Citation Nr: 1320475 Decision Date: 06/25/13 Archive Date: 07/05/13 DOCKET NO. 06-15 243 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Oakland, California THE ISSUES 1. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for posttraumatic stress disorder (PTSD), and if so, whether the reopened claim should be granted. 2. Entitlement to compensation under 38 U.S.C. § 1151 for a left hip disability, status post total hip arthroplasty (THA). REPRESENTATION Appellant represented by: California Department of Veterans Affairs WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD K. Haddock, Associate Counsel INTRODUCTION The Veteran had active military service from October 1958 to April 1959. The Veteran also had service in the California Army National Guard. This case comes before the Board of Veterans' Appeals (Board) on appeal from June 2004 and April 2005 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California. In connection with his appeal, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge at the RO in March 2009. A transcript of that hearing has been associated with the claims file. The Board has reviewed the physical claims file and the Virtual VA electronic claims file. Although the RO determined that new and material evidence had been submitted to reopen the Veteran's claim of entitlement to service connection for PTSD, the Board must determine on its own whether new and material evidence has been submitted to reopen this claim. See Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). This case was previously before the Board, most recently in December 2011, at which time the issues currently on appeal were remanded for additional development. The issue of entitlement to service connection for PTSD is addressed in the REMAND following the ORDER section of this decision. FINDINGS OF FACT 1. In an unappealed July 1998 decision, the Board denied entitlement to service connection for PTSD. 2. The evidence associated with the claims file subsequent to the July 1998 Board decision includes evidence that relates to an unestablished fact necessary to substantiate the claim, is neither cumulative nor redundant of evidence already of record, and raises a reasonable possibility of substantiating the claim of entitlement to service connection for PTSD. 3. The Veteran does not have an additional left hip disability, status post THA, that resulted from an event not reasonably foreseeable or any carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA. CONCLUSIONS OF LAW 1. New and material evidence has been received to reopen a claim of entitlement to service connection for PTSD. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2012). 2. The criteria for entitlement to compensation under 38 U.S.C. § 1151 for a left hip disability, status post THA, are not met. 38 U.S.C.A. § 1151 (West 2002); 38 C.F.R. § 3.361 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), codified in pertinent part at 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2012), and the pertinent implementing regulation, codified at 38 C.F.R. § 3.159 (2012), provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. They also require VA to notify the claimant and the claimant's representative, if any, of any information, and any medical or lay evidence, not previously provided to the Secretary that is necessary to substantiate the claim. As part of the notice, VA is to specifically inform the claimant and the claimant's representative, if any, of which portion, if any, of the evidence is to be provided by the claimant and which part, if any, VA will attempt to obtain on behalf of the claimant. The Board also notes that the United States Court of Appeals for Veterans Claims (Court) has held that the plain language of 38 U.S.C.A. § 5103(a) requires that notice to a claimant pursuant to the VCAA be provided "at the time" that, or "immediately after," VA receives a complete or substantially complete application for VA-administered benefits. Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). The timing requirement enunciated in Pelegrini applies equally to the initial-disability-rating and effective-date elements of a service-connection claim. Dingess v. Nicholson, 19 Vet. App. 473 (2006). With regard to the Veteran's claim to reopen, the Board notes that the Veteran has been provided all required notice, to include notice pertaining to the disability-rating and effective-date elements of his claim and notice pertaining to the basis of the prior denial. In addition, the Board has determined that the evidence currently of record is sufficient to substantiate the Veteran's claim to reopen his claim of entitlement to service connection for PTSD. Therefore, no further development is required under 38 U.S.C.A. §§ 5103, 5103A or 38 C.F.R. § 3.159. The record reflects that the Veteran was mailed letters in January 2005, March 2006, and January 2012 advising him of what the evidence must show and of the respective duties of VA and the claimant in obtaining evidence. The March 2006 letter provided the Veteran with appropriate notice with respect to the disability-rating and effective-date elements of his claim. Although the Veteran was not provided adequate notice until after the initial adjudication of the claims, the Board finds that there is no prejudice to the Veteran in proceeding with the issuance of a final decision. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). In this regard, the Board notes that following the provision of the required notice and the completion of all indicated development the claims were readjudicated. There is no indication or reason to believe that the ultimate decision on the merits of the claims would have been different had complete VCAA notice been provided at an earlier time. See Overton v. Nicholson, 20 Vet. App. 427, 437 (2006) (A timing error may be cured by a new VCAA notification followed by a readjudication of the claim). The Board also finds the Veteran has been afforded adequate assistance in response to his claim. VA Medical Center and private treatment notes have been obtained and the Veteran has been afforded appropriate VA examination. The Board notes that only partial copies of the Veteran's service treatment records (STRs) and service personnel records (SPRs) are available for review. The remainder of the Veteran's records were determined to be unavailable for review as they were destroyed by fire at the National Personnel Records Center (NPRC). The Veteran was made aware of the unavailability of these records in an August 2012 letter and afforded the opportunity to submit any records he had in his possession. Additional records have not been received. As the Veteran was made aware of the unavailability of his service records and afforded an opportunity to submit additional records, the Board finds that there is no bar to proceeding with a final decision at this time. Accordingly, the Board will address the merits of the claims. Legal Criteria Claim to Reopen Generally, a claim that has been denied in an unappealed RO decision or an unappealed Board decision may not thereafter be reopened and allowed. 38 U.S.C.A. §§ 7104(b), 7105(c) (West 2002). The exception to this rule is 38 U.S.C.A. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence is defined as evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. 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). The Court recently 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." The Court emphasized that the regulation is designed to be consistent with 38 C.F.R. § 3.159(c)(4), which, "does not require new and material evidence as to each previously unproven element of a claim." Shade v. Shinseki, 24 Vet. App. 110 (2010). For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). Compensation under 38 U.S.C. § 1151 Compensation under 38 U.S.C. § 1151 shall be awarded for a qualifying additional disability or qualifying death of a veteran in the same manner as if such additional disability or death were service-connected. An additional disability or death is a qualifying additional disability or death if the disability or death was not the result of the veteran's willful misconduct and if the disability or death was caused by hospital care, medical or surgical treatment, or examination furnished the veteran under any law administered by the Secretary, either by a VA employee or in a VA facility, and the proximate cause of the disability or death was carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing the hospital care, medical or surgical treatment, or examination; or an event not reasonably foreseeable. 38 U.S.C.A. § 1151 (West 2002); 38 C.F.R. § 3.361 (2012). Burden of Proof Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R. § 3.102 (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Analysis Claim to Reopen The Veteran originally filed his claim of entitlement to service connection for PTSD in March 1996. In a November 1996 rating decision, the Veteran was denied entitlement to service connection for PTSD based on a finding that the Veteran did not have a confirmed diagnosis of PTSD. The Veteran appealed this decision and in a July 1998 decision, the Board denied entitlement to service connection for PTSD based on a finding that the Veteran did not have PTSD as a result of a verified in-service stressor. The Veteran did not appeal this decision. The pertinent evidence of record at the time of the July 1998 Board decision included the following: an incomplete copy of the Veteran's SPRs, which are absent any verification of the Veteran's claimed in-service stressor or any indication he received mental health treatment during active service; numerous statements from the Veteran in which he reported that he witnessed an explosion when some ammunition powder was accidentally ignited and that during the explosion he saw two soldiers burned alive; numerous statements from the Veteran's spouse in which she reported that the Veteran had been affected very deeply by the events in active service and that he experienced rather severe symptoms of PTSD as a result; VA Medical Center and private treatment records which show that the