Citation NR: 9629537 Decision Date: 10/21/96 Archive Date: 10/30/96 DOCKET NO. 94-33 593 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to an increased (compensable) evaluation for residuals of hemorrhoidectomy. 2. Entitlement to service connection for post traumatic stress disorder (PTSD). 3. Whether new and material evidence has been submitted to reopen a claim for service connection for sigmoid polyps. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Christopher P. Kissel, Associate Counsel INTRODUCTION The appellant retired from the United States Air Force in October 1962 with over twenty years of active duty service. This case comes before the Board of Veterans’ Appeals (the Board) on appeal from a December 1993, rating decision of the Los Angeles, California, Department of Veterans Affairs (VA) Regional Office. The St. Petersburg, Florida, VA Regional Office (VARO) presently has jurisdiction of this claim. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that his hemorrhoidectomy disability is more disabling than presently evaluated. He also contends that a number of stressful incidents he experienced in service, particularly incidents related to his removal from active flying status in 1956 to an “on ground” assignment in the Inspector General’s office and a negative job performance evaluation he received from a superior officer related to those duties, resulted in PTSD which now entitles him to service connection. He also contends that he should be service connected for sigmoid polyps because the hemorrhoidectomy procedure performed in service was actually conducted to remove sigmoid polyps. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1995), has reviewed and considered all of the evidence and material of record in the veteran’s claims file(s). Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that a preponderance of the evidence is against the appellant’s claim seeking an increased (compensable) disability evaluation for his service-connected hemorrhoids disability. It is also the decision of the Board that the appellant’s claim for service connection for PTSD is not well grounded and that new and material evidence has not been submitted to enable the Board to reopen and review the record as to the appellant’s claim of entitlement to service connection for sigmoid polyps. FINDINGS OF FACT 1. On VAX in 1993, the rectal examination was negative for the presence of hemorrhoidal tags and there was no evidence of bleeding, soiling, anemia or fecal leakage. 2. The appellant did not serve in a war zone or engage in combat with the enemy during his period of active duty between May 1942 and October 1962. 3. The occurrence of the appellant’s claimed inservice noncombat stressors is corroborated by credible supporting evidence. 4. Although a current diagnosis of PTSD is indicated, the appellant’s described inservice noncombat stressors are not sufficiently severe, stressful events to support a diagnosis of PTSD for the purposes of service connection under the criteria adopted by VA for determining the sufficiency of such stressors. 5. In May 1990, the Los Angeles, CA, VA regional office denied service connection for sigmoid polyps. That decision was not appealed to the Board within the time allowed by law and regulations and became final. 6. Evidence submitted by the appellant since the May 1990 rating decision, including evidence obtained by the Los Angeles, CA, VA regional office and VARO in conjunction with the present appeal, which is new, fails to show any disability of service origin which is etiologically related to the sigmoid colon polyp that was surgically resected in March 1990. CONCLUSIONS OF LAW 1. The evidence does not warrant the assignment of a compensable rating for the appellant’s service-connected hemorrhoids disability. 38 U.S.C.A. §§ 1155, 5107(b) (West 1991); 38 C.F.R. Part 4, Code 7336 (1995). 2. The claim for service connection for PTSD is not well grounded and there is no statutory duty to assist the appellant in developing facts pertinent to this claim. 38 U.S.C.A. § 5107(a) (West 1991). 3. The May 1990 rating decision is final; evidence submitted since that decision does not constitute new and material evidence which allows the Board to reopen and review the appellant’s claim of service connection for sigmoid polyps. 38 U.S.C.A. §§ 5108, 7105(d)(3) (West 1991); 38 C.F.R. §§ 3.104(a), 3.156(a) (1995). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Increased Disability Evaluation Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 C.F.R. Part 4 (1994). Separate diagnostic codes identify the various disabilities. Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2 (1994); Peyton v. Derwinski, 1 Vet.App. 282 (1991). Recent medical evaluation of the appellant’s hemorrhoids disability is contained in the report of a VA compensation examination (VAX) conducted in November 1993. It is noted that this examination was provided in conjunction with his claim filed in June 1992. The schedular criteria provide that external or internal hemorrhoids which are mildly to moderately disabling are rated noncompensably disabling; a 10 percent rating is warranted for hemorrhoids that are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences; a 20 percent rating, which represents the maximum schedular evaluation, is warranted for hemorrhoids manifested by persistent bleeding and secondary anemia, or with fissures present. 38 C.F.R. § 4.110, Diagnostic Code 7336 (1995). After having reviewed the relevant medical evidence, the Board is of the opinion that the appellant is appropriately rated as noncompensably disabling for his service-connected hemorrhoids disability. Service records on file indicate that the appellant underwent a hemorrhoidectomy procedure in 1959 without reported post operative complication or sequale for the remainder of his military service. In addition, the Board notes that there is no medical evidence of follow-up treatment for any residuals of this procedure in the post service period. On the recent VAX conducted in November 1993, the rectal examination was negative for the presence of hemorrhoidal tags and there was no evidence of bleeding, soiling, anemia or fecal leakage. Thus, in the absence of any current medical evidence showing large or thrombotic hemorrhoids, the criteria for a compensable evaluation have not been met. Since the medical findings and diagnoses provided on the VAX of November 1993 are uncontradicted by any other competent (i.e., medical diagnosis or opinion) evidence, the Board finds this recent medical evaluation of the appellant’s hemorrhoids disability to be dispositive to the outcome of this appeal. See Francisco v. Brown, 7 Vet.App. 55 (1994). Accordingly, the Board finds that the appellant’s contentions offered in conjunction with his claim for increased compensation benefits are outweighed by the medical evidence cited above which has been found more probative to the issue on appeal and therefore, such contentions cannot serve to establish a finding of increased disability. Consideration has been given to the potential application of the relevant provisions of 38 C.F.R. Parts 3 and 4 See Schafrath v. Derwinski, 1 Vet.App. 589 (1991). However, it is the Board’s opinion that the currently assigned disability rating for his hemorrhoidectomy residuals accurately reflects the level of impairment pursuant to the schedular criteria. For the reasons discussed above, the Board finds that the evidence in this case is not so evenly balanced so as to allow application of the benefit of the doubt rule as required by law and VA regulations. 38 U.S.C.A. § 5107(b) (West 1991); 38 C.F.R. §§ 3.102, 4.3 (1995). II. Service Connection: PTSD Service connection for PTSD requires (1) medical evidence establishing a clear diagnosis of the condition; (2) credible supporting evidence that the claimed inservice stressor actually occurred; and (3) a link, established by medical evidence, between current symptomatology and the claimed inservice stressor. 38 C.F.R. § 3.304(f) (1995); see also VA ADJUDICATION PROCEDURE MANUAL M21-1, Part VI, 7.46 (Oct. 11, 1995) (reiterating the three PTSD service-connection requirements set forth in regulation § 3.304(f) and specifically requiring “credible supporting evidence that the claimed in-service stressor actually occurred”). The MANUAL M21-1 provisions in paragraph 7.46 are substantive rules which are “the equivalent of [VA] [r]egulations”. See Hayes v. Brown, 5 Vet.App. 60, 67 (1993) (citing Karnas v. Derwinski, 1 Vet.App. 308, 313 (1991)). With regard to the second criterion, the evidence necessary to establish that the claimed stressor actually occurred varies depending on whether it can be determined that the veteran “engaged in combat with the enemy.” 38 U.S.C.A. § 1154(b) (West 1991); see also Gregory v. Brown, 8 Vet.App. 563 (1996); Collette v. Brown, 82 F.3d 389 (Fed.Cir. 1996). The United States Court of Veterans Appeals (Court) has held that “[w]here it is determined, through recognized military citations or other supportive evidence, that the veteran was engaged in combat with the enemy and the claimed stressors are related to such combat, the veteran’s lay testimony regarding claimed stressors must be accepted as conclusive as to their actual occurrence and no further development for corroborative evidence will be required, provided that the veteran’s testimony is found to be ‘satisfactory,’ e.g., credible, and ‘consistent with the circumstances, conditions, or hardships of [combat] service.’” Zarycki v. Brown, 6 Vet.App. 91, 98 (1993). However, where VA determines from the evidence that the veteran did not engage in combat with the enemy or where the veteran, even if he did engage in combat, is claiming stressors not related to combat, his lay testimony alone is not enough to establish that the stressors actually occurred. West (Carleton) v. Brown, 7 Vet.App. 70, 76 (1994); see also, Zarycki, 6 Vet.App. at 98. The standard set forth in West and Zarycki, that in a noncombat situation “the record must contain service records which corroborate the veteran’s testimony as to the occurrence of the claimed stressor” (West, supra), differs somewhat from the standard that the Court had set forth in Doran v. Brown, 6 Vet.App. 283, 289 (1994). Doran held that the MANUAL M21-1 statement that the “[s]ervice records must support the assertion that the veteran was subjected to a stressor of sufficient gravity to evoke the symptoms in almost anyone” means that “those service records which are available must support, i.e., must not contradict, the veteran’s lay testimony concerning his non-combat related stressors.” Doran, 6 Vet.App. at 289. The Court also stated in Doran that “the absence of corroboration in the service records, when there is nothing in the available records that is inconsistent with other evidence, does not relieve the [Board] of its obligations to assess the credibility and probative value of the other evidence.” Id. at 290-91. The MANUAL M21-1, as revised effective October 1995, provides that the required “credible supporting evidence” of a noncombat stressor “may be obtained from” service records or “other sources.” See Moreau v. Brown, No. 94-883 (U. S. Vet.App. September 12, 1996). This new version of M21-1 does not expressly state that a veteran’s testimony may not, by itself, constitute credible evidence of the actual occurrence of a stressor. However, since the issuance of the October 1995 M21-1 revision, the Court has held that the requirement in § 3.304(f) for “credible supporting evidence” means that “the appellant’s testimony, by itself, cannot, as a matter of law, establish the occurrence of a noncombat stressor.” Dizoglio v. Brown, 9 Vet.App. 163, 166 (1996) (citing Doran, supra, (“if the claimed stressor is not combat-related, [the] appellant’s lay testimony regarding in-service stressors is insufficient to establish the occurrence of the stressor”)). Although the revised MANUAL M21-1 states that proof of an in- service stressor may be obtained from sources other than service records, it does not set forth the type of proof that is required to show a noncombat stressor. The regulations governing service connection for PTSD differ from those governing service connection for other conditions because they require evidence of an in-service stressor rather than evidence of “incurrence or aggravation” of a disease or injury in service or within a postservice presumptive period. The Court’s caselaw allows a physician’s opinion of causal nexus, in certain circumstances, to establish in-service or presumptive-period incurrence or aggravation even when the examination on which the opinion was based was made many years after service. See e.g., ZN v. Brown, 6 Vet.App. 183 (1994). However, since the requirements in § 3.304(f) for a “link, established by medical evidence, between current symptomatology and the claimed inservice stressor” and for “credible supporting evidence that the claimed in[-]service stressor actually occurred,” indicate that something more than medical nexus is required, the Court recently held in Moreau, supra, that “credible supporting evidence of the actual occurrence of an in-service stressor cannot consist solely of after-the-fact medical nexus evidence.” In addition to requiring that an alleged stressful event be corroborated, the law requires that a stressful event be of sufficient gravity or severity to warrant service connection for PTSD. The revised MANUAL M21-1 provides that the essential diagnostic criteria for PTSD, as established by the Diagnostic and Statistical Manual of Mental Disorders-III-R (3rd ed. 1987) (DSM-III-R), requires that the “[t]he person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone; e.g., serious threat to one’s life or physical integrity; serious threat or harm to one’s children, spouse, or other close relatives and friends; sudden destruction of one’s home or community; or seeing another person seriously injured or killed as the result of an accident or physical violence.” Although this legal requirement may sometimes be at odds with the medical findings of an individual physician, the Board may disregard such medical findings if it determines on a factual basis that the alleged event (or series of events) is not of sufficient gravity or severity to qualify as a stressor. West, 7 Vet.App. 70, 78-79 (1994) (noting that a significant diagnostic feature of PTSD requires that the sufficiency of the stressor be clinically established but not holding that this matter is purely a medical question in every case); Wilson v. Derwinski, 2 Vet.App. 614, 616-18 (1992) (affirming a Board decision which noted that whether an alleged event is a stressor is a question of fact for the Board to decide involving factors as much historical as psychological); see also Swann v. Brown, 5 Vet.App. 229 (1993) (holding that veteran’s descriptions of experiences in service “are not beyond the ordinary, i.e., they would not, in and of themselves, evoke symptoms in ‘almost everyone.’”); and, Wood v. Derwinski, 1 Vet.App. 190 (1991) (noting that service in a combat zone is stressful in some degree to all who are there, whatever their duties and experiences). Turning to the facts in this case, the Board notes that the appellant was diagnosed with PTSD, chronic, mild, and generalized anxiety disorder, on a recent VA psychiatric examination (VAX) conducted in November 1993. This diagnosis was based on his reported complaints of anxiety attacks and feeling of nervousness. He also reported complaints of poor sleep and “episodes of rage.” With respect to these feelings, the appellant indicated that he held a great deal of resentment towards a former serviceman, a Colonel, who had given him a bad evaluation. The report of the 1993 VAX described this history as follows: He was especially upset that he was labeled as a malingerer and was accused of ‘fainting and illness.’ At that time he reports that he was a test pilot in the Air Force and there was an incident wherein during his test flight he had symptoms of hyperventilation and after full examination and treatment, there were no organic symptoms associated with it and he was then labeled a ‘malingerer.’ This series of events and problems lasted until his discharge from the service after twenty years, and he got an honorable discharge. The appellant’s service records corroborate the above-cited account of treatment for problems with anxiety and hyperventilation that led to his removal from active flying status in 1956 and there is corroboration in these records that he received a negative evaluation on an Officer Effectiveness Report (OER) from a superior officer in connection with his duties in the Inspector General’s office in 1957. His service medical records also document an extensive history of acute anxiety attacks beginning in July 1945 related to situational stress. See Report of Neuropsychiatric Evaluation, dated April 10, 1957. In addition, there is on file a lay statement from the appellant’s wife, dated March 8, 1995, that reflects her account of the problems the appellant has had over the years related to the malingering charges and the negative OER. She indicated that the negative OER left a “permanent mark on his brain which time has not healed.... [and she further indicated that] I know of no other words to describe his condition other than ‘Post-Traumatic Stress Disorder’ which started while he was still on active duty as a Major at Norton AF Base, California.” Thus, in view of the above, it is shown by the evidence that the elements of a valid claim for PTSD requiring medical evidence establishing a clear diagnosis of the condition and credible supporting evidence that the claimed inservice stressors actually occurred has been met. However, as stated in Moreau, supra, the third element or requirement in § 3.304(f) for a link, established by medical evidence, between current symptomatology and the claimed inservice stressor, indicate that something more than medical nexus is required. In this case, the Board finds that the question of whether the reported stressors are sufficient to establish service connection for PTSD is for consideration. Initially, with respect to the applicable law and VA regulations, the Board notes that the liberalizing evidentiary standards set forth under 38 U.S.C.A. § 1154(b) and its corresponding regulatory section, 38 C.F.R. § 3.304(d), are not for application in this case. Although the appellant’s active duty service in the Air Force extended through two periods of war (World War II and Korea), his service records do not indicate duty assignments in combat zones during these war periods. See Officer Military Record, AF Form 11, No. 2, of record. Accordingly, it is not shown that he engaged in combat with enemy forces. 38 U.S.C.A. § 1154(b); Gregory, 8 Vet.App. 563 (1996). However, since the appellant does not contend, nor does the evidence show, that he engaged in combat with the enemy or that his stressors are related to combat activities, the Board’s analysis of this case will address the sufficiency of his noncombat stressors for purposes of establishing service connection for PTSD. Notwithstanding the above-cited diagnosis of PTSD entered on VAX in 1993 and the appellant’s accounts of his inservice stressor incidents upon which this diagnosis was apparently based, the Board finds that his reported stressors are not of sufficient gravity or severity to warrant service connection for PTSD. As indicated above, although the Court has noted that a significant diagnostic feature of PTSD requires that the sufficiency of the stressor be clinically established, the Court has not held that this matter is purely a medical question in every case. West, 7 Vet.App. 70, 78-79 (1994); Wilson, 2 Vet.App. at 617; Swann, 5 Vet.App. at 233; Wood, 1 Vet.App. at 193. In reaching this determination, the Board looks to the essentials of a diagnosis of PTSD that have been accepted by the VA and to the holdings of the Court. In Zarycki, the Court noted that the DSM-III-R “has been adopted by the VA for rating psychiatric conditions such as PTSD” and that “[a]ccording to DSM-III-R, the ‘essential feature’ of PTSD is ‘a psychologically distressing event that is outside the range of usual human experience.’” Zarycki, 6 Vet.App. at 98, citing DSM-III-R at 247; see 38 C.F.R. § 4.125 (1995). The Court also observed that the “DSM-III-R notes in this context that the ‘most common traumata’ include a threat to one’s life, a threat to the lives of one’s friends, or seeing another person who has recently been seriously injured or killed as the result of an accident or physical violence.” Id. Turning to the facts of this case, the Board finds that the appellant’s accounts of anxiety-induced trauma due to incidents he experienced in service do not constitute events that are outside the range of usual human experience and that would be markedly distressing to almost anyone. These incidents, essentially comprising a long history of acute anxiety attacks related to job performance, see, supra, Report of Neuropsychiatric Evaluation, dated April 10, 1957, contrast sharply in emotional and psychological intensity, severity, and gravity to the kinds of stressful events that the DSM-III-R and the M21-1 have provided as examples of psychologically stressful occurrences that could support a diagnosis of PTSD. The Board notes that none of the appellant’s reported stressors involve serious threat to one’s life or physical integrity; serious threat or harm to one’s children, spouse, or other close relatives and friends; sudden destruction of one’s home or community; or seeing another person seriously injured or killed as the result of an accident or physical violence. The Court has found, without resorting to medical evidence or opinion, that certain experiences at least as stressful as, if not more stressful than, the ones in this case were insufficient to support a diagnosis of PTSD for service connection purposes. In Swann, the Court observed that a veteran’s accounts of having experienced two mortar attacks at air bases where he served in Vietnam and of having observed decaying flesh fall little by little from a Viet Cong corpse hanging in a tree, even if true, did not portray situations where the veteran was exposed to more than an ordinary stressful environment. Swann, 5 Vet.App. at 233. In Wood, the Court noted that service in a combat zone was stressful in some degree to all who are there whatever their duties and responsibilities, and in Zarycki, the Court made clear that mere service in a combat zone, was not in itself sufficiently stressful to support a diagnosis of PTSD. Wood, 1 Vet.App. at 193; Zarycki, 6 Vet.App. at 99. Here, the appellant’s stressor incidents do not involve combat experiences, death or serious injury to others and further, there is no direct or circumstantial evidence on file that indicates that these incidents imposed a serious threat to his own life or physical integrity. Accordingly, the Board concludes that in this case, the question of the sufficiency of the stressors is factual in nature, and not a medical question, and therefore it may be resolved by the Board by applying the criteria adopted by the VA for this purpose from the DSM-III-R and by referring to the above-cited cases where the Court has found, without recourse to medical evidence, that certain events do not constitute sufficient stressors to support a diagnosis of PTSD for the purposes of service connection. Considering the foregoing, the Board concludes that the appellant’s claim for service connection for PTSD is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991); see Caluza v. Brown, 7 Vet.App. 498 (1995) (a “well grounded” claim for service connection requires evidence of a current disability as provided by a medical diagnosis; evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, a nexus, or link, between the in-service disease or injury and the current disability as provided by competent medical evidence). In this case, it is not shown that the appellant engaged in combat with the enemy during his war period service and although there is credible supporting evidence to corroborate the occurrence of the noncombat stressors that he claims to have experienced in service, the stressors described by the appellant have been found by the Board to be of insufficient gravity or severity to support a diagnosis of PTSD for the purposes of service connection. In view of the above, the Board concludes that a remand is not required to take steps to verify the appellant’s exposure to these stressors, including a request for information from the United States Army and Joint Services Environmental Support Group. A remand would serve no useful purpose in this case because the events do not meet the criteria which VA has adopted from the DSM-III-R and against which the sufficiency of stressors in individual cases must be weighed in determining whether service connection for PTSD may be granted. Soyini v. Derwinski, 1 Vet.App. 540, 546 (1991) (strict adherence to requirements in the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran); Sabonis v. Brown, 6 Vet.App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided); cf. Brady v. Brown, 4 Vet.App. 203, 207 (1993) (a remand is unnecessary even where there is error on the part of VA, where such error was not ultimately prejudicial to the veteran’s claim). Where the veteran has not met this burden, the VA has no further duty to assist him in developing facts pertinent to his claim, including no duty to provide him with another medical examination. 38 U.S.C.A. § 5107(a); Rabideau v. Derwinski, 2 Vet.App. 141, 144 (1992) (where the claim was not well grounded, VA was under no duty to provide the veteran with an examination). Although where a claim is not well grounded VA does not have a statutory duty to assist a claimant in developing facts pertinent to the claim, VA may be obligated under 38 U.S.C.A. § 5103(a) to advise a claimant of evidence needed to complete his application. This obligation depends on the particular facts of the case and the extent to which the Secretary has advised the claimant of the evidence necessary to be submitted with a VA benefits claim. Robinette v. Brown, 8 Vet.App. 69 (1995). Here, VARO fulfilled its obligation under section 5103(a) in the statement of the case issued in June 1994. In this respect, the Board is satisfied that the obligation imposed by section 5103(a) has been satisfied. See Franzen v. Brown, 9 Vet.App. 235 (1996) (VA’s obligation under sec. 5103(a) to assist claimant in filing his claim pertains to relevant evidence which may exist or could be obtained). See also Epps v. Brown, No. 93-438 (U. S. Vet.App. Aug. 27, 1996) (sec. 5103(a) duty attaches only where there is an incomplete application which references other known and existing evidence). It is not shown nor contended that additional relevant evidence exists that has not already been associated with the claims file. Although VARO did not specifically state that it denied the appellant’s claim on the basis that it was not well grounded, the Board concludes that this error was harmless. See Edenfield v. Brown, 8 Vet.App. 384 (1995) (en banc) (remedy for deciding on the merits a claim that is not well grounded should be affirmance, on the basis of nonprejudicial error, of the decision by agency of original jurisdiction). Accordingly, the Board must deny the appellant’s claim for service connection for PTSD as not well grounded. Edenfield, 8 Vet.App. at 390 (disallowance of a claim as not well grounded amounts to a disallowance of the claim on the merits based on insufficiency of evidence). III. New and Material Evidence: Service Connection for Sigmoid Polyps The appellant’s original claim of service connection for sigmoid polyps was the subject of an unappealed, unfavorable rating decision by the Los Angeles, CA, VA regional office in May 1990. That decision was appealed by notice of disagreement filed by the appellant in July 1991, but is considered to be final because the appellant did not perfect his appeal to the Board by filing a substantive appeal. 38 U.S.C.A. § 7105(d)(3) (West 1991); 38 C.F.R. §§ 19.32, 20.302(b) (1995). In that decision, VARO noted that an x-ray report from the Beaver Medical Clinic, Redlands, CA, dated in March 1990 indicated that a sigmoid colon polyp was suspected but denied service connection for this disability because his service medical records were entirely silent for any complaints, treatment or diagnosis of sigmoid polyps. Under pertinent law and VA regulations, as interpreted by the United States Court of Veterans Appeals, the Board may reopen and review a claim which has been previously denied only if new and material evidence is submitted by or on behalf of the appellant. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1995); Manio v. Derwinski, 1 Vet.App. 140 (1991). “New” evidence means evidence which is not merely cumulative or redundant. Colvin v. Derwinski, 1 Vet.App. 171 (1992). “Material” evidence is evidence which is relevant and probative of the issue at hand and which, furthermore, when viewed in context of all of the evidence of record, would create a reasonable possibility that the previously disallowed claim would now be allowed. Cox v. Brown, 5 Vet.App. 95, 98 (1993); see also, Justus v. Principi, 3 Vet.App. 510, 513 (1992) (in determining whether evidence is new and material, the credibility of the evidence is to be presumed). See also Evans v. Brown, No. 93-1220 (U. S. Vet. App. Aug. 1, 1996) (VA required to review all of the evidence submitted by the claimant since the time the claim was finally disallowed on any basis, not only since the time the claim was last disallowed on the merits). In the opinion of the Board, the evidence submitted since Los Angeles, VA regional office denied service connection for the claimed disability in May 1990, which is new is not material to the issue of service connection. That is, it does not lead to a conclusion that, when viewed in the context of all the evidence of record, there is a reasonable possibility it would change the outcome of the case. Cox, 5 Vet.App. 95 (1993). On the contrary, a portion of the current evidence, in particular, the appellant’s pleadings (notice of disagreement and substantive appeal) and personal statements of record, essentially reiterates his previously considered contentions with respect to the claimed disability, and as such are not considered to be new. See Reid v. Derwinski, 2 Vet.App. 312 (1992). Furthermore, although the appellant contends that that he should be service connected for sigmoid polyps because the hemorrhoidectomy procedure performed in service was actually conducted to remove sigmoid polyps, such contentions, to the extent that they reflect his lay speculation on medical issues involving the reasons why a medical procedure was performed in service, are not probative to the issue on appeal and therefore, are deemed to be not new and material. See Pollard v. Brown, 6 Vet.App. 11 (1993) (pursuant to Espiritu v. Derwinski, 2 Vet.App. 492 (1992), lay testimony attempting to diagnose frostbite or arthritis in service held to not be competent evidence for such purpose, and thus not material); see also, Moray v. Brown, 5 Vet.App. 211 (1993) (lay assertions of medical causation cannot serve as the predicate to reopen a claim under 38 U.S.C.A. § 5108). The evidence which is new to the issue of service connection for sigmoid polyps, consisting of private treatment reports dating from July 1987 through July 1992 from the aforementioned Beaver Medical Clinic and the report of a VAX conducted November 1993, does not provide a basis to establish service connection for the claimed disability. This evidence confirms that a colon polyp was removed in March 1990. However, service connection for sigmoid polyps was denied in 1990 because his service records did not show a treatment or diagnosis of this condition and because there was no evidence that competently linked the post service x-ray findings of a suspected colon polyp to any treatment or condition reflected in the service medical records. The same analysis can be applied to the above-cited medical reports in that these records also show no evidence relating the resection of the colon polyp in March 1990 to service or the hemorrhoidectomy procedure performed therein. In summary, the findings noted above in this “new” evidence are not essentially different from the pertinent facts and medical evidence of record which was previously considered in 1990. Thus, while the new evidence submitted by the appellant and/or obtained by VARO in conjunction with the present claim reflects his belief that he had sigmoid polyps in service, for the reasons discussed above, none of this evidence would change the outcome of the case and therefore, is not material and sufficient to allow reopening of the claim. Smith v. Derwinski, 1 Vet.App. 178, 180 (1991). Accordingly, the Board concludes that the appellant has not submitted evidence which is new and material such as to form the basis to reopen and review the previously denied claim seeking entitlement to service connection for sigmoid polyps. Although VA is obligated under 38 U.S.C.A. § 5103(a) to advise a claimant of the kind of evidence needed to reopen a previously denied claim, see Graves v. Brown, 8 Vet.App. 522 (1996), this obligation depends on the particular facts of the case and the extent to which the Secretary has advised the claimant of the evidence necessary to be submitted with a VA benefits claim. See Robinette v. Brown, 8 Vet.App. 69 (1995). Here, VARO adequately fulfilled its obligation under section 5103(a) with the issuance of the statement of the case. Unlike the situation in Graves, he has not put VA on notice of the existence of any specific, particular piece of evidence that, if submitted, could reopen his claim on the basis of new and material evidence, notwithstanding the fact that he has been provided opportunities to do the same. ORDER The benefits sought on appeal are denied. KENNETH R. ANDREWS, JR. Member, Board of Veterans’ Appeals The Board of Veterans’ Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741 (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1995), a decision of the Board of Veterans’ Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans’ Judicial Review Act, Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans’ Appeals. - 2 -