Citation Nr: 0007647 Decision Date: 03/22/00 Archive Date: 03/28/00 DOCKET NO. 95-03 117 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado THE ISSUES 1. Whether new and material evidence has been submitted in order to reopen a claim of entitlement to service connection for a psychiatric disorder (other than a post-traumatic stress disorder (PTSD)). 2. Whether new and material evidence has been submitted in order to reopen a claim of entitlement to service connection for back disability. 3. Entitlement to service connection for a skin disorder, claimed as chloracne, as secondary to exposure to Agent Orange. 4. Entitlement to service connection for a pulmonary disorder, as secondary to exposure to Agent Orange. 5. Entitlement to service connection for PTSD. 6. Entitlement to benefits under the provisions of 38 U.S.C.A. § 1151 for disability related to VA medical treatment. REPRESENTATION Appellant represented by: Colorado Department of Social Services WITNESSES AT HEARING ON APPEAL Appellant and his mother ATTORNEY FOR THE BOARD G. Wm. Thompson, Counsel INTRODUCTION The appellant had active military service with the United States Navy from November 1, 1968, to December 23, 1968. He also had a period of service with the United States Army from May 3, to August 22, 1978, which was voided by the Army because of a fraudulent enlistment. This case was previously before the Board of Veterans' Appeals (Board) and remanded for further development in December 1997. The requested action has been completed to the extent possible, and the case has been returned to the Board for further appellate consideration. The record shows that every reasonable effort was made to secure additional records, and that Stegall v. West, 11 Vet. App. 268 (1998) is not for application. The appellant provided testimony before the undersigned member of the Board sitting at Denver, Colorado, in June 1997. It was noted in the December 1997 remand, that the appellant had raised the issue of service connection for organic brain syndrome, considered to be an issue separate and apart from the psychiatric disorder issue on appeal. The RO was to treat this issue de novo. A rating action in November 1998 denied service connection for organic brain syndrome. Although the Board cannot find a specific notice of disagreement for this issue, it was made a part of the November 1998, and September 1999 supplemental statements of the case (SSOC). The SSOC's constitutes no more than notice of the rating action, and absent a notice of disagreement (NOD), this issue is not before the Board. 38 C.F.R. §§ 19.25, 20.200 (1999). It was also pointed out in the December 1997 remand that the appellant has also raised the issues of service connection for cellulitis of the feet. The cellulitis of the feet issue was treated in rating actions in November 1998, and December 1999, with no NOD in file. As pointed out above, absent a NOD, the issue is not before the Board. FINDINGS OF FACT 1. In a decision in dated in December 1985 the Board denied the veteran's claims for service connection for a back disability, arthritis, and a psychiatric disorder. 2. In a decision in dated in September 1990 the Board held that the evidence added to the record since the December 1985 decision did not establish the onset or aggravation of a chronic back disability during service, or arthritis of the lumbosacral spine within the one-year presumptive period post service, or the onset or aggravation of a chronic acquired psychiatric disorder during service. 3. Evidence submitted since the last final Board decision consists primarily of evidentiary assertions by the appellant, and cumulative and duplicate medical evidence. 4. The evidentiary assertions by the appellant are not new as they are redundant, duplicative, and cumulative of evidence previously submitted; to the extent the testimony by his mother is new, it is not material as she has no medical expertise and her testimony by itself or in connection with evidence previously assembled is not so significant that it must be considered in order to fairly decide the merits of the claim. 5. There is no competent medical evidence that the appellant has a skin disease subject to presumptive service connection based on exposure to herbicide agents; and there is no competent medical evidence of any relationship between any post-service skin problems and any Agent Orange exposure in service or any other incident or event of service. 6. There is no competent medical evidence that the appellant has a pulmonary disorder subject to presumptive service connection based on exposure to herbicide agents; and there is no competent medical evidence of any relationship between any post-service pulmonary problems and any Agent Orange exposure in service or any other incident or event of service. 7. There is no competent medical evidence of PTSD related to any incident or event of service. 8. There is no competent medical evidence of any additional disability related to VA medical treatment. CONCLUSIONS OF LAW 1. The September 1990 Board decision is final as to the claims of entitlement to service connection for a back disorder and a psychiatric disorder. 38 U.S.C.A. § 7104 (West 1991); 38 C.F.R. § 20.1100 (1999). 2. New and material evidence to reopen the veteran's claims for service connection for a back disorder and a psychiatric disorder has not been submitted; the claims are not reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1999). 3. The appellant's claim for service connection for a skin disorder, claimed as chloracne, secondary to Agent Orange exposure is not well-grounded. 38 U.S.C.A. § 5107(a) (West 1991). 4. The appellant's claim for service connection for a pulmonary disorder, claimed as secondary to Agent Orange exposure, is not well-grounded. 38 U.S.C.A. § 5107(a) (West 1991). 5. The appellant's claim for service connection for PTSD is not well-grounded. 38 U.S.C.A. § 5107(a) (West 1991). 6. The appellant's claim for benefits under the provisions of 38 U.S.C.A. § 1151 for disability related to VA medical treatment is not well-grounded. 38 U.S.C.A. § 5107(a) (West 1991. REASONS AND BASES FOR FINDINGS AND CONCLUSION Given the interlocking nature of the issues on appeal, and the expanse of evidence running through 8 volumes, that often contain material germane to all issues, the Board will present the evidence, chronologically in each volume, to preserve continuity and for ease of review. Pertinent elements of evidence will then be discussed with review and analysis of each issue. Volume I. The appellant was born in August 1949. In January 1954, when he was 4 years of age, he was struck by an automobile while walking. He was hospitalized for multiple fractures, numerous broken teeth, lacerations to the face and lip, multiple contusions, and shock. In April 1955 he was hospitalized for a moderate cerebral concussion. In November 1957 he was hospitalized for primary mental retardation and cephalalgia on a secondary basis. Records dated in 1960 reflect that he was having difficulty with school work and that he suffered organic brain damage reportedly in the area of the brain that controls motor coordination. He was hospi- talized in February 1963 for epileptiform seizures. It was noted that he was 13 years old and had had a long and rather unusual history of bodily injuries since the age of 4 or 5. His symptoms were reported to be suggestive of focal epilepsy and Jacksonian epilepsy. The report of the appellant's examination for enlistment in the United States Navy in September 1968 reflects that he denied difficulty with school studies or teachers. He did report a history of broken bones, but did not note any residuals of serious accident or head injury prior to enlistment. Service medical records for the appellant do not reflect any complaints or findings pertaining to back, skin, or pulmonary disorders. He was treated for cellulitis of both feet in November 1968. He was examined in connection with an unsuitability discharge on December 18, 1968. The examination was negative except for defective vision. A chest x-ray was negative. A Report of Aptitude Board, dated December 19, 1968, reflects that the appellant had spent fourteen days in a dispensary and seven days in the Special Holding Company. He was referred for psychiatric evaluation by a medical officer. To assist in the evaluation a full progress report was submitted by his Company Commander, characterizing the appellant's progress and performance as poor, and downhill. The appellant was described as a sick bay addict, unreliable, disobedient, a wise guy, over boisterous, a physical weakling, sad, depressed, needing repeated instruction, and never getting anything done right. Psychiatric evaluation revealed a recruit who had been under psychiatric care since a car accident in 1954. Before he entered service he had tried to hang himself once, and was an admitted kleptomaniac of women's clothing. He had spent two weeks on Ward A because of physical ailments, which at this time seem to be getting better. If he returns to his company he would face charges for being absent without leave (AWOL). During psychological examination he easily revealed himself as a belligerent person, impulsive, and lacing motivation to remain in the Navy. It was strongly recommended that the be discharged as unsuitable for further training. It was recorded that he had no mental or physical disability that would warrant his discharge by reason of physical disability. He was discharged December 23, 1968, with an honorable discharge by reason of unsuitability. The appellant filed an application for disability benefits in August 1969, listing cellulitis as the condition for which the claim was made. He made no reference to a psychiatric disorder, back problem, skin problem or pulmonary disorder. The appellant was treated at a VA outpatient clinic in July 1970. At that time he underwent an excision of a cyst in the neck area. It was remarked that there were multiple areas of drainage. The appellant, in a statement dated in January 1971, reported that he entered service October 31, 1967, and believed that he had been confused with an [redacted], who served in boot camp with him. Medical records from the appellant's voided period of military service in 1978 show that when he was examined for service in April 1978 he denied that he had ever been rejected for military service or been discharged from military service because of physical, mental, or other reasons and he denied that he had ever applied for compensation for existing disability. He reported a history of a right inguinal hernia repair in 1974 and examination revealed a surgical scar on his right knee. Medical records were obtained which reflect that he had undergone a right lateral meniscectomy in May 1977 at the VA hospital in Denver, Colorado. The appellant entered service with the United States Army on May 3, 1978. The appellant was seen at the dispensary in May 1978 for blisters involving both feet. He was treated in June 1978 for rope burns involving the left hand. It was reported that there was a vascular rash with drainage, edema or plaques on both arms. The rash was pruritic in nature. The assessment was friction burns and poison ivy. At the time of the June 1978 separation examination, the appellant reported no history of problems involving the skin, back or lungs, or a psychiatric disorder. The examination showed no pertinent abnormality. A chest x- ray was negative. An August 1978 report of a mental status evaluation reflects that the appellant had no psychiatric diagnosis. He was psychiatrically cleared for administrative action. An entry dated August 4, 1978, reflects that he was seen for routine evaluation for "Chap 14. Failed to list prior service with USN x 10 years ago. Received non- waiverable reenlistment code. Cleared for admin action." The appellant was released from service on August 22, 1978. The Report of Separation from Active Service (DD Form 214) reflects that his time in service was voided and he was credited with no active service. In a May 1979 Administrative Decision, the RO determined that the appellant's service from May 3 to August 22, 1978, was under dishonorable conditions for VA purposes and was a bar for the payment of benefits. It was reported that the appellant was entitled to have care under Chapter 17, of Title 38, United States Code, for any disabilities determined to be service connected. In file are VA clinic records, from 1975 to December 1983. A neurology record from May 1975 noted headache complaints from 1972, with EEG abnormality. History as reported by his mother was to the effect the appellant was in a serious automobile accident at age 4, with poor motor coordination thereafter. Further, testing in the first grade was said to have demonstrated brain damage without loss of verbal ability. The assessment was that he was depressed and frustrated secondary to his inability to find employment suitable for his underlying handicap. In July 1981, he reported back pain for the prior year. In October 1982, the assessment was right leg and knee pain secondary to scoliosis. He was evaluated at a VA orthopedic clinic in January 1983 complaining of low back pain which began from a lifting injury one year earlier. An April 1983 VA electroencephalographic report was interpreted as "probably within normal limits." Neurology evaluation in May 1983 noted complaints of headaches, memory problems and difficulty with retention. Mental status examination found no abnormality. In June 1983 he was involved in a car accident. Also in June he complained of a rash associated with concrete. A July record noted that he hit his head hard on the steering wheel in the car accident, and since then felt his headaches were worse. In September 1983 he reported that his back was progressively worse for 2 years. X-rays of the lumbosacral spine conducted in September 1983 showed degenerative changes involving the lumbosacral spine and minimal slippage involving the L5 - S1. The assessment was chronic recurrent mechanical low back pain and anxiety disorder. In December 1983 the appellant was evaluated at a VA pain clinic for low back and neck pain. The appellant reported that his back and neck pain began approximately four years earlier following lifting a heavy object while employed at a cement company. His pain was deep and constant and was exacerbated by cold and exertion. His pain interfered with his sleep and an active social life. Another source of pain was constant bilateral frontal headaches which he had had for 15 years. He was in an automobile accident at the age of five and sustained a head injury with a loss of consciousness for three days. He was later diagnosed as having a learning disability from his head injury. He reported that in November 1971, he was struck in the right temple by a heavy pipe which fell from three feet. This resulted in his being hospitalized. He had been involved in an automobile accident in June 1983 and struck his head at the steering wheel but did not lose consciousness. A CAT (computed axial tomography) scan in August 1983 revealed "cavieum velum intraposetum." It was noted that a previous CAT scan several years before was negative. Pervious EEG's had found a slow wave focus on the left posterior temporal. Background information in December 1983 noted recitation by the appellant of mistreatment by his father, teachers, and classmates, as well as by others while he had been in the military. He reported being beaten by his father, and related a somewhat 'bizarre story" to explain his brief enlistment in the Navy, which his mother corroborated. He was given the wrong shoe sizes, which caused cellulitis. Because he was unable to perform at the level of the others in his company, he was beaten by a pipe which was rolled into a towel and was given a GI shower which involved his skin being scrubbed raw with a brush. He was forced to perform jumping jacks with a mattress over his head. His company commander refused doctor's orders which allowed him to wear tennis shoes and refused to transfer him to another company. He entered the Army for a second enlistment and approximately two weeks prior to his completing basic training, he consulted an attorney when finding that his classification as not enlistable had not been removed, which had contrasted with the recruiter's comments. He was then promptly discharged from the military. Psychological testing in December 1983 revealed strong evidence that the appellant channeled psychological conflict into somatic complaints. Several tests indicated a great deal of emotional distress. The assessment was that the appellant was angry, depressed, and bitter, and perceived himself as getting a raw deal out of life. His emotional problems were long standing. He had difficulty in processing information, possibly because of organic involvement, and this impairment contributed to his suspiciousness. He was extremely dependent on his mother and experienced conflict over this dependency. VA neuropsychological evaluation was performed in January 1984. History as provided by the appellant was essentially as before. It was noted that in July 1982 he suffered cardiac arrest, and was unconscious for 20 hours. The Halstead impairment index was 1.0, which is characteristic of individuals with documented cerebral lesions. Analysis of performance on a battery of tests yielded an overall picture of mild to moderate, fairly generalized, cerebral dysfunction. There was discussion of implication for everyday functioning. MMPI (Minnesota Multiphasic Personality Inventory) did not yield a valid profile. The appellant's application for disability benefits in February 1984 listed scoliosis-degenerative arthritis-mental process degeneration in certain area November 27, 1968" as the conditions for which the claim was made. An accompanying 6 page typewritten letter from the appellant noted a EEG (electroencephalogram) at a private hospital in February 1969, a brain scan at a VA medical facility concerning bad headaches from 1968 to 1974, arthritis and loss of hearing due to beatings and physical abuse in the Navy, and orthopedic evaluation at a Navy Hospital from October 31, to December 23, 1968, which showed the left leg to be shorter than the right leg. He reported being beaten with a pipe wrapped in a towel and with a rubber hose, and being scrubbed raw with brushes. He was made to do jumping jacks with a mattress over his head, push-ups with a foot in his back and a rifle over his fingers with a person standing on the rifle. He claimed that the beatings started the degeneration in his back. Mental health problems were found by the VA on testing in 1975 and 1984. Further, the records from Greeley County hospital do not show that he was under psychiatric care after the accident in 1954, what the psychiatrist in service said about this was a lie, and the first EEG in February 1969 showed brain damage, which he did not have before the military. He essentially repeated the above in another typed 6 page letter in March 1984. Received in April 1984 were copies of medical records from St. May-Corwin Hospital, showing treatment for the appellant in February 1969. It was noted that approximately 6 months before, in August, while working at Fort Collins, he was lifting two 150 pound containers of meat and noted difficulty with his back but no pain. The pain developed 2 days later. While in the Navy in October 1968, he was hospitalized because of back pain, with no therapy or x-rays. He was unsure whether his discharge in December 1968 was a medical discharge, for he was psychologically unadaptable to the Navy. He was tense and anxious. He also reported that since the age of 4, after an automobile accident, he had episodes of a complex characterized by feelings of dizziness, often followed by a brief period of syncope. X-ray studies of the lumbosacral spine were negative. Brain scan was negative, and EEG findings were within the range of normal. The pertinent diagnoses after examination, were probable chronic low back syndrome with low back muscle and ligamentous strain, and question of convulsive disorder characterized by episodes of vertigo and syncope. When discharged later in February, the final diagnosis was hyperventilation syndrome, and associated diagnoses were tension, anxiety reaction, and unstable back syndrome. Also received was a private medical report showing the appellant had been hospitalized in January 1954 for a fracture of the right radius, right ulna displaced, a fracture of the right femur, displaced, and a fracture of the maxilla and numerous teeth. There were lacerations to the face, lip, multiple contusions, and shock. Treatment included a bronchoscopy with aspiration of the bronchial tree. In April 1955 he was hospitalized for a moderate cerebral concussion. He was hospitalized in February 1963 for epileptiform seizures. By rating action in June 1984, service connection was denied for a chronic back disorder, arthritis, and a nervous condition. The appellant was notified of that determination and his appellate right in July 1984. The appellant, in a statement in August 1984, requested a hearing and recounted how his feet were injured in service, and he asserted that the psychiatric information in the Navy records is untrue. He also recounted his mistreatment in service. In hearing testimony in December 1984, the appellant testified that the beatings he received in service involved his back and head, and while working in the cafeteria, he lifted a couple of buckets of meat and fell against a steel tank. This occurred about the 20th of December, 1968, Transcript(T.) pp. 3 and 4. He reported that he had no problems getting along with others prior to service, and that the beatings caused his nervous and psychiatric problems, T. p. 5. It was recorded that he saw a doctor for his back for 3 consecutive days in December 1968, before he was released from service, and that his back problems continued after service. In 1972 his scoliosis was found at a VA hospital, and just recently he was found to have arthritis of the back, T. pp. 7 and 8. The appellant reported that while in Mr. A.'s company, from November 22-30, 1968, he was beaten 4-7 times, with the beatings lasting half an hour. When he was discharged he had bruises up and down his back from the beatings, T. 9, 10. The appellant, in a statement in January 1985, again reported that the psychiatric report in service that a psychiatric condition existed prior to service was not supported by any evidence, and was not based on fact. Associated with his statement was a letter from the Navy, dated in July 1984, noting that a search of records disclose no records pertaining to the appellant, and that he had already received copies of all records maintained at the national Personnel Records Center (NPRC). An additional letter from the Naval Investigative Service noted that a search of files failed to locate any record in the appellant's name, which meant that an investigation had never been conducted. In file are 2 separate multi-page letters from the appellant, received in April 1985. These letters addressed the appellant's concerns over his service records, calling to attention what he felt were discrepancies between the material in the files, his account of events, and the lack of corroborating data. The appellant's April 1985 substantive appeal was essentially a repetition of the other two April statements. He again pointed out that the tests referred to by the psychiatrist were not of record. The appellant repeated his arguments and contentions in an 11 page letter received in June 1985. He followed this with a 9 page letter in August 1985. In that letter he referred to delayed stress symptoms as reported in a DAV pamphlet. A 19 page letter was received in October 1985. The appellant disputed information reported in his VA files, concerning the cause of his headaches, the diagnoses, and what was causing his back pain. He also visited his contentions concerning the Navy files. In a 5 page letter in November 1985, he again set forth his contentions concerning his claim. In a decision in dated in December 1985 the Board denied the veteran's claims for entitlement to service connection for a back disability, arthritis, and a psychiatric disorder. In its discussion and evaluation of the evidence, the Board stated the following: The veteran is seeking service connection for a back disability. The first clinical documentation of a back disability is presented by a hospital report for a period of hospitalization in early 1969. At that time, a history of a preservice back injury was noted. The veteran also reported at that time that he had been treated during service for back pain. His separation physical examination, however, shows that back was normal. Given the veteran's short period of service and the fact that his service medical records are negative for any complaints, treatment or findings concerning a back disability, we find that a reasonable basis has not been presented upon which we can conclude that the veteran's back disability is attributable to service. The veteran is also seeking service connection for arthritis. The evidence shows that the arthritis was not manifested until many years after separation from service. Accordingly, service connection for arthritis must be denied. The veteran is also seeking service connection for a psychiatric disorder. The exact nature [of the appellant's] present psychiatric disorder has not been made clear. He has reported that he was told that he had a personality disorder. This is substantiated by his history of pre-service psychiatric symptoms. The post service outpatient treatment records also indicate the presence of a personality disorder. A personality disorder is a congenital or developmental abnormality for which service connection cannot be granted. An anxiety disorder was first demonstrated many years after service. On the basis of the veteran's short period of service and the nature of his disorder, we find that the veteran's psychiatric disorder, however classified, is not attributable to service. The appellant in a letter recounting his contentions, received in January 1986, included copies of military records and regulations. An undated, unsigned record showed denial of any prior psychiatric problems, and a document reporting recommendation for discharge due to unsuitability was highlighted. Received in August and September 1986 were private and VA medical reports. Of record is a copy of the private hospital report regarding the treatment the appellant received following the automobile accident in January 1954. Also received was a copy of April 1960 conference notes regarding the appellant's school work. At that time it was reported that the appellant was having difficulty in school, displayed temper, took things that did not belong to him, and felt less worthwhile because he was "not too sharp." There was evidence that he suffered organic brain damage as a result of an accident. This brain damage is in the area of the brain that controls motor coordination, known as motor aphagia. An August 1982 private psychological report indicates that the appellant had a learning disability. He received intermittent treatment at a private facility during 1986 for back and neurological complaints. The impressions rendered in May 1986 were mild to moderated fairly generalized cerebral dysfunction by history, headaches due to tension and old head injuries, chronic back pain with a large amount of functional overlay per old records, and short leg on the left side. In file are several letters from the appellant received prior to December 1986. Accompanying a letter received in September 1986 was a copy of a record pertaining to discharges for unsuitability because of personality disorders or mental retardation. In September 1986 the appellant filed a claim for disability benefits for chronic brain syndrome, arthritis, scoliosis, borderline mental retardation, and passive aggressive personality disorder. Associated with the September 1986 claim was another portion of the private records associated with his accident in 1954. The record noted cerebral concussion, and a hand written annotation was to the effect the appellant had the organic brain syndrome before he entered the military. Received in January 1987 was a copy of the first page of a letter from the appellant to Chief of Navy Personnel, dated August 10, 1972. The letter started out explaining how boots issued in a small size caused all of his military problems. Associated with the above were records, most of which were either duplicative or redundant of material previously submitted. The appellant, in a statement in May 1987, reported that chronic brain syndrome, organic brain syndrome, learning disability, S-type scoliosis (due to left leg shortening), were caused by the accident in 1954, and were aggravated by his military duty. He pointed out that the preexisting disorders were not shown on enlistment examinations in 1968 or 1978. Also received in May 1987 was a copy of a VA progress note, dated November 14, 1975, indicating that the appellant had rather severe limitations due to brain damage "that may date back to age 4." There was also another record associated with the accident in 1954. The appellant, in a multi-page letter received in July 1987, made reference to Social Security Administration (SSA) benefits, and VA domiciliary care. Received in August 1987 were copies of VA regulations, apparently high-lighted by the appellant. In a multi-page letter received in September 1987 he indicated that he should be entitled to VA domiciliary care, as the State of Colorado found him permanently and totally disabled due to organic brain syndrome. The RO, in a letter to the appellant in October 1987, addressed the December 1985 Board decision, the requirement for new and material evidence, his claim for pension benefits, and the hearing that he missed. The appellant, in multiple page letters received in October and December 1987, complained of the treatment he had received, and the denial of benefits that he was due. In February 1988 he reported that he was a qualified handicapped person, eligible for benefits. He filed a separate letter, also dated in February 1988. In June 1988 the appellant submitted a host of material, most of it duplicative or redundant of material previously submitted. However, there was included a psychiatric evaluation dated in August 24, 1984. The background provided by the appellant and his mother was essentially as previously reported. The Axis I diagnosis, tentative, was intermittent explosive disorder or question of organic personality syndrome with emotional lability, impulsiveness, temper outbursts, and verbose in speech and writing. The Axis II diagnosis was history of an oppositional disorder, 315.81; he had a problem with his father, and Navy authority figures, and now as a result he probably had a passive-aggressive type personality. Another letter from the appellant, also in June 1988, requested that the information in his letter be added to his file. He submitted another letter with is contentions in August 1988. The RO, in July and September 1988 informed the appellant that new and material evidence had not been submitted. In a letter in September 1988, the appellant requested a hearing. He was scheduled for hearing. The appellant and his mother provided testimony at a March 1989 hearing. It was reported that the issues were service connection for chronic back disability, and psychiatric disability by way of aggravation, and service connection for residuals of cellulitis. There was discussion of his brain injury in 1954, the changes in his personality after his service in the Navy, and that he was on Valium for 1 month and 23 days, T. pp. 2-4. He reported treatment for his back in the Navy during the two weeks he had been hospitalized. He had been seen at a clinic on a daily basis, and he was diagnosed with scoliosis, T. pp. 6 and 7. The appellant reported two weeks in a medical holding company, and 2 weeks in a hospital, for a total of 14 days. There was a finding of a personality problem, but according to the appellant, it was brought on by not treating the scoliosis and cellulitis, and not finding that he was dyslexic and had a learning problem, T. p. 8. He stated that he wanted rehabilitation training, T. p. 10. The appellant's mother testified that the appellant never received psychiatric treatment prior to the Navy, and contact only with one psychiatrist, Dr. F., who diagnosed an aphasic condition, T. p. 11. In a letter received in July 1989 the appellant again expressed his hostility toward the VA for not following, according the appellant, federal laws. In a certified statement dated in September 1989, the appellant referred to PTSD, and being hit by rifle butts. The appellant submitted additional arguments in support of his claims, in May, June, and August 1990. The appellant, in testimony before members of the Board, sitting at Washington, D.C., in July 1990, reported his mistreatment in service, and asserted that the beatings and physical abuse in service caused his nervous condition, T. p. 6. He reported being hit in the back of the head and forehead. It was also reported that he was hit in the back with a rifle butt, and that this caused his arthritis, T. pp. 7-8. In September 1990 the Board denied the appellant's claim for service connection for a back disability and a psychiatric disability. The Board found that the evidence added to the record since the decision of the Board in December 1985 did not establish the onset or aggravation of a chronic back disability during service, or arthritis of the lumbosacral spine within the one-year presumptive period post service, or the onset or aggravation of a chronic acquired psychiatric disorder during service. The Board's decision of September 1990 was affirmed by the United Stated Court of Veterans Appeals (now known as United States Court of Appeals for Veterans Claims) in a memorandum decision (U.S. Vet. App. No. 990-1271 (April 19, 1993)). The appellant submitted about an inch of correspondence in support of his claim in December 1992, including copies of VA regulations. Volume II. Received in October 1989 was a copy of a report from University Hospital which reflects that the appellant had a 5/8 inch leg length discrepancy due to his scoliosis. The appellant, in a letter received in June 1990, reported that while loading a ship he was bathed with a chemical from a drum punctured by a fork lift. He claimed service connection for Agent Orange exposure. In December 1990 the appellant submitted VA Form 21-526, noting delayed stress syndrome beginning in November 1968. Received in February 1991 was VA Form 21-2680 for the appellant, signed by M. B., M.D., showing traumatic brain injury with impaired reasoning, OBS (organic brain syndrome), unable to work. The diagnosis was traumatic brain injury. Attached for reference was a September 28, 1987, cognitive evaluation of the appellant, noted the closed head injury in 1954, the 1981 cardiac arrest due to iodine reaction, resulting in problems including memory deficits, "dysgraphia and dyscalcula," visual problems, difficulty following instruction, and difficulty with reading comprehension and retention. It was noted that he had received 3 years of cognitive retraining at a VA facility in Fort Lyon, Colorado. Reference was made to reports from other treating physicians, and cognitive evaluation results were set forth. Impressions and recommendations were also provided. In March 1991 the appellant was accorded psychiatric and physical examinations for disability evaluation purposes by the VA. The reports of these examinations reflect that the following history was noted: In 1954, the appellant was injured in a car/pedestrian accident, sustaining a severe head injury which resulted in unconsciousness for three days, a concussion, an injury to the right forearm and right femur which were fractured and the femur was shortened. After he entered the military in 1968, he was beaten up with a rubber hose and rifle butt and had a concussion. Later he was loading Agent Orange on ships when a forklift driver stabbed a barrel, bathing him in Agent Orange. He treated for 15 days at Balboa United States Naval Hospital. He was then sent to a medical holding area for seven days. His skin condition began at that time. He had an eruption mainly on the forehead and the inner aspect of the forearms and legs. He then lifted 250 pounds of frozen hamburger meat in the kitchen and injured his back, receiving treatment again at the Balboa Hospital. The diagnosis was pulled muscles in the back. He had scoliosis with short leg syndrome of the left leg. In 1969, he was diagnosed as having psychosomatic pain in the back and later diagnosed as having organic brain syndrome. An examination of the skin showed that the forehead had no rashes. The medial aspects of the inner arms had a very tiny punctate red rash. The thighs also had a fine red rash. The rash looked like folliculitis. An examination of the lungs was clear to percussion and auscultation. X-rays of the cervical spine showed no abnormality. X-rays of the lumbosacral spine showed minimal narrowing of the L5 - S1 disc space. The pertinent diagnoses were folliculitis with signs and symptoms described, insufficient clinical evidence at present to warrant a diagnosis of an acute or chronic disorder of the lumbar spine, residuals thereof, insufficient clinical evidence at present to warrant a diagnosis of any acute or chronic disorder or residuals thereof regarding the lungs. The appellant underwent a VA psychiatric evaluation. Following that examination, the diagnoses were organic personality disorder, competent, and dementia. In May 1991 the appellant filed a claim for VA vocational rehabilitation. In June and August 1991 he submitted letters asserting his position that appropriate laws had not been applied concerning his traumatic brain injury. Additional argument and material were submitted in October 1991. In January 1992 the appellant filed a claim for an "eye condition due to organic brain syndrome contamination by Agent Orange, and respiratory problems due to contamination through Agent Orange." In April 1992 the appellant presented additional arguments concerning his various claims and reported being on the Agent Orange register since 1976. Received in June 1992 was a SSA form for the appellant, dated in March 1986, showing disability determination, with primary diagnosis of organic brain syndrome, and secondary diagnosis of borderline personality. An additional form, dated in August 1986, shows a supplemental determination for an effective date of April 1970 as the onset of the appellant's disability. He was seen at a VA outpatient clinic in July 1992. The clinical history indicated that he had PTSD. A Report of Contact, dated in December 1992, noted that the appellant had inquired about DIC benefits based on his father's service in 1918. Also in file is a VA records envelope with a host of material submitted by the appellant, none of which is dated. The material includes, but is not confined to, the appellant's father's death certificate, copies of court decisions, copies of public laws, highlighted and annotated medical records, hand and type written contentions and allegations, and an annotated copy of the United Stated Court of Veterans Appeals memorandum decision affirming the September 17, 1990, Board decision, U.S. Vet. App. No. 990-1271 (April 19, 1993). It appears that at least some of the material was directed to a DIC claim, and other material towards his continuing claim for recognition of his mental problems as service induced. The Board has reviewed material submitted by the appellant in December 1992, and January 1993. In July 1993 the appellant submitted material to the President which was forwarded to the VA. The appellant cited Marbury v. Madison and multiple other court cases at various levels, and presented contentions concerning misapplication of laws. He also submitted copies of material previously submitted, with some new material from 1986 concerning evaluation for employability, apparently associated with his SSA claim. Volume III. In August 1994 the appellant filed a claim for benefits under 38 U.S.C.A. § 1151, noting that he had attached a personal statement and supporting documents for his claim. Associated material received the same day included an August 17, 1994, statement from the appellant to the effect that the VA facilities at Denver, Colorado, and Fort Lyon, Colorado, had aggravated his mental and physical conditions. It was not discernable from his writing just how this occurred, or the time frame involved. The RO, in a rating action in September 1994 found no new and material evidence to reopen a claim for service connection for a psychiatric disorder and back disability. Additionally, service connection was denied for folliculitis and a pulmonary disorder. In a multi-page missive in October 1994 the appellant recited his contentions in regard to disabled children of veterans. In November 1994 he referred to a claim for chloracne, and respiratory problems based on "presumed exposure to Agent Orange or other herbicides." He then discussed traumatic brain injuries and disabled children of veterans. In November 1994 the appellant submitted another VA Form 21- 526, apparently directed to an Agent Orange claim for chloracne, and bronchial problem. The RO, in December 1994, provided the appellant with a letter of explanation concerning his Agent Orange claims, his claim for benefits as a helpless child, and why his November 1994 letter was not considered an NOD. Volume IV. In file is a host of material received from the appellant in September 1994. The typed material and copies of regulations, and articles are redundant and cumulative of material previously submitted. He submitted additional material which he felt concerned handicapped people in February 1995. In March 1995 the appellant submitted a host of material in support of his claim. A great deal of the material was duplicative, redundant, or cumulative of material previously submitted. There was an August 25, 1982, orthopedic clinic record from University Hospital, noting low back and leg pain . It was recorded that the appellant said he had back pain for 3 years and believed it was caused over a period of time when he was shoveling as a laborer for an asphalt company, and that he was predisposed to the pain because of the left leg being 1 inch shorter than the right as a result of a motor vehicle accident in 1954. A private radiology report dated in June 1989, found mild degenerative disc disease L4- 5. An undated last page of a VA disability evaluation examination in Denver, Colorado, showed findings for the knees, and neurologic findings. Examination of the skin showed no rashes, and the skin was clear. The pertinent diagnoses included "[P]ossible exposure to toxic herbicides," and mild degenerative arthritis of the lumbosacral spine. The examination was signed by S. O., M.D. D. R., M.D., in a medical record dated August 20, 1991, noted that the appellant had cardiac arrest in 1981 with brain damage due to iodine reaction, and extensive chiropractic treatment since an accident in 1988. X-rays were interpreted as showing pelvic tilt and lumbar scoliosis. The diagnoses were short left leg, and myofascitis, cervical, thoracic, and lumbar spine. The examination report was signed by S. O., M.D. The RO, in a rating action in March 1995, found that the appellant's claim for benefits under 38 U.S.C.A. § 1151, was not well grounded. It was pointed out that his claim was not well grounded as he had not identified a specific disability as the result of treatment at a VA facility. He was provided with a copy of the rating action. The appellant's letter of March 1995, and material associated therewith, was construed by the RO as a NOD to the rating action in March 1995, which found that the appellant's claim for benefits under 38 U.S.C.A. § 1151, was not well grounded. Received in March 1995 was a copy of a VA letter dated March 24, 1987, noting that the appellant suffered brain trauma in 1975, and was in a cognitive rehabilitation program. A similar March 1995 letter from the appellant also noted disagreement with the finding that this claim was not well grounded. In material submitted in April 1995, the appellant continued his disabled child arguments and contentions. An October 1994 letter from the appellant, apparently received in June 1995, noted disagreement with an October 11, 1994, letter. The October 1994 VA letter referred to the denial of the Agent Orange claims, and 1151 claim. A June 1995 rating action found that new and material evidence had not been submitted to reopen a claim for service connection for folliculitis and pulmonary disorder due to Agent Orange, a back disorder, and that the 38 U.S.C.A. § 1151 claim was not well grounded. A statement of the case (SOC) was issued in August 1995, addressing the issues as shown on appeal. Volume V. Material submitted by the appellant in July 1995 included a copy of records from Children's Hospital dated in November 1957, with an admission diagnosis of convulsive disorder. The final diagnoses included primary mental retardation. An additional submission by the appellant in July 1995 appears to be directed to a claim for benefits as a disabled child of a veteran. The appellant's August 1995 substantive appeal was accompanied by a host of material, including court cases, articles, and typed and hand written contentions by the appellant. The appellant did refer to DIC benefits. A claim for PTSD was submitted by the appellant in August 1995. He reported being treated for this disorder in Denver and Salt Lake VA facilities. An attached VA progress note dated July 17, 1995, included reference to PTSD and degenerative changes in the spine. Apparently a PTSD consult was requested. VA clinic records, from March to September 1995, note treatment for a rash the appellant related to Agent Orange. The assessment was keratosis pilaris, and xerosis. A June 1995 record shows treatment for seborrheic dermatitis and a small area of superficial infection. Several days later in June, after spending time in the sun, he was seen for blisters on his feet, red spots on the right distal shin, and a rash on his face. The diagnostic impressions were blisters on feet due to ill fitting shoes; and first degree burn. In August 1995 he was seen again with dermatitis on the upper lip, arms, and legs. The appellant felt he had Agent Orange exposure. The assessment was seborrheic dermatitis. An August 29, 1995, dermatology clinic noted that the appellant presented for follow-up for questionable chloracne, "now presents with documentation of Agent Orange exposure and previous treatment." In September 1995 the appellant submitted additional material, including a survey of his medical problems. He submitted additional documents in November 1995 that appear to be concerned with perceived lack of adherence to court cases and rules concerning disabled persons. In October 1995 the appellant submitted a statement concerning aggravation of his back condition and organic brain syndrome. He repeated his stories concerning boots that were too small, cellulitis of the feet, and Agent Orange exposure. He also felt that his PTSD was due to the trauma in the retraining company. In association with the October statement were records of private treatment concerning his accident in 1954, an April 22, 1960, evaluation, and a record dated February 28, 1996, concerning evaluation of epileptic symptoms. The appellant's exaggeration concerning his achievements and his behavior problems in school were noted. The impression was a focus of cortical irritation in the left frontal parietal area. In December 1995 the appellant submitted documents apparently on behalf of a claim for benefits as a disabled child of a veteran. Similar statements were submitted in January, April, and May 1996. A VA consultation sheet, dated in February 1996, shows referral to a PTSD clinic, with a provisional diagnosis of PTSD. A February 21, "1995" note was to the effect the appellant was not eligible for "PCT" as he did not have combat experience. Volume VI. In May, June and July 1996, the appellant submitted copies of court documents, West Law documents, and allegations of discrimination against handicapped people. Similar documents and arguments were submitted in September and October 1996. A VA form 9 submitted by the appellant in November 1996 does not appear to address any of the issues on appeal. Submission of contentions and documents by the appellant in May and June 1997, were similar to those submitted in 1996. The appellant and his mother provided testimony before the undersigned member of the Board sitting at Denver, Colorado, in June 1997. The appellant testified that he was pursuing a class action suit, hence his submission of the Court Rules and Regulations of the Court of Veterans Appeal, and the petitions to be considered for "those Court cases." The appellant reported that he received benefits as a disabled child from SSA, that a court ordered SSA to pay him benefits as a dependent child, and that the court order should also be binding on the VA, T. pp. 3-4. He also reported that Dr. O. flatly stated that there was "possible exposure to Agent Orange," T. p. 7. He asserted that he was in boot camp for 8 1/2 weeks, beaten with a rifle butt in service, and sent to the hospital twice, and sent before a court-martial board and psychiatric review board, and then released from service, T. pp. 9-11. It was noted that he was hospitalized 2 weeks after he started basic training for cellulitis of the heels, T. p. 12. There was also recitation of his injuries in 1954, T. pp. 13-15. In regard to the 1151 claim, he asserted that he had additional disability as a result of the lack of VA orthopedic treatment from 1969 to 1997, T. p. 17. It was noted that his pulmonary problems were found after 1969, T. pp. 18-20. Additional documents were submitted by the appellant in July 1997, and April 1998. Volume VII. Statements submitted by the appellant in July and October 1997 appear to address his class action claim. Material submitted in December 1997 appears to address his claim for benefits as a dependent child of a veteran. Per the December 1997 remand, the RO, in March 1998 again requested military information concerning the appellant, from the National Personnel Records Center (NPRC). Material received from the NPRC in April 1998 was essentially duplicative of material already in file. Received in April 1998 were submissions from the appellant that included a mixture of VA and private medical records, copies of material which had previously been submitted, and multiple pages of arguments and contentions advanced by the appellant for the purpose of showing that he was not receiving benefits to which he was entitled, based on his SSA benefits. The records reflect that the appellant had been diagnosed with PTSD in July 1992, and that he had a past medical history of "OBS" and anoxia secondary to cardiac arrest. Also in July 1992 he was treated for tinea corpora of 3 days duration. Dermatology clinic findings in December 1994 did not include Agent Orange or chloracne. An EEG in May 1995 was abnormal due to the presence of increased beta activity and diffuse intermixed slowing. The increased beta activity was consistent with medication effect. The diffuse intermixed slowing was thought to represent diffuse cerebral dysfunction and was nonspecific with respect to etiology. The impression was possible premature ventricular contractions. A VA record dated September 20, 1995, noted PTSD symptoms, and episodes of questionable (undecipherable word) versus seizure. The assessment was questionable seizure (undecipherable word) versus (undecipherable word) with PTSD. In October 1996 he was seen at a dermatology clinic for treatment of rashes all over his groin, legs, sides, face, axillae, and lip. It was very itchy, and the appellant reported exposure to Agent Orange in Vietnam. The assessment was tinea cruris. He was treated for tinea again in December 1996, and January 1997. In March 1997 the assessment was hypersensitive skin, and in March 1998, the assessments were AK (actinic keratosis) right temple; pruritus xerosis; and perioral dermatitis. Neuropsychological evaluation in November 1991 recounted findings and conclusions of the testing, with no opinion as to incurrence or aggravation during his brief period of service. Records of private treatment for the appellant's right knee, in 1988 and 1990, note that the appellant related a shrapnel injury to his knee in Vietnam. Volume VIII. Received in April 1998 were medical records from the VA Medical Centers at Denver, Colorado, and Fort Lyon, Colorado, for the appellant from the 1970's into the 1990's. Most of the records from the Denver Medical Center were duplicative, cumulative, or redundant. The appellant was hospitalized in June and July 1972 with epigastric pain. While hospitalized, a psychiatric consultation related to possible psychosomatic abdominal complaint resulted in a finding of "borderline personality" with very poor adjustment. A December 1974 psychiatry evaluation noted that the appellant wanted to be declared "normal" so he could change his Navy discharge status as it made him ineligible for reenlistment, and he wanted to join the Army to be with his girlfriend. The impression was borderline personality disorder. Physical examination in April 1977 showed no skin disorder. Included in the VA records were the first 2 pages of an October 6, 1983 disability evaluation by S. O., M.D., for evaluation for possible exposure to toxic chemicals. It was recorded that the appellant reported being in Vietnam for 2 tours with the Navy, between August 1966 and August 1967, and again between December 1967 and December 1968. His movements in Vietnam were "vague." He reported being in defoliated areas around Loc Minh. His current medical complaints included back and knee problems, first present in 1970, and exacerbated following a motorcycle accident in 1978. He related skin rash on his forehead, neck and arms since service in Vietnam. As previously reported, examination of the skin showed it to be clear and with no rashes, and the pertinent diagnosis was possible exposure to toxic herbicides. There was no diagnosis of a skin disorder. A January 26, 1984, psychology note concerning neuropsychological evaluation testing indicated that the results were consistent with previous evaluation performed 8 1/2 years before, indicating mild to moderate, fairly generalized cerebral dysfunction. The testing was apparently in regard to placement in a cognitive rehabilitation program. He appears to have been in this program from 1984 to 1987. An October 30, 1990, medical certificate noted that the appellant had a many year history of PTSD, post-traumatic head injury, and organic brain dysfunction. The assessment included "PTSD OBS" send to "PES." A December 31, 1990, record noted complaint of PTSD, with the appellant reporting "flashbacks -- relives scenes from Vietnam." In March 1991 there was a summary of medical problems for the appellant, from private records. The problems included personality disorder, and chronic anoxic encephalopathy. A neurology clinic entry in May 1991 noted multiple head injuries, including a rifle butt in 1968, and anoxic brain injury in 1981. The Fort Lyon records show a March 25, 1996, mental health clinic record to the effect that the appellant reported that he had a history of brain damage when hit by a rifle butt as a POW (prisoner of war) for 5 days in Vietnam. It was noted that his main symptoms of PTSD were temper, long history of depression, suicide attempts in the past, sleeping poorly, and nightmares about beatings in Vietnam. A pulmonary record dated in March 1996 noted that a very mild small airway obstruction was suggested. The July 1998 323 page (type on both sides) submission by the appellant has been reviewed by the Board. In August 1998 there was a formal finding by the RO that all efforts to obtain "needed service records or military information have been exhausted; further efforts are futile." It was decided that additional service records for the appellant were unavailable. The appellant's August 1998 submissions have also been reviewed. They essentially echo past submissions. Submissions in November 1998, and April 1999 do not provide additional relevant evidence to the appellant's claims on appeal. Received in May 1999 was a copy of a private MRI of the appellant's lumbar spine. The finding reflected degenerative changes in the lumbar spine, with no opinion as to onset or etiology. It was noted that there was no evidence of scoliosis or other abnormal curvature. A formal finding in September 1999, again, as in August 1998, stated that that all efforts to obtain needed service records or military information had been exhausted, further efforts were futile, and it was decided that additional service records for the appellant were unavailable. The appellant submitted, in September 1999, copies of November 1968 medical records, and a copy of a page of private evaluation in February 1969 showing his skin to be without rash, icterus, or ecchymosis. There was no reference to any back problems. Reference was made to an accident at age 4, with episodes of a complex characterized by a feeling of dizziness, often followed by a brief period of syncope. The appellant submitted additional material in October 1999. New and Material Evidence, Psychiatric Disorder and Back Disorder Legal Criteria. Where a final Board decision exists on a given claim, that claim "may not thereafter be reopened and allowed and a claim based upon the same factual basis may not be considered" by the Board. 38 U.S.C.A. § 7104(b). The exception is that "[i]f new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim." 38 U.S.C.A. § 5108. Therefore, once a Board decision becomes final under § 7104(b), "the Board does not have jurisdiction to consider [the previously adjudicated claim] unless new and material evidence is presented, and before the Board may reopen such a claim, it must so find." Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996); Butler v. Brown, 9 Vet. App. 167, 171 (1996) (When new and material evidence has not been submitted in a previously disallowed claim "[f]urther analysis . . . is neither required, nor permitted."). The provisions of 38 C.F.R. § 3.156(a), provide that "new and material evidence" is evidence not previously submitted which bears directly and substantially upon the specific matter under consideration, is not cumulative or redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. Furthermore, the Court of Appeals for the Federal Circuit has indicated that evidence may be considered new and material if it contributes "to a more complete picture of the circumstances surrounding the origin of a veteran's injury or disability, even where it will not eventually convince the Board to alter its ratings decision." Hodge v. West, 115 F.3d 1356, 1363 (Fed. Cir. 1998). The Court has held that in order to reopen a previously and finally disallowed claim there must be new and material evidence presented since the time that the claim was finally disallowed on any basis, not only since the time that the claim was last disallowed on the merits. Evans v. Brown, 9 Vet. App. 273, 285 (1996). With regard to petitions to reopen previously and finally disallowed claims, the Board must conduct a three-part analysis. Elkins v. West, 12 Vet. App. 209 (1999). First, VA must determine whether the evidence presented or secured since the prior final disallowance of the claim is "new and material" under 38 C.F.R. § 3.156(a). Second, if new and material evidence has been presented, immediately upon reopening the VA must determine whether, based upon all the evidence and presuming its credibility, the claim is well grounded pursuant to 38 U.S.C.A. § 5107(a). Finally, if the claim is well-grounded, the VA may evaluate the merits after ensuring the duty to assist under 38 U.S.C.A. § 5107(b) has been fulfilled. In Vargas-Gonzales v. West, 12 Vet. App. 321 (1999), the Court further concluded that a determination as to whether evidence is new is separate from a determination as to whether the evidence is material. If the Board determines that the evidence is not new, that should end the Board's analysis as to whether the evidence is "new and material." Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service or for a chronic disease, i. e. arthritis, which is manifested to a degree of 10 percent disabling within one year following a veteran's release from active duty. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). Personality disorders are not diseases or injuries within the meaning of the applicable legislation. 38 C.F.R. § 3.303(c) (1999). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). A veteran is presumed to be in sound physical condition when examined, accepted, and enrolled for service, except for defects, infirmities, or disorders noted at the time of the time of the examination, acceptance, or enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. § 1111 (West 1991). A preexisting injury or disease will be considered to have been aggravated by active service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C.A. § 1153 (West 1991); 38 C.F.R. § 3.306(a) (1999). Analysis - Psychiatric Disorder. The Board, in its December 1985 decision, noted that while the exact nature of the appellant's psychiatric disorder was not clear, he had had a severe head injury and psychiatric symptoms prior to service and that outpatient treatment after service indicated the presence of a personality disorder. An anxiety disorder was first demonstrated many years after the appellant's short period of service. The Board concluded that the veteran's psychiatric disorder, however classified, was not attributable to service. The evidence added to the record prior to the Board's September 1990 decision included written and parole evidence from the appellant. However, the additional evidence contained no medical evidence or opinion which tended to link an acquired psychiatric disorder to his brief period of military service during 1968. The Board, in September 1990, held that the evidence added to the record supported the prior denial and that none of the additional evidence showed that the appellant had a chronic acquired psychiatric disorder which had its onset in or was aggravated by service. The Board found that the evidence received subsequent to the December 1985 Board decision merely confirmed treatment for a back disorder in the 1980's, many years after service, and did not demonstrate that the appellant had a chronic back disability during service or proximate thereto. The Board, noting that the evidence received subsequent to the December 1985 decision included evidence dated in 1960 reflecting that the veteran had organic brain damage due to an accident and evidence dated in 1984 reflecting a diagnosis of intermittent explosive disorder or passive-aggressive personality disorder, held that the new evidence did not demonstrate that the appellant had a chronic acquired psychiatric disorder which had its onset in or was aggravated by service. The evidence received since the September 1990 Board decision includes private medical records showing treatment for neuropsychiatric problems as a result of the 1954 head injury prior to the appellant's entry into active duty and VA and private medical records reflecting treatment and evaluation for residuals of the preservice head injury beginning in the early 1970s, several years following his release from active duty. It is noted that the SSA determined that he was entitled to benefits due to organic brain syndrome and a borderline personality beginning in April 1970. This is more than a year following his discharge from active duty. Keeping in mind that the organic brain syndrome is a separate issue, and that PTSD will be discussed below, review of the evidence from Volume II through Volume VIII does not reveal any medical evidence which tends to relate an acquired psychiatric disability to any incident of the veteran's 1968 military service. Most of the medical evidence submitted concerned the appellant's injury in 1954, and private treatment and evaluation in the 1980's when the appellant was trying to get SSA benefits. This material did not show an acquired psychiatric disorder in service, or the post-service presence of an acquired psychiatric disorder related to service. The appellant has not submitted any competent medical evidence which tends to show that he currently has an acquired psychiatric disorder which is of service origin or which tends to show that any psychiatric disorder which may have pre-existed entry into service was aggravated during active duty. The Board has considered the statements and testimony of the appellant and his mother. The Board finds that the appellant's written and parole evidence is cumulative and redundant of his assertions of record at the time of the September 1990 decision. His story of mistreatment in service is essentially the same as he had related prior to 1990. His mother's testimony regarding cellulitis is not pertinent. Additionally, the Board notes that while lay statements are deemed competent evidence regarding the occurrence of an incident during service and a description of the pertinent symptomatology during and following service, the Court has held that, where the determinative issue involves a question of a medical diagnosis or causation, only individuals possessing specialized training and knowledge are competent to render an opinion. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The veteran himself is not shown to possess the medical expertise to determine the etiology of his various medical symptoms or their relationship to service, and his claims of medical causation are of limited probative value. He has not provided competent evidence of the presence of a chronic acquired psychiatric disorder in service, or post-service medical evidence which tends to relate a current acquired psychiatric disorder to his 1968 military service. The Board holds that none of the evidence added to the record since the September 1990 decision constitutes new or material evidence. No item of evidence added to the record since the September 1990 decision is by itself, or when considered in connection with evidence previously assembled, so significant that it must be considered in order to fairly decide the merits of the claim. Accordingly, the appellant claim of entitlement to a psychiatric disorder is not reopened. Analysis - Back Disorder. The evidence of record prior to the Board's decision of September 1990 did not contain any competent evidence which reflected the presence of a chronic back disorder in service or which tended to link any post- service back pathology to the veteran's military service or any incident therein. The additional evidence submitted since the September 1990 decision includes VA and private medical records reflecting treatment for a back disability several years following his release from active duty. His back disorder was variously diagnosed to include scoliosis and degenerative changes. These records are essentially cumulative in nature. The appellant has not submitted any competent medical evidence which tends to show that he currently has a back disorder which is of service origin, or that any back disorder which pre-existed entry into service was aggravated during active duty. The evidence after September 1990 is not new and material to reopen the appellant's claim. In 1995 he submitted an August 1982 private medical record wherein he reported back injury in 1979 while working for an asphalt company. It is noted that in 1983 the appellant reported that his back was injured while working for a cement company. In 1984 he reported that his back was injured as the result of the beatings he received in service and as a result of a lifting injury. In 1986 he reportedly attributed his back problems to left leg shortening due to an accident in 1954. Scoliosis due to left leg shortening was reported in 1987. In 1989 the appellant testified that scoliosis was found in service and he was hospitalized for 2 weeks with his back. In July 1990 he testified that a rifle butt injury to his back caused his arthritis. Private medical evaluation in 1999 showed no scoliosis, and while degenerative changes in the lumbar spine were noted there was no opinion as to date of onset or etiology. The appellant, in his parole and written testimony since 1990 essentially presents the same contentions as he advanced prior to 1990. He claims his back was injured in service, and he was hospitalized with the back problem. While the appellant is competent to establish that he experienced back symptoms during service and was treated for such symptoms, he is not competent to establish that any particular chronic back pathology was present during service or that any current back pathology is related to the back symptoms he experienced during service. Lay persons are not competent to render testimony concerning medical causation or diagnosis. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Similarly, "lay assertions of medical causation . . . cannot serve as a predicate to reopen a claim under [38 U.S.C. § 5108]". Moray v. Brown, 5 Vet. App. 211, 214 (1993)." Mintz v. Brown, 6 Vet. App. 277, 280 (1994). In other words while the Board must accept the appellant's contention of back injury and treatment in service, his claim that the current back problems are related to such injury are not sufficient to reopen his claim. Corroborating medical evidence is required. The statements he has made since the September 1990 decision are redundant and cumulative of testimony provided prior to 1990, and are not new. Such testimony was considered in the 1985 and 1990 determinations. The Board must conclude that the appellant has failed to present new and material evidence to reopen a claim for service connection for back disability alleged to be due to events in service. Skin Disorder claimed as Chloracne, Secondary to Agent Orange The threshold question that must be resolved with regard to a claim is whether the appellant has presented evidence that the claim is well grounded. Under the law, it is the obligation of the person applying for benefits to come forward with a well-grounded claim. 38 U.S.C.A. § 5107(a). A well grounded claim is "[a] plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of § 5107(a)." Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997). Mere allegations in support of a claim that a disorder should be service-connected are not sufficient; the appellant must submit evidence in support of the claim that would "justify a belief by a fair and impartial individual that the claim is plausible." 38 U.S.C.A. § 5107(a); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). The quality and quantity of the evidence required to meet this statutory burden depends upon the issue presented by the claim. Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993). The United States Court of Appeals for Veterans Claims (Court) has held that, in general, a claim for service connection is well grounded when three elements are satisfied with competent evidence. Caluza v. Brown, 7 Vet. App. 498 (1995). First, there must be competent medical evidence of a current disability (a medical diagnosis). Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) Second, there must be evidence of an occurrence or aggravation of a disease or injury incurred in service (lay or medical evidence). Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991); Layno v. Brown, 6 Vet. App. 465 (1994). Third, there must be a nexus between the in-service injury or disease and the current disability (medical evidence or the legal presumption that certain disabilities manifest within certain periods are related to service). Grottveit v. Brown, 5 Vet. App. 91, 93; Lathan v. Brown, 7 Vet. App. 359 (1995). The Court has further held that the second and third elements of a well-grounded claim for service connection can also be satisfied under 38 C.F.R. § 3.303(b) (1997) by (a) evidence that a condition was "noted" during service or an applicable presumption period; (b) evidence showing post- service continuity of symptomatology; and (c) medical or, in certain circumstances, lay evidence of a nexus between the present disability and post-service symptomatology. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495- 97 (1997). Alternatively, service connection may be established under 38 C.F.R. § 3.303(b) by evidence of (i) the existence of a chronic disease in service or during an applicable presumption period and (ii) present manifestations of the same chronic disease. Ibid. Where the determinant issue involves a question of medical diagnosis or medical causation, competent medical evidence to the effect that the claim is plausible or possible is required to establish a well-grounded claim. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Lay assertions of medical causation or diagnosis cannot constitute evidence to render a claim well grounded under 38 U.S.C.A. § 5107(a) (West 1991); if no cognizable evidence is submitted to support a claim, the claim cannot be well grounded. Id. The Court has held that "[i]n the absence of competent medical evidence of a current disability and a causal link to service or evidence of chronicity or continuity of symptomatology, a claim is not well grounded." Chelte v. Brown, 10 Vet. App. 268 (1997). In Brammer v. Derwinski, 3 Vet. App. 223 (1992), the Court noted that Congress specifically limited entitlement for service-connected disease or injury to cases where such incidents had resulted in a disability. In Rabideau v. Derwinski, 2 Vet. App. 141 (1992), the Court held that the failure to demonstrate that a disability is currently manifested constitutes failure to present a plausible or well-grounded claim. Analysis. In regard to the appellant's claim for VA benefits for Agent Orange exposure, the law requires more than just an allegation; a claimant must submit supporting evidence. Under the law and the decisions of the Court, it is the obligation of the appellant to come forth with such evidence. Here, the appellant has not submitted any medical evidence that he has a skin disorder linked to service. The appellant is asserting that his skin disorders resulted from exposure to Agent Orange. He asserts that he was exposed to Agent Orange during his service in 1968 in San Diego, California. In this regard, the service medical records for the appellant's recognized period of active duty reflect no definitive finding relative to a skin disorder. It is noted that he was treated for cellulitis involving the feet. The first evidence of a skin disorder was in July 1970 when he underwent an excision of a cyst in the neck area at a VA outpatient clinic. This is more than a year following his release from active duty. He was next treated in June 1978, during his second period of military service. At that time poison ivy was diagnosed. In 1983 he complained of a rash associated with concrete. However, there is no further clinical evidence of a skin disorder until the March 1991 VA examination, when folliculitis was diagnosed. This is many years following his release from active duty. In 1994 and 1995 he received treatment at a VA facility and his skin disorders were diagnosed as keratosis pilaris, xerosis, and seborrheic dermatitis. In August 1995 he was seen at a VA dermatology clinic for possible chloracne, however, this disability was not clinically confirmed. The Board has considered the statements and testimony of the appellant and his mother. As previously discussed, when the issue involves a question of a medical diagnosis or of a causation, lay statements are not deemed to be competent evidence per Espiritu. There is no medical evidence of record which confirms the presence of chloracne. Additionally, the appellant has not submitted any competent medical evidence, nor is there any competent medical evidence of record which establishes a causal relationship between the appellant's current skin disorder and his period of active duty. Accordingly, per Caluza, his claim for service connection for a skin disorder, claimed as chloracne, as secondary to exposure to Agent Orange, is not well grounded. The appellant does not have any skin disorder on the presumptive list for exposure to toxic herbicides. So there is no nexus on a presumptive basis. The other acute skin problems reported in the 1990's have never been associated with the appellant's service, other than by the appellant's own testimony, and he is not medically qualified to make any assertion as to causation or etiology. There is no competent medical opinion as to any relationship between the skin problems identified post-service, and any incident of the appellant's brief period of military duty. The appellant's claim fails in the absence of nexus to service. In regard to the appellant's testimony that Dr. O. flatly stated that there was possible toxic exposure to Agent Orange, the Board points out that initially the appellant only submitted the last page of Dr. O's evaluation, which did contain the impression of "possible" exposure to Agent Orange. The first 2 pages of the evaluation, received in April 1996, show that the appellant reported exposure to Agent Orange while on duty in Vietnam. Dr. O's report of Agent Orange exposure was equivocal, and based on false information. An opinion based upon an inaccurate factual premise has no probative value. Hadsell v. Brown, 4 Vet. App. 208, 209 (1993). The appellant had less than 8 weeks of service in 1968, he did not serve in Vietnam, and there is no competent evidence to the contrary. Pulmonary Disorder, Secondary to Agent Orange Analysis. No pulmonary problems for the appellant were reported for many years after service; however, in 1990 the appellant reported exposure to Agent Orange, and for the purpose of this appeal, this will be accepted for the purpose of determining that he has met his burden of meeting the second element of a well grounded claim, i.e. evidence of a disease or injury in service. He also meets the first element of a well-grounded claim, that of current disability, based on the 1996 finding of mild airway obstruction. At this point it should be emphasized that the medical record does not show that the appellant has any respiratory cancer or other pulmonary disorder on a presumptive basis of exposure to Agent Orange or other toxic herbicides. In regard to the current mild respiratory dysfunction, there is no medical opinion as to the onset or the etiology of this disability. Early examination records do not reveal any respiratory complaints or problems for the appellant. As the appellant has not provided any medical evidence of a relationship between the respiratory problem first identified decades post-service and service, his claim is now well grounded. Post-Traumatic Stress Disorder Analysis. The appellant has less than 8 weeks of documented military service in the Navy, from November 1, 1968, to December 23, 1968. He did not finish his recruit training. Under such circumstances there normally would be no problem to stating categorically that in regard to his PTSD claim he did not have combat, and 38 U.S.C.A. § 1154(b) would not be for consideration. However, the appellant reported in 1983 that he spent 2 tours in Vietnam, the first in 1966 and 1967, and the second from December 1967 to December 1968. In 1988 and 1990 he reported shrapnel injury to his knee in Vietnam, and in December 1990 it was reported that the appellant relived scenes from Vietnam. In 1996 he reported being a POW in Vietnam. The appellant's voided duty in the Army in 1978 was after the Vietnam Era, and there is not a scintilla of objective evidence that the appellant has any other military duty other than that verified for this claim. As pointed out above, for the limited purpose of determining whether a claim is well grounded, evidentiary assertions must be accepted as true. However, the appellant's assertions of duty in Vietnam are inherently incredible. See Samuels v. West, 11 Vet. App. 433 (1998). Simply said, the appellant had no combat related to his brief service in the Navy. In passing the Board notes several inquires to the NPRC for records for the appellant, without any reported military duty other than that previously verified. The appellant has asserted that his PTSD is related to beatings suffered while in the Navy. These statements will be accepted for the purpose of determining that he has met his burden of meeting the second element of a well grounded claim, i.e. evidence of a disease or injury in service. Regarding the first element of a well-rounded claim, the presence of a current disability, an October 1990 medical record noted a many year history of PTSD, and there was an assessment of "PTSD OBS." The symptoms and/or traumatic events for this diagnosis were not reported. In July 1992 it was noted that the appellant had PTSD, but neither the symptoms nor the stressor which provided the basis for such a diagnosis were reported. In July 1995 a VA record included reference to PTSD, and in September it was noted the appellant had PTSD symptoms and the assessment offered 2 different psychiatric diagnoses for the appellant, including one with PTSD. In other words the examiner was not sure that the appellant had PTSD. In February 1996 there was a provisional diagnosis of PTSD. The Board notes that a provisional diagnosis is not an unequivocal diagnosis of the disorder. While there does not appear to be a specific and unequivocal diagnosis of PTSD for the appellant, assuming that one, or all of the above, is sufficient for the first element of a well-grounded claim, the next question is whether the third element, nexus of any PTSD to service, has been demonstrated. A diagnosis of PTSD could be based on the appellant's reported beatings in service (which have not been corroborated by any credible supporting evidence as required by 38 C.F.R. § 3.304(f)), his traumatic injuries before and after service, or his reported Vietnam duty. PTSD based on injuries not experienced in service, or the spurious Vietnam duty would not suffice for nexus to service, for obvious reasons. On review of the reports of PTSD for the appellant, it is immediately clear that not a single PTSD reference specifically associates the PTSD with the appellant's reported injuries in service. The October 1990 record, while reporting a long history of PTSD, also noted traumatic head injury, and OBS. The basis for the PTSD assessment was not specified, and the OBS likely referred to the traumatic head injury which more than likely was the serious head injury in 1954, but it is not clear as to the etiology of any PTSD. As noted above, the July 1992 reference to PTSD did not include symptoms or the basis for that observation. The 1995 references to PTSD did not include symptoms or etiology, and the provisional diagnosis of PTSD in 1996 was equivocal and neutral as to the origins for the provisional opinion. There is no medical diagnosis of PTSD for the appellant that specifically links the disorder to the reported injuries in service. Without a medical opinion as to the relationship of any PTSD to service, the appellant's claim for service connection for PTSD is not well-grounded. 38 U.S.C.A. § 1151 38 U.S.C.A. § 1151 (West 1991) provides that, where a veteran suffers an injury or aggravation of an injury resulting in additional disability by reason of VA hospital, medical or surgical treatment, compensation shall be awarded in the same manner as if such disability were service connected. Applicable regulations provide that, in determining whether additional disability resulted from a disease or injury or an aggravation of any existing disease or injury suffered as a result of VA hospitalization, medical or surgical treatment, it will be necessary to show that additional disability is actually the result of such disease or injury or aggravation of an existing disease or injury and not merely coincidental therewith. 38 C.F.R. § 3.358(c). See above for the criteria for a well-grounded claim. The Board notes that considerations for a well-grounded claim for compensation benefits under 38 U.S.C.A. § 1151 are conceptually the same as a claim for service connection, except that the key time frame at issue is the period of VA care rather than active service. Analysis. The appellant's claim for benefits under 38 U.S.C.A. § 1151 is without merit. The appellant has not provided either the time, date, or place of VA treatment, or the specific disability related to VA treatment. He was informed in March 1995, that specific information in regard to the disability claimed was required to make his claim well-grounded. He did not provide any such information. There can be no meaningful discussion of this claim when no specific disability has been identified. During his July 1997 hearing, the appellant indicated that his claim for benefits pursuant to 38 U.S.C.A. § 1151 was based on the failure by the VA to treat him. However he has not identified the dates when he was entitled to treatment by the VA and said treatment was denied nor has he described the additional disability caused by the lack of said treatment. As such, the Board finds that the appellant's claim is not plausible. Therefore it is not well ground and must be denied. Where the claimant fails to cooperate in the development of the record where his cooperation is required, the Board finds that VA has no further obligation under the duty to assist to plead again with the claimant to do that which he failed to due when first asked. See Evans v. West, No. 96-1574 (U.S. Vet. App. Nov. 16, 1998)12 Vet. App. 22 (1998). ORDER As the appellant has not provided new and material evidence to reopen his claim for service connection for a psychiatric disorder and a back disability, the appeal as to these issues is denied. Having found the claims for service connection for a skin disorder claimed as chloracne, and a pulmonary disorder, not to be well-grounded, the claims are denied. Having found the claim for PTSD not to be well-grounded, the claim is denied. Having found the claim for benefits under the provisions of 38 U.S.C.A. § 1151 for disability related to VA medical treatment not to be well-grounded, the claim is denied. Gary L. Gick Member, Board of Veterans' Appeals