Citation Nr: 18130006 Decision Date: 08/28/18 Archive Date: 08/28/18 DOCKET NO. 13-31 940 DATE: August 28, 2018 ORDER New and material evidence has been received and the claim of entitlement to service connection for posttraumatic stress disorder (PTSD) is reopened. New and material evidence has been received and the claim of entitlement to service connection for prostate cancer is reopened. New and material evidence has been received and the claim of entitlement to service connection for throat cancer is reopened. New and material evidence has been received and the claim of entitlement to service connection for asthma is reopened. Service connection for prostate cancer, to include any residuals of treatment for prostate cancer, is granted. REMANDED Entitlement to service connection for PTSD is remanded. Entitlement to service connection for throat cancer, including of the mouth and pharynx, is remanded. Entitlement to service connection for asthma is remanded. Entitlement to service connection for obstructive sleep apnea is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to a rating in excess of 30 percent for a left knee disability is remanded. Entitlement to a compensable rating for a left knee scar is remanded. FINDINGS OF FACT 1. The Veteran timely appealed the RO’s January 2014 denial of the claims for higher disability evaluations for a left knee scar and the left knee disability, service connection for obstructive sleep apnea, and a right knee disability, and to reopen the previously denied claims for service connection for throat cancer, PTSD, prostate cancer, and asthma. However, he died in May 2017, prior to completion of the appeal. 2. The appellant is the Veteran’s surviving spouse, who was properly substituted as the claimant to continue the Veteran’s pending claims on appeal to completion. 3. A November 1997 rating decision that denied the Veteran’s original service connection claims for PTSD and throat cancer is final. 4. An August 2007 rating decision that denied the Veteran’s original service connection claim for prostate cancer and declined to reopen the previously denied the claims for service connection for PTSD and throat cancer is final. 5. An August 2009 rating decision that denied the Veteran’s original service connection claim for breathing problems and declined to reopen the previously denied the claims for service connection for PTSD and prostate cancer is final. 6. Evidence received since the last final decision raises a reasonable possibility of substantiating the claims of service connection for PTSD, asthma, prostate cancer, and throat cancer. 7. Resolving reasonable doubt in the Veteran’s favor, he was exposed to herbicide agents while stationed at Korat Royal Thai Air Force Base (RTAFB), Thailand in 1964. 8. The Veteran’s prostate cancer is presumed to be related to his exposure to herbicide agents. CONCLUSIONS OF LAW 1. The appellant, the Veteran’s surviving spouse, is a proper substitute claimant in this case. 38 U.S.C. § 5121A (2012). 2. The November 1997 rating decision that denied the claims for entitlement to service connection for PTSD and throat cancer is final. See 38 U.S.C. §§ 7103, 7104 (2012); 38 C.F.R. §§ 3.156, 20.1100 (2017). 3. The August 2007 rating decision denying service connection for prostate cancer and declining to reopen the service connection claims for PTSD and throat cancer is final. See 38 U.S.C. §§ 7103, 7104 (2012); 38 C.F.R. §§ 3.156, 20.1100 (2017). 4. The August 2009 rating decision denying service connection for breathing problems and declining to reopen service connection claims for PTSD and prostate cancer is final. See 38 U.S.C. §§ 7103, 7104 (2012); 38 C.F.R. §§ 3.156, 20.1100 (2017). 5. Evidence received subsequent to the last final decision is new and material, and the claims of service connection for PTSD, asthma, prostate cancer, and throat cancer are reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2017). 6. The criteria to establish service connection for prostate cancer have been met. 38 U.S.C. §§ 1110, 1116, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1968 to February 1976. He also had unverified service in the Louisiana Air National Guard. Unfortunately, he died in May 2017. The appellant is his surviving spouse and, as discussed below, has been properly substituted as claimant in the claims addressed herein. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. Regardless of any RO determination on the application to reopen, the Board has a jurisdictional responsibility to consider whether it is proper for the claim to be reopened. See Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). After reviewing the contentions and evidence of record, the Board finds that the issue of entitlement so service connection for squamous cell carcinoma of the mouth is more accurately stated as entitlement to service connection for throat cancer. The Board notes that the United States Court of Appeals for Veterans Claims (Court) has held that when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. See Brokowski v. Shinseki, 23 Vet. App. 79 (2009) (holding that a claimant may satisfy the requirement to identify the benefit sought by referring to a body part or system that is disabled or by describing symptoms of the disability); see also Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (holding that the scope of a mental health disability claim includes any mental disorder that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and other information of record). The medical evidence of record indicates that the Veteran had been diagnosed with squamous cell carcinoma of the mouth in 1993, as well as squamous cell carcinoma of the left oropharynx in April 2017. The April 2017 private treatment record indicated that both the previous and current cancers were types of throat cancer. Therefore, in consideration of the medical evidence and the holdings in Brokowski and Clemons, the Board has recharacterized the claim as entitlement to service connection for throat cancer, including of the mouth and pharynx. The Board notes that the Veteran has a separate pending appeal as to whether the reduction in the rating for a left knee scar from 10 percent to 0 percent, effective December 1, 2012, was proper. In the November 2013 VA Form 9, the Veteran requested a Board videoconference hearing as to this issue. No such hearing has yet been afforded to the appellant. Therefore, the Board will not address this issue herein. The Board considered whether an inferred request for a total disability rating based on individual unemployability (TDIU) has been raised under Rice v. Shinseki, 22 Vet. App. 447 (2009). Here, the record reflects that the Veteran has been retired since 2008, and neither the Veteran nor the evidence raise the issue that he was be unemployable on account of his service-connected left knee disability and left knee scar. Accordingly, a TDIU request as concerning his service-connected left knee disability and left knee scar has not been inferred. See Roberson v. Principi, 251 F.3d 1378, 1384 (2001). See, too, Comer v. Peake, 552 F.3d 1362 (Fed. Cir. 2009) (requiring cogent evidence of unemployability). The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Appellant as Substitute-Claimant When a Veteran has claims pending at the time of his death, his surviving spouse may be paid periodic monetary benefits, which were due and unpaid, to which he was entitled at the time of his death based on existing ratings or decisions, or other evidence that was on file when he died. 38 U.S.C. § 5121 (2012); 38 C.F.R. § 3.1000 (2017). The statute regarding accrued benefits claims was amended on October 10, 2008. See Veterans’ Benefits Improvement Act of 2008, Pub. L. No. 110-389, § 212 (2008). Section 212 created a new statute, which provided that if a claimant died while a claim or appeal for any benefit under a law administered by VA was pending, a living person who would be eligible to receive accrued benefits due to the claimant may, not later than one year after the date of the death of the claimant, request to be substituted as the claimant for the purposes of processing the claim to completion. See 38 U.S.C. § 5121A. The new statute allows a person who could be considered an accrued benefits claimant to substitute for a deceased claimant to continue adjudication of the deceased claimant’s claim. The provisions of the new statute apply with respect to the claim of any claimant who dies on or after October 10, 2008. See Pub. L. No. 110-389, § 212, 122 Stat. 4145, 4151 (2008). Prior to the completion of the Veteran’s appeal of the January 2014 rating decision, the RO received confirmation of his May 2017 death. In June 2017, the appellant submitted VA Form 21-0847, Request for Substitution of Claimant Upon Death of Claimant. In June 2017, the RO allowed for the appellant’s substitution in the Veteran’s claims that were on appeal. She was notified of this decision in a letter that same month. Therefore, the Board recognizes that the Veteran’s surviving spouse has been properly substituted for the Veteran. As the Veteran’s death occurred after October 10, 2008, the appellant’s claim is not one for accrued benefits, but remains his original claim into which she is substituted in his stead. Reopening Based on New and Material Evidence Rating decisions are final and binding based on evidence on file at the time the claimant is notified of the decision and may not be revised on the same factual basis except by a duly constituted appellate authority. 38 C.F.R. § 3.104(a). The claimant has one year from notification of a RO decision to initiate an appeal or submit new and material evidence before the decision becomes final. 38 U.S.C. § 7103, 7104 (2012); 38 C.F.R. §§ 20.1100 (2017). An exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, VA shall reopen the claim and review the former disposition of the claim. Under applicable regulations, 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). In determining whether evidence is new and material, the credibility of the evidence is generally presumed. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held, however, that evidence that is merely cumulative of other evidence in the record cannot be new and material even if that evidence had not been previously presented to the Board. Anglin v. West, 203 F.3d 1343 (2000). In deciding whether new and material evidence has been submitted, the Board looks to the evidence submitted since the last final denial of the claim on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). In order to determine whether new and material evidence has been received, the Board must analyze the law applicable to the underlying service connection claim. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). 1. Whether new and material evidence has been received to reopen a previously denied claim of entitlement to service connection for PTSD. In November 1997, the RO denied the Veteran’s claim for entitlement to service connection for PTSD. The November 1997 denial of service connection for PTSD was based on a determination that there was no current diagnosis of PTSD and that there was no verifiable stressor. The Veteran was notified of this denial, but did not appeal the decision. Therefore, the decision was final. See 38 U.S.C. §§ 7103, 7104; 38 C.F.R. §§ 3.156, 20.1100. In August 2007 and August 2009, the RO denied the Veteran’s applications to reopen the previously denied claim of entitlement to service connection for PTSD. The RO declined to reopen these claims as there was no evidence relating the unestablished element of a confirmed stressor during service. Notice was provided and the Veteran neither appealed the decision nor submitted new and material evidence within the one-year appeal period. The rating decisions thus became final. See 38 U.S.C. §§ 7103, 7104; 38 C.F.R. § 20.1100. Based on this procedural history, the August 2009 rating decision is the last final decision regarding the PTSD claim. The same factual basis is not generally thereafter considered. The RO’s August 2009 denial of service connection for PTSD was based on a determination that the Veteran did not have a verified stressor during service. The evidence before the RO at that time included the Veteran’s service treatment records, VA treatment records, private treatment records, lay statements, and an August 2009 formal finding of lack of information required to corroborate stressors. The evidence received since the August 2009 rating decision includes an October 2016 statement from the Veteran indicating that he was stationed at Korat RTAFB from approximately November 1974 into 1975. He stated that he would take wounded soldiers to De Nang Air Force Base in Thailand. He also raised the question as to whether he is listed on the helicopter manifests, as asserted. Presuming the credibility of the Veteran’s statements with regard to dates and the helicopter manifests, this evidence is new and relates to the basis of the prior denial. For this reason, the Board reopens the claim for service connection for PTSD. 2. Whether new and material evidence has been received to reopen a previously denied claim of entitlement to service connection for prostate cancer. In August 2007, the RO denied the Veteran’s claim for entitlement to service connection for prostate cancer. The Veteran was notified of this denial, but did not appeal the decision. Therefore, the decision was final. See 38 U.S.C. §§ 7103, 7104; 38 C.F.R. §§ 3.156, 20.1100. In August 2009, the RO denied reopening the previously denied claim of entitlement to service connection for prostate cancer. The RO declined to reopen these claims as there was no evidence relating the unestablished element of service in Vietnam or exposure to herbicide agents during service. Notice was provided and the Veteran neither appealed the decision nor submitted new and material evidence within the one-year appeal period. The rating decision thus became final. See 38 U.S.C. §§ 7103, 7104; 38 C.F.R. § 20.1100. Based on this procedural history, the August 2009 rating decision is the last final decision regarding the prostate cancer claim. The same factual basis is not generally thereafter considered. The August 2009 denial of service connection for prostate cancer was based on a determination that the did not serve in the Republic of Vietnam during the Vietnam era and the prostate cancer was not etiologically related to his service. The evidence before the RO at that time included the Veteran’s service treatment records, the January 2007 VA examination report, the Veteran’s statements, and VA treatment records. However, the evidence received since the August 2009 rating decision includes a map of Korat RTAFB that purportedly shows that the Veteran’s duties placed him on or near the perimeters of the base. Presuming the credibility of the assertion for the purposes of reopening, this evidence relates to the basis of the prior denial. Accordingly, it is new and material, and reopening of the claim for service connection for prostate cancer is warranted. 3. Whether new and material evidence has been received to reopen a previously denied claim of entitlement to service connection for throat cancer. In November 1997, the RO denied the Veteran’s claim for entitlement to service connection for throat cancer. The Veteran was notified of this denial, but did not appeal the decision. Therefore, the decision was final. See 38 U.S.C. §§ 7103, 7104; 38 C.F.R. §§ 3.156, 20.1100. In August 2007, the RO denied reopening the previously denied claim of entitlement to service connection for oral squamous cell carcinoma. The RO declined to reopen these claims as there was no evidence relating the unestablished element of service in Vietnam or exposure to herbicide agents during service. Notice was provided and the Veteran neither appealed the decision nor submitted new and material evidence within the one-year appeal period. The rating decision thus became final. See 38 U.S.C. §§ 7103, 7104; 38 C.F.R. § 20.1100. Based on this procedural history, the August 2007 rating decision is the last final decision regarding the throat cancer claim. The same factual basis is not generally thereafter considered. The November 1997 denial of service connection for throat cancer was based on a determination that the Veteran did not serve in the Republic of Vietnam during the Vietnam era and was not otherwise exposed to herbicide agents during service. The evidence before the RO at that time included the Veteran’s service treatment records, VA treatment records, and a private hospital report. However, the evidence received since the August 2007 rating decision includes a map of Korat RTAFB that purportedly shows that the Veteran’s duties placed him on or near the perimeters of the base. Presuming the credibility of the assertion for the purposes of reopening, this evidence relates to the basis of the prior denial. Accordingly, it is new and material, and reopening of the claim for service connection for throat cancer is warranted. 4. Whether new and material evidence has been received to reopen a previously denied claim of entitlement to service connection for asthma. In August 2009, the RO denied the Veteran’s claim for entitlement to service connection for breathing problems. The Veteran was notified of this denial, but did not appeal the decision. Therefore, the decision was final. See 38 U.S.C. §§ 7103, 7104; 38 C.F.R. §§ 3.156, 20.1100. The August 2009 denial of service connection for breathing problems was based on a determination that the Veteran did not have a current diagnosis of a respiratory condition. The evidence before the RO at that time included the Veteran’s service treatment records, VA treatment records, lay statements, and private treatment records. The evidence received since the August 2009 rating decision includes the July 2013 VA examination report indicating that the Veteran has a current diagnosis of asthma. As this evidence relates to the basis of the prior denial, it is new and material, and reopening of the claim for service connection for asthma is warranted. Service Connection Applicable law and Regulations Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303(a) (2017). 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 incurred in service. 38 C.F.R. § 3.303(d) (2017). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Congress specifically limited entitlement to service-connected disease or injury to cases where such incidents have resulted in a disability. In absence of proof a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Service connection may also be established on a presumptive basis; certain diseases associated with exposure to herbicide agents used in support of military operations in Vietnam during the Vietnam era will be considered to have been incurred in service. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). The presumption requires exposure to an herbicide agent and manifestation of the claimed disease to a degree of 10 percent or more within the time period specified for each disease. 38 C.F.R. § 3.307(a)(6)(ii). Diseases found associated with herbicide agent exposure for purposes of the presumption are specified in the statute and regulation and include prostate cancer. 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e). Prostate cancer may be presumptively service-connected if it manifests at any time after service. 38 C.F.R. § 3.307(a)(6)(ii). VA has determined that there was significant use of herbicides on the fenced-in perimeters of military bases in Thailand intended to eliminate vegetation and ground cover for base security purposes as evidenced in a declassified Department of Defense document titled “Project CHECO Southeast Asia Report: Base Defense in Thailand.” Therefore, VA has established specific procedures for verifying exposure to herbicides for veterans who served in Thailand during the Vietnam Era. See VA Adjudication Manual, M21-1MR, (“M21-1MR”) Part IV, Subpart ii, Chapter 2, Section C. Special consideration of herbicide agent exposure on a facts-found or direct basis are extended to those veterans whose duties placed them on or near the perimeters of Thailand military bases, which allows for presumptive service connection of the diseases associated with herbicide exposure. The majority of troops in Thailand during the Vietnam Era were stationed at the RTAFBs of U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat, and Don Muang. If a veteran served on one of these air bases as a security policeman, security patrol dog handler, member of a security police squadron, or otherwise served near the air base perimeter, as shown by his or her MOS, performance evaluations, or other credible evidence, then herbicide agent exposure should be acknowledged on a facts-found or direct basis. This allows for presumptive service connection of the diseases associated with herbicide exposure and applies only during the Vietnam Era, from February 28, 1961, to May 7, 1975. See M21-1MR, Part IV, Subpart ii, Chapter 2, Section C.10.q. 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 favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical disability, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. Here, however, the Veteran’s DD-214 indicates that his military occupational specialty was a medical service specialist, thereby indicating that he received some medical training. As such, the Board finds that the Veteran had some medical expertise and was competent to provide an opinion based on such expertise. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 5. Entitlement to service connection for prostate cancer, to include any residuals of treatment for prostate cancer. The Veteran contended that his prostate cancer was etiologically related to exposure to herbicide agents during service. The Veteran’s personnel and service treatment records reflect that he was stationed in Southeast Asia from April 1975 to November 1975, and specifically at Korat RTAFB. The question that remains is whether the Veteran was exposed to herbicide agents while stationed in Thailand. Affording the Veteran the benefit of the doubt, the Board finds that he served near the perimeter of Korat RTAFB and that he was likely exposed to herbicide agents during service. A September 1975 service treatment record indicated that the Veteran had been restricted to the limits of Korat RTAFB for 14 days, thereby implying that he was generally able to leave the base, presumably by crossing the base perimeter. A November 1975 Performance Report indicated that the Veteran operated a medical service vehicle used to transport patients. In an October 2016 statement, the Veteran stated that he would take wounded soldiers to other military bases in Thailand because those bases had better medical facilities. When read together, the Veteran’s statement and the Performance Report imply that the Veteran likely entered and left the base by driving across the base perimeter. In March 2018, the appellant’s representative submitted maps of Korat RTAFB showing that Non-Commissioned Officers (NCO) Club, physical training/recreation area, and living quarters were located near the perimeter of the base. The proximity of these facilities to the base perimeter make it highly likely that the Veteran served near the perimeter of the base. Resolving any reasonable doubt in the Veteran’s favor, the Board finds that the Veteran was likely frequented the perimeter of Korat RTAFB. Therefore, the Board concludes that he performed his duties near the perimeter of the Korat RTAFB and was likely exposed to herbicide agents while stationed in Thailand. Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Moreover, the medical evidence of record establishes a diagnosis of prostate cancer. See July 1999 private treatment record. As prostate cancer is a disease subject to presumptive service connection upon finding a Veteran was exposed to an herbicide agent during service, service connection is granted. 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e). REASONS FOR REMAND 1. Entitlement to service connection for PTSD. In November 2006, the Veteran stated that his first flight while based in Thailand was in August 1975. He stated that he flew several flights into Vietnam, some to evacuate soldiers needing urgent medical attention and some to retrieve the bodies of dead soldiers. He stated that his first “non-social” flight into Vietnam was in September 1975. He stated that as the flight approached the landing area, he was told that he would be under extreme and heavy enemy gunfire, enemy snipers, mortars, and long-range rocket fire. He stated that he was one of the first to exit the flight and had to take cover immediately due to gunfire. He stated that he helped to evacuate wounded soldiers. He reported another flight into hostile enemy area when he had to perform “body part detail.” Despite the Veteran’s October 2016 statement indicating that he was stationed at Korat RTAFB from approximately November 1974 into 1975, the military personnel records in the claims folder indicate that he was stationed in Thailand from April 1975 to November 1975. According to 38 C.F.R. § 3.2, the Vietnam era ended on May 7, 1975, prior to the dates of the Veteran’s reported stressors. As the Veteran’s reported stressors are related to hostile military activity and dated a few months after the end of the Vietnam era, the Board finds that additional information is needed to verify the Veteran’s actual dates of service in Thailand and reported stressors. In August 2009, the RO made a formal finding of a lack of information required to corroborate the Veteran’s reported stressors. However, the actions taken by the RO to verify the stressor(s), as described by the RO in the August 2009 formal finding, are insufficient. Specifically, the RO has not attempted to verify the Veteran’s stressors by obtaining the unit records or flight manifests that might support the Veteran’s statements regarding his reported stressors. As such, further development is required as to the Veteran’s reported stressors. The Board notes that neither the Veteran (during his lifetime) nor the appellant has provided 60-day windows for the dates of his claimed stressors, which is required by the JSRRC before it will begin research. However, the AOJ must submit multiple requests to the JSRRC to cover the relevant time window in 60 day increments because VA’s duty to assist is not bound by the JSRRC’s 60 day limitation. See Gagne v. McDonald, 27 Vet. App. 397 (2015). 2. Entitlement to service connection for throat cancer. As noted above, the Veteran is presumed to have been exposed to herbicide agents during service. If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases shall be service connected if the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. However, the Veteran’s diagnosed throat cancer is not listed as a disease associated with exposure to certain herbicide agents under 38 C.F.R. § 3.309(e). The representative appears to contend that the Veteran’s diagnosed throat cancer should be treated as a type of respiratory cancer. However, the representative is not competent to diagnosis the particular type of cancer that affected the Veteran. See Rucker, 10 Vet. App. at 74; Jandreau, 492 F.3d at 1377, n.4. While respiratory cancers (cancer of the lung, bronchus, larynx, or trachea) are listed as diseases associated with exposure to certain herbicide agents under 38 C.F.R. § 3.309(e), under the authority granted by Congress in the Agent Orange Act of 1991 and the Veterans Education and Benefits Expansion Act of 2001, the VA Secretary has determined that a presumption of service connection is not warranted for any disease not affirmatively named in the presumptive list, including carcinoma of the pharynx, neck, and hypopharynx. See 77 Fed. Reg. 47,924 (Aug. 10, 2012). Based on the law, the appellant cannot benefit from this presumption, regardless of whether the Veteran was exposed to herbicide agents in service. Id. When a veteran is found not to be entitled to a regulatory presumption of service connection for a disability, the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed.Cir.1994). In light of the Board’s finding herein that the Veteran is presumed to have been exposed to herbicide agents during service and the appellant’s contention that the Veteran’s throat cancer was related to such exposure, remand is warranted to obtain a medical opinion as to whether the Veteran’s throat cancer was related to or caused by service, including his presumed exposure to herbicide agents. 3. Entitlement to service connection for asthma. Every veteran is presumed to have been in sound condition at entry into service except as to defects, infirmities, or disorders noted at the time of such entry, or where clear and unmistakable evidence demonstrates that the injury or disease existed before entry and was not aggravated by such service. 38 U.S.C. § 1111. The term “noted,” in 38 U.S.C. § 1111, refers to “[o]nly such conditions as are recorded in examination reports.” 38 C.F.R. § 3.304(b). As a diagnosis of asthma was not noted at entry into service, the Veteran is presumed to have been in sound condition with regard to asthma at this time. In order to rebut this presumption of soundness on entry into service, VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). The Veteran was afforded a VA respiratory conditions examination in July 2013. Once VA undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The VA examiner opined that the Veteran’s diagnosed asthma was less likely than not incurred in or caused by service. The VA examiner explained that the Veteran’s Reports of Medical History dated October 1974 and January 1976 indicated a history of asthma in childhood with no recurrences, no consequences, and no sequelae. The VA examiner stated that “there also were no records provided showing that the asthma condition, which clearly and unmistakably existed prior to enlistment, was exaggerated beyond its natural progression.” The Board finds this opinion inadequate. While the VA examiner opines that the Veteran’s asthma clearly and unmistakably existed prior to enlistment, no reason is given for this opinion other than the Veteran’s lay statements during service. A mere history of pre-service existence of conditions recorded at the time of examination does not constitute a notation of such conditions. See 38 C.F.R. § 3.304 (b)(1); Crowe v. Brown, 7 Vet. App. 238 (1995). Therefore, remand is required to obtain an adequate opinion as to the etiology of the Veteran’s asthma. 4. Entitlement to service connection for obstructive sleep apnea. The Veteran had a current diagnosis of sleep apnea. See November 2010 VA treatment record. The Veteran appears to have contended that his sleep apnea was etiologically related to either his exposure to herbicides during service or his service-connected disabilities. To date, VA has not obtained a competent medical opinion addressing this claim. Accordingly, a VA medical opinion is necessary prior to further adjudication. See McClendon v. Nicholson, 20 Vet. App. 79 (2006). 5. Entitlement to service connection for a right knee disability. The Veteran had a current diagnosis of arthritis of the right knee. See February 2012 VA x-ray report. The Veteran contended that his right knee disability was etiologically related to his service-connected left knee disability. To date, VA has not obtained a competent medical opinion addressing this claim. Accordingly, a VA medical opinion is necessary prior to further adjudication. See McClendon v. Nicholson, 20 Vet. App. 79 (2006). 6. Entitlement to a rating in excess of 30 percent for a left knee disability. The record contains a March 1999 letter from the Social Security Administration (SSA) indicating that the Veteran had applied for disability benefits. However, the records related to such application are not in the claims file. As such records may be pertinent to the claims, the Veteran’s complete SSA records, if available, should be obtained and associated with the claims file. See Murincsak v. Derwinski, 2 Vet. App. 363, 370-72 (1992); Collier v. Derwinski, 1 Vet. App. 413, 417 (1991); see also Quartuccio v. Principi, 16 Vet. App. 183, 187-88 (2002) (stating that “the possibility that the SSA records could contain relevant evidence... cannot be foreclosed absent a review of those records.”). 7. Entitlement to a compensable rating for a left knee scar. As noted above, the Veteran had a separate pending appeal as to whether the reduction in the rating for a left knee scar from 10 percent to 0 percent, effective December 1, 2012, was proper. The Board must defer consideration of entitlement to compensable rating for a left knee scar, as it is inextricably intertwined with the issue of whether the reduction in rating for the left knee scar was proper. See Smith (Daniel) v. Gober, 236 F.3d 1370, 1373 (Fed. Cir. 2001) (Where the facts underlying separately claims are “intimately connected,” the interests of judicial economy and avoidance of piecemeal litigation require that the claims be adjudicated together); see also Harris v. Derwinski, 1 Vet. App. 180 (1991) (issues are inextricably intertwined if one claim could have significant impact on the other). The matters are REMANDED for the following action: 1. Obtain the Veteran’s updated VA treatment records. 2. Obtain from SSA all records pertaining to the Veteran’s claim for disability benefits, if any, including copies of all medical records considered in deciding any claim. If the records are not available, that should be documented in the record. 3. Verify the Veteran’s dates of service in Thailand. 4. Complete all appropriate development, including contacting the JSRRC, as to the Veteran’s claimed stressors while stationed in Thailand, to include obtaining any available unit records or flight manifests that might support the Veteran’s stressors. After this development is completed, make a formal finding regarding the Veteran’s claimed stressors. All development efforts should be documented in the claims file. 5. Obtain a VA medical opinion regarding the nature and etiology of the Veteran’s diagnosed throat cancer. The entire claims file, including a copy of the Remand, should be made available to, and be reviewed by, the VA examiner. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s throat cancer was related to or caused by service, to include exposure to herbicide agents. A detailed rationale should be provided for the opinions rendered. If the examiner cannot provide the requested information without resort to speculation, he or she must state the reasons why. 6. Obtain an addendum medical opinion regarding the nature and etiology of the Veteran’s diagnosed asthma. The entire claims file, including a copy of the Remand, should be made available to, and be reviewed by, the VA examiner. The VA examiner must provide the following opinions: (a) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s diagnosed asthma was related to or caused by service, including exposure to herbicide agents. (b) Whether the diagnosed asthma clearly and unmistakably preexisted service and, if so, whether such preexisting disorder clearly and unmistakably was not aggravated by service. A detailed rationale should be provided for the opinions rendered. If the examiner cannot provide the requested information without resort to speculation, he or she must state the reasons why. 7. Obtain a VA medical opinion regarding the nature and etiology of the Veteran’s diagnosed sleep apnea. The entire claims file, including a copy of the Remand, should be made available to, and be reviewed by, the VA examiner. The examiner should provide the following opinions: (a) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s sleep apnea was related to or caused by service, including exposure to herbicide agents. (b) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s sleep apnea was related to or caused by his service-connected disabilities. The examiner should note the articles submitted by the representative in March 2018 regarding a correlation between sleep apnea and squamous cell carcinoma, and a correlation between sleep apnea and PTSD. A detailed rationale should be provided for the opinions rendered. If the examiner cannot provide the requested information without resort to speculation, he or she must state the reasons why. 8. Obtain a VA medical opinion regarding the nature and etiology of the Veteran’s diagnosed right knee disability. The entire claims file, including a copy of the Remand, should be made available to, and be reviewed by, the VA examiner. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s right knee disability, to include arthritis, was related to or caused by his service-connected left knee disability. A detailed rationale should be provided for the opinions rendered. If the examiner cannot provide the requested information without resort to speculation, he or she must state the reasons why. 9. Then, readjudicate the claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Thomas, Associate Counsel