Citation Nr: 19129152 Decision Date: 04/15/19 Archive Date: 04/15/19 DOCKET NO. 17-20 443 DATE: April 15, 2019 ORDER 1. The application to reopen the claim of entitlement to service connection for diabetes mellitus type II is granted. 2. Entitlement to service connection for diabetes mellitus type II, to include as due to herbicide exposure, for accrued benefits purposes, is denied. 3. The application to reopen the claim of entitlement to service connection for a coronary artery disease is granted. 4. Entitlement to service connection for coronary artery disease, to include as due to herbicide exposure, for accrued benefits purposes, is denied. 5. Entitlement to service connection for hemorrhage from brain vessels, to include stroke and as secondary to coronary artery disease, for accrued benefits purposes, is denied. 6. The application to reopen the claim of entitlement to service connection for an acquired psychiatric disorder is granted. 7. Entitlement to service connection for an acquired psychiatric disorder, to include anxiety, depression, and panic attacks, for accrued benefits purposes, is denied. 8. The application to reopen the claim of entitlement to service connection for erectile dysfunction is granted. 9. Entitlement to service connection for erectile dysfunction, to include as secondary to diabetes mellitus type II, for accrued benefits purposes, is denied. 10. The application to reopen the claim of entitlement to service connection for bilateral arthritis of the feet is granted. 11. Entitlement to service connection for bilateral arthritis of the feet, to include as secondary to a service-connected disability, for accrued benefits purposes, is denied. 12. The application to reopen the claim of entitlement to service connection for bilateral arthritis of the hands is granted. 13. Entitlement to service connection for bilateral arthritis of the hands, to include as secondary to a service-connected disability, for accrued benefits purposes, is denied. 14. Entitlement to service connection for the cause of the Veteran’s death is denied. REMANDED 15. Entitlement to a death pension is remanded. FINDINGS OF FACT 1. The most probative evidence of record does not establish that he was as likely as not exposed to tactical herbicides or tactical-grade commercial pesticides in connection with his service in Thailand during the Vietnam era. 2. Evidence associated with the claims file after the October 2012 rating decision relates to an unestablished fact, is not cumulative or redundant of evidence already of record, and raises a reasonable possibility of substantiating the claim for service connection for diabetes mellitus type II. 3. The most probative evidence of record establishes that diabetes mellitus type II did not manifest in service or within one year of discharge from service, and was not otherwise attributable to service. 4. Evidence associated with the claims file after the October 2012 rating decision relates to an unestablished fact, is not cumulative or redundant of evidence already of record, and raises a reasonable possibility of substantiating the claim for service connection for a coronary artery disease. 5. The most probative evidence of record establishes that a coronary artery disease did not manifest in service or within one year of discharge from service, and was not otherwise attributable to service. 6. The most probative evidence of record establishes that hemorrhage from brain vessels, to include stroke, did not manifest in service or within one year of discharge from service, was not otherwise attributable to service, or caused or aggravated by a service-connected disability. 7. Evidence associated with the claims file after the October 2012 rating decision relates to an unestablished fact, is not cumulative or redundant of evidence already of record, and raises a reasonable possibility of substantiating the claim for service connection for an acquired psychiatric disorder. 8. The most probative evidence of record establishes that an acquired psychiatric disorder, to include anxiety, depression, and panic attacks, did not manifest or was diagnosed in service, and was not otherwise attributable to service. 9. Evidence associated with the claims file after the October 2012 rating decision relates to an unestablished fact, is not cumulative or redundant of evidence already of record, and raises a reasonable possibility of substantiating the claim for service connection for erectile dysfunction. 10. The most probative evidence of record establishes that erectile dysfunction did not manifest or was diagnosed in service, was not otherwise attributable to service, or caused or aggravated by a service-connected disability. 11. Evidence associated with the claims file after the October 2012 rating decision relates to an unestablished fact, is not cumulative or redundant of evidence already of record, and raises a reasonable possibility of substantiating the claim for service connection for bilateral arthritis of the feet. 12. The most probative evidence of record establishes that bilateral arthritis of the feet did not manifest in service or within one year of discharge from service, was not otherwise attributable to service, or caused or aggravated by a service connected disability. 13. Evidence associated with the claims file after the October 2012 rating decision relates to an unestablished fact, is not cumulative or redundant of evidence already of record, and raises a reasonable possibility of substantiating the claim for service connection for bilateral arthritis of the hands. 14. The most probative evidence of record establishes that bilateral arthritis of the hands did not manifest in service or within one year of discharge from service, was not otherwise attributable to service, or caused or aggravated by a service connected disability. 15. At the time of death, the Veteran was not service-connected for any disability, and his death certificate reflects that no service-connected disability was a primary or contributory cause of his death. CONCLUSIONS OF LAW 1. After the final October 2012 rating decision, new and material evidence has been received and requires reopening of the claim of entitlement to service connection for diabetes mellitus type II, for accrued benefits purposes. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 2. The criteria for entitlement to service connection for diabetes mellitus type II, for accrued benefits purposes, have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107, 5121; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.1000. 3. After the final October 2012 rating decision, new and material evidence has been received and requires reopening of the claim of entitlement to service connection for a coronary artery disease, for accrued benefits purposes. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 4. The criteria for entitlement to service connection for a coronary artery disease, for accrued benefits purposes, have not been met. 38 U.S.C. §§ 1101, 1111, 1112, 1131, 5107, 5121; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.1000. 5. The criteria for entitlement to service connection for hemorrhage from brain vessels, to include stroke, for accrued benefits purposes, have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107, 5121; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310, 3.1000. 6. After the final October 2012 rating decision, new and material evidence has been received and requires reopening of the claim of entitlement to service connection for an acquired psychiatric disorder, for accrued benefits purposes. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 7. The criteria for entitlement to service connection for an acquired psychiatric disorder, for accrued benefits purposes, have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107, 5121; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.1000. 8. After the final October 2012 rating decision, new and material evidence has been received and requires reopening of the claim of entitlement to service connection for erectile dysfunction, for accrued benefits purposes. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 9. The criteria for entitlement to service connection for erectile dysfunction, for accrued benefits purposes, have not been met. 38 U.S.C. §§ 1101, 1111, 1112, 1131, 5107, 5121; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310, 3.1000. 10. After the final October 2012 rating decision, new and material evidence has been received and requires reopening of the claim of entitlement to service connection for bilateral arthritis of the feet, for accrued benefits purposes. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 11. The criteria for entitlement to service connection for bilateral arthritis of the feet, for accrued benefits purposes, have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107, 5121; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310, 3.1000. 12. After the final October 2012 rating decision, new and material evidence has been received and requires reopening of the claim of entitlement to service connection for bilateral arthritis of the hands, for accrued benefits purposes. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 13. The criteria for entitlement to service connection for bilateral arthritis of the hands, for accrued benefits purposes, have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107, 5121; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310, 3.1000. 14. The criteria for entitlement to service connection for the cause of the Veteran’s death have not been met. 38 U.S.C. §§ 101, 1101, 1112, 1113, 1131, 1310, 5107; 38 C.F.R. §§ 3.1, 3.5, 3.102, 3.303, 3.307, 3.309, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1966 to June 1969. He passed away in May 2016. The appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of October 2012 and December 2016 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for the cause of the Veteran’s death, and the appellant’s entitlement to accrued benefits and a death pension. 1. Background A. Factual and Procedural Developments The Veteran’s military personnel records (MPRs) show that he was stationed at the Korat Royal Thai Air Force Base (Korat) from November 1966 to July 1968; and his military occupational specialty was Company Clerk while serving at Korat, after his transfer out of Korat, it changed to Personnel Administrative Specialist. In September 2010, the Veteran applied for disability compensation benefits for: diabetes mellitus type II and an unspecified heart condition, both due to his alleged exposure to herbicide agents in Thailand; erectile dysfunction, secondary to his diabetes mellitus type II; and a psychological condition, to include depression and panic disorder, secondary to his yet-to-be-determined service-connected disabilities. In January 2011, he filed a Fully Developed Claim for ischemic heart disease. In June 2011, he filed a lay statement asserting, inter alia, that he was “dealing with r[he]umatoid arthritis.” In April 2012, he filed a claim for a “non-service connected compensation” for arthritis of the hands and feet. In October 2012, the RO issued a rating decision denying service connection for coronary artery disease, diabetes mellitus type II, bilateral arthritis of the hands and feet, erectile dysfunction, and panic disorder with anxiety and depression. Almost three years later, i.e., in August 2015, VA associated the Veteran’s service treatment records (STRs) with the claims file. In November 2015, he filed another application for disability compensation for: diabetes mellitus type II, as based on the alleged herbicide exposure; coronary artery disease, as based on the alleged herbicide exposure; erectile dysfunction, as based on the alleged herbicide exposure; stroke, to include as secondary to his coronary artery disease; bilateral arthritis of the hands and feet; and anxiety and depression. In April 2016, VA associated with the claims file the Veteran’s MPRs. In May 2016, the Veteran passed away. In June 2016, his surviving spouse moved to substitute as an appellant and applied for a dependency and indemnity compensation (DIC) based on his cause of death or, in alternative, for a death pension. In December 2016, the RO issued a rating decision denying the appellant accrued benefits for failure to submit new and material evidence. The December 2016 rating decision also denied her DIC but omitted to address her application for a death pension. In January 2017, the appellant filed a Notice of Disagreement (NOD) raising the death pension challenge, as well as challenges based on the RO’s denial of the cause of death and accrued benefits. In March 2017, she filed an affidavit as to her net worth and income, and provided records of the Veteran’s burial expenses and medical expenses associated with his treatment prior to death. One week later, the RO issued a Statement of the Case (SOC) reiterating the findings made in the December 2016 rating decision as to the accrued benefits and DIC claims and stating that a death pension was denied for the appellant’s failure to provide information as to her income and net worth. In April 2017, she filed her Substantive Appeal; it was certified in November 2017. In January 2019, the RO determined that she was an eligible substitute appellant. B. Reopening of the Claims Adjudicated in the October 2012 Rating Decision In April 2017, the appellant’s representative requested reopening of this matter, arguing that the documents filed by her and the Veteran after the October 2012 rating decision became final qualified as new and material evidence. The Board notes that, following the October 2012 rating decision, the RO associates with the claims file the Veteran’s STRs and MPRs. Had these records not previously been considered by the RO, the Board would be required to review all claims adjudicated in the October 2012 rating decision de novo rather than reopening this matter since, under 38 C.F.R. § 3.156(c), service department records include MPRs and STRs. However, the October 2012 rating decision includes a list of evidence showing that the RO obtained and considered the STRs and MPRs in connection with issuing the October 2012 rating decision. Thus, the October 2012 rating decision is final for the Board’s purposes. However, a presentment of new and material evidence requires reopening of a finally disallowed claim. New evidence is evidence not previously submitted to the VA. Material evidence is evidence that, when considered by itself or 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, and must raise a reasonable possibility of substantiating the claim. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). Here, after the October 2012 rating decision became final, the appellant and the Veteran submitted extensive documentary evidence and lay statements related to the onset and progression of his diabetes mellitus type II, coronary artery disease, acquired psychiatric disorder, erectile dysfunction, bilateral arthritis of the feet, and bilateral arthritis of the hands. Given that this evidence is neither cumulative nor redundant of the evidence of record at the time of the October 2012 rating decision and the October 2012 rating decision denied service connection for these disabilities upon finding that they did not have their onset in service and were not otherwise related to service, reopening of these claims is required. Solely for the purposes of reopening these claims, all evidence submitted after the October 2012 rating decision is deemed credible. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). C. Jurisdiction over the Death Pension Claim Further, while the December 2016 rating decision omitted to address the appellant’s application for a death pension, her January 2017 NOD raised challenges based on a death pension, thus vesting the Board with appellate jurisdiction over this claim. Correspondingly, regardless of the RO’s failure to address this claim in the December 2016 rating decision, the claim – being certified on appeal – is properly before the Board. See Percy v. Shinseki, 23 Vet. App. 37, 47 (2009) (a certified appeal is construed as curing procedural oversights, provided that the appellate jurisdiction is properly vested); see also 38 C.F.R. § 3.152(b)(1); Isenhart v. Derwinski, 3 Vet. App. 177, 179 (1992) (a claim by a surviving spouse for DIC is also deemed to be a claim for a death pension and accrued benefits, and a claim by a surviving spouse for a death pension is also deemed to be a claim for DIC and accrued benefits). 2. Service Connection A. Accrued Benefits Claims Claims for VA benefits do not survive a veteran’s death. However, a qualified survivor, including a spouse, may carry on the deceased veteran’s claims for benefits by submitting an application for accrued benefits within one year after the veteran’s death. See 38 U.S.C. § 5121(a), (c); 38 C.F.R. § 3.1000. Accrued benefits are periodic monetary benefits to which the veteran was entitled at the time of death. See id. An accrued-benefits claim incorporates any prior final adjudication on claims brought by a veteran because it derives from the veteran’s claims. However, an accrued benefits claim, while derivative of, is distinct and separate from the veteran’s claims. See Zevalkink v. Brown, 6 Vet. App. 483, 489 490 (1994), aff’d, 102 F.3d 1236 (Fed. Cir. 1996). In the adjudication of a claim for accrued benefits, the claimant is bound by the same legal requirements to which the veteran would have been bound had (s)he survived to have his/her claims decided. B. Criteria for Service Connection – Generally Service connection may be granted on a primary basis for a disability resulting from a disease or injury incurred in service during a period of war or a period other than war. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection can be established directly or presumptively. See 38 C.F.R. §§ 3.303, 3.304; Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007). The Board gives a claimant the benefit of the doubt on any issue material to his/her claim when evidence is in equipoise, but the Board determines the competence and credibility of the evidence, and weighs the competence and probative value of the evidence, including lay statements, against the entirety of the record. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). (a) Direct Service Connection Direct service connection raised on a primary basis requires competent evidence of three things: (1) a current disability; (2) a precipitating in-service event, e.g., a disease or injury; and (3) a nexus, i.e., a causal connection operating as a link between such an event, disease, or injury, and the current disability. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Further, a direct service connection may be granted on a secondary basis for a current disability that was caused or aggravated by a service-connected disability. See 38 C.F.R. § 3.310(a). (b) Presumptive Service Connection – Generally There are numerous ways to establish a presumptive service connection. For example, if a certain chronic disease has manifested to a compensable degree within the applicable period after the date of the veteran’s separation from service, such a disease is presumed to have been incurred in service, even if there is no evidence of such a disease during service. See 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307(a), 3.309(a). Alternatively, a veteran may establish service connection by showing that a chronic disease listed in § 3.309 was clearly diagnosed during the applicable period, and the veteran’s present disability is a current manifestation of the same disease. See 38 C.F.R. §§ 3.303(b), 3.309(a). Further, where the chronicity can legitimately be questioned, service connection could be established by evidence of continuity of symptomatology, i.e., by showing that the symptoms caused by or indicative of a condition listed in § 3.309(a) reoccurred regularly, without an intercurrent cause, from service to the date of the claim. See 38 U.S.C. § 1112; 38 C.F.R. §§ 3.303(b). In addition, there are other presumptions applicable to certain disabilities, e.g., certain diseases developed by Vietnam veterans or veterans exposed to chemical warfare agents. 38 C.F.R. § 3.309(e). B. Presumptive Service Connection – Vietnam Era (a) Veterans Who Served in the Republic of Vietnam “In 1991, Congress passed the Agent Orange Act [(Act)], codified at 38 U.S.C. § 1116, granting a presumption of service connection for certain diseases to veterans who served in the Republic of Vietnam,” i.e., on the landmass and inland waterways of the Republic of Vietnam, and its 12-nautical-mile territorial sea. Procopio v. Wilkie, __ F.3d __, 2019 U.S. App. LEXIS 2906, at *3, 5, 21 (Jan. 29, 2019) (internal quotation marks omitted). Thus, VA regulations implementing this statutory presumption allow service connection for certain diseases when the evidence might otherwise not indicate that service connection is warranted. See, e.g., 38 C.F.R. § 3.303(d). For instance, Section 3.307 provides that a veteran who served in the Republic of Vietnam from January 9, 1962, to May 7, 1975, during his active military, naval, or air service, shall be presumed to have been exposed to a tactical herbicide agent, to include Agent Orange, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during his/her service. See 38 C.F.R. § 3.307(a)(6)(iii). Section 3.307 provides that the term “herbicide agent” means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during this period, “specifically: 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and Picloram.” 38 C.F.R. § 3.307(d)(6)(i). Agent Orange was not the only one but the most prevalent tactical herbicide containing such chemical compounds; in contrast, commercial herbicides that typically do not contain these chemical compounds fall outside the scope of § 3.307(a)(6)(i). Thus, such diseases as type II diabetes mellitus diseases and ischemic heart disease are deemed presumptively service connected if a veteran was exposed during this period to a tactical herbicide or a tactical-grade commercial pesticide during his/her active service. See 38 C.F.R. § 3.309(e). The term “ischemic heart disease” includes myocardial infarction and coronary artery disease but “does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke.” Id. at Note (2). (b) Veterans Who Served in Thailand While, under the Act, all veterans who served in the Republic of Vietnam on the landmass, inland waterways, and territorial sea during the Vietnam era are presumed to have been exposed to tactical herbicide agents, the Act did not expressly address the veterans who served outside Vietnam from January 9, 1962, to May 7, 1975. However, VA has adopted a policy (May 2010 policy) creating a service connection presumption as to those veterans who, as likely as not, were exposed to tactical herbicides because of their service in Thailand during the Vietnam era. See New Procedures for Claims Based on Herbicide Exposure in Thailand and Korea, Comp. & Pension Serv. Bulletin (May 2010), available at http://veteransvoteyour cause.com/files/Compensation_Pension_Sevice_Bulletin_-_May_20102.pdf. As pertinent here, the May 2010 policy guides as follows: After reviewing documents related to herbicide use in Vietnam and Thailand, [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. Evidence of this can be found in a declassified Vietnam era Department of Defense (DoD) document titled Project CHECO Southeast Asia Report: Base Defense in Thailand. Therefore, when herbicide related claims from Veterans with Thailand service are received, RO personnel should now evaluate the treatment and personnel records to determine whether the Veteran’s service activities involved duty on or near the perimeter of the military base where the Veteran was stationed. DoD has provided information that commercial herbicides, rather than tactical herbicides, were used within the confines of Thailand bases to control weeds. These commercial herbicides have been, and continue to be, used on all military bases worldwide. They do not fall under the VA regulations governing exposure to tactical herbicides such as Agent Orange. However, there is some evidence that the herbicides used on the Thailand base perimeters may have been either tactical, procured from Vietnam, or a commercial variant of much greater strength and with characteristics of tactical herbicides. Therefore, [VA] has determined that a special consideration of herbicide exposure on facts found or direct basis should be extended to those Veterans whose duties placed them on or near the perimeters of Thailand military bases. This 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 Royal Thai Air Force Bases of U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat, and Don Muang. If a US Air Force 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 MOS (military occupational specialty), performance evaluations, or other credible evidence, then herbicide exposure should be acknowledged on facts found or direct basis . . . . [T]his applies only during the Vietnam era, from February 28, 1961 to May 7, 1975. Along with air bases, there were some small Army installations established in Thailand during this period, which may also have used perimeter herbicides in the same manner as the air bases. Therefore, if a US Army Veteran claims a disability based on herbicide exposure and the Veteran was a member of a military police (MP) unit or was assigned an MP MOS and states that his duty placed him at or near the base perimeter, then herbicide exposure on facts found or direct basis should be acknowledged for this Veteran. The difference in approach for US Army Veterans is based on the fact that some MPs had criminal investigation duties rather than base security duties. Therefore, the Veteran’s lay statement is required to establish security duty on the base perimeter. This also applies to US Army personnel who served on air bases in Thailand. During the early years of the war in Vietnam, before Air Force security units were fully established on air bases in Thailand, US Army personnel may have provided perimeter security. In such cases, if the Veteran provides a lay statement that he was involved with perimeter security duty and there is additional credible evidence supporting this statement, then herbicide exposure on facts found or direct basis can be acknowledged for this Veteran. Id. at 3-4 (emphasis supplied). The goal of the May 2010 policy was to establish a presumptive service connection in those cases where the evidence shows that a Thailand veteran’s military duty during the Vietnam era was such that it placed him/her near or on the base of the perimeter for prolonged periods of time on a regularly repeated, i.e., daily-like basis consistent with one’s performance of his/her assigned duty. See VBMS entry with document type “VA Memo,” receipt date 03/20/2012, at page 2 (stating that “if a Veteran s MOS . . . or unit is one that regularly had contact with the base perimeter[,] there was a greater likelihood of exposure to commercial pesticides including herbicides. Security police units were known to have walked the perimeters[,] especially dog handlers”). Further, if a veteran’s assigned duty did not place him/her near or on the perimeter of the base for prolonged periods of time on such a regularly repeated basis, (s)he could still establish exposure to tactical herbicides or tactical grade commercial pesticides by evidence showing that, as likely as not, (s)he had a comparably regular, repeated, and prolonged presence near or on the perimeter. Accord Haas v. Peake, 525 F.3d 1168, 1178 (Fed. Cir 2008) (noting that the presumptive limits were rooted in a statistical probability of exposure to herbicides), rev’d on other grounds by Procopio, __ F.3 __, 2019 U.S. App. LEXIS 2019. The policy also made it clear that a veteran could establish exposure to tactical herbicides or tactical-grade commercial pesticides on a direct basis, even if it was a single exposure incident. Conversely, and pertinent here, nothing in the policy suggested that a mere fact of a veteran’s presence in a Thailand Air Force base during the Vietnam era would automatically qualify him/her for a presumptive service connection for 38 C.F.R. § 3.309(e) diseases if (s)he merely asserted that it could have been possible that (s)he or anyone else on the base might have been at one point or another exposed to herbicide vapors. While the Boars is mindful of the impact of the pro-claimant cannon, the “as likely as not” equipoise standard is met by evidence more exacting than a mere allegation of a purely hypothetical, not-supported-statistically possibility, cf. Ashcroft v. Iqbal, 556 U.S. 662, 687 (2009) (observing that “the plausibility standard . . . asks for more than a sheer possibility”), because a legal adjudication cannot rest on a chain of exponentially hypothetical allegations, cf. Salyer Land Co. v. Tulare Lake Basin Water Storage Dist., 410 U.S. 719, 731 (1973) (noting that “adjudication cannot rest on any such ‘house that Jack built’ foundation”). A simplified version of the May 2010 policy was incorporated into VA’s Adjudications Procedures Manual (M21), albeit M21 was to be used merely as a guide. Indeed, the U.S. Court of Appeals for Veterans Claims (Court) stressed that “the nonbinding M21 position” cannot be relied upon mechanically and “without analysis”; rather, if “M21 [is utilized] as a factor in [an] analysis . . . , it must [be based on] adequate reasons or bases for doing so.” Overton v. Wilkie, 30 Vet. App. 257, 259 (2018). 3. Veteran’s Alleged Exposure to Herbicides in Thailand A. Evidence of Record Here, the evidence of record includes various reports. A DoD Project CHECO Southeast Asia Report: Base Defense in Thailand which clarifies, inter alia, that “[p]erimeter lines at most bases consisted of various combinations of rolls of concertina wire, . . . barbed-wire barriers, and, occasionally, chain-link fences”. A June 2005 U.S. Department of the Air Force (USAF) statement that, to USAF’s “knowledge, no herbicides were stored in Thailand . . . . [As to the] spraying of vegetation with herbicides such as Agent Orange, Agent Pink, Agent Green, Agent Blue, Agent Purple, or Agent White at Takhli, Udon (or Udorn) or Nakhon Phanom bases or the Phu-mu Signal Site[, b]ecause commanders were at liberty to use herbicides for defoliation around, their activities using either handheld or vehicle mounted units, with no accountability required, we do not have any more specific information”. A compilation of USAF documents reflecting a use of Agent Orange at the Udorn base in December 1968, with a clarification that “[t]his is the first documented time that Agent Orange has been determined to be at a USAF installation in Thailand”. A February 2014 memorandum as to “the military’s possible usage of pesticides, insecticides, and non-tactical herbicides at Korat Thai Air Force Base from July 1968 to August 1969,” stating that USAF did “not maintain official records of use or exposure to any specific environmental hazards or chemicals, including herbicides and insecticides, nor do we possess any individual’ personnel records dealing with pesticides,” although USAF located a DoD “Supply Bulletin SB 3-40 [that] list[ed] twenty five commercial herbicides as being available in the Federal Supply System for military usage during the time period question,” without any information as to where or when this supply might have been used. The record further includes a document compiled in May 2011 by L.W. L.W.’s document incorporates some of the above-listed evidence of record and adds more specific information. The document notes that USAF directed a “[v]egetation control necessary to prevent insurgents from infiltrating and possibly killing USAF personnel, and/or from damaging USAF assets” noting that that these types of “[a]ttacks did occur at Ubon, Udorn and U-Tapao Air Bases in Thailand in this period”. A DoD “manual . . . indicate[d that] herbicide spray used on the ground [could] drift for 500 meters from the intended spray area”. The operations area that might have entailed the need for a spray was at “the north east section of Korat”. It was noted that some of the Korat troops’ “living quarters were very close to the perimeter, some as near as 11 meters. . . . [T]hese ‘hootch’ type living quarters were not barracks. The hootches did not have glass windows, were not air conditioned, with the window openings covered only with screens”. The area the Korat troops “used for physical training was very close to the perimeter, about 35 meters [and the] softball field used for recreation . . . was about [38 meters] from the perimeter”. Troops “who went into the town of Korat . . . or other Thai cities, traveled by perimeter road both going to town and returning to base”, so almost everyone had contact with the perimeter. Additionally, “from time to time[,] ground and air crew members . . . were verbally assigned the responsibility to guard the perimeter”. Finally, it was noted that “some type of toxic chemical(s) were in use near the . . . squadron shops.” L.W.’s document also incorporates photographs which show two rows of hootches situated away from the perimeter’s fence; hootches situated next to the perimeter chain-link fence; the perimeter’s chain-link fence on its own; and the perimeter’s chain-link fence with a road crossing for going out of the base. In addition, the record includes a topological plan of Korat with a delineation of the 500-meter possible drift zone from the entirety of the perimeter, indicating that the internal area removed from the perimeter by 500 meters or more constituted about 45 percent of the base, that about 10 percent of the flight line was within the 500-meter potential drift zone, that no building was at the northern part of the base, and only about a third of a certain non-residential construction was within the 500 meter possible drift zone on the eastern side of the base. Additionally, the plan showed an enlarged portion depicting a recreational/exercise area and a movie theater/club, and demonstrating that some, but not all, hootches were situated within the 500 meter possible drift zone, and all of the hootches were situated in the south of the base, with no hootches in the 500-meter possible drift zone from the north or east of the perimeter (where, according to L.W., the spraying took place). Finally, the record includes four personal photographs submitted by the Veteran, as well as his October 2015 affidavit. His photographs depict a gathering by the troops in front of an open-air stage for entertainment by a band and certain performers who were filmed, and no fence, barbed wire, or rolls of concertina wire in sight, with utility poles and antennae in the background, indicating that the stage was not near the perimeter; a landscape with a construction resembling a watch or water tower in the center, surrounded by a road with hootches extending far on both sides, two small military vehicles, one antenna near the tower and another far in the distance, with no fence, barbed wire, or rolls of concertina wire in sight, hence suggesting that these hootches were not situated near the perimeter; a movie theater building (which might or might not have operated as the base’s club noted on the Korat map), with flyer-display boxes and no window openings, large vehicles parked on the side, several utility poles nearby, and hootches in the background, with no fence, barbed wire, or rolls of concertina wire in sight; and a shopping area of a local town, potentially Korat. The Veteran’s October 2015 affidavit asserted, in pertinent part, as follows: I worked on orders, did a lot of paperwork and drove officer[s to] different places around the base, including to the flight line. I typed schedules and passes, did morning reports[,] and took inventory of the supplies. I worked Monday through Friday 8 am to 5 pm. I worked relatively close to the perimeter. I lived pretty close to the perimeter of the base. I did not live in the barracks, but rather [in] a hoo[t]ch, and the mess hall was close by. We had a movie theatre on [the] base, and an area where we regularly played softball and did exercises, both of these [facilities] were near the perimeter as well. During our downtime, we used to play some sports on the base and we would sometimes have parties on [the] base[,] and I would go downtown to Korat and into Bangkok and visit places of interest. During my time in Thailand, I went through two monsoon seasons and we did have some flooding throughout the base. Any area where I travelled, worked, and lived in the area could have exposed anyone, including myself, to herbicides. Also, we would walk all over the base, including right on the perimeter; take short cuts from point “A” to point “B” on, around, and near the perimeter, etc. Being on, around, or near the perimeter was simply routine during my time of active duty in Korat – it was not off limits. I’ve enclosed . . . pictures of downtown Korat, Bob Hope Christmas show, water containers and movie theat[er] . . . that I took while I was stationed there. Notably, while the Veteran stated that the movie theater and exercise area were “near” the perimeter, he did not state the same about the location of his living quarters or his work place. Rather, he stated that he worked “relatively close” to the perimeter and lived “pretty close” to the perimeter. Moreover, he did not assert that he either worked or lived within the 500-meter potential drift zone. Further, while he stated that he drove personnel to the flight line, he did not state that he drove them to the small portion of the flight line that fell within the 500 meter potential drift zone, nor did he clarify how frequently he drove to the flight line or whether he ever got out of the vehicle. Moreover, the Veteran utilized the pronoun “we” to describe the recreational activities of the Korat troops, without clarifying how much time he, personally, spent playing “some sports” or went on, around, or near the perimeter, or crossed the perimeter to go to Korat/other towns. The Veteran’s statement was meant to show that it would have been difficult for him to avoid being exposed while on the base. B. Analysis In January 2017, acting through her representative, the appellant’s submitted a de facto Appellant’s Brief arguing that the M21 was binding on the Board; and pursuant to M21, the Veteran was entitled to a presumptive service connection for Section 3.309(e) diseases because he was, at certain instances, on or near the Korat perimeter. Taking the “otherwise credible evidence” qualifier out of the context of an M21’s guidance that an herbicide exposure could be presumptively established by showing that a veteran’s duty-based obligation required him/her to be present on or near the base perimeter for prolonged periods of time on a regularly repeated, daily-like basis (because the veteran served as “a security policeman [or] security patrol dog handler [or] member of the security police squadron, or [was] otherwise near the air base perimeter as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence”), the Appellant’s Brief maintains, in sync with the gist of the Veteran’s affidavit, that any piece of evidence showing that he spent any time being within the 500-meter potential drift zone or crossing the perimeter should be sufficient, in and by itself, to establish his entitlement to a presumptive service connection for Section 3.309(e) diseases. M21, however, is not binding, see Overton, 30 Vet. App. at 259, and the May 2010 policy’s goal was to make a presumptive service connection available to those veterans who served in Thailand and, due to their military duties, had a greater likelihood of being exposed to tactical herbicides or tactical-grade commercial pesticides for prolonged periods of time on a regularly repeated, daily-like basis. In this case, the Veteran’s Thailand assignment was as a Company Clerk, not a Personnel Administrative Specialist, as incorrectly alleged by the Veteran and the appellant, and his MPRs and the October 2015 affidavit do not suggest that his duties required him to be present on the perimeter or within the 500-meter potential drift zone for prolonged periods of time on a regular, daily-like basis. While the Board is mindful of the Veteran’s assertion that, with an unspecified frequency, he had to drive certain personnel to the flight zone, a small portion of which was within the 500-meter potential drift zone, his affidavit does not suggest that these occasions placed him on or near the perimeter for prolonged periods of time on a regular, daily-like basis comparable to that of a veteran whose military duty required such a presence. The Veteran conceded that his military duties were largely clerical, and no evidence of record suggests that he had to perform these duties in the construction, a third of which fell within the 500-meter drift zone. Therefore, the Board finds that the Veteran did not establish that his military duties in Thailand placed him on or near the perimeter on a regular basis for prolonged periods of time. The foregoing, however, would not preclude the Veteran from establishing a presumptive service connection by showing that, even though his Thailand assignment did not place him on or near the perimeter on a regularly repeated basis for prolonged periods of time, other circumstances of his Thailand service entailed such a presence. The Board acknowledges the Veteran’s statements that suggest that he was among those troops who were playing “some sports” in the 500-meter potential drift zone at the south-western portion of the base and that the perimeter itself and a crossing of the perimeter were “not off limits” to the Korat troops. However, even if the Board were to disregard L.W.’s statement, which suggests that a contamination with tactical herbicides or tactical-grade commercial pesticides was limited to the north-eastern portion of the Korat perimeter, the Veteran’s affidavit and his photographs tend to show that his Thailand duty-unrelated circumstances did not placed him on or near the perimeter on a regular basis for prolonged periods of time. Nothing in his affidavit suggests that the phrase “some sports” could be construed as an activity that he, personally, performed for prolonged periods of time on a regular, daily-like basis comparable to that of a veteran’s daily military duty. Similarly, assuming he occasionally watched movies in the movie theater (which, according to his photograph, had no window openings and, thus, provided at least some protection from herbicides), such an assumption would not suggest that these occasional instances of entertainment placed him near the perimeter for the time periods and with the regularity comparable to those of a veteran whose daily military duty placed him/her on or near the perimeter. The Board also notes that the Veteran’s photograph of the movie theater, with no fence, barbed wire, or rolls of concertina wire in sight, suggests that the movie theater was a building different from the club, given that, on the Korat map the club is so located that a fence should be seen, being right next to the club and the club’s T-shape on the map is inconsistent with the rectangular shape of the building in his photograph. Thus, the evidence does not tend to show that the movie theater was in the 500 meter potential drift zone, or that movie-goers were exposed to tactical herbicides. Moreover, his photograph of Bob Hope’s Christmas show, with no fence, barbed wire, or rolls of concertina wire in sight, cannot be construed as suggesting that the show took place in the 500-meter potential drift zone and, in any event, even if the Veteran attended that show (and other occasional stage shows), this fact would not place him near the perimeter for the time periods and with the regularity comparable to those of a veteran whose daily military duty placed him/her on or near the perimeter. Analogously, the fact that the perimeter (or the act of crossing the perimeter to go to and return from a local town) was not “off limits” to the troops does not suggest that the Veteran, personally, walked on the perimeter or crossed it on such a regular basis and for such prolonged periods of time that these activities placed him on or near the perimeter with the regularity and for the time periods comparable to those of a veteran whose daily duty was on or near the perimeter. Further, the Veteran’s photograph of the area around a construction resembling a watch or water tower, surrounded by a road with hootches extending far on both sides and a base antenna in the distance, with no fence, barbed wire, or rolls of concertina wire in sight, suggests that the area was so far removed from the perimeter that no perimeter was visible. Since the Veteran never asserted that he, personally, was housed in one of those hootches that were within the 500-meter potential drift zone, the evidence of record is against a finding that his housing arrangement placed him on or near the perimeter. The Board acknowledges that a veteran’s combined exposure to tactical herbicides or tactical-grade commercial pesticides resulting from the cumulative circumstances of his/her service might yield a total exposure comparable to that of a veteran performing his/her daily military duty on or near the perimeter. Here, however, the totality of the evidence, even if assessed on a cumulative basis, does not show that the Veteran was as likely as not exposed to tactical herbicides or tactical-grade commercial pesticides during his Thailand service based on his military duty and the cumulative circumstances of his service unrelated to his active duty. The appellant, nonetheless, maintains that the May 2010 policy reflected in M21 should be broadly construed and, therefore, should allow for a presumptive service connection simply because the Veteran submitted his affidavit indicating that he was “present” near the perimeter at least in some instances. This assertion is in sync with the Veteran’s position that anyone who lived or worked in, or just travelled through Korat was automatically bound to suffer exposure to tactical herbicides or tactical-grade commercial pesticides for the purposes of a presumptive service connection. In support of this contention, the appellant relies, inter alia, on the portion of M21, pursuant to which a Vietnam era veteran who served on a naval ship that docked in the Republic of Vietnam could be entitled to a presumption of exposure upon submitting a credible lay statement showing that (s)he “disembarked the ship, even if momentarily[,] and even if such disembarkment was done only once.” Therefore, the appellant, through her representative, invites the Board to adopt the same blanket rule as to the veterans who served in Thailand during the Vietnam era. The Board declines the invitation. The Act and the regulations do not extend such a broad presumption to the veterans other than those who served in the Republic of Vietnam on the landmass, inland waterways, and territorial sea during the Vietnam era. See 38 U.S.C. § 1116(a). Neither the letter nor the spirit of the Act precludes adoption of custom-tailored policies as to the veterans who served at different locations and/or periods of time. Had Congress wished to extend the Act’s broad presumption to the veterans who served in Thailand, it would have done so. The May 2010 policy is harmonious with the Act because it is tailored for a case-by-case evaluation of each veteran’s circumstances. Because the circumstances in Thailand were different from those in the Republic of Vietnam, and – as the record suggests – the circumstances at different Thailand bases, e.g. Udorn and Korat, might too have been different, a careful case-by-case review is warranted. Correspondingly, a mere assertion that a veteran was simply “present” in a Thailand base during the Vietnam era is insufficient for the purposes of a presumptive service connection. Rather, a veteran is required to produce credible evidence showing a likelihood of his/her individual exposure to tactical herbicides or tactical-grade commercial pesticides because his/her military duty or other circumstances of his/her service placed the veteran on or near the perimeter for prolonged periods of time on a regular, daily-like basis. Thus, while the Board finds that the Veteran was competent to submit his affidavit, that his affidavit is largely credible, and the affidavit and his photographs are highly probative, neither the affidavit nor the photographs, or other evidence of record provides a basis for a finding that he established a likelihood of his exposure to tactical herbicides or tactical-grade commercial pesticides by the equipoise standard. Correspondingly, a presumptive service connection for Section 3.309(e) diseases is not warranted. Therefore, a direct service connection between his disabilities and an herbicide exposure is denied for failure to meet both the in-service-event and nexus elements. The Board, therefore, turns to the appellant’s claims based on the Veteran’s specific disabilities, as assessed in light of the above-stated finding. 4. Claim Based on Diabetes Mellitus Type II The Veteran contended that he was entitled to service connection for diabetes mellitus type II. However, his STRs reflect no complaints, symptoms, findings, or diagnosis of diabetes. Further, his April 2016 hospitalization note indicates that he was diagnosed with diabetes mellitus type II in 2010 or 2011. Additionally, his April 2010 treatment record reflects a family history of diabetes on his mother’s side and shows that he began monitoring his blood sugar with glucose test strips in April 2010 upon being diagnosed with a pre-diabetic condition over 40 years after his separation from service. In sync, his medical evaluations of active problems recorded prior to 2010 did not include any mention of diabetes. Rather, his April 2007 treatment record indicates that he was cautioned by his treating practitioner that his treatment of an acquired psychiatric disorder with Seroquel might have a “potential for development of . . . diabetes.” The Veteran’s treatment records from July 2010 to April 2016 establish that, after being diagnosed with diabetes mellitus type II, he did not require insulin or oral hypoglycemic agents, and his disability was controlled by a restricted diet. No portion of his treatment records that relates to his diabetes mellitus type II contains any statement linking it to service, even though these treatment records indicate that the Veteran repeatedly reported to his treating practitioners his service during the Vietnam era and alleged exposure to Agent Orange. In sum, there is no medical opinion of record suggesting a nexus between the Veteran’s service and his diabetes mellitus type II. Further, neither the Veteran nor the appellant has alleged that he had diabetes in service, or that this disability manifested to a compensable degree within one year after his discharge, or that he had regular symptoms indicative of this condition during the 40-year period from his separation from service to his pre-diabetic diagnosis. See 38 C.F.R. § 3.303(b); Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and any medical complaints or documentation of a claimed disability is a factor that weighs against a claim for service connection). Moreover, neither the Veteran nor the appellant expressed any relation between this disability and his service, short of their allegations of his presumptive herbicide exposure. In addition, to the extent that the Veteran or the appellant intended to advance their own theory that his diabetes mellitus type II was related to service, they have not been shown to possess the expertise necessary to opine on the etiology of his diabetes mellitus type II. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). And while a lay witness may, in some circumstances, opine on questions of diagnosis and etiology, see Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009), neither the Veteran nor the appellant offered any specific contention as to why this disability was related to his service, short of his alleged herbicide exposure, and the probative value of such a general assertion is outweighed by the evidence that document the onset of his diabetes mellitus type II over 40 years after his service with no suggestion that this disability was caused by an in-service event, disease, or injury, to include his alleged herbicide exposure. Based on the foregoing, the preponderance of the evidence is against a finding that the Veteran’s diabetes mellitus type II had its onset in service or was otherwise related to service, including to herbicide exposure. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for this disability. Thus, the doctrine of the benefit of the doubt is not applicable, and the claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 5. Claim Based on Ischemic Heart Disease The Veteran also contended that he was entitled to service connection for ischemic heart disease. The Veteran’s STRs show that a November 1966 in-service examiner determined that, five months after his enlistment, the Veteran’s vascular system was normal. The Board, however, acknowledges that, a year prior, i.e., during his November 1965 induction examination, the Veteran reported a history of heart palpitations, and that he reported the same during his December 1968 separation-from-service examination. The STRs also show that, in light of these reports, the Veteran was evaluated for this particular condition prior to his entry into service and at his discharge. At his separation from service, the issue was referred for a specialist’s opinion, the outcome of which was negative, and the December 1968 separation-from-service examiner recorded that the Veteran’s cardiovascular system was abnormal, but clarified that no disease was found at discharge, and noted that the Veteran’s reported history of heart palpitations was related to the mumps he had in childhood. A veteran is considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service. 38 U.S.C. § 1111. When no preexisting condition is noted upon entry, the veteran is presumed to have been sound upon entry and the presumption of soundness attaches. “Noted” means only such conditions as are recorded in examination reports, and the history of preservice conditions recorded at the time of examination does not constitute a notation of such conditions. 38 C.F.R. § 3.304; see also Crowe v. Brown, 7 Vet. App. 238, 245 (1994). Given that no preexisting condition was “noted” upon the Veteran’s entry into service and he was evaluated for a coronary condition at the entry into and discharge from service with no disease found, his reports of having a history of heart palpitations do not change the fact that he was sound condition upon enlistment. Similarly, neither the Veteran nor the appellant has argued that his preexisting coronary condition was aggravated in service. Further, his post-service treatment records reflect no cardiovascular symptoms, findings, or diagnosis prior to 1994, when he had his first myocardial infarction and a bypass procedure. In other words, the records show that the first relevant development took place 25 years after his discharge. His treatment records also show that he was monitored for a chronic ischemic heart condition since 1994 and, five years later, i.e., in 1999, had a cardiac catheter procedure. In addition, his April 2015 treatment record shows that he had additional myocardial infarctions in May, June, and October 2014. In February 2016, his treating medical practitioner noted a then-recent coronary artery narrowing due to native plaque. In sum, while his post-service treatment records as to ischemic heart disease are extensive, there is no medical opinion of record suggesting a nexus between his ischemic heart disease and his service, even though his treatment records show that the Veteran repeatedly reported his service during the Vietnam era and asserted exposure to Agent Orange. In addition, neither the Veteran nor the appellant had expressed any relation between his ischemic heart disease and service outside his allegations of presumptive herbicide exposure. Nor did they allege an in-service disease, event, or injury, or assert that this disability manifested to a compensable degree within one year after his discharge, or that he had regular symptoms of this disability for the 25-year period between his service and his first myocardial infarction. See 38 C.F.R. § 3.303(b); Maxson, 230 F.3d at 1333. Moreover, to the extent the Veteran or the appellant intended to advance their own theory that his ischemic heart disease was related to his service, they have not been shown to possess the expertise necessary to opine on the etiology of this disability. Layno, 6 Vet. App. at 469. Finally, while a lay witness may, in some circumstances, opine on questions of diagnosis and etiology, see Davidson, 581 F.3d at 1316, the Veteran and the appellant offered no specific contention as to why this disability could be related to his service outside his presumptive herbicide exposure, and the probative value of such a general assertion would be outweighed by the evidence documenting that he had no disease at separation from service and no record of ischemic heart disease or a relevant condition for 25 years after his discharge. Based on the foregoing, the preponderance of the evidence weighs against a finding that the Veteran’s ischemic heart disease had its onset in service or was otherwise related to service, including to herbicide exposure. Thus, the Board concludes that the preponderance of the evidence is against the claim for service connection for this disability, the benefit-of-the-doubt doctrine does not apply, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 6. Claim Based on Hemorrhage from Brain Vessels The Veteran further contended that he was entitled to service connection for hemorrhage from brain vessels, to include stroke, on a primary basis or as secondary to his ischemic heart disease. However, neither his examinations conducted upon his induction into service or at discharge, nor his STRs contain any complaint, symptoms, finding, or diagnosis indicative of a brain vessel hemorrhage. Moreover, the record shows that, in April 2010, i.e., 41 years after his discharge, the Veteran reported to his treating practitioner that he began taking a blood-pressure medication as a precautionary measure, i.e., solely to “protect the heart,” since his “blood pressure was never high.” The Veteran’s treatment records show that he had his first cerebrovascular accident in November 2014, i.e., 45 years after separation from service, and another cerebrovascular accident three months later, either in February or in March 2015. In April 2015, his treating practitioner recorded that a magnetic resonance imaging showed innumerable infarcts in both hemispheres; at the same time, a blood clot was detected in the left ventricle of his heart, triggering his treatment with Warfarin, a blood thinner. In February 2016, his prescription of Lisinopril, a blood vessel relaxer, was discontinued since his blood pressure became too low. His death certificate listed thrombocytopenia and cerebrovascular accident among his causes of death. There is no medical opinion of record suggesting a nexus between the Veteran’s service and his cerebrovascular accidents or infarcts in either hemisphere. Further, while his post-2014 treatment records are extensive as to hemorrhages from his brain vessels, nothing in his treatment records could be construed as indicative of a relation between this disability and his service, and neither he nor the appellant detailed their basis for a relation between his hemorrhage from brain vessels and his service, or alleged an in-service disease, event, or injury, or asserted that this disability manifested to a compensable degree within one year after his discharge, or that he had regular symptoms indicative of this disability for the 45 year period from his service to his first cerebrovascular accident. See 38 C.F.R. § 3.303(b); Maxson, 230 F.3d at 1333. Moreover, to the extent the Veteran or the appellant intended to advance their own theory that his hemorrhage from brain vessels was related to service, they have not been shown to possess the expertise necessary to opine on the etiology of this disability. See Layno, 6 Vet. App. at 469. In addition, while a lay witness may, in some circumstances, opine on questions of diagnosis and etiology, see Davidson, 581 F.3d at 1316, neither the Veteran nor the appellant offered any specific contention as to why this disability could be related to his service, and the probative value of such a general assertion would be outweighed by the evidence documenting that he had no disease at separation from service and no record of hemorrhage from brain vessels for 45 years after his discharge. Finally, while the Board acknowledges the Veteran’s and the appellant’s allegations that his hemorrhage from brain vessels was secondary to his ischemic heart disease, and the evidence of record is not against a finding of a correlation between these disabilities, this fact does not alter the Board’s conclusion because the Veteran’s ischemic heart disease is not service connected. Based on the foregoing, the preponderance of the evidence is against a finding that his hemorrhage from brain vessels, to include stroke, had its onset in service or was otherwise related to service, or caused or aggravated by a service-connected disability. Therefore, the Board concludes that the preponderance of the evidence is against the claim for service connection for this disability. Correspondingly, the benefit-of-the-doubt doctrine is inapplicable, and the claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 7. Claim Based on an Acquired Psychiatric Disorder The Veteran contended that he was entitled to service connection for an acquired psychiatric disorder, to include anxiety, depression, and panic attacks. The Board acknowledges that the Veteran reported history of “nervous trouble of any sort” during his November 1965 induction examination and during his December 1968 separation examination, although no abnormalities were noted by his examiners, and he was found negative for a psychiatric condition during his November 1966 and June 1968 in-service examinations. Given that a report of a history of a preexisting condition does not affect a veteran’s sound condition for VA purposes, see 38 C.F.R. § 3.304; accord Crowe, 7 Vet. App. at 245, the Veteran’s reports of a history of “nervous trouble of any sort” at induction and discharge does not alter the Board’s analysis. The Veteran’s post-service treatment records show that, in September 2002, i.e., 33 years after his discharge, he reported being nervous because of an upcoming colonoscopy procedure. In February 2003, he reported to a nurse that he was experiencing anxiety and seeking care “in the community”; the nurse left the determination as to an appropriate medication to the Veteran’s treating practitioner. In November 2003, the Veteran reported that his anxiety reduced with adoption of a breathing technique. He denied depression and declined medication. In January 2004, he admitted anxiety but again denied depression and declined referral to a specialist to obtain medication. In January 2006, being treated with Hydroxyzine, he switched to Wellbutrin and reported remission of anxiety and panic attacks. Simultaneously, he stated that he “continue[d] to enjoy activities, working in his wood-working shop, playing music with [the appellant], and spending time with family members.” In August 2007, he was assessed by his treating practitioner as “mildly anxious.” He, however, reported going to an emergency room with complaints of anxiety due to his concern about his declining physical health and the ineffectiveness of Hydroxyzine. In September 2007, he reported feeling less anxious and free of panic attacks while being treated with Paxil. In October 2007, he continued to deny depression but was again diagnosed with panic attacks. In May 2010, being treated with Paroxetine, he denied depression and reiterated his position that his anxiety and panic attacks were caused by his concern about his declining physical health. Although the Veteran’s mental health treatment records generated since 2003 are extensive, they do not contain any statement by the Veteran or his treating practitioners that could be construed as drawing a nexus between his service and his acquired psychiatric disorder. Rather, his treatment records show that, in May 2010, he reported that he was considering seeking VA disability compensation benefits because his declining physical health began to affect his ability to work. In July 2010, he reported that his anxiety decreased and, to accommodate the appellant’s sexual needs, he began taking his psychiatric medication intermittently. No portion of his reports reflected in his treatment records suggests that he correlated his acquired psychiatric disorder to an in-service event, disease, injury, or other stressor. The appellant’s lay statements reflecting on this disability are in sync. For instance, in June 2011, she filed a lay statement qualifying his acquired psychiatric disorder as “extreme” and detailed her hardship of “deal[ing] with it”. In April 2012, she filed another lay statement asserting that he had been suffering from depression and panic disorder “for years”, but clarifying that he went to an emergency room due to panic attacks based on his concern with his declining physical health, since he kept “thinking he was dying,” and not because of a service-based stressor. In sum, there is no medical opinion finding a nexus between this disability and an in-service stressor, and nothing in the treatment records could be construed as suggesting such a relation. Further, neither the Veteran nor the appellant expressed their basis for a primary relation between his acquired psychiatric disorder and his service, or alleged an in-service disease, event, injury, or stressor. Moreover, to the extent the Veteran or the appellant intended to advance their own theory that his acquired psychiatric disorder was related to service, they have not been shown to possess the expertise necessary to opine on the etiology of this disability. See Layno, 6 Vet. App. at 469. In addition, while a lay witness may, in some circumstances, opine on questions of diagnosis and etiology, Davidson, 581 F.3d at 1316, neither the Veteran nor the appellant offered any specific contention as to why this disability could be related to his service, see Buchanan, 451 F.3d at 1337, and the probative value of such a general assertion would be outweighed by the evidence documenting that he had no mental health disease at separation from service and no record of a psychiatric disorder for at least 33 years after his discharge. While the evidence of record is not against a finding of a correlation between his acquired psychiatric disorder and physical disabilities, service connection for an acquired psychiatric disorder cannot be awarded on a secondary basis because his underlying physical disabilities are not service-connected. Finally, while the Board acknowledges that, during his March 2012 examination, the Veteran reported history of posttraumatic stress disorder (PTSD), service connection for PTSD has unique evidentiary requirements. Specifically, it requires: (1) medical evidence diagnosing PTSD in accordance with 38 C.F.R. § 4.125(a); (2) credible supporting evidence that an in-service stressor occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. See 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. 128 (1997). Here, none of these elements is met, and no PTSD claim has been raised in the applications filed by the Veteran. Therefore, regardless of the broad implications of Clemons v. Shinseki, 23 Vet. App. 1 (2009), the Board does not construe the record as raising a PTSD claim. In light of the foregoing, the preponderance of the evidence is against a finding that the Veteran’s acquired psychiatric disorder had its onset in service or was otherwise related to service on a primary or secondary basis. Therefore, the Board concludes that the preponderance of the evidence is against the claim for service connection for this disability. Correspondingly, the benefit-of-the-doubt doctrine is inapplicable, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 8. Claim Based on Erectile Dysfunction The Veteran also contended that he was entitled to service connection for erectile dysfunction on a primary basis, due to an alleged herbicide exposure, or as secondary to his diabetes mellitus type II. The STRs show that, in May 1966 and October 1966, the Veteran had urinary infections, but his genitourinary system was found normal during his in-service November 1966 examination. The Board acknowledges that, a December 1968 separation-from-service examiner noted that the Veteran’s genitourinary system was abnormal in the sense that he had a retractile testicle. However, since there is no medical opinion suggesting a nexus between his retractile testicle (or urinary infections) and his erectile dysfunction, and neither the Veteran nor the appellant asserted a correlation between his disability and these in-service conditions, service connection has not been established on this basis. See Buchanan, 451 F.3d at 1337. Further, the Veteran’s treatment records demonstrate that, in October 2005, shortly after he switched from Hydroxyzine to Paxil as a treatment for his acquired psychiatric disorder, he reported noticing a “minor decrease in his sexual function,” i.e., “not achieving full erections, though he [was] still able to complete sexual intercourse, on occasion, but it [was] more difficult.” Three months later, i.e., in January 2006, having switched to Wellbutrin to manage his acquired psychiatric disorder, the Veteran reported “resolution of the sexual side effects he was previously experiencing.” In April 2007, having his acquired psychiatric disorder treated again by Paxil, he reported a renewal of sexual side effects, and elected to discontinue Paxil, to try Zoloft, and to return to Hydroxyzine. However, dissatisfied with the relief he was obtaining from these medications, he switched to Seroquel and returned to Paxil, notwithstanding the “sexual side effects.” Being again dissatisfied with the relief, he switched to Paroxetine by December 2009 and began taking that medication with intermittent low-dosage periods “to help limit sexual dysfunction.” By May 2010, he was diagnosed with erectile dysfunction but continued with Paroxetine, which he took with regular “intermittent drug holidays . . . to help facilitate sexual relations with [the appellant].” In contradiction to his treatment records, he filed a lay statement in April 2012 asserting that he “had not been able to be sexually active for about [five] years,” i.e., since 2007. There is no medical opinion of record drawing a nexus between the Veteran’s erectile dysfunction and his service. The above-detailed treatment records: demonstrate that this disability had its onset in October 2005, i.e., 36 years after his discharge and resulted from medications needed to control his acquired psychiatric disorder. Neither the Veteran nor the appellant expressed their basis for a primary relation between his erectile dysfunction and his service outside his alleged exposure to herbicide agents and the Board has found that the Veteran has not established exposure to herbicide agents for direct or presumptive purposes and, in any event, erectile dysfunction is not among diseases amenable to a presumptive service connection under § 3.309(e). Finally there is no medical opinion suggesting that this disability was a result of such an exposure. Moreover, to the extent the Veteran or the appellant intended to advance their own theory that his erectile dysfunction was related to service outside his alleged exposure to herbicides agents, they have not been shown to possess the expertise necessary to opine on the etiology of this disability. Layno, 6 Vet. App. at 469. In addition, while a lay witness may, in some circumstances, opine on questions of diagnosis and etiology, see Davidson, 581 F.3d at 1316, neither the Veteran nor the appellant offered any specific contentions as to why this disability could be related to his service, see Buchanan, 451 F.3d at 1337, and the probative value of such a general assertion would be outweighed by the evidence documenting that he had no erectile dysfunction at separation from service and no record of symptoms of this disability for at least 36 years after his discharge. Further, to the extent the Veteran or the appellant sought service connection for erectile dysfunction as secondary to his diabetes mellitus type II, the record suggests that his erectile dysfunction was a result of his treatment for an acquired psychiatric disorder, not his diabetes mellitus type II. This is further supported by the fact that the onset of his erectile dysfunction predated his diabetes mellitus type II diagnosis in the sense that it coincided with the earliest stages of his pre-diabetic condition. In any event, his diabetes mellitus type II is not service connected. Finally, to the extent the Veteran or the appellant sought service connection for erectile dysfunction as secondary to his disability other than his diabetes mellitus type II, an award of service connection is unwarranted because he had no service-connected disabilities. Based on the foregoing, the preponderance of the evidence is against a finding that his erectile dysfunction had its onset in service or was otherwise related to service. The Board concludes that the preponderance of the evidence is against the claim for service connection for this disability, the benefit-of-the-doubt doctrine is not applicable, and this claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 9. Claims Based on Arthritis Lastly, the Veteran contended that he was entitled to service connection for: arthritis of the hands and feet. During his November 1965 induction and December 1968 separation-from-service examinations, he consistently denied swollen or painful joints. No condition related to arthritis was noted by his induction or discharge examiners, and his December 1968 discharge examiner found that his upper and lower extremities were normal. The same finding was made by his in service November 1966 examiner. In addition, his STRs do not contain any entries that could be construed as recording symptoms or diagnosis of arthritis, and the Veteran’s August 2012 consent to release of medical information stated that his arthritis had its onset “after” service. The Veteran’s post-service treatment records show that, in April 2016, he reported having rheumatoid arthritis for 20 years, i.e., since 1996. Consistently with this report, his treatment records show that his arthritis of the feet progressed further in October 2007, and his condition worsened when he omitted his Prednisone treatment in May 2008. The treatment records also show that his arthritis of the feet caused feet deformity by December 2009 and blisters by August 2010, and he reported flare ups in February 2012. In March 2012, his medical practitioner recorded that his arthritis of the right foot increased further. However, nothing in his extensive treatment records suggests that the Veteran reported an in-service event, disease, or injury that could be construed as related to his arthritis of the feel, and nothing in his treatment records could be read as indicating that his arthritis of the feet was clearly diagnosed or manifested to a compensable degree within one year of his separation from service. Further, there is no medical opinion of record suggesting a nexus between his service and arthritis of the feet. Moreover, the Veteran’s April and August 2012 consents to release of medical information suggested that he construed swelling, infection, or inflammation of his feet joints as symptoms of arthritis, even though these symptoms were, at least on occasion, caused by an unrelated condition, e.g., his April 2016 treatment record reflects that he had his left great toe amputated due to infection from mulch. Therefore, to the extent the Veteran or the appellant intended to advance their own theory that his arthritis of the feet was related to service, they have not been shown to possess the expertise necessary to opine on the etiology of this disability. See Layno, 6 Vet. App. at 469. In addition, while a lay witness may, in some circumstances, opine on questions of diagnosis and etiology, see Davidson, 581 F.3d at 1316, neither the Veteran nor the appellant offered any specific contention as to why this disability could be related to his service, see Buchanan, 451 F.3d at 1337, and the probative value of such a general assertion would be outweighed by the evidence documenting that he had no arthritic condition for about 27 years after his discharge. Analogously, the Veteran’s treatment records reflect arthritic changes in his hands by July 2007 and bilateral hand deformities consistent with arthritis by May 2010. The Board further acknowledges his February 2012 reports of flare ups, his treating practitioner’s March 2012 observation that arthritis rendered the Veteran’s knuckles very pronounced, and the notation that a hand surgery was considered by September 2012. However, while the Veteran’s treatment records of arthritis of the hands are extensive, and he asserted in his April 2012 Statement in Support of Claim that his treating practitioner recommended him to stop working because of his arthritis of the hands, nothing in his treatment records suggests an in-service event, disease, or injury related to his arthritis of the hands, or that this disability was clearly diagnosed or manifested to a compensable degree within one year of his separation from service, or that there is a nexus between his service and arthritis of the hands. Further, to the extent the Veteran or the appellant intended to advance their own theory that his arthritis of the hands was related to service, they have not been shown to possess the expertise necessary to opine on the etiology of this disability. See Layno, 6 Vet. App. at 469. In addition, while a lay witness may, in some circumstances, opine on questions of diagnosis and etiology, see Davidson, 581 F.3d at 1316, neither the Veteran nor the appellant offered any specific contention as to why this disability could be related to his service, see Buchanan, 451 F.3d at 1337, and the probative value of such a general assertion would be outweighed by the evidence documenting that he had no arthritic condition for about 27 years after his discharge. Consistently with his treatment records, in April 2012 the Veteran filed a claim for a nonservice-connected compensation for arthritis of the hands and feet. Based on the evidence of record, the preponderance of the evidence is against a finding that his arthritis of the hands and/or arthritis of the feet had its onset in service or was otherwise related to service. Therefore, direct and presumptive service connection on a primary basis is denied. In addition, while the Board acknowledges the Veteran’s passim references to his arthritic condition in a fashion that could be construes as indicative of his position that there was a relation between his arthritis and his other disabilities, his arthritis of the hands and/or feet has not been shown to be caused or aggravated by a service connected disability, given that the Veteran was not service connected for any disability. The Board, therefore, finds that the preponderance of the evidence is against the claims for service connection for arthritis of the hands and arthritis of the feet. Correspondingly, the benefit-of-the-doubt doctrine is not applicable, and both claims are denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 10. Service Connection for the Cause of the Veteran’s Death An individual who qualifies as a surviving spouse, surviving child, or surviving parent of a veteran may apply for DIC monthly benefits if the veteran’s death was service-connected. See 38 U.S.C. § 1310(a); 38 C.F.R. § 3.5(a). To qualify as a veteran’s surviving spouse, a claimant must show that (s)he was the valid or deemed valid spouse of the veteran at the time of his/her death. See 38 U.S.C. § 101(3); 38 C.F.R. § 3.50(b). Here, the appellant was properly qualified by the RO as a substitute appellant based on her status as the Veteran’s valid spouse at the time of his death; therefore, she qualifies as his surviving spouse for the § 3.5 purposes on the same basis. A veteran’s death is considered as being due to a service-connected disability when the evidence establishes that the service-connected disability was either the principal or a contributory cause of death, see 38 C.F.R. § 3.312(b), (c), based on an exercise of sound judgment, without recourse to speculation after a careful analysis has been made of all the facts and circumstances surrounding the death of the veteran, including autopsy reports, see 38 C.F.R. § 3.312(a). A service-connected disability is deemed the principal, i.e., primary cause of death when the disability, singly or jointly with some other condition, was the immediate or underlying cause of death, or was etiologically related thereto. See 38 C.F.R. § 3.312(b). A contributory cause of death is inherently one that is not related to the principal cause. See 38 C.F.R. § 3.312(c). In order for a service-connected disability to be determined as a contributory cause of a veteran’s death for compensation purposes, it must be shown that it: (1) contributed substantially or materially; (2) combined to cause death; and (3) aided or lent assistance to the production of death. It is not sufficient to show that it causally shared in producing death; rather, it must be shown that there was a causal connection. See 38 C.F.R. § 3.312(c)(1); Gabrielson v. Brown, 7 Vet. App. 36, 39 (1994). In this case, the Veteran’s death certificate reflects that he died in May 2016 from a combination of sepsis, pneumonia, thrombocytopenia, and a cerebrovascular accident. The Veteran’s treatment records from the year and a half preceding his passing show that, in March 2015, he was admitted to a hospital following a cerebrovascular accident with expressive dysphasia. Following therapy, he improved and was released, but was hospitalized a year later, in April 2016, just over a month prior to his passing, based on pneumonia in the lower right lobe of his lung. Upon his April 2016 admission, the appellant reported that the Veteran had minimally productive cough and general weakness for three days. Three days after the April 2016 admission, the Veteran became delirious but was discharged two days later upon the appellant’s insistence. He was readmitted one day after that discharge with hypoglycemia and residuals of pneumonia, and in a state of delirium, and transferred to another facility for a rehabilitation, but then transferred back due to pneumonia. He had hospice called in and passed away in May 2016, and the appellant relayed that his original pneumonia never cleared. She also indicated that he suffered a chest contusion and complained of a pain on his left side after having a seatbelt injury in March 2016, about six weeks prior to his April 2016 admission. His cerebrovascular accident was recorded among his primary causes of death as etiologically related, although his pre-death treatment records show no treatment for a cerebrovascular accident or a brain hemorrhage. Further, the Veteran’s ischemic heart disease or other disabilities underling the appellant’s accrued benefit claims were not mentioned in his death certificate. Given that the Veteran was not service connected for a cerebrovascular accident (or for sepsis or pneumonia, or thrombocytopenia) by the time of his death, these disabilities cannot serve as a basis for the appellant’s entitlement to service connection for the cause of death. The Board acknowledges her contention that the Veteran’s cerebrovascular accident was secondary to his ischemic heart disease, hence suggesting that the latter could have been an etiologically-related principal cause of death or, if unrelated, contributed substantially or materially to the cause of death. Even assuming, arguendo, that the Veteran’s ischemic heart disease was a principal or contributory cause, such an assumption is not a basis for the appellant’s entitlement to service connection for the cause of death because, as detailed above, the evidence of record weighs against a finding of service connection for ischemic heart disease. Further, the evidence of record does not support a finding that the Veteran’s other disabilities, such as his acquired psychiatric disorder, diabetes mellitus type II, arthritis of the hands and feet, or erectile dysfunction contributed to his death and, in any event, these disabilities were not service connected. Therefore, the preponderance of the evidence is against the claim for service connection for the cause of the Veteran’s death. The benefit-of-the-doubt doctrine is, hence, not applicable, and the claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.   REASONS FOR REMAND Entitlement to a death pension is remanded In some circumstances, death pension benefits are available for a surviving spouse of a veteran based on the veteran’s nonservice-connected death. See 38 U.S.C. § 1541(a); 38 C.F.R. § 3.3(b)(4). Specifically, a surviving spouse is entitled to these benefits if: (1) the veteran served on active duty for 90 consecutive days or more, part of which was during a period of war, or if the veteran served during a period of war and was discharged from service due to a service-connected disability or had a disability determined to be service-connected, which would have justified a discharge for disability; and (2) the spouse meets the net worth requirements under 38 C.F.R. § 3.274, and does not have an annual income in excess of the Maximum Annual Pension Rate (MAPR) specified in 38 U.S.C. §§ 1521, 1542, as increased from time to time under 38 U.S.C. § 5312. Assuming these requirements are met, an eligible surviving spouse will be paid the MAPR amount reduced by the amount of his/her countable income. See 38 U.S.C. § 1541; 38 C.F.R. § 3.23. On the other hand, if the surviving spouse’s income exceeds the MARP amount, (s)he would be deemed ineligible to receive death pension payments. In determining income for this purpose, payments of any kind from any source, including salary, retirement or annuity payments, or similar income, which has been waived, are counted as income during the 12-month annualization period in which received, unless specifically excluded. 38 U.S.C. § 1503; 38 C.F.R. § 3.271. The annual period generally runs from the effective date of the initial claim or the date of a change in the claimant’s income. Income exclusions include unreimbursed medical expenses above five percent of the maximum income rate allowable, to the extent they were paid. See 38 C.F.R. § 3.272(g)(1)(iii). Such expenses may be deducted only for the 12-month annualization period in which they were paid. In addition, expenses of the veteran’s last illness, burials, and just debts that were paid during the calendar year following that in which death occurred may be deducted from the annual income for the 12-month annualization period in which they were paid or from the annual income for any 12-month annualization period which began during the calendar year of death, whichever is to the claimant’s advantage. See 38 C.F.R. § 3.272(h). Further, for VA pension purposes, net worth is the sum of a claimant’s assets and annual income. 38 C.F.R. § 3.274(b)(1). Assets, in turn, include such property as bank accounts, stocks, bonds, mutual funds, annuities, and any property other than residence and a reasonable lot area. See 38 C.F.R. § 3.275; accord M21-1, Part V, Subpart iii, Chapter 1, Section J (Sep. 20, 2018). If a claimant’s assets are large enough that (s)he could use these assets to pay living expenses for a reasonable period of time, his/her net worth is considered a bar to pension benefits. See id. For purposes of entitlement to VA pension, including death pension, the net worth limit effective October 18, 2018, is $123,600. See 38 C.F.R. § 3.274(a). Prior to October 18, 2018, there was no specific dollar limitation on net worth that barred an otherwise eligible claimant from receiving pension benefits under § 3.274; rather, as a general rule, the agency of original jurisdiction (AOJ) was required to undertake development action to determine if net worth was excessive for any claimant who had an estate of $80,000 or greater. Here, the March 2017 SOC effectively denied the appellant entitlement to nonservice-connected death pension benefits incorrectly asserting her failure to provide any income and net worth information prior to the issuance of the SOC. The appellant, however, submitted her affidavit prior to the issuance of the SOC indicating that, by March 2017 her estimated annual income was comprised of $1,569 monthly Social Security benefits and $300 monthly wages, i.e., it was estimated to be $22,428 annually. Her 2017 assets included $4,089 held on her checking account and a $171,280 money market account that she held jointly with her daughter. Correspondingly, the appellant combined net worth in 2017 was $197,797. She also clarified that the Veteran’s burial expenses were $11,292, and she paid medical bills associated with his last illness in the amount of $561. At the first blush, it appears that the appellant was not entitled to a death pension for the 2017 annualized period, given that her annual 2017 income was $22,428, while MAPR for a surviving spouse with no dependents was $8,630, see Survivors Pension Rate Tables - Effective 12/1/14, available at http://www. benefits.va.gov/PENSION/rates_survivor_pen14.asp (last visited Feb. 12, 2019), even if the Board were to factor in the Veteran’s burial expenses and medical expenses associated with his last illness (which might or might have not been reimbursed, given the ambiguity of the evidence of record as to these matters). Additionally, the appellant’s 2017 net worth was $197,797 which substantially exceeded the $80,000 benchmark triggering a review/development. The appellant, however, has not clarified her personal unreimbursed medical expenses as to any portion of the period on appeal, including 2017. Further, she did not clarify whether her annual income in 2017 differed from her annual income during the portion of 2016 following the Veteran’s death. In addition, the evidence of record also provides no information as to her income from 2018 forward. Moreover, the evidence of record does not clarify whether her checking account and/or mutual fund were set up prior to the effective date of her claim, and whether either of these accounts has remained in existence and unchanged in the amount from 2017 forward. In light of the foregoing, the appellant should be provided with an opportunity to submit information regarding her income, assets, and medical expenses during the entire period on appeal, from the effective date of her claim forward, to determine her eligibility for death pension benefits. The matter is REMANDED for the following action: 1. Provide the appellant with a VA Form 21-8416, Medical Expense Report, and direct her to report her medical expenses for the years from 2016 forward. The appellant should be specifically instructed that the only medical expenses that should be included are ones that have been paid by her and not reimbursed. 2. Request the appellant to submit a Form 21-0516-1, Improved Pension Eligibility Verification Report, including her assets and her income from all sources and deductions from countable income, for each year for which she seeks VA nonservice-connected death pension benefits. 3. The AOJ is also directed to obtain the appellant’s Social Security payment amounts relevant to the entire period on appeal. 4. After completing any additional notification or development deemed necessary, the AOJ should readjudicate the appellant’s claim. If the benefit sought on appeal is not granted, the appellant and her representative should be provided a Supplemental SOC and afforded the appropriate time period within which to respond thereto. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). 5. This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or the Court for additional development or other appropriate action must be handled in an expeditious manner. 38 U.S.C. §§ 5109B, 7112. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Anna Kapellan, Associate Counsel