Veteran received current treatment for various mental health disabilities, to include PTSD; and, the Veteran's June 1998 Board hearing testimony, in which he reiterated his reported stressor. The pertinent evidence that has been received since the July 1998 Board decision includes the following: additional statements from the Veteran in which he reiterates his reported stressor; additional statements from the Veteran's spouse in which she reiterates the Veteran's mental health struggles due to PTSD; additional VA Medical Center and private treatment notes which show that the Veteran has continued to receive treatment for PTSD; the Veteran's March 2009 Board hearing testimony at which time the Veteran again described his PTSD stressor; and an August 2012 statement from Mr. J.D., who served with the Veteran, in which he reported that he remembered hearing about an explosion on base when stationed at Fort Ord with the Veteran. Assuming its credibility for purposes of the analysis of whether the claim can be reopened, the Board finds that the August 2012 statement from Mr. J.D. in which he recalled that he remembered hearing rumors of an explosion at Fort Ord when he was stationed there with the Veteran new and material. Justus, supra. Therefore, the evidence is not cumulative or redundant of the evidence previously of record. Moreover, it is sufficient to raise a reasonable possibility of substantiating the claim. Accordingly, reopening of the claim of entitlement to service connection for PTSD is in order. Entitlement to Compensation under 38 U.S.C. § 1151 The Veteran has asserted that he developed additional disability in his left hip as a result of placement of an artificial left hip joint in a July 1997 left THA. Specifically, the Veteran has asserted that the hip joint used in the THA was too small for his stature and as such, failed within 10 years of placement; or in the alternative, that the positioning of the artificial joint by the surgeon was improper, causing the subsequent dislocations necessitating THA revision. A review of the record shows that in July 1997, the Veteran underwent a left THA at the VA Medical Center. The Veteran was 57 years old at the time of the joint replacement. A review of the record shows that in a preoperative treatment note, the Veteran was noted to have verbalized understanding of the procedure. In the attending surgeon's preoperative report, the Veteran was noted to have been informed of the benefits, risks, and alternatives to the left THA prior to surgery. Furthermore, the Veteran was noted to understand the benefits, risks, and alternatives and it was noted the Veteran chose to proceed with surgery. Following the left THA, the Veteran was noted to have an uncomplicated recovery and to do well in physical therapy. There is no indication from the record that the Veteran had significant problems with his left hip replacement until the joint dislocated in April 2004. At that time, the Veteran was seen at the emergency room and underwent a successful closed reduction of his left hip and his left hip was noted to be stable following the reduction. In June 2004, the Veteran was again seen in the emergency room for a second left hip dislocation. A closed reduction of the left hip was attempted, but not successful, necessitating a surgical reduction of the left hip. In July 2004, the Veteran underwent a revision of his left THA by a private orthopedic surgeon. At the time of the revision surgical procedure, the Veteran's left hip artificial joint was noted to have substantial polyethylene wear. The original stem and cup were stable and left in place and a new artificial joint was placed. Following the July 2004 left THA revision, the Veteran was noted to have substantial postoperative complications. Specifically, the Veteran sustained a severe infection in the surgical site which necessitated removal of the prosthetic, implantation of antibiotic beads into the surgical site, and intravenous antibiotic therapy. In September 2005, following negative cultures, the Veteran's left hip prosthetic was re-implanted. The Veteran has asserted that had the July 1997 THA been done correctly, he would not have had to undergo the July 2004 revision and so, would not have been subjected to the severe post-surgical complications. Of record are several letters from the Veteran's private orthopedic surgeon, Dr. P.A., in support of the Veteran's claim. In a May 2005 letter, Dr. P.A. noted that the Veteran had experienced left hip problems, which started as an unstable left hip and then required multiple surgeries thereafter for revision THA and subsequent infection that required numerous debridements of the left hip. Dr. P.A. noted that the Veteran had been left with an open wound which had been healing by secondary intention over the last nine months. He further noted that the Veteran had been through quite an ordeal and should be considered completely disabled as it was unlikely he would be able to return to work for at least a 12 month period as he needed to regain his strength. Even after regaining his strength, Dr. P.A. noted that it was doubtful that the Veteran would ever be able to return to serious gainful employment as a result of his age and the ordeal he had been through. In a second May 2005 letter, Dr. P.A. noted that when reviewing the Veteran's case as a medical evaluator, given the fact that the Veteran had both hips replaced within one year of each other, by the same surgeon, using the same prosthetic device and presumably the same technique, one must surmise that the Veteran's difficulties with the left hip THA resulted from the left prosthetic device being malpositioned, thus allowing post-operative dislocations. Dr. P.A. noted that it was difficult to deny the Veteran's problems were a function of the malpositioned prosthesis. In November 2005, the Veteran was afforded a VA examination. At that time, the examiner noted that he had examined the Veteran and performed an extensive and thorough review of the Veteran's claims file. As for the Veteran's physical condition at that time, the examiner noted that the Veteran was quite disabled. He reported that the Veteran was very limited in his functional abilities in that he was unable to walk, he was unable to stand on his own, and he was hardly able to perform transfers with his right lower extremity. The examiner was also asked to provide an opinion regarding the question of whether there was carelessness, negligence, lack of proper skill, error in judgment, or other similar instance of fault on the part of VA. The examiner opined that following a very thorough review of the claims file and the facts, he concluded that the left hip dislocations that resulted in the left THA revision and other complications was not the result of carelessness, negligence, lack of proper skill, error in judgment, or other similar instance of fault on the part of VA. In this regard, the examiner acknowledged the statements made by the Veteran's private orthopedist indicating that the left hip prosthesis was malpositioned at the time of the original July 1997 THA and noted that after careful review, Dr. P.A.'s theory simply was not supported by the facts. The VA examiner noted that after his left THA in July 1997, the Veteran did very well. He ambulated well and did not have significant pain. The VA examiner noted that there were no reports of record confirming that the prosthesis was not placed correctly and noted that Dr. P.A. had not documented any X-ray report, or other evidence, to make the judgment that the prosthesis had been malpositioned, but rather, that he was making that judgment based solely on the fact that the hip had dislocated. Instead, the VA examiner noted that it was possible that given the Veteran's weight, it may have been time for the hip to dislocate. In this regard, the examiner noted that the Veteran did quite well following his left THA until the dislocations in 2004 and that even in individuals who were not heavy, problems could develop. However, the VA examiner noted that since the Veteran was overweight, there was naturally more wear and tear on the prosthesis and more likelihood of such outcomes. The VA examiner also acknowledged Dr. P.A.'s opinion that the VA examiner had chosen the wrong prosthesis at the time of the July 1997 original left THA. However, in this regard, the examiner noted that the prosthesis used in the 1997 left THA had been similar to that used with successful results in the Veteran's 1996 right THA. The examiner noted that any surgeon would have concluded that as the prosthesis had been successful in the right THA, it was the right kind of prosthesis for that particular patient. The VA examiner further noted that while different surgeons could come up with different opinions regarding the selection of an appropriate prosthesis, there was no exact scientific method to say that this was an improper choice. Therefore, the VA examiner found that there could be no finding of carelessness, negligence, lack of proper skill, error in judgment, or other similar instance of fault on the part of VA based on the selection of the left hip prosthesis. In a January 2006 letter, Dr. P.A. noted that the Veteran continued his rehabilitation following his July 2004 THA revision and subsequent infectious complications, but that he continued to have severe disability with regards to his ambulatory capacity, endurance, and his ability to rid his body of infection. In a March 2006 letter, Dr. P.A. reported that the fact that the Veteran had a hip that was chronically dislocating and needed revision was a testament to the fact that the hip was not a stable construct and was placed in a malpositioned orientation that allowed for the frequent dislocations. Dr. P.A. further noted that the exact same prosthesis on the opposite side never dislocated once in over 10 years. Dr. P.A. also noted that the infectious complications following the revision THA surgery were complications that can be expected to occur with a joint revision surgery. In a March 2009 letter, Dr. P.A. reported that the Veteran's left hip replacement had caused him multiple problems since its beginning. In this regard, Dr. P.A. noted that initially, the Veteran was seen for complaints of thigh pain and was prescribed codeine by his treating surgeon. Dr. P.A. noted that the codeine was covering a much larger issue in that the prosthesis itself was wearing down which ultimately led to the dislocations in 2004. Further, Dr. P.A. noted that there are many prosthetic hips available to a surgeon and that he felt the prosthesis used in July 1997 was improper as it was a smaller model that had no place in a 6'5", 300 pound man. Dr. P.A. noted that the smaller prosthetics had smaller contact areas and as such, were much more susceptible to wear as well as instability and ultimate dislocation. Given the contradicting opinions or record, in March 2011, the Veteran's claims file was sent to an independent medical expert for an opinion. In June 2011, Dr. S.C., an orthopedic surgeon and professor at Virginia Commonwealth University Medical Center, provided the requested opinion. Dr. S.C. completed a very thorough review of the claims file and based on that review found that the July 1997 left THA performed at the VA Medical Center did in fact cause the Veteran additional disability. In this regard, Dr. S.C. reported that the dislocations in 2004 were directly related to the Veteran's 1997 left THA and that had the Veteran not had the left hip replaced, he obviously would not have encountered the resultant problems. However, Dr. S.C. opined that the additional disability was not the result of carelessness, negligence, lack of proper skill, or similar instance of fault on the part of VA in performance of the July 1997 left THA or in subsequent treatment for such. In this regard, Dr. S.C. noted that the primary total hip placed in 1997 was well within the standard of care for that time. In particular, Dr. S.C. noted that the choice of prosthesis was acceptable for this patient. Dr. S.C. also noted that ever since total hips have been placed, there had been great debate regarding bearing surfaces. However, even today, metal on polyethylene probably remained the gold standard, even in the younger patient population. Dr. S.C. noted that although the 26 millimeter (mm) head was a bit on the smaller size, it did not contribute to any of the problems the Veteran experienced later. In this regard, Dr. S.C. noted that while a smaller head can lead to decreased stability of the hip, this would have been encountered in the immediate postoperative period, not seven years later. Dr. S.C. noted that what lead to the dislocations in this case was the excessive polyethylene wear which was not to be unexpected in a man who was 6'6" and weighed anywhere between 255-340 pounds. Dr. S.C. noted that Veteran's excess weight and relatively young age would tend to wear down a hip faster than someone who was older and weighed less. Dr. S.C. also opined that the additional disability incurred was not the result of an event not foreseeable. In this regard, Dr. S.C. noted that hip dislocations remain one of the most common complications of any THA and something that a reasonable health care provider would have disclosed in connection with the informed consent process. Furthermore, Dr. S.C. noted that it would be expected that a man of the Veteran's stature would have the potential to wear out the hip sooner than someone who was older, less active, and lighter and that a reasonable health care provider would have also disclosed this in the informed consent process. Dr. S.C. noted that with excessive polyethylene wear, the risk for late instability also increases with the need for an earlier subsequent revision and that the risk for infection in revision surgeries was increased when compared to primary THA procedures. In an October 2012 letter, Dr. P.A. noted that while it was his opinion that the Veteran's left hip problems stemmed from malpositioning of the prosthesis in July 1997, not having been there during the surgery he could not comment on the position of the prosthesis in a 2D reconstruction of an X-ray of the prosthesis, as it was impossible to tell the orientation of those components. In this regard, Dr. P.A. noted that it seemed obvious that if two THAs were performed by the same surgeon, using the same prosthesis, the only variance in the procedures would be the orientation of the placement of the prosthesis, and if one prosthesis remained technically stable for 16 years and the other did not, the only rationale for the left hip prosthesis failure would be malpositioning of the prosthesis in the original THA. Dr. P.A. further noted in prior statements he had questioned the size of the left hip prosthesis used in the July 1997 THA. However, he noted that the fact that the Veteran's right hip prosthesis, which was the same as the left hip prosthesis placed in July 1997, was still functioning normally rendered the size of the prosthesis immaterial. He further noted that while he would have selected a larger prosthesis for the initial THA, the questioning of the size was no longer an issue. In March 2013, the Veteran was afforded another VA examination. At that time, the examiner performed an examination of the Veteran and conducted a thorough review of the Veteran's entire claims file. The examiner diagnosed left hip degenerative joint disease, status post THA; left hip recurrent dislocation, status post revision of THA; and removal of left hip prosthesis and placement of cement spacer with removal of cement spacer and re-implantation of stable bipolar component. The examiner noted that Veteran's functional impairment included severe left hip pain, severely decreased mobility, severe decrease in left hip range of motion, left lower extremity weakness, and inability to stand for long periods or ambulate more than 5-10 feet. The examiner noted that the Veteran was wheelchair bound and required assistance when leaving the house and when performing activities of daily living such as chores, cooking, housekeeping, and laundry. The March 2013 VA examiner also provided an opinion regarding any negligence, carelessness, error in judgment, lack of proper skill, or similar instance of fault on the part of VA in performance of the Veteran's primary 1997 left THA. The examiner opined that the Veteran's current left hip disability was less likely as not a result of the events of the July 1997 left THA. In this regard, the examiner noted that the Veteran's left THA was successful and that there was no dislocation, loosening, or aggressive lesion evidenced by left hip X-ray in July 1999. Further, the VA examiner noted that the Veteran fell and injured his left hip in January 1999, which he recovered from and experienced no problems with his left hip until the well documented 2004 dislocations. The examiner further noted that surgical technique could not be blamed for the 2004 dislocations as surgical complications of THA procedures mostly occur within three months of surgery and in this case, there was no complication until seven years following surgery. Further, the examiner noted that based on a medical literature review, being overweight can cause instability following a primary THA. Greater weight may be placed on one physician's opinion than another's depending on factors such as the reasoning employed by the physicians and whether (and the extent to which) they reviewed prior clinical records and other evidence. Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994). Additionally, while the findings of a physician are medical conclusions that the Board cannot ignore or disregard, Willis v. Derwinski, 1 Vet. App. 66 (1991); the Board is free to assess medical evidence and is not obligated to accept a physician's opinion. Wilson v. Derwinski, 2 Vet. App. 614 (1992). The Board finds that the opinions provided by the November 2005 and March 2013 VA examiners and the June 2011 independent medical expert to be more probative than those provided by the Veteran's private physician. In this regard, the Board notes that while the Veteran's private orthopedist has indicated that he reviewed the Veteran's entire medical record pertaining to his left hip, he failed to cite to any evidence of record or any outside medical literature to support his opinion that the left hip prosthesis was malpositioned at the time of the July 1997 primary THA. Further, the Veteran's private orthopedist failed to provide any other evidence of negligence, carelessness, lack of proper skill, error in judgment, or similar instance of fault on part of VA in providing the initial July 1997 primary THA and subsequent treatment for such. Additionally, the Veteran's private orthopedist has not indicated that the Veteran's 2004 dislocations and subsequent left THA revision were the result of an event to reasonably foreseeable. Therefore, the opinions provided by Dr. P.A. are not adequate to serve as the basis of a grant of entitlement to compensation under 38 U.S.C. § 1151. In contrast, the Board notes that the June 2011 independent medical expert conducted a very thorough review of the record and indicted that the events and circumstances of the July 1997, to include selection of the prosthesis, were those that would be expected of a reasonable health care provider. Additionally, the June 2011 independent medical expert indicated that dislocations and subsequent THA revision are some of the more common complications of a primary THA and would have been disclosed in the informed consent process. The Board notes that the Veteran was noted to have been advised of all the benefits, risks, and alternative treatment options regarding his THA and he was noted to have expressed his understanding prior to surgery. Additionally, the November 2005 VA examiner specifically addressed the contentions set forth by the Veteran's private provider that the hip was malpositioned. The examiner cited to a lack of any evidence, to include X-rays, to corroborate this finding. Further, the March 2013 VA examiner cited to a July 1999 X-ray report which failed to show any problems with the left hip prosthesis. In sum, the Veteran has failed to show he has a left hip disability, status post THA, that resulted from an event not reasonably foreseeable or any carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA. Therefore, the Board finds that the preponderance of the evidence is against the claim and entitlement to compensation for a left hip disability, status post THA, under 38 U.S.C. § 1151 is not warranted. ORDER New and material evidence has been received to reopen the claim of entitlement to service connection for PTSD, and to that extent, it is granted. Entitlement to compensation under 38 U.S.C. § 1151 for a left hip disability, status post THA, is denied. REMAND The Board finds that additional development is required before the Veteran's claim of entitlement to service connection for PTSD is decided. The Board notes that the Veteran has consistently reported that he has PTSD as a result of seeing two men burned alive during an ammunition powder explosion while serving at Fort Ord, California. The Board notes that the Veteran has been unable to provide the names of the two men he saw die or provide a specific date or timeframe for the event. In an effort to verify the Veteran's stressor, the RO requested verification of the events as described by the Veteran from the U.S. Army's Environmental Support Group while developing the Veteran's original March 1996 claim of entitlement to service connection for PTSD. The Environmental Support Group was unable to verify the Veteran's reported stressor and it does not appear from the record that other efforts to verify the Veteran's stressor were made. As discussed above, the claim was ultimately denied. However, as noted above, the Veteran has submitted an August 2012 statement from a fellow service member in support of his claim. In that letter, Mr. J.D. reported that he remembered hearing about the explosion described by the Veteran, but that he did not see it in person. It does not appear from the record that any further efforts to verify the Veteran's reported stressor were made following the receipt of the August 2012 statement from Mr. J.D. Regardless of whether the Veteran can provide names of the men he saw die or a specific date of the event, the Board notes that additional development should be conducted in an effort to verify the Veteran's stressor, to include contacting Joint Services Records Research Center (JSRRC) for verification. Additionally, the fact that the Veteran is unable to provide a specific date of the event is immaterial. The Board notes that the Veteran was only in active service for a short six month period. Records for this entire period would be easily searchable in an effort to verify the Veteran's reported stressor. Therefore, the Board finds that additional efforts to verify the Veteran's stressor must be made. Further, current treatment records should be obtained before a decision is rendered with regard to this issue. Accordingly, the case is REMANDED to the RO or the Appeals Management Center (AMC), in Washington, D.C., for the following action: 1. The RO or the AMC should undertake appropriate development attempt to verify the Veteran's reported stressor, to include a search conducted by the JSRRC. All attempts of stressor verification must be recorded in the claims files. 2. The RO or the AMC should obtain any pertinent VA or private treatment records that are not already of record. All attempts to obtain these treatment records should be recorded in the claims files. 3. Then, if the Veteran's PTSD stressor is verified or if otherwise warranted, the Veteran should be afforded a VA examination by a psychiatrist or a psychologist with appropriate expertise to determine the nature and etiology of his PTSD. The Veteran's claims file and any pertinent evidence in Virtual VA that is not contained in the claims file should be made available to and reviewed by the examiner. Any indicated studies must be performed. Based on the examination results and a review of the record, the examiner should provide an opinion as to whether there is a 50 percent or better probability that the Veteran's PTSD is etiologically related to the his active service, specifically to any verified stressor. The rationale for all opinions expressed must be provided. 4. The RO or the AMC should undertake any other development it determines to be warranted. 5. Then, the RO or the AMC should readjudicate the Veteran's claim on appeal. If the benefit sought on appeal is not granted to the Veteran's satisfaction, the Veteran and his representative should be furnished a Supplemental Statement of the Case and provided an appropriate opportunity to respond. Thereafter, if indicated, the case should be returned to the Board for further appellate action. By this remand, the Board intimates no opinion as to any final outcome warranted. The Veteran need take no action until he is 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). This REMAND must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or the Court 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). ______________________________________________ F. JUDGE FLOWERS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs