency. The examination report did not indicate whether this is a type of ischemic heart disease. Accordingly, a remand is necessary to obtain an addendum from the examiner. Accordingly, the case is REMANDED for the following action: 1. Obtain an addendum from the VA examiner who performed the March 2011 VA examination for heart conditions. If that individual is no longer available, another VA physician can provide the opinion. The examiner should state an opinion as to whether the Veteran currently has ischemic heart disease. If this opinion cannot be provided without a new VA examination, then such an examination should be scheduled. 2. Obtain an addendum from the VA psychiatric examiner who performed the 2011 examination and provided the 2012 addendum. If that individual is no longer available, another VA psychiatrist can provide the opinions. The VA examiner should perform a retroactive review of the record and identify, if possible, the baseline symptoms of the Veteran's psychotic disorder and then opine as to what symptoms and/or impairment (social and occupational) are likely the result of aggravation from the Veteran's PTSD. 3. Following the completion of the requested development, the claims on appeal should be readjudicated. If any benefit sought remains denied, issue a supplemental statement of the case and afford the appropriate period to respond. Thereafter, the case should be returned to the Board, as warranted. The appellant 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). 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). ______________________________________________ MICHELLE L. KANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs