Citation Nr: 0001835 Decision Date: 01/24/00 Archive Date: 02/02/00 DOCKET NO. 93-13 603 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a hyperpigmented skin disorder, secondary to radiation exposure or to toxic chemical exposure. 2. Entitlement to service connection for residuals of prostate cancer, secondary to radiation exposure or to toxic chemical exposure. 3. Entitlement to service connection for hypothyroidism, peptic ulcer disease, a hand disorder, an elbow disorder, a back disorder, arthritis of the cervical and lumbosacral spine, and residuals of a lipoma, secondary to radiation exposure or to toxic chemical exposure. 4. Entitlement to an effective date prior to November 13, 1997, for a 40 percent evaluation for bilateral hearing loss. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD S. D. Regan, Counsel INTRODUCTION The veteran had active service from September 1945 to March 1950. This matter came before the Board of Veterans' Appeals (hereinafter "the Board") on appeal from an October 1990 rating decision of the Lincoln, Nebraska Regional Office (hereinafter "the RO") which declined to reopen the veteran's claim for entitlement to service connection for a hyperpigmented skin disorder, secondary to radiation exposure or to toxic chemical exposure. Service connection was also denied for residuals of prostate cancer, hypothyroidism, peptic ulcer disease, a hand disorder, an elbow disorder, a back disorder, arthritis of the cervical and lumbosacral spine, and residuals of a lipoma, secondary to radiation exposure or to toxic chemical exposure. A January 1988 rating decision, in pertinent part, granted service connection for bilateral hearing loss and assigned a noncompensable disability evaluation effective December 7, 1995 and a 40 percent disability evaluation effective November 18, 1997. An April 1999 rating decision, in pertinent part, continued the noncompensable disability evaluation effective December 7, 1995 and assigned an effective date of November 13, 1997 for the 40 percent disability evaluation. The veteran is presently represented in this appeal by the Veterans of Foreign Wars of the United States. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The RO denied service connection for a hyperpigmented skin disorder, secondary to radiation exposure or to toxic chemical exposure in December 1982. The veteran was notified in writing of the decision in December 1982. The veteran did not perfect a substantive appeal within one year of the adverse decision. 3. The additional documentation submitted since the December 1982 decision is not so significant that it must be considered in order to fairly decide the merits of the claim. 4. Hypothyroidism, peptic ulcer disease, a hand disorder, an elbow disorder, a back disorder, arthritis of the cervical and lumbosacral spine and residuals of a lipoma are not recognized by the VA radiogenic diseases. 5. Hypothyroidism, peptic ulcer disease, a hand disorder, an elbow disorder, a back disorder, arthritis of the cervical and lumbosacral spine and residuals of a lipoma are not recognized by the VA as causally related to full-body exposure to vesicant agents. 6. There is no competent evidence of record showing that the veteran's claimed hypothyroidism, peptic ulcer disease, hand disorder, elbow disorder, back disorder, arthritis of the cervical and lumbosacral spine and residuals of a lipoma were incurred secondary to radiation exposure during service or to exposure to vesicant agents. 7. On December 7, 1995, the veteran's claim for service connection for bilateral hearing loss was received. 8. In a January 1998 rating decision, service connection was granted for bilateral hearing loss with a noncompensable disability evaluation effective December 7, 1995 and a 40 percent disability evaluation effective November 18, 1997. 9. An April 1999 rating decision continued the noncompensable disability evaluation for the veteran's service-connected bilateral hearing loss from December 7, 1995 and granted a 40 percent disability evaluation effective November 13, 1997. 10. A November 13, 1997, VA audiological examination report indicated that the veteran had level VIII hearing loss in the right ear and level VI in the left ear. An increase in disability, as to the veteran's service-connected bilateral hearing loss, was not shown prior to that date. CONCLUSIONS OF LAW 1. The additional documentation received since the December 1982 RO decision denying service connection for a hyperpigmented skin disorder, secondary to radiation exposure or to toxic chemical exposure, does not constitute new and material evidence. 38 U.S.C.A §§ 5107, 5108 (West 1991 & Supp. 1999); 38 C.F.R. § 3.156(a) (1999). 2. The RO's December 1982 decision denying service connection for a hyperpigmented skin disorder, secondary to radiation exposure or to toxic chemical exposure, is final and may not be reopened. 38 U.S.C.A. §§ 1110, 1131, 5107, 5108, 7105 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.104(a), 3.156(a) (1999). 3. The claim for entitlement to service connection for hypothyroidism, peptic ulcer disease, a hand disorder, an elbow disorder, a back disorder, arthritis of the cervical and lumbosacral spine, and residuals of a lipoma, secondary to radiation exposure or to toxic chemical exposure, is not well-grounded. 38 U.S.C.A. § 5107 (West 1991 & Supp. 1999). 4. The criteria for an effective date prior to November 13, 1997, for a 40 percent evaluation for bilateral hearing loss are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.157, 3.400 and Part 4, including § 4.3 and Diagnostic Code 6100 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Whether New and Material Evidence has been Submitted to Reopen a Claim of Entitlement to Service Connection for a Hyperpigmented Skin Disorder, Secondary to Radiation Exposure or to Toxic Chemical Exposure A. Prior RO Decision In December 1982, the RO denied service connection for a hyperpigmented skin disorder, secondary to radiation exposure or to toxic chemical exposure. It was reasoned, essentially, that the etiology of the veteran's hyperpigmented skin disorder was unknown and that there was no evidence of exposure to radiation and that, therefore, service connection for such disorder was not warranted. The veteran was informed in writing of the denial in December 1982 and did not perfect an appeal within the following year. The evidence upon which the RO formulated its December 1982 denial of service connection may be briefly summarized. The available service personnel records indicate that the veteran had active service from September 1945 to March 1950. Such records also reflect that he had nine months and twenty-seven days of foreign and/or sea service. The veteran is noted to have received the Asiatic-Pacific Campaign Medal, the China Service Medal, the World War II Victory Medal and a Navy Occupation Medal. The veteran's service medical records do not refer to complaints of or treatment for a skin disorder. A May 1949 examination included a notation that the veteran's skin and glands were normal. VA treatment records dated from March 1958 to November 1973 indicated that the veteran was treated for several disorders. An April 1973 hospital summary noted that the veteran had a history of epigastric pain and melena. The diagnoses did not refer to a skin disorder. The veteran underwent a VA general medical examination in November 1974. The examiner noted that his skin was normal. A July 1982 VA hospital summary noted that a physical examination was significant for areas of hyperpigmentation over the body with areas of pale skin. The diagnoses included hyperpigmentation. A July 1982 history report included a notation that the veteran had loss of pigmentation to his hands or face in 1968. There was also a notation that the veteran had vitiligo of the hands and face. A July 1982 consultation report noted that the veteran had patchy hyperpigmentation which possible causes including injury, drugs and cosmetics. It was noted that the veteran denied all such causes. The examiner noted that the etiology of the hyperpigmentation could not be determined. A July 1982 biopsy report noted a diagnosis of hyperpigmented skin, etiology undetermined. In a September 1982 statement on appeal, the veteran reported that while aboard ship in the pacific, he participated in three or four atomic tests. He stated that he did not recall how far from "ground zero" his ship was, but that they were below decks during the explosion. He stated that they remained in the area for fifteen days after the explosion. B. New and Material Evidence Prior RO decisions are final, and may be reopened only upon the receipt of additional evidence that, under the applicable statutory and regulatory provisions, is both new and material. Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996); Butler v. Brown, 9 Vet. App. 167, 171 (1996); 38 U.S.C.A. §§ 5108, 7104(b). A "two-step analysis" is used to evaluate a claim to reopen. Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). The first step involves a determination as to whether the evidence presented is new and material; and the second step is a review of all of the evidence of record to determine the outcome of the claim on the merits. Id. The second step is only required if the evidence presented is found to be new and material, and thereby sufficient to reopen the claim at issue; if the evidence is not new and material then review on the merits is not justified. Manio, supra; see also Sutton v. Brown, 9 Vet. App. 553, 562 (1996). Pursuant to the applicable regulation, new and material evidence means evidence not previously submitted to agency decision makers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor 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. 38 C.F.R. § 3.156(a) (1999). In order to be "new" the evidence must not have been in the record at the time of the last final denial of the claim, and must not be merely redundant or cumulative of already considered evidence; that is, it should present new information. Evans v. Brown, 9 Vet. App. 273, 283 (1996); see also Dolan v. Brown, 9 Vet. App. 358, 363 (1996). In addition to being "new," the evidence must be material, in that it pertains to the issue for which the petition to reopen is requested. Evans v. Brown, 9 Vet. App. 273, 283 (1996). In order to be "material," the evidence need not warrant revision of a previous decision. Hodge v. West, No. 98-7017, (Fed. Cir. Sept. 16, 1998). The significant factor is whether there is a complete record for evaluation of an appellant's claim. Id. Further, in determining whether evidence is new and material, the credibility of the new evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The evidence received since the RO's December 1982 decision consists of statements on appeal from the veteran; VA treatment records dated from December 1965 to November 1985; private treatment records dated from March 1985 to January 1989; a June 1991 hearing transcript; an August 1991 statement from the Department of the Army; U.S. Army & Joint Services Environmental Support Group; A January 1992 statement from the Department of the Navy, Bureau of Medicine and Surgery; an October 1992 hearing transcript; private treatment records dated from March 1989 to January 1995; VA treatment records dated from October 1988 to June 1995; private treatment records dated from November 1995 to February 1996; a February 1996 VA audiological examination report; a September 1996 hearing transcript; private treatment records dated from June 1996 to December 1996; a February 1997 private physician statement; VA treatment records dated from July 1995 to February 1997; private treatment records dated from January 1997 to March 1997; an April 1997 statement from Vernon G. Ward, M.D.; a June 1997 hearing transcript; November 1997 VA ear , genitourinary, orthopedic, dermatological, gastrointestinal, thyroid and audiological examination reports; a June 1999 transcript of a hearing before a member of the Board; and VA treatment records dated from April 1997 to October 1999. The VA treatment records dated from December 1965 to November 1985 indicated that the veteran was treated for multiple disorders. A December 1965 hospital report noted that the veteran had a history of being burned as a result of a sudden explosion of butane gas on the hands and face. The diagnoses included second degree burns of the hands and face, three and one-half weeks post burn. A January 1979 entry noted an assessment which included vitiligo. Treatment records dated from January 1984 to May 1984, indicated that the veteran continued to receive treatment for vitiligo. Private treatment records dated from March 1985 to January 1989 indicated that the veteran continued to receive treatment for multiple disorders. At the June 1991 hearing on appeal, the veteran testified that he was aboard a destroyer that went to Japan and that he was transferred to a demolition team to clean out caves. He stated that he was at the "Yokosuka", Japan Naval Base. The veteran reported that some of the caves had chemicals in them and that he cleaned the caves for eighteen to twenty months. He indicated that he had discoloration on the skin of his face, neck, elbows and hands. The veteran reported that he had no protective clothing while cleaning the caves. He noted that the discoloration started to occur in the late sixties. The veteran stated that sometimes chemicals would get splashed on him and cause burning. An August 1991 statement from the U.S. Army Joint Services Environmental Support Group indicated that they were unable to verify that the veteran assisted with the clean-up of caves in the hills around Yokosuka, Japan or to provide a listing of the alleged chemicals removed from the caves. A January 1992 statement from the Department of the Navy, Bureau of Medicine and Surgery, indicated that they did not have information about the veteran's possible exposure to toxic chemicals in 1946 and 1947. At the October 1992 hearing on appeal, the veteran testified that he was exposed to Mercury while cleaning out the caves in Japan. He stated that the Mercury was in tubes four to six inches long. The veteran indicated that he would get the substance on his hands. Private treatment records dated from March 1989 to January 1995 referred to continued treatment as did VA treatment records dated from October 1988 to June 1995. Private treatment record dated from November 1995 to February 1996 indicated that the veteran was treated for disorders other than a skin disorder. At the September 1996 hearing on appeal the veteran testified as to other disorders. VA treatment records dated from July 1995 to February 1997 and private treatment records dated from June 1996 to April 1997 indicated that the veteran continued to receive treatment for multiple disorders. In an April 1997 statement, Vernon G. Ward, M.D., noted that the veteran reported that his duties during service included cleaning out caves which the Japanese used for storage of toxic material. Dr. Ward noted that the veteran believes that Mercury was present and that he was in Japan close enough after the atomic bomb explosions to have been affected by radioactivity. Dr. Ward noted that the veteran had raised a question as to whether such type of exposure could be a factor in his overall general health. At the June 1997 hearing on appeal, the veteran testified that his skin condition was caused by his thyroid. He stated that he was exposed to all types of chemicals. The veteran reported that he was part of a demolition team during service. The veteran underwent a VA dermatological examination in January 1997. He reported that he had vitiligo for many years, even just after his discharge from service. It was noted that the veteran reported that he had been told by his family physician that the skin disorder was caused by his thyroid disorder. The diagnoses included seborrhea and seborrheic dermatitis of the face and vitiligo covering one- third of the body surface. The examiner commented that the vitiligo that the veteran manifested was not due to any exposure from ionizing radiation in the atmosphere or weaponry, or to toxic chemicals. The examiner remarked that it would appear that the pattern was more of a vitiligo than a toxic exposure phenomenon. At the June 1999 hearing before a member of the Board, the veteran testified that he served in Japan for eighteen months. He indicated that they removed "stuff" from caves that would break when it was "winched out". The veteran noted that he was in Japan in 1946. The veteran stated that he first noted white spots about a year after service and that he had worsening itching about two to three years after service. The Board has made a careful longitudinal review of the record. It is observed that the December 1982 RO decision denied service connection for a hyperpigmented skin disorder, secondary to radiation exposure or to toxic chemical exposure, on the basis that the etiology of the veteran's skin disorder was unknown and that there was no evidence of exposure to radiation. At the time of the December 1982 RO decision, the veteran's available service personnel records indicated that he had nine months and twenty-seven days of foreign and/or sea service. The veteran was noted to have received the Asiatic-Pacific Campaign Medal, the China Service Medal, the World War II Victory Medal and an apparent Naval Occupation Medal. The veteran's service medical records made no reference to complaints of or treatment for any skin disorders. A May 1949 examination report included a notation that the veteran's skin and glands were normal. Additionally, the Board notes that an April 1973 hospital summary noted that the veteran had a history which included melena and that a November 1974 VA general medical examination report included a notation that the veteran's skin was normal. The Board observes that a July 1982 VA hospital summary related diagnoses which included hyperpigmentation. Also, a July 1982 consultation report noted that the veteran had patchy hyperpigmentation and indicated that the etiology of such disorder could not be determined. The Board notes that the additional evidence submitted since the December 1982 decision is essentially cumulative of evidence previously of record. A December 1965 VA hospital report noted that the veteran had a history of being burned as a result of a sudden explosion of butane gas on his hands and face. The diagnoses, at that time, included second degree burns of the face, three and one-half weeks post burn. A January 1979 entry noted an assessment which included vitiligo. Subsequent VA and private treatment records indicated that the veteran was treated for variously diagnosed skin disorders including hyperpigmentation and vitiligo. Further, the Board notes that an August 1991 statement from the U.S. Army Joint Services Environmental Support Group indicated that it was unable to verify that the veteran assisted with the clean-up in the hills around Yokosuka, Japan. Also, a January 1992 statement from the Department of the Navy, Bureau of Medicine and Surgery, indicated that there was no information about the veteran's possible exposure to toxic chemicals in 1946 and 1947. The Board observes that an April 1997 statement from Dr. Ward noted that the veteran reported that his duties during service included cleaning out caves which the Japanese used for storage of toxic chemicals. Dr. Ward stated that the veteran believed that Mercury was present and that he was in Japan close enough after the atomic bomb explosions to have been affected by radioactivity. Dr. Ward noted that the veteran had raised a question as to whether such type of exposure could be a factor in his overall health. The Board notes that Dr. Ward solely reported the history provided by the veteran. The Board observes that the Court has held that evidence which is simply information recorded by a medical examiner, unenhanced by any additional medical comment by the examiner, does not constitute "competent medical evidence" satisfying the Grotveit v. Brown, 5 Vet.App. 91 (1993) requirement. Additionally, as to a determination of whether evidence is new and material, a bare transcription of a lay history is not transformed into "competent medical evidence" merely because the transcriber happens to be a medical professional. See LeShore v. Brown, 8 Vet.App. 406 (1995). The Board also observes that although an examiner can render a current diagnosis based on his examination of the veteran, without a thorough review of the record, his opinion regarding etiology can be no better than the facts alleged by the veteran. See Swann v. Brown, 5 Vet.App. 229, 233 (1993). Further, the Board notes that the January 1997 VA dermatological examination report indicated diagnoses which included seborrhea and seborrheic dermatitis of the face and vitiligo covering one-third of the veteran's body surface. The examiner specifically commented that the vitiligo that the veteran manifested was not due to any exposure from ionizing radiation in the atmosphere or weaponry, or to toxic chemicals. The Board observes that the medical evidence of record submitted subsequent to the December 1982 RO decision fails to indicate any relationship or nexus between any presently diagnosed hyperpigmented skin disorder and the veteran's period of service. See Caluza v. Brown, 7 Vet.App. 498 (1995). There is simply no medical evidence relative to the etiology of the veteran's claimed disorder or indicating that any skin disorder had its onset during his period of service. Additionally, the Board notes that the veteran's claimed hyperpigmented skin disorder is not included among the lists of radiogenic disease in the regulations governing service connection based on radiation exposure. 38 C.F.R. §§ 3.309(d)(3); 3.311 (1999). The veteran's claimed disorder also is not entitled to consideration under the presumption of service connection for exposure to vesicant agents because it is not listed as a disability under the applicable regulation. 38 C.F.R. § 3.316 (1999). The Board observes that the veteran has alleged in statements and testimony on appeal that a back disorder originated during his period of service as a result of radiation exposure or toxic chemical exposure. However, the veteran, as a lay person, is not competent to offer a medical diagnosis or to assert medical causation. Grottveit v. Brown, 5 Vet.App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992). Therefore, the Board concludes that the additional evidence submitted is not new and material as it is not so significant that it must be considered in order to fairly decide the merits of the claim. Accordingly, the RO's December 1982 decision denying service connection for a skin disorder, secondary to radiation exposure or to toxic chemical exposure, remains final and the claim is not reopened. II. Entitlement to Service Connection for Hypothyroidism, Peptic Ulcer Disease, a Hand Disorder, a Back Disorder, Arthritis of the Cervical and Lumbosacral Spine, and Residuals of a Lipoma, Secondary to Radiation Exposure or to Toxic Chemical Exposure Initially, it is necessary to determine if the veteran has submitted well-grounded claims within the meaning of 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1997), and if so, whether the VA has properly assisted him in the development of his claims. A "well-grounded" claim is one which is not implausible. Murphy v. Derwinski, 1 Vet.App. 78 (1990). A review of the record indicates that the veteran's claim for an effective date prior to November 13, 1997, for a 40 percent evaluation for bilateral hearing loss is well- grounded and that all relevant facts have been properly developed. As discussed below, the Board finds that the veteran's claims for service connection for hypothyroidism, peptic ulcer disease, a hand disorder, an elbow disorder, a back disorder, arthritis of the cervical and lumbosacral spine, and residuals of a lipoma, secondary to radiation exposure or to toxic chemical exposure are not well-grounded and that, therefore, there is no further duty to assist the veteran with development of such claims. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110, 1131 (West 1991 & Supp. 1999). Additionally, where a veteran served ninety (90) days or more during a period of war or during peacetime service after December 31, 1946, and arthritis and peptic ulcers become manifest to a degree of 10 percent within one year from the date of termination of such service, such diseases shall be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309 (1999). The disease entity for which service connection is sought must be "chronic" as opposed to merely "acute and transitory" in nature. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time as distinguished from merely isolated findings or a diagnosis including the word "chronic". Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. Where the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (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). The United States Court of Appeals for Veterans Claims (hereinafter "the Court") has held that in order for a claim for service connection to be well-grounded, there must be (1) competent evidence of a current disability; (2) proof as to incurrence or aggravation of a disease or injury in service; and (3) competent evidence as to a nexus between the inservice injury or disease and the current disability. See Caluza v. Brown, 7 Vet.App. 498 (1995). A radiation exposed veteran is a veteran who participated in a radiation risk activity during service. A radiation risk activity includes onsite participation in an atmospheric detonation of a nuclear device. Onsite participation means during the official operational period of an atmospheric nuclear test, presence at the test site or performance of official military duties in connection with ships, aircraft, or other equipment used in direct support of the nuclear test. 38 U.S.C.A. § 1112 (West 1991 & Supp. 1999); 38 C.F.R. § 3.309(d)(3)(i), (ii), (iii) (1999). The following diseases listed shall be service-connected if they become manifest in a radiation exposed veteran, provided the rebuttable presumption provisions of §3.307 are satisfied: Leukemia (other than chronic lymphocytic leukemia), cancer of the thyroid, cancer of the breast, cancