Citation Nr: 9811624 Decision Date: 04/14/98 Archive Date: 04/28/98 DOCKET NO. 97-24 296 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Whether new and material evidence has been presented to reopen a claim of entitlement to service connection for a psychiatric disorder. 2. Whether new and material evidence has been presented to reopen a claim of entitlement to service connection for cardiovascular disease. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant INTRODUCTION The veteran served on active duty from October 1950 to November 1953 and from December 1953 to February 1956. His period of service from December 1953 to February 1956 was characterized as dishonorable; however, it was upgraded to a General Discharge in 1978. See Memorandum, Department of the Army, Office of the Assistant Secretary, dated June 14, 1978; Proceedings, Department of the Army, Army Board for Correction of Military Records, dated April 19, 1978; Administrative Decision, dated September 1978. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 1997 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama, that denied a petition to reopen claims of entitlement to service connection for a psychiatric disorder and cardiovascular disease. In May 1997, the veteran requested that he be scheduled for a personal hearing before a traveling member of the Board; however, the RO scheduled him for a hearing before a local hearing officer in July 1997. In April 1998, the Board contacted the veteran by telephone to clarify his desire for a hearing before the Board. He stated that he did not desire such a hearing. A review of the record indicates that the veteran also wishes to pursue a claim of entitlement to service connection for post traumatic stress disorder (PTSD). On September 15, 1994, the veteran also expressed disagreement with a September 7, 1994, letter from the RO concerning his pension benefits. These issues are not inextricably intertwined with the issues now on appeal, see Harris v. Derwinski, 1 Vet. App. 180 (1991), nor have they been developed or certified for appeal. 38 U.S.C.A. § 7105(c) (West 1991). Therefore, they are referred to the RO for appropriate action. By motion received at the Board on March 17, 1998, the appellant requested advancement on the docket for good cause. By letter dated March 31, 1998, the Acting Chairman ruled favorably on the appellant’s motion, pursuant to 38 C.F.R. § 20.900(c) (1997). CONTENTIONS OF APPELLANT ON APPEAL The veteran argues that he has a current psychiatric disorder as the result of his inservice boxing career, inservice exposure to dichlorodiphenyltrichloroethane (DDT) and asbestos, and inservice ingestion of Dapsone and chloroquine for the prevention of malaria. He further maintains that inservice exposure to DDT and asbestos and inservice ingestion of Dapsone and chloroquine for the prevention of malaria caused his current cardiovascular disease. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1997), has reviewed and considered all of the evidence and material of record in the veteran’s claims files. 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 new and material evidence has not been presented to reopen the claims of entitlement to service connection for a psychiatric disorder or for cardiovascular disease. FINDINGS OF FACT 1. The Board denied a petition to reopen a claim for service connection for a psychiatric disorder in July 1988. 2. Evidence has not been presented or secured since the July 1988 Board decision which, when viewed in the context of all the evidence, both old and new, creates a reasonable possibility of changing the outcome of the claim. 3. The Board denied a petition to reopen a claim for service connection for cardiovascular disease in March 1982. 4. Evidence has not been presented or secured since the March 1982 Board decision which, when viewed in the context of all the evidence, both old and new, creates a reasonable possibility of changing the outcome of the claim. CONCLUSIONS OF LAW 1. The July 1988 Board decision denying a petition to reopen a claim for service connection for a psychiatric disorder is final. 38 U.S.C.A. § 7103(a) (West Supp. 1997); 38 C.F.R. § 20.1100 (1997). 2. Evidence received since the July 1988 Board decision denying a petition to reopen a claim for service connection for a psychiatric disorder is not new and material, and the veteran’s claim for service connection for this disability has not been reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156 (1997). 3. The March 1982 Board decision denying a petition to reopen a claim for service connection for cardiovascular disease is final. 38 U.S.C.A. § 7103(a) (West Supp. 1997); 38 C.F.R. § 20.1100 (1997). 4. Evidence received since the March 1982 Board decision denying a petition to reopen a claim for service connection for cardiovascular disease is not new and material, and the veteran’s claim for service connection for this disability has not been reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156 (1997). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Factual background The veteran served on active duty from October 1950 to November 1953 and from December 1953 to February 1956. His DD-214 and service personnel records show that he served a part of that time in Korea, from May to October 1953. He served with the 23d Infantry Regiment. His military specialty was that of a combat infantryman. He was awarded the National Defense Service Medal, the Korean Service Medal with one Bronze Service Star, and the United Nations Service Medal, none of which is indicative of combat service. Manual of Military Decorations & Awards, Report No. DOD 1348.33-M, Assistant Secretary of Defense (Force Management and Personnel), (September 1996). On the veteran’s report of medical examination for enlistment, in October 1950, his sitting blood pressure was 130/80, and his pulse was 72. The veteran’s service medical records disclose that he complained of chest pains and being nervous in August 1951; however, no diagnosis was rendered. The notation indicated the condition was not incurred in line of duty (LOD) and that it existed prior to service (EPTS). In January 1953, physical examination, including a chest x- ray, was negative. In September 1953, the veteran had a cyst removed from his mouth above his upper front teeth. On separation examination in November 1953, cardiovascular and psychiatric examinations were negative. Sitting blood pressure was 110/70. On examination for his second period of service, his sitting blood pressure was 112/68. During his second period of service, in February 1954, the veteran was referred for psychiatric evaluation because of poor adjustment with fellow soldiers and frequent arguments with his commanding officer. He complained of frequent nightmares, nervousness, headaches and insomnia, but mainly felt dissatisfied with his superiors and present organization. He stated that his military occupational specialty was that of a clerk typist. He was sent to Korea for nine months where he did “detail.” He claimed he was wounded in the head from a shell fragmentation and hospitalized for three weeks. The examiner found no evidence of a psychiatric disorder. On re-enlistment examination in March 1955, the veteran’s heart and psychiatric systems were normal. His sitting blood pressure was 110/78. The veteran sought treatment for left- sided chest pain in June 1955. Physical examination was negative. The examiner diagnosed possible pleurisy. In August 1955, the veteran gave a history of a head injury while in Korea. The examiner noted no neurological signs of injuries. In October 1955, the veteran was again referred for psychiatric examination because of difficulties getting along with officers and non-commissioned officers (NCOs). On intake report, he gave a history of participating in boxing at Fort Sill, Oklahoma, but denied ever being knocked out or receiving a severe head injury. The examiner’s impression was that the veteran tended to strongly project responsibility for his behavior onto others. He was described as an “impulsive person who reacts with hostility to situations imposing restriction on him.” No psychiatric diagnosis was rendered. The examiner recommended that the veteran be administratively discharged. The veteran subsequently returned to this examiner for further evaluation, and the examiner noted that he was not anxious and seemed interested in impressing that he was a medical rather than administrative problem. On neuropsychiatric examination in October 1955, the examiner noted that veteran had four courts martial, including for disobeying a lawful order of an NCO, disobeying a lawful order, disrespect toward an NCO and breaking restriction. The examiner diagnosed the veteran as having an emotional instability reaction, chronic, moderate. There were no mental or physical defects sufficient to warrant discharge for psychiatric reasons. The veteran also sought treatment for chest pain in October 1955. On October 31, 1955, he indicated that he was unable to talk or open his mouth. No organic pathology was noted and no diagnosis was rendered. In early November 1955, the veteran said his legs were paralyzed. Neurological examination was negative. His reflexes were “ok” and his reaction to pin point sensation was good. No diagnosis was given. The veteran was diagnosed as having acute tenosynovitis of the right foot in November 1955. In January 1956, he sought treatment for aching and swelling of his feet. The examiner noted swelling across the instep and toes. On separation examination in January 1956, examination of the cardiovascular system was negative. The veteran was diagnosed as having a passive aggressive reaction, chronic, mild. The veteran’s inservice immunization record did not show that he was administered any drugs for the prevention of malaria, nor that he received any drugs for treatment of leprosy. Following his separation from service, the veteran was imprisoned at Fort Leavenworth, Kansas, from 1956 until 1958. In February 1956, he complained of backache. His chest was clear, and blood pressure was 120/80. In April 1956, on his initial physical, his heart was normal, and his sitting blood pressure was 122/78. A blood pressure reading of 138/90 was recorded in February 1958. The veteran was described as worried, nervous and in need of rest in July 1958. Physical examination was negative. On “release punitive discharge examination” in October 1958, the veteran’s blood pressure reading was 140/68. Examination of the cardiovascular system was negative. He was diagnosed as having a character and behavior disorder. The veteran was afforded a VA general medical examination in July 1959. Cardiovascular and psychiatric examinations were negative for any abnormalities. The veteran submitted his original claim for a psychiatric disorder to the RO in May 1963. He stated that he did not recall if he was treated for this condition in service; however, looking back at his actions he felt that he must have been suffering from mental illness during service. Outpatient treatment records from the VA Medical Center (VAMC) in Brooklyn, New York, revealed that the veteran was treated for psychiatric symptomatology from May to July 1963. It was noted that he had sought treatment after being charged with resisting arrest, disorderly conduct, assaulting an officer, and indecent exposure. He was found to have a “socio-pathic personality disturbance, sexual deviation, exhibitionism (indecent exposure) and masturbation.” He was also described as bordering on the “psychopathic,” “quite seriously disturbed,” and “in need of intensive psychiatric treatment.” His motivation for treatment was assessed as the desire to avoid imprisonment. The veteran was diagnosed as having a personality disturbance with sociopathic features and emotional instability on VA examination in January 1964. At that time, he gave a history of being a boxer since 1953. Examination of the cardiovascular system was negative. The RO denied entitlement to service connection for a psychiatric disorder in January 1964 on the grounds that the veteran suffered from a personality disorder, or a “constitutional or developmental abnormality,” which was not a disability under the law. The veteran was notified of this decision by means of a February 4, 1964, letter. He did not appeal. In December 1963, the veteran was hospitalized at Kings County Hospital. There was no evidence of psychotic behavior. He was diagnosed as having an emotionally unstable personality - schizoid personality. The veteran sought additional treatment at the Brooklyn VAMC from December 1963 to March 1964 and from March to July 1966. Pertinent diagnoses included a character disorder. In an October 1966 rating decision, the RO found that new and material evidence had not been submitted to reopen a claim of entitlement to service connection for a psychiatric disorder. The veteran was notified of this decision by means of an October 12, 1966, letter. He did not appeal. The veteran sought additional treatment at the Brooklyn VAMC from February to May 1967. No diagnosis was rendered. The veteran’s medical records (under an alias) from the Department of Corrections, dated from 1973 to 1975, reveal that he was diagnosed as having hypertension as early as December 1973. He was also involved in a fight in February 1974. Pertinent diagnoses included head trauma and cerebral concussion syndrome. The veteran was afforded VA examinations in January and February 1976. His blood pressure reading was 156/106. An electrocardiogram revealed left ventricular hypertrophy, possibly a residual of an inferior myocardial infarction, although more likely a normal variant. Chest x-ray showed no cardiac pathology. The examiner diagnosed mild, essential hypertension and regular sinus rhythm, class II. Nervous system was said to be normal. The veteran was treated at the emergency room at Cumberland Hospital on several occasions in 1974. Pertinent diagnoses included mild head trauma. In November 1974, Otto Knoller, M.D. diagnosed the veteran as having, in pertinent part, “Blood-pressure 170/100.” The veteran submitted a claim for service connection for psychiatric and cardiovascular disorders to the RO in June 1980. He stated that his high blood pressure was caused by the anxieties of his five years in service. He further alleged that he was treated for swollen feet and chest pains from 1955 to 1958, which he believed were the forerunners of his heart disease. With respect to a psychiatric disorder, he claimed that this condition had resulted from his inservice head wounds. In July 1980, the RO notified the veteran that entitlement to service connection for cardiovascular and psychiatric disorders was denied. The veteran appealed the RO’s decision to the Board. In support of his claim, the veteran provided additional treatment records from the VAMC in Brooklyn, New York, dated through 1980. These records showed that he was diagnosed as having an anxiety reaction in June 1980 and high blood pressure and arteriosclerotic heart disease with angina in August 1980. An examiner in June 1980 also indicated that it was hard to say whether the veteran should be classified as a paranoid antisocial personality disorder or a schizoid. Jaweed Husain, M.D. diagnosed the veteran as having schizophrenia, paranoid type, rule out organicity, in November 1980. The veteran also provided a copy of a January 1981 Social Security Administration (SSA) decision and medical records used in arriving at that decision. SSA found that the veteran was suffering from a severe emotional disorder complicated by several minor body dysfunctions and that he was disabled for Supplemental Security Income (SSI) benefits effective March 1979. Additional copies of the veteran’s Department of Corrections medical records revealed that in October 1974, a staff psychiatrist testified at a hearing that that she had examined the veteran in July 1974. She concluded that he suffered from a personality disorder, moderately severe. Medical records from Ft. Greene Medical Group reveal that the veteran suffered from increased blood pressure in December 1975. The veteran was also treated at Old Broadway Medical-Dental Center in July 1976 for hypertension. In November 1976, Richard H. Hamilton, M.D. and James C. Hirschy, M.D. reported that that the veteran’s chest x-rays showed prominence of the left ventricle consistent with left ventricular hypertrophy, but cardiac size was within normal limits. Joseph A. Grossman, M.D. also diagnosed the veteran as having hypertensive heart disease with left ventricular dysfunction and angina pectoris in November 1976. In January 1977, Otto Knoller, M.D. reported that the veteran suffered from a cerebral concussion and post concussion syndrome, i.e., as a result of plaster ceiling falling on his head, as well as hypertension, 160/120. In a February 1978 statement, Young Wook Koh, M.D. reported that the veteran had been under his care for high blood pressure since November 1977. On examination by James Cavanaugh, M.D. in March 1979, the veteran reported that he thought he was slow in his thinking because of a head injury while in prison. Dr. Cavanaugh’s impression was hypertension and anxiety reaction, moderate, which occasionally verged on seeming paranoia and grudge collecting. Finally, the veteran was examined by Peter Strassberg, M.D. in March 1979, who diagnosed him as having hypertension, psychiatric abnormalities and atherosclerotic heart disease with some changes on resting electrocardiogram. The veteran testified at a personal hearing before the RO in February 1981. He alleged, in essence, that based upon findings in his service medical records and post-service medical records, his psychiatric disorder had its onset during active service. The veteran further stated that his cardiovascular disease had its onset during service because his inservice blood pressure readings were abnormal. He also claimed that it may have been related to his inservice chest pains and swelling of the feet. The Board denied entitlement to service connection for psychiatric and cardiovascular disorders in March 1982. Specifically, the Board found that the veteran suffered from a personality disorder during service, which could not be service connected; that there was no evidence during service of the veteran’s recently diagnosed anxiety reaction or schizophrenia; and that a psychosis was not manifest to a degree of 10 percent or more within one year following service. With respect to cardiovascular disease, the Board determined that such a disability was not manifest until many years after service and was not shown to be attributable to the inservice chest pain or swelling of the feet. In March 1982 written statements, veteran alleged that his psychiatric disorder had progressed through the years following active service until it became so severe as to constitute a disability. Pursuant to the veteran’s request, the Board’s March 1982 decision concerning entitlement to service connection for an acquired psychiatric disorder was reconsidered. The decision was affirmed in an October 1982 reconsideration decision. In a written statement received at the RO in December 1984, the veteran claimed that he had been awarded the Combat Infantryman Badge. In August 1985, the veteran submitted a written statement, as well as several documents to the RO. He argued that his psychiatric disorder was caused by an inservice infection of his mouth and gums following an operation for removal of a cyst, his alleged inservice head injury in Korea, exposure to DDT and Malathion in Korea, the use of a mosquito rubbing compound in Korea, ingestion of drugs for malaria prevention (Dapsone and Chloroquine) in Korea, an alleged inservice head injury incurred when he was knocked out while boxing, his inservice imprisonment, exposure to cold weather, and head trauma incurred in an automobile accident. An excerpt from testimony provided in conjunction with the veteran’s discharge proceedings was included with the written statement. His attorney stated that the veteran had served in Korea from April to November 1953 and that part of this time was during combat. He further stated that the veteran participated in boxing during service. The veteran also submitted a newspaper clipping reviewing one of his inservice boxing matches and a picture of himself in a boxing ring during service in 1955. Also associated with these documents was a copy of a “Product Information” leaflet from Winthrop Laboratories concerning possible side-effects of injection of chloroquine hydrochloride for malaria and extraintestinal amebiasis. Possible adverse reactions similar to those for short-term oral administration of chloroquine phosphate were noted, to include rare instances of cardiovascular effects, hypotension and electrocardiographic changes (particularly inversion or depression of the T-wave, widening of the QRS complex) and psychic stimulation. A leaflet from Jacobus Pharmaceuticals also addressed complications of Dapsone therapy, including psychosis and depression. According to the leaflet, this drug was used for the treatment of leprosy. Finally, a certificate from the National Personnel Records Center (NPRC) indicated that 80 to 90 percent of records pertaining to members of the United States Army discharged before 1960 maintained on the sixth floor of the NPRC were destroyed as the result of a fire in July 1973, and that if a complete record for the veteran did exist at the NPRC prior to that date, such records presumably were lost in the fire. In an August 1985 rating decision, the RO found that new and material evidence had not been submitted to reopen a claim of entitlement to service connection for a psychiatric disorder. The veteran appealed the RO’s decision to the Board. In September 1985, the veteran provided a copy of a June 1981 SSA decision confirming that he was entitled to a period of disability insurance commencing in March 1979. In December 1985, the veteran submitted a December 1982 report of examination by J. Fiks, M.D. and a January 1983 report of examination by Roy Eriksen, M.D. Dr. Fiks diagnosed the veteran as having an intermittent explosive disorder, rule out antisocial personality disorder. Dr. Eriksen diagnosed the veteran as having hypertensive cardiovascular disease, angina and personality disorder. The veteran also submitted an article by Robert H. Boyle and Wilmer Ames concerning effects of boxing, including brain damage, to the RO in December 1985. A December 1985 SSA decision determined the veteran was entitled to widower’s insurance benefits as a result of disability, i.e., schizophrenia, explosive personality disorder and hypertensive cardiovascular disease, effective from January 1982. A Psychiatric Review Technique showed that the veteran suffered from schizophrenic, paranoid or other psychotic disorders and personality disorders, including an explosive personality disorder. In March 1986, the veteran submitted a service personnel record indicating that he engaged in boxing for recreation. In April 1986, the veteran submitted copies of morning reports to the RO. The reports reflect TDY (temporary duty) assignments for boxing, while the veteran was at Fort Sill, Oklahoma, in 1954 and 1955. In June and July 1986, he also submitted photographs of his inservice boxing trophies, himself and what are allegedly his medals, including a Combat Infantryman Badge. A December 1985 newspaper article from The Birmingham News reported that exposure to DDT was suspected in cases of high blood pressure and kidney and heart problems. The veteran submitted a claim for service connection for cardiovascular disease to the RO in July 1986. He claimed that this was caused by an inservice infection of his mouth and gums following an operation for removal of a cyst, exposure to DDT and Malathion, ingestion of drugs for malaria prevention (Dapsone and Chloroquine), and inservice head injuries incurred while boxing. In August 1986, the veteran submitted morning reports dated in June and July 1953. On June 2, 1953, the veteran was an “assigned gain” to a heavy mortar company of the 23d Infantry Regiment. On July 13, 1953, he was shown as an “assigned loss” to the heavy mortar company, 23d Infantry Regiment and as an “assigned gain” to Headquarters and Headquarters Company. In a September 1986 rating decision, the RO found that new and material evidence had not been submitted to reopen a claim of entitlement to cardiovascular disease. The RO stated that the service records and post-service records showed no findings of exposure to the claimed chemicals, that the evidence did not show that any current heart condition was attributable to chemical exposure, and there were no findings of any residuals of the inservice cyst removal. In a November 1986 written statement, the veteran argued, in pertinent part, that the RO had wrongly characterized his inservice psychiatric disability as a congenital or developmental defect. The veteran testified at a personal hearing before the RO in December 1986. He essentially reiterated some of his contentions concerning a psychiatric disorder as noted above. The Board denied the veteran’s petition to reopen his claim of entitlement to service connection for an acquired psychiatric disorder in March 1987. The Board stated that the recently received evidence did not show that the veteran had an acquired psychiatric disorder which may be reasonably related to active service, nor did it document a psychosis within the first post-service year. The Board specifically acknowledged the evidence concerning the veteran’s inservice history and alleged effects of boxing. The veteran requested reconsideration of the Board’s decision in April 1987. The Board denied the veteran’s motion in July 1987. On July 10, 1987, the RO mailed the veteran a notice of the above-mentioned September 1986 rating decision; however, it did not advise him of the decision concerning his claim for service connection for cardiovascular disease. The veteran sought to reopen his claim for service connection for a psychiatric disorder in August 1987. The RO denied the veteran’s claim by means of a September 1987 rating decision. The veteran appealed the RO’s decision to the Board. In so doing, he claimed that he should be afforded the same presumption as those afforded veterans seeking entitlement to service connection for residuals of Agent Orange, and requested consideration of “Lalone v. United States (1896) 164 US 255, 41 Led. 425 17 S Ct. 74.” He also again claimed, in essence, that his psychiatric disorder had been wrongly characterized as a congenital or developmental defect. See Notice of Disagreement, received at the RO on September 29, 1987; Substantive Appeal, received at the RO on December 29, 1987. In March 1988, the veteran submitted a statement from C. Melvin Corbett, M.D. dated in February 1988. Dr. Corbett stated that the veteran sought treatment for left-sided chest pain at the Family Medicine Clinic of Carraway Methodist Hospital in February 1988. The Board denied the veteran’s petition to reopen his claim of entitlement to service connection for an acquired psychiatric disorder in July 1988. In June 1988, the veteran sought to reopen his claim for service connection for cardiovascular disease. In conjunction with his claim, he submitted to the RO medical records from Carraway Methodist Medical Center showing that he was treated for myocardial ischemia in March 1988. The veteran was then transferred to the VAMC in Birmingham, Alabama for treatment from March to April 1988. Discharge diagnoses included coronary artery disease, myocardial infarction and hypertension. These records were apparently not associated with the claims folder at the time of the Board’s July 1988 decision. The RO found that new and material evidence had not been submitted to reopen a claim for service connection for cardiovascular disease in August 1988. The RO notified the veteran of this decision on August 26, 1988, and he submitted a notice of disagreement on September 13, 1988. A statement of the case was not issued. The veteran requested reconsideration of the Board’s July 1988 decision in August 1988. The Board denied the veteran’s request in December 1988. The veteran again requested reconsideration of the Board’s July 1988 decision in December 1988. In January 1989, the veteran submitted numerous, duplicate copies of records. He also submitted one new item of evidence, a June 1986 SSA decision finding that he was entitled to widower’s insurance benefits based on disability effective from September 1980. In June 1989, the veteran submitted a claim for service connection for a psychiatric disorder to the RO. He submitted some duplicative copies of evidence, as well as some new photographs of himself with his boxing trophies and a picture of a boxing trophy. He also provided two newspaper articles concerning benefits for prisoners of war (POWs) and veterans exposed to ionizing radiation. He argued, in essence, that he should be entitled to the same legal presumptions as POWs and veterans exposed to ionizing radiation. The Board denied the veteran’s request for reconsideration of the Board’s July 1988 decision in January 1990. The RO found in March 1990 that new and material evidence had not been submitted to reopen a claim for service connection for a psychiatric disorder in March 1990. The RO notified the veteran of this decision on April 30, 1990. On June 27, 1990, the veteran submitted a notice of disagreement with this decision. There is no statement of the case concerning this issue of record. In January 1993, the veteran provided numerous duplicate copies of evidence, as well as an April 1988 letter from William J. Rogers, M.D. noting that he had recently suffered a heart attack. The veteran sought to reopen his claims for service connection for psychiatric and cardiovascular disorders in February 1995. In support of his claims, he submitted duplicate copies of many of his records to the RO, including copies of the articles concerning boxing and exposure to DDT and the product information on Dapsone and chloroquine. Additional evidence included a September 1995 VA treatment record showing a provisional diagnosis of angina and no findings of a psychosis or mood disturbance; a September 1995 VA report of hospitalization, showing diagnoses of status post non-Q-wave myocardial infarction, paranoid tendencies, type II diabetes mellitus and hypertension; and a September 1995 VA report of hospitalization, showing that the veteran was treated for coronary artery disease and hypertension. In July 1996 and subsequent written statements, the veteran stated that cardiovascular and psychiatric disorders were caused by exposure to DDT during combat service in Korea and to asbestos fibers and dust. He claimed that he was exposed to asbestos during service while working in boiler rooms, while working in warehouses storing ammunition, while working in a shipyard loading and unloading ships, while cleaning latrines and mopping decks aboard a ship, while spraying DDT pesticides both in Korea and in the United States, while using gymnastics equipment, and while sleeping in a bag lined with asbestos. The RO denied the veteran’s petition to reopen his claims of entitlement to service connection for psychiatric and cardiovascular disorders in March 1997. The veteran appealed the RO’s decision to the Board. The veteran submitted three pieces of medical evidence to the RO in March 1997. A December 1993 report of examination and statement from Anthony P. Ciulla, M.D. revealed that the veteran suffered from, in pertinent part, hypertension. David S. Bridges, M.D. diagnosed the veteran as having hypertension and ischemic heart disease in October 1994. And in July 1995, Darin K. Bowling, D.O. diagnosed the veteran as having hypertension and ischemic heart disease. In April 1997, the veteran further provided a VA hospitalization report dated from July to August 1996, showing diagnoses of unstable angina and small vessel coronary disease. In written statements received at the RO in April and May 1997, the veteran argued that his cardiovascular disease resulted from exposure to DDT and Malathion and the ingestion of Dapsone and chloroquine during combat in Korea. He also stated that he sprayed DDT pesticides while engaged in combat with the enemy. The veteran further argued in June 1997 that his psychiatric disorder resulted from his inservice boxing. He provided a July 1996 computed tomography (CT) of the head, which showed ischemic foci in the left internal capsule, left subinsular white matter and biparietal periventricular regions of uncertain age. The veteran testified at a personal hearing before the RO in July 1997. He stated that his psychiatric disorder resulted from his inservice boxing career and that his heart disease resulted from inservice exposure to DDT and Malathion and ingestion of Dapsone and chloroquine. In December 1997, the veteran submitted a photo-copy of a type-written transcription, allegedly taken from a publication of proceedings before the Department of Natural Resources of the State of Wisconsin in 1968 and 1969. The material included excerpts, allegedly from testimony provided by Alan Steinbach, M.D., concerning effects of DDT on the nervous system. Dr. Steinbach testified that exposure to DDT had a detrimental effect on the neurological system. The veteran also provided an excerpt concerning the work of Dr. William Deichman, a toxicologist. Dr. Deichman had allegedly performed autopsies on people who had died of terminal diseases, i.e., arteriosclerosis and hypertension, and had discovered that their fat tissue contained significantly higher concentrations of DDT and its metabolites than normally found in healthy individuals. The veteran waived the RO’s consideration of this evidence, as well as any evidence that had not been considered by the RO, pursuant to 38 C.F.R. § 20.1304(c). See Informal Hearing Presentation, dated March 20, 1998. The veteran has submitted numerous copies of duplicative evidence over the years, including copies of service medical and service personnel records, lay statements, articles, SSA records, and VA and private medical records, all of which have not been set forth specifically above for the sake of brevity. Legal analysis General Direct service connection may be established for a disability resulting from diseases or injuries which are clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. §§ 3.303(a), (b), (d) (1997). Establishing direct service connection for a disability which has not been clearly shown in service requires evidence sufficient to show (1) the existence of a current disability; (2) the existence of a disease or injury in service; and (3) a relationship or connection between the current disability and a disease contracted or an injury sustained during service. Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). In addition, the law provides that, in the case of any veteran who engaged in combat with the enemy in active service, satisfactory lay or other evidence of an injury incurred in service shall be accepted as sufficient proof of service incurrence of the injury if the evidence is consistent with circumstances of service and notwithstanding that there is no official record of service incurrence of the injury. 38 U.S.C.A. § 1154(b) (West 1991). Service connection may also be established for a current disability on the basis of a “presumption” under the law that certain chronic diseases that become manifest to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C.A. §§ 1110, 1112 (West 1991 & Supp. 1997); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a) (1997). Service connection for psychoses and cardiovascular disease may be established based on a legal “presumption” by showing that either disorder was manifest to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C.A. § 1112 (West 1991 & Supp. 1997); 38 C.F.R. §§ 3.307, 3.309 (1997). A personality disorder is not a disease or injury within the meaning of applicable legislation providing compensation benefits. 38 C.F.R. § 3.303(c) (1997). Service connection may not be granted for congenital or developmental defects unless they are subject to superimposed disease or injury during a veteran’s military service which results in disability. VAOPGCPREC 82-90 (July 18, 1990). Decisions on appeal to the Secretary are made by the Board and are final unless the Chairman orders reconsideration. 38 U.S.C.A. §§ 7103(a) and 7104(a) (West Supp. 1997); 38 C.F.R. § 20.1100 (1997). When the Board disallows a claim, the claim may not be reopened and allowed and a claim based upon the same factual basis may not be considered. 38 U.S.C.A. § 7104(b) (West 1991). In order to reopen a claim which has been previously finally denied, the claimant must present new and material evidence. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1997). VA must conduct a two-step analysis by determining, first, whether evidence is new and material. Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). “New evidence” is evidence that is not “merely cumulative” of other evidence on the record. Colvin v. Derwinski, 1 Vet. App. 171, 174 (1991). Evidence is “material” where “it is relevant to and probative of the issue at hand and where there is a reasonable possibility that, when viewed in the context of all the evidence, both new and old, it would change the outcome.” Wilkinson v. Brown, 8 Vet. App. 263, 267-68 (1995); Blackburn v. Brown, 8 Vet. App. 97, 102 (1995). VA is directed to consider the evidence that has been added to the record since the last final disallowance of the claim on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). The evidence must also be reviewed in light of the pertinent statutes and regulations. Wilkinson, 8 Vet. App. at 268. The Court has summarized the law on “step one” of the “reopening” process as follows: Hence, in order to warrant reopening a previously and finally disallowed claim, the newly presented or secured evidence must be not cumulative of evidence of record at the time of the last prior final disallowance and must tend to prove the merits of the claim as to each essential element that was a specified basis for that last disallowance of the claim. Evans, 9 Vet. App. at 284. Second, if that evidence is new and material, VA must review all the evidence, both old and new. Whether new and material evidence has been presented to reopen a claim of entitlement to service connection for a psychiatric disorder The last final disallowance of this claim is the July 1988 Board decision. 38 U.S.C.A. § 7103(a) (West Supp. 1997); 38 C.F.R. § 20.1100 (1997). The March 1997 rating decision is the subject of this appeal, and therefore it is not a final decision and does not constitute the last final disallowance of the claim. Moreover, the RO’s March 1990 denial of a petition to reopen a claim of entitlement to service connection for a psychiatric disorder did not become final as no statement of the case was issued after the filing of the June 1990 notice of disagreement. See Tablazon v. Brown, 8 Vet. App. 359, 361 (1995) (citing 38 U.S.C. § 7105(d)(1)); see also Archbold v. Brown, 9 Vet. App. 124, 129 (1996). Consequently, in this case the Board must determine if new and material evidence has been received since the July 1988 decision. At the time of the July 1988 decision, the evidence of record did not establish that the veteran’s current psychiatric disorder had its onset during service; that a psychosis was manifest to a degree of 10 percent within the first post-service year; or that the veteran’s current psychiatric disorder was related to any inservice event, including head injuries, exposure to DDT or ingestion of Dapsone or chloroquine. Thus, for the purpose of reopening the claim, the issue at hand is whether the veteran has a current psychiatric disability that was present during active duty, (i.e., was superimposed upon a personality disorder); or, if a psychosis, within one year thereafter; or whether there is any nexus or connection between any current psychiatric disability and the veteran’s active service. Much of the evidence, i.e., service medical records, service personnel records, SSA records, and private and VA medical records, is not new because it was in the claims file at the time of the July 1988 Board decision on the claim for service connection for a psychiatric disorder. This evidence also includes, in pertinent part, the articles submitted by the veteran concerning exposure to DDT and boxing, and the pamphlets concerning the adverse reactions to Dapsone and chloroquine. Although the Board did not expressly refer to all of this evidence in the July 1988 decision, pursuant to the presumption of regularity attending the official acts of public officers, it must be concluded that all relevant law and evidence was considered. Dolan v. Brown, 9 Vet. App. 358, 362 (1996). The veteran has also provided numerous lay statements, including testimony presented at a personal hearing in July 1997. These statements pertain primarily to the alleged etiology of his psychiatric disorder, including his contentions that it resulted from boxing, exposure to DDT, and/or ingestion of Dapsone and chloroquine. This evidence is cumulative and not new. See Paller v. Principi, 3 Vet. App. 535, 538 (1992) (distinguishing corroborative evidence from cumulative evidence). Moreover, the statements presented by the veteran with respect to the date of onset and etiology of his current psychiatric disorder are not competent as he lacks medical expertise and is not qualified to offer medical opinions. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Turning to the “new” evidence that has been received since July 1988, the veteran has provided: (1) medical records from Carraway Methodist Medical Center dated in March 1988; (2) a VA report of hospitalization from the VAMC in Birmingham, Alabama, dated from March to April 1988; (3) a June 1986 SSA decision; (4) newspaper articles concerning benefits for POWs and veterans exposed to ionizing radiation; (5) an April 1988 letter from William J. Rogers, M.D.; (6) a September 1995 VA treatment note; (7) two September 1995 VA reports of hospitalization; (8) a December 1993 report of examination and statement from Anthony P. Ciulla, M.D.; (9) an October 1994 report of examination by David S. Bridges, M.D.; (10) a July 1995 report of examination by Darin K. Bowling, D.O.; (11) a July 1996 CT of the head; (12) a VA hospitalization report dated from July to August 1996; and (13) excerpts, allegedly from testimony provided by Alan Steinbach, M.D. With regard to whether the new evidence is relevant and probative of the issue at hand in the case, the Board finds that the additional VA and private medical records (items 1, 2, 5, 6, 8, 9, 10, 11 and 12) are not. First, the overwhelming majority of these medical reports pertain to other medical complaints. Second, while some of these records do suggest the presence of a psychiatric disorder, they do not show that such a disability was present during active duty or, if a psychosis, within the first post-service year, but rather are limited to showing that the veteran was diagnosed with a psychiatric disorder many years after service. No medical examiner has ascribed the veteran’s post-service psychiatric disorder to any alleged event in active service, including his personality disorder, boxing, DDT, asbestos, or Dapsone or chloroquine ingestion. The medical evidence does not show that a psychiatric disorder, first demonstrated in 1980, is related to the veteran’s active service in any manner. While Alan Steinbach, M.D., noted that exposure to DDT had a detrimental on the neurological system, he did not indicate that it caused any psychiatric disorders. The items listed in (3) and (4) are not material because they fall short of creating a reasonable possibility of changing the result of the previous adjudication. The June 1986 SSA decision merely granted the veteran an earlier affective date for an award of widower’s insurance benefits based on disability. The two newspaper articles concerning benefits for POWs and veterans exposed to ionizing radiation have no bearing on the veteran’s claim as he was not a POW and he does not claim, nor does the record show, that he was exposed to ionizing radiation during service. Accordingly, the Board concludes that new and material has not been submitted to reopen the claim for service connection for a psychiatric disorder and the July 1988 Board decision remains final. 38 U.S.C.A. § 7103(a) (West Supp. 1997). The veteran’s representative has asked that the Board obtain an independent medical expert (IME) opinion. See Informal Hearing Presentation, dated March 20, 1998. When, in the judgment of the Board, additional medical opinion is warranted by the medical complexity or controversy involved in an appeal, the Board may obtain an advisory medical opinion from one or more medical experts. 38 C.F.R. § 20.901(d) (1997). In this case, the veteran has not come forward with any new and material evidence, i.e., medical opinion or evidence that supports his contentions, which are based on lay speculation on his part as to what he feels might have happened. There is no medical complexity or controversy involved. Accordingly, the Board does not find that an IME opinion is warranted. Where a claimant refers to a specific source of evidence that could reopen a finally denied claim, VA has a duty to inform him of the necessity to submit that evidence to complete his application for benefits. See Graves v. Brown, 6 Vet. App. 166, 171 (1994). VA has no outstanding duty to inform the veteran of the necessity to submit certain evidence, 38 U.S.C.A. § 5103(a) (West 1991), in this case, because nothing in the record suggests the existence of evidence that might reopen the finally denied claim for service connection for a psychiatric disorder. The RO has obtained all available VA and private medical records. Accordingly, the Board concludes that VA did not fail to meet its obligations with regard to this claim under 38 U.S.C.A. § 5103(a) (West 1991). Whether new and material evidence has been presented to reopen a claim of entitlement to service connection for cardiovascular disease The last final disallowance of this claim is the March 1982 Board decision. 38 U.S.C.A. § 7103(a) (West Supp. 1997); 38 C.F.R. § 20.1100 (1997). The March 1997 rating decision is the subject of this appeal, and therefore it is not a final decision and does not constitute the last final disallowance of the claim. The RO’s August 1988 denial of a petition to reopen a claim of entitlement to service connection for a cardiovascular disorder did not become final as no statement of the case was issued after the filing of the September 1988 notice of disagreement. See Tablazon v. Brown, 8 Vet. App. 359, 361 (1995) (citing 38 U.S.C. § 7105(d)(1)); see also Archbold v. Brown, 9 Vet. App. 124, 129 (1996). Moreover, the RO’s September 1986 denial of a petition to reopen a claim of entitlement to service connection for a cardiovascular disorder did not become final because the veteran was not provided notice of this decision. The veteran must be provided appropriate notice of a rating decision and of the steps he must take in order to appeal a denial of his claim. 38 U.S.C.A. § 5104 (West 1991 & Supp. 1997); 38 C.F.R. § 3.104(a); Best v. Brown, 10 Vet. App. 322, 325 (1997). Absent proper notice of the determination, there has been no opportunity for the veteran to initiate appeal of this issue through filing a notice of disagreement. Consequently, in this case the Board must determine if new and material evidence has been received since the March 1982 decision. At the time of the March 1982 decision, the evidence of record did not establish that the veteran’s current cardiovascular disorder had its onset during service; that it was manifest to a degree of 10 percent within the first post-service year; or that it was attributable to the inservice chest pain or swelling of the feet. Thus, the Board concludes that, for the purpose of reopening the claim, the issue at hand is whether the veteran’s current cardiovascular disease was present during active duty or within one year thereafter, or whether there is any nexus or connection between any current cardiovascular disability and the veteran’s active service. Turning to the evidence that has been received since March 1982, the veteran has provided: (1) his own lay statements containing various theories of causation of his cardiovascular disease, including exposure to DDT and Malathion, ingestion of chloroquine and Dapsone, oral surgery to remove a cyst, boxing head injuries, exposure to asbestos in sleeping bags and in each and every one of his duty assignments in the Army; (2) product information leaflets indicating that hypotension and EKG changes may rarely follow short-term administration of oral chloroquine; (3) newspaper clippings regarding the veteran’s in-service boxing activities; (4) a leaflet noting possible complications of Dapsone therapy; (5) a certificate from NPRC indicating that many records for service members discharged before 1960 had been destroyed in a 1973 fire at the NPRC; (6) a copy of a June 1981 SSA decision of entitlement to a period of disability commencing in March 1979; (7) a December 1982 diagnosis of intermittent explosive disorder, rule out antisocial personality disorder from Dr. Fiks; (8) a January 1983 diagnosis of hypertensive cardiovascular disease, angina, and personality disorder from Dr. Eriksen; (9) an article on the effects of boxing, including brain damage; (10) a December 1985 decision of the SSA awarding widower’s benefits as a result of, in part, hypertensive cardiovascular disease; (11) a service personnel excerpt showing that the veteran engaged in boxing; (12) morning reports showing temporary assignments in 1953, 1954, and 1955; (13) photocopies of photographs and of medals; (14) a newspaper article about the effects of DDT on high blood pressure; (15) a letter from Dr. Corbett saying that the veteran had left- sided chest pain in February 1988; (16) records showing treatment for myocardial ischemia, coronary artery disease, myocardial infarction, and hypertension in March and April 1988; (17) a June 1986 SSA decision awarding widower’s benefits effective from September 1980; (18) newspaper articles concerning benefits for former POWs and veterans exposed to ionizing radiation; (19) an April 1988 letter from Dr. Rogers indicating that the veteran had recently had a heart attack; (20) VA records dated in 1995 showing treatment for coronary artery disease, hypertension, and status post non-Q-wave myocardial infarction and in 1996 with diagnoses of unstable angina and small vessel coronary disease; (21) medical records dated in 1993, 1994, and 1995 reflecting diagnoses of hypertension and heart disease; (22) testimony at a personal hearing; (23) a typescript allegedly taken from published proceedings of the Wisconsin Department of Natural Resources containing a reference to levels of DDT in the body fat of persons dying of terminal diseases; and (24) numerous duplicates of service medical excerpts, statements, articles, SSA records, and VA and private medical records. Duplicates of medical records, statements or articles (24) are by their nature not new, and they do not serve to reopen the veteran’s claim. To the extent that the veteran’s statements and testimony ((1) and (22)) reiterate his belief that his cardiovascular condition or hypertension had their onset in service, they are not new. To the extent that the veteran has articulated new theories by which his cardiovascular disease might related to his service, those statements are new. The veteran is, however, a lay person who is not competent to offer testimony on matters requiring medical expertise, such as medical diagnosis or causation. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Therefore, his theories that his heart disease was caused by exposure to pesticides, by drug therapy for malaria or leprosy, because of oral surgery, or because of boxing head injuries or exposure to asbestos in sleeping bags are not material. Product information about chloroquine and Dapsone ((2) and (4)) is new, but not material. Whatever the possible side- effects of these drugs may be, there is no medical evidence that the veteran took either of them in service, and the veteran is not competent to testify as to the chemical nature of any medications he might have taken in service. Information as to their possible side-effects is not material. Likewise, the newspaper article (14) and excerpt from proceedings before a Wisconsin State agency regarding DDT (23) are new, but not material. Product information, articles, and agency proceedings do not relate specifically to this veteran’s medical condition. Even assuming that the veteran was exposed to each of these substances in service, the articles do not provide competent medical nexus evidence linking this individual’s current cardiovascular condition with such exposure. Cf. Libertine v. Brown, 9 Vet. App. 521, 523 (1996) (medical treatise evidence does not demonstrate a causal relationship between the appellant’s psychiatric disorder and his substance abuse). Information regarding the appellant’s participation in boxing during service and on the effects of boxing (items (3), (9), (11) and (12)) are not new to the extent that they show the appellant engaged in boxing during service. To the extent that they deal with possible adverse consequences such as head injuries, they are new, but not material. As with the general evidence cited above regarding the effects of DDT or drugs, articles on the dangers of boxing do not provide evidence linking the appellant’s boxing to his current cardiovascular disease. As they do not raise a reasonable possibility of a different outcome, they cannot serve to reopen this claim. The NPRC certificate regarding fire destruction of some service medical records (5) is new but not material. The veteran’s service medical records had been associated with a claims folder established for him by VA long before the 1973 fire at the NPRC. The various SSA determinations of disability (items (6), (10), and (17)) are new, but not material. They reflect determinations of disability by SSA, in part because of cardiovascular disorder, but they do not contain any finding attributing cardiovascular disease to service. Dr. Fiks’ psychiatric diagnosis (7) is irrelevant to the appellant’s claim for cardiovascular disease, and it is not material to reopen the claim. Medical records reflecting diagnosis or treatment of cardiovascular disease (items (8), (15), (16), (19), (20), and (21)) are cumulative to the extent that they reflect continuing need for treatment for cardiovascular disorders. To the extent that they reflect the progress of the disease and treatment received, they are new. However, they do not raise a reasonable possibility of changing the outcome of the earlier denial of service connection. None of the medical records offered in any way associates the veteran’s heart disease with any disease or injury in military service. It is not disputed that the veteran has cardiovascular disease. Continuing treatment for this disease does not make it more likely that the disease may be attributed to military service. Photocopies of photographs of boxing awards and medals (13) are new, but not material. Service awards, whether indicative of combat service or not, do not have a bearing on an issue such as medical causation, which requires medical expertise and competence. They do not raise a reasonable possibility that the veteran’s cardiovascular disease might be related to his military service. Likewise, articles about benefits for former POWs and veterans exposed to ionizing radiation (18) are new, but not material. The veteran is not a former POW, nor is there any evidence that he was exposed to ionizing radiation. These articles do not raise a reasonable possibility of a different outcome in the denial of service connection for cardiovascular disease. As new and material evidence has not been submitted, the appellant’s claim of entitlement to service connection for cardiovascular disease is not reopened, and the March 1982 Board decision remains final. 38 U.S.C.A. § 7103(a) (West Supp. 1997). As with the claim to reopen for service connection for psychiatric disorder, the veteran’s representative requested an independent medical expert (IME) opinion pursuant to 38 C.F.R. § 20.901 (1997). As the veteran has not presented evidence that is both new and material to reopen his claim of entitlement to service connection for cardiovascular disease, there is no medical complexity or controversy to be resolved by an IME, and the request for such opinion is denied. Nothing in the record suggests that there might be evidence that might serve to reopen the claim of entitlement to service connection for cardiovascular disease, and there is no outstanding duty to inform the veteran of the need to submit any evidence under 38 U.S.C.A. § 5103(a). ORDER New and material evidence not having been submitted, the claim of entitlement to service connection for a psychiatric disorder is not reopened, and the appeal is denied. New and material evidence not having been submitted, the claim of entitlement to service connection for cardiovascular disease is not reopened, and the appeal is denied. J. SHERMAN ROBERTS Member, Board of Veterans’ Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1997), 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 -