Citation Nr: 18156237 Decision Date: 12/11/18 Archive Date: 12/07/18 DOCKET NO. 15-06 618 DATE: December 11, 2018 ORDER Whether new and material evidence has been received to reopen a claim of entitlement to service connection for residuals of a left heel injury is granted. Entitlement to service connection for residuals of a left heel injury, based on substitution of the appellant, is denied. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for residuals of an eye injury is denied. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for an acquired psychiatric disorder, including chronic adjustment disorder granted. Entitlement to service connection for an acquired psychiatric disorder, including adjustment disorder is granted. Entitlement to service connection for a breathing disorder, diagnosed as chronic obstructive pulmonary disease (COPD) and bronchitis is denied. FINDINGS OF FACT 1. The Veteran died in August 2014 during the pendency of this appeal, and his widow filed a timely request to be substituted as the appellant in his place. 2. In an unappealed decision of January 1998, the RO denied the Veteran’s attempt to reopen his claim of entitlement to service connection for residuals of a left heel injury. 3. Evidence received since the January 1998 rating decision relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for residuals of a left heel injury. 4. The Veteran's left heel injury was first shown many years after discharge from service and is not otherwise shown to be related to military service. 5. In an unappealed decision of January 1998, the RO denied the Veteran’s claim of entitlement to service connection for residuals of an eye injury. 6. The evidence received since January 1998 does not, by itself or when considered with previous evidence of record, relate to an unestablished fact necessary to substantiate the claim for service connection for residuals of an eye injury. 7. In an unappealed January 1998 rating decision, the RO denied the Veteran’s attempt to reopen his claim of entitlement to service connection for an acquired psychiatric disorder. 8. Evidence received since the January 1998 rating decision relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for an acquired psychiatric disorder, including depressive disorder and adjustment disorder with anxious features. 9. The Veteran’s acquired psychiatric disorder, diagnosed as depressive disorder and adjustment disorder, is attributable to active service. 10. The Veteran's respiratory disorder, including bronchitis, did not have onset during active service or until years thereafter, and is not otherwise etiologically related to an injury, disease, or other event in active service. CONCLUSIONS OF LAW 1. The January 1998 rating decision, that denied the Veteran’s attempt to reopen the claim of entitlement to service connection for residuals of a left heel injury, is final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. 2. The criteria for reopening a claim of entitlement to service connection for residuals of a left heel injury have been met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156 (a), 20.1103. 3. The criteria for service connection for residuals of a left heel injury have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The January 1998 rating decision, that denied the Veteran’s claim of entitlement to service connection for residuals of an eye injury, is final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. 5. The criteria for reopening a claim of entitlement to service connection for residuals of an eye injury have not been met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156 (a), 20.1103. 6. The January 1998 rating decision, that denied the Veteran’s attempt to reopen the claim of entitlement to service connection for an acquired psychiatric disorder, is final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. 7. The criteria for reopening a claim of entitlement to service connection for an acquired psychiatric disorder, including depressive disorder, have been met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156 (a), 20.1103. 8. The criteria for service connection for an acquired psychiatric disorder, diagnosed as depressive disorder and adjustment disorder with anxious features, have been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 9. The criteria for service connection for a breathing disorder, diagnosed as chronic obstructive pulmonary disease COPD and bronchitis, have not been met. 38 U.S.C. §§ 1101, 1110, 1131 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1952 to July 1954. He died in October 2017, and the appellant is his surviving spouse. This matter comes before the Board of Veterans' Appeals (hereinafter Board) on appeal from a November 2012 rating decision, which denied the Veteran’s attempt to reopen his claims of entitlement to service connection for residuals of a left heel injury, service connection for residuals of an eye injury, and service connection for an acquired psychiatric disorder; the RO also denied a claim of entitlement to service connection for a breathing disorder. He perfected a timely appeal to that decision. Unfortunately, the Veteran passed away before a decision could be made regarding his appeal. In November 2017, the appellant requested that she be substituted as the claimant in the Veteran's appeal that was pending before the Board. In a December 2017 letter, the appellant was advised that she had been substituted in the Veteran's appeal. Effective October 10, 2008, the law was changed concerning substitution in the case of the death of a claimant. The newly revised statute provides that, "If a claimant dies while a claim for any benefit under a law administered by the Secretary, or an appeal of a decision with respect to such a claim, is pending, a living person who would be eligible to receive accrued benefits due to the claimant under 38 U.S.C. § 5121 (a) of this title may, not later than one year after the date of the death of such claimant, file a request to be substituted as the claimant for the purposes of processing the claim to completion." 38 U.S.C. § 5121A (2012). The Board notes that unlike an accrued benefits claim, the record is not closed on the date of death of the original claimant, but remains open for submission and development of any pertinent additional evidence. On March 22, 2018, the Appellant testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. The record was held open to submit additional evidence. Following the Board hearing, the Veteran submitted additional evidence, which was not accompanied by a waiver of RO review. However, since the Veteran's substantive appeal was received after February 2, 2013, the Board no longer is required to obtain a waiver of initial review by the agency of original jurisdiction (AOJ). Service Connection Once the AOJ makes a determination as to a claim, it must mail to the claimant, and his or her representative if there is one, proper notice of the decision, including notice of the claimant's procedural due process and appellate rights. 38 U.S.C. § 7105 (b) (1) (2012); 38 C.F.R. §§ 3.103 (b) (1), 19.25, 20.1103 (2017). An appeal of an AOJ decision to the Board is initiated by the filing of a notice of disagreement (NOD) with the decision. 38 U.S.C. § 7105 (a) (2012); 38 C.F.R. § 20.200 (2017). Unappealed rating decisions by the RO are final with the exception that a claim may be reopened by submission of new and material evidence. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. § 3.156. When a veteran seeks to reopen a claim based on new evidence, VA must first determine whether the additional evidence is "new" and "material." Smith v. West, 12 Vet. App. 312 (1999). New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence means 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 previously of record, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The U.S. Court of Appeals for Veterans Claims (Court) has 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). See also Evans v. Brown, 9 Vet. App. 273, 284 (1996) (the newly presented evidence need not be probative of all the elements required to award the claim, but only need to be probative in regard to each element that was a specified basis for the last disallowance). For the purpose of establishing whether new and material evidence has been submitted, the credibility of evidence is presumed unless the evidence is inherently incredible or consists of statements that are beyond the competence of the person or persons making them. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). "To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"- the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In addition, the law provides that, where a veteran served ninety days or more of qualifying service and a psychosis or organic disease of the nervous system becomes manifest to a degree of 10 percent or more within one year from the date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. The Veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id., see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 1. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for residuals of a left heel injury Historically, the Veteran initially filed a claim for service connection for a left heel injury (VA Form 21-4138) in May 1987. At that time, the record included the Veteran's service treatment records (STRs). These records consisted solely of the separation examination, dated in July 1954, which reported a finding of flat feet; there were no complaints or findings of a left heel injury. Clinical evaluation of the feet was normal at separation from service in July 1954, except for a finding of flat feet. Also considered were private treatment reports dated from April 1985 to July 1985, which are completely silent for any complaints or treatment for a left heel injury. By a rating action in August 1987, the RO denied the Veteran's claim of entitlement to service connection for a left heel injury, based on a finding that the claimed injury to the left heel was not shown by the evidence of record. At a personal hearing in August 1988, the Veteran testified that he sustained a heel injury when he fell in the boiler room and his feet got tangled up in a piece of steel; he recalled being issued a special shoe. The Veteran indicated that he has had a limp ever since that inservice injury. In a June 1989 decision, the Board found that the Veteran was not shown to have a left heel injury in service. In July 1997, the Veteran sought to reopen his claim of entitlement to service connection for a left heel injury. Submitted in support of the claim were VA outpatient treatment reports dated from March 1994 to March 1995 were completely silent for any complaints or treatment of a left heel injury. By a rating action in January 1998, the RO determined that no new and material evidence had been submitted to reopen the claim of entitlement to service connection for a left heel injury. The Veteran did not file a notice of disagreement (NOD) with that determination within one year of the notification thereof in January 1998. Consequently, as no timely NOD or new and material evidence was received during the appeal period following the January 1998 notice of determination, that decision became final. See 38 C.F.R. § 3.156 (b); Buie v. Shinseki, 24 Vet. App. 242, 252 (2010); 38 C.F.R. §§ 20.200, 20.201, 20.1103 (2017). New and material evidence is therefore required to reopen the claim of service connection for a left heel injury. See 38 U.S.C. § 5108 (2012); Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001); 38 C.F.R. § 3.156. The Veteran's request to reopen his claim for service connection for a left heel injury (Form 21-526EZ) was received in September 2011. Submitted in support of the claim were VA treatment reports dated from October 2003 through November 2011. Also submitted were private treatment reports dated from March 2012 through October 2012. None of these records reflect treatment for or diagnosis of a left heel injury. At the personal hearing in March 2018, the appellant indicated that she started noticing problems with the Veteran’s heel about 10 years ago; she noticed that he was ‘hopping’ around. The appellant indicated that the Veteran reported that his heel pain started during basic training and it was caused by the marching. She noted that the heel pain started getting worse when the Veteran went back to work at the South Pacific Railroad. The appellant related that it became difficult for the Veteran to walk. In October 2018, the appellant submitted a statement from Dr. Frank A. Graf, dated in July 2018, who reported that he reviewed the Veteran’s files and considered the conditions claimed. Dr. Graf stated that it is more likely than not that the Veteran’s left heel pain was present at the time of his active duty military service; his condition has been progressive up through to the present. In this regard, the Board notes that the pertinent evidence added to the record since the final denial in January 1998 includes the private medical statement from Dr. Graf who opines that the Veteran had left heel pain at the time of his military service, and it has been present since. This evidence was not previously of record, and is not cumulative or duplicative of evidence before the RO in January 1998. Hence, the evidence is "new" within the meaning of 38 C.F.R. § 3.156. The new evidence also includes the appellant’s testimony during the March 2018 videoconference hearing at which time she maintained that he began having problems with heel pain in service; she noted that the Veteran claimed to have developed the heel problems as a result of marching. The evidence is relevant and probative of the issue regarding the development of the left heel injury, and bears directly and substantially upon the facts regarding whether the Veteran's left heel injury is related to an inservice event. Since the credibility of the evidence is presumed in determining whether new and material evidence has been submitted, this evidence is relevant and probative of the issue of whether the Veteran's left heel injury was incurred as a result of active service. Justus v. Principi, 3 Vet. App. 510, 513 (1992). Accordingly, the standards under 3.156(a) have been met and the claim is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 2. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for residuals of an eye injury Historically, the Veteran filed a claim for service connection for a right eye injury (VA Form 21-526) in April 1985; he reported receiving a blow to the eye. At that time, the record included the Veteran’s service treatment records (STRs), which consisted solely of the separation examination dated in July 1954. Clinical evaluation of the eyes was normal at separation from service in July 1954; his vision was 20/20. Also considered were private treatment reports dated from April 1985 to July 1985, which are completely silent for any complaints or treatment for an eye injury. By a rating action in August 1987, the RO denied the Veteran’s claim of entitlement to service connection for an eye injury, based on a finding that there was no evidence of the condition during service. At the personal hearing in August 1988, the Veteran indicated that he was struck in the eye while in Germany by another service member who claimed that he stepped on his foot. The Veteran indicated that he had bleeding in the left eye following the blow to his eye; he was literally blind in the eye for several months after the incident. The Veteran indicated that he currently experienced pain in that eye. In a June 1989 decision, the Board found that the Veteran was not shown to have a left eye injury in service. In July 1997, the Veteran sought to reopen his claim of entitlement to service connection for an eye injury. Submitted in support of the claim were VA outpatient treatment reports dated from January 1994 to February 1995. During a clinical visit in October 1994, it was noted that the Veteran reported suffering blunt trauma to the left eye in 1953 with decreased visual acuity; the assessment was history of trauma, left eye, with no evidence of residual disability and refractive error. A February 2015 progress note reflects a finding of increased visual acuity with refraction. By a rating action in January 1998, the RO denied the Veteran’s attempt to reopen his claim of entitlement to service connection for a left eye injury, based on a finding that new and material evidence had not been submitted sufficient to reopen the claim. The Veteran did not appeal that decision within one year of the notification thereof in January 1998. Consequently, as no timely NOD or new and material evidence was received during the appeal period following the January 1998 notice of determination, that decision became final. See 38 C.F.R. § 3.156 (b); Buie v. Shinseki, 24 Vet. App. 242, 252 (2010); 38 C.F.R. §§ 20.200, 20.201, 20.1103 (2017). New and material evidence is therefore required to reopen the claim of service connection for a left eye injury. See 38 U.S.C. § 5108 (2012); Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001); 38 C.F.R. § 3.156. The Veteran’s request to reopen his claim for service connection for an eye injury (Form 21-526EZ) was received in September 2011. Submitted in support of the claim were VA treatment reports dated from October 2003 through November 2011. These records show that the Veteran was diagnosed with glaucoma. An August 2010 optometry note reported that the Veteran had visual acuity decreased more than can be explained by cataract; it was noted that diabetic macular ischemia was a possibility. An August 2011 nursing note indicates that the Veteran was seen for evaluation of cataract in the left eye. Also submitted were private treatment reports dated from March 2012 through October 2012. At her personal hearing in March 2018, the appellant reported that the Veteran told her that he was hit in the eye by another person in service. He started wearing glasses after service, and his eyes got worse. One of his eyes remained red most of the time after the injury. Submitted after the hearing was a statement from Dr. Frank A. Graf, dated in July 2018, who reported that he reviewed the Veteran’s files and considered the conditions claimed. Dr. Graf stated that current diagnoses of glaucoma and cataracts are also documented. After a review of the evidence mentioned above, the Board finds that new and material evidence relating to the Veteran's claim of service connection for an eye injury has not been received, and the claim may not be reopened. The majority of this evidence is new in that it was not previously before the Board. However, none of this evidence is material for purposes of reopening the service connection claim. Other than reiterating the Veteran’s previous assertions, the appellant has not offered any additional evidence that the Veteran has residuals of an eye injury that originated in, or is/are in any way related to his military service. As such, the Board finds that the evidence submitted since January 1998 is cumulative or redundant of evidence previously considered by the RO in adjudicating the Veteran's claim of service connection for a right eye injury. Under the circumstances described above, the Board concludes that new and material evidence has not been submitted with regard to the previously denied claim of entitlement to service connection for a right eye injury. Therefore, the claim may not be reopened, and the appeal must be denied. There is no reasonable doubt to be resolved as to reopening the claim. 3. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for an acquired psychiatric disorder, including adjustment disorder Historically, the Veteran initially filed a claim for service connection for a nervous condition (VA Form 21-4138) in April 1985. At that time, the record included the Veteran’s service treatment records (STRs). The only record available was the separation examination, dated in July 1954, which was negative for any complaints or findings of a psychiatric disorder. Also considered were private treatment reports dated from April 1985 to July 1985, which are completely silent for any complaints or treatment for a psychiatric disorder. By a rating action in August 1987, the RO denied the Veteran’s claim of entitlement to service connection for a psychiatric disorder, based on a finding that there was no evidence of a chronic acquired psychiatric disorder in service or of a psychosis within one year of Veteran’s discharge from service. At a personal hearing in August 1988, the Veteran indicated that he was hospitalized at the psychiatric department after having gone AWOL. The Veteran related that he continuously sought treatment and saw the chaplain for his psychiatric problems. The Veteran indicated that he continued to seek medical attention for his psychiatric disorder after his discharge from service. Submitted in November 1988 was a report from the Office of the Surgeon General which reflects that the Veteran was admitted to a hospital in Germany in April 1953, with a diagnosis of inadequate personality. It was noted that this condition existed prior to entry on active military service. In a June 1989 decision, the Board found that the Veteran was not shown to have manifested an acquired psychiatric disorder in service. The Board determined that the diagnosis of inadequate personality in April 1953 is a congenital or developmental defect and not a disability for purposes of service connection. It was also determined that no acquired psychiatric disorder was manifested in service, and the evidence does not show that a psychosis became manifested to a compensable degree during the year after service. In July 1997, the Veteran sought to reopen his claim of entitlement to service connection for a nervous condition (VA Form 21-526). Submitted in support of the claim was the report of a psychiatric evaluation, performed by Dr. Roland Levy in September 1994. At that time, the Veteran reported that his psychiatric history went back to a nervous breakdown in service in 1953; he reported going to the hospital several times because of “substance abuse.” The Veteran reported problems with depression, low energy, insomnia and forgetfulness. Dr. Levy noted that the Veteran appeared to have a history of substance abuse involving a considerable amount of alcohol in the recent past. In addition, he appeared to be depressed, which tends to affect memory. It was recommended that the Veteran be given a thorough evaluation for his depression. By a rating action in January 1998, the RO determined that no new and material evidence had been submitted to reopen the claim of entitlement to service connection for a psychiatric disorder. The Veteran did not file a notice of disagreement (NOD) with that determination within one year of the notification thereof in January 1998. Consequently, as no timely NOD or new and material evidence was received during the appeal period following the January 1998 notice of determination, that decision became final. See 38 C.F.R. § 3.156 (b); Buie v. Shinseki, 24 Vet. App. 242, 252 (2010); 38 C.F.R. §§ 20.200, 20.201, 20.1103 (2017). New and material evidence is therefore required to reopen the claim of service connection for a psychiatric disorder. See 38 U.S.C. § 5108 (2012); Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001); 38 C.F.R. § 3.156. The Veteran’s request to reopen his claim for service connection for a mental health condition (Form 21-526EZ) was received in September 2011. Submitted in support of the claim were VA treatment reports dated from October 2003 through November 2011. These records indicate that the Veteran had been receiving clinical attention and treatment for depression. In September 2010, a list of active problems reported depressive disorder, NOS, diagnosed in July 2010. A primary care note, dated in January 2011, indicates that the Veteran has a history of depression. Also submitted were private treatment reports dated from March 2012 through October 2012. At the personal hearing in March 2018, the appellant maintained that the Veteran developed a psychiatric disorder as a result of an incident that occurred while on active duty in Germany. She testified that the Veteran told her of an incident when he was shooting pool by himself and three guys came in, grabbed him by the neck, choked him and threw him to the ground. The Veteran related that this incident was mentally traumatic to him; he was essentially “ganged up” on by three guys. In October 2018, the appellant submitted a statement from Dr. Quinn Austin-Small, dated in February 2018, who reported that he reviewed the Veteran’s files and considered the conditions claimed. Dr. Austin-Small noted that the records indicate the Veteran was hospitalized psychiatrically for one month while in the military; he was also hospitalized at least one time further in the community after his discharge. He also noted that the Veteran received outpatient mental health care per records in the 1970s. Dr. Austin-Small stated that, based on the totality of evidence, an accurate diagnostic formulation for the Veteran would be persistent depressive disorder and adjustment disorder with anxiety; there’s also a question of episodic cocaine abuse based on the records. The psychologist further noted that it is clear that the Veteran did not have any psychiatric history prior to his military enlistment. Dr. Austin-Small concluded that Veteran’s depression and anxiety more likely than not began during his service; and, as he required subsequent hospitalization after leaving the service and continued to be diagnosed with depression throughout the rest of his life per records, the Veteran dearly continued to have-difficulties caused by his depression and anxious conditions. The Board finds that the evidence received since the January 1998 rating decision is both new and material. In the instant case, the additional evidence includes a current diagnosis of an acquired psychiatric disorder. The record now contains the result of a review of the Veteran’s file and evaluation, dated in February 2018, which contains a diagnosis of depressive disorder and adjustment disorder with anxious features. This evidence is new, as it was received by VA after the issuance of the January 1998 rating decision and could not have been considered by prior decision makers. Moreover, it is material as it addresses the existence of an acquired psychiatric disorder based on the claimed in-service event, which were elements of service connection that the January 1998 rating decision found lacking. In making this determination, the Board must presume that newly submitted evidence is credible. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). The evidence described above is enough to reopen under the low threshold of Shade. The claim of entitlement to service connection for an acquired psychiatric disorder, to include depressive disorder and adjustment disorder, is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2017). 4. Entitlement to service connection for residuals of a left heel injury Prior to his death, the Veteran maintained that he had a left heel injury in service. At his personal hearing in August 1988, the Veteran testified that he sustained a heel injury when he fell in the boiler room and his feet got tangled up in a piece of steel; he recalled being issued a special shoe. The Veteran indicated that he has had a limp ever since that inservice injury. The Board has reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by a veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The Veteran's STRs, which includes the July 1954 separation examination, are silent as to complaints, diagnoses, or treatments for a leg disorder. Significantly, the separation examination is normal for lower extremities. No pertinent defects or diagnoses were noted. Following separation from active duty in July 1954, the first documented report of a left heel disorder is the Veteran's claim for service connection in May 1987. However, VA and private treatment records reflect complaints, treatments, and diagnoses for various conditions, but nothing regarding the left heel. After a review of all the evidence of record, lay and medical, the Board finds that the weight of the competent evidence demonstrates there is no relationship between the Veteran's claimed left heel injury and his military service, including no credible evidence of continuous or recurrent symptoms of a left heel injury during active service, continuous or recurrent symptomatology of the left heel injury following service separation, or competent medical evidence establishing a link between the claimed left heel injury and active service. Therefore, the Board finds that a preponderance of the evidence that is of record weighs against the claim for service connection for the left heel injury, and outweighs the Veteran's more recent contentions regarding in-service continuous or recurrent symptoms and continuous or recurrent post-service symptoms. The Board acknowledges the positive medical opinion submitted by the appellant in October 2018, wherein Dr. Graf opines that it is more likely than not that the Veteran's left heel pain was present at the time of his active duty military service and have been progressive through the present. However, this medical opinion is based on an inaccurate factual premise, that the Veteran incurred a left heel injury during service. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that an opinion based upon an inaccurate factual premise has no probative value). Consequently, the Board concludes that such an opinion does not support a finding of service connection. The Board acknowledges the appellant's belief that her husband's left heel injury is related to his active service. However, neither her nor her late husband's statements alone establish a medical nexus. Indeed, while the Veteran and the appellant are competent to provide evidence regarding matters that can be perceived by the senses, neither is shown to be competent to render medical opinions on questions of etiology under the facts of this case. See Jandreau, 492 F.3d 1372; see also Barr, 21 Vet. App. 303 (lay testimony is competent to establish the presence of observable symptomatology). As such, as lay people, they are without the appropriate medical training and expertise to offer an opinion on a medical matter, including the diagnosis, etiology, or causation of a specific disability. The question of diagnosis and causation, in this case, involves complex medical issues that neither the Veteran nor the appellant are competent to address. Jandreau. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence on any aforementioned theory of entitlement. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Thus, the claim must be denied. 5. Entitlement to service connection for an acquired psychiatric disorder, including chronic adjustment disorder Having reopened the claim for entitlement to service connection for an acquired psychiatric disorder, to include depressive disorder and adjustment disorder, the Board will now consider the claim on its merits. The Board has reviewed all of the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). It is argued that the Veteran developed a psychiatric disorder as a result of an incident in service. At his personal hearing in August 1988, the Veteran indicated that he was hospitalized in the psychiatric department during service. He was hospitalized in 1953 for approximately one month. After he was discharged from the hospital, he continued to seek psychiatric help. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. At the outset, the Board notes that Veteran's STRs are silent with respect to any symptoms or diagnoses of an acquired psychiatric disorder. The July 1954 separation examination did not document any complaints of psychiatric symptoms. Furthermore, there is no competent and credible evidence of record of a diagnosis or complaints of a psychiatric disorder within the year following the Veteran's discharge from active service. Therefore, service connection cannot be presumed under 38 C.F.R. § 3.307, and the Veteran's claim must meet the criteria for general service connection claims. 38 C.F.R. § 3.303. However, after careful review of the evidentiary record, the Board concludes that the Veteran has a current diagnosis of depressive disorder and adjustment disorder that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a). Significantly, the February 2018 psychiatric evaluation by Dr. Austin-Small reported a diagnosis of depressive disorder and adjustment disorder with anxiety, and the examiner opined that the Veteran's depression and anxiety more likely than not began during the course of his service. The examiner noted that the Veteran had a one-month psychiatric hospitalization while in the military in 1953; he observed that the timing of this hospitalization suggests that the depression and anxiety began in earnest during the military, rather than prior to enlistment. The examiner explained that had the Veteran been suffering from depression or anxiety to the degree where hospitalization would be necessary, it would be unlikely that he would be able to maintain himself through boot camp and initial overseas assignment for over a year. The fact that the Veteran was able to participate well and perform his duties well for a full year prior to hospitalization suggests that the illness began, or severely worsened, during service. The examiner concluded that the Veteran’s persistent depressive disorder and adjustment disorder with anxious features more likely than not began during military service. Upon review of the evidence, the Board finds that doubt can be resolved in the Veteran's favor and service connection for an acquired psychiatric disorder is warranted. Competent evidence establishes that the Veteran does have an acquired psychiatric disorder that is etiologically related to the Veteran's active service. Personnel records indicate that the Veteran was hospitalized for one month during service for a mental breakdown in April 1953, and a private psychologist, who is competent to provide an opinion as to the etiology of psychiatric disorders, concluded that the Veteran had a diagnosis that was related to his experiences in military service. Consequently, the criteria for service connection for an acquired psychiatric disorder, diagnosed as depressive disorder and adjustment disorder with anxious features, have been met. The claim is granted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102 (2017). 6. Entitlement to service connection for a breathing disorder The Veteran contends that he has a breathing disorder that is related to active service. Based upon a review of all the lay and medical evidence, the Board finds the weight of the competent and credible evidence shows that the current breathing/respiratory disorder diagnosed as chronic obstructive pulmonary disease (COPD) and bronchitis, is not related to injury, disease, or other event in active service. Significantly, VA treatment reports dated from March 2011 to November 2011 reflect diagnoses of COPD. A private treatment report, dated in March 2012, indicates that the Veteran was seen with complaints of shortness of breath and chest pain. It was noted that he had COPD and bronchitis. More recently, in a private medical statement dated in February 2018, Dr. Graf noted that the Veteran has bronchitis. The available STRs do not reflect any complaints of or treatment for a respiratory disorder. Significantly, on the occasion of his separation examination in July 1954, clinical evaluation of the lungs and chest was normal. As noted, the first evidence of shortness of breath symptoms was in March 1996, more than 42 following his discharge from service. At that time, the Veteran was diagnosed with atypical chest pain; it was reported that the symptoms were relieved with doses of nitroglycerin. The Veteran was subsequently diagnosed with COPD and bronchitis in March 2011, over 57 years after service separation. The Board notes that the passage of time between the Veteran's discharge and an initial diagnosis for the claimed disorder is one factor that weighs against the Veteran's claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board acknowledges the positive medical opinion submitted by the appellant in October 2018, wherein Dr. Graf opines that it is more likely than not that the Veteran’s bronchitis was present at the time of his active duty military service and have been progressive through the present. However, this medical opinion is based on an inaccurate factual premise, that the Veteran incurred a breathing disorder during service. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that an opinion based upon an inaccurate factual premise has no probative value). The opinion is not supported by the record, which clearly reflects that the Veteran did not report any symptoms of a breathing disorder at the time of his discharge from service in July 1954; in fact, complaints of a breathing disorder is not documented until decades after his discharge from military service. Consequently, the Board concludes that such an opinion does not support a finding of service connection. The Board acknowledges the appellant’s belief that her husband had a respiratory disability related to his active service. However, neither her nor her late husband’s statements alone establish a medical nexus. Indeed, while the Veteran and the appellant are competent to provide evidence regarding matters that can be perceived by the senses, neither is shown to be competent to render medical opinions on questions of etiology under the facts of this case. See Jandreau, 492 F.3d 1372; see also Barr, 21 Vet. App. 303 (lay testimony is competent to establish the presence of observable symptomatology). The question of diagnosis and causation, in this case, involves complex medical issues that neither the Veteran nor the appellant are competent to address. Jandreau. (Continued on the next page)   In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence on any aforementioned theory of entitlement. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Thus, the claim must be denied. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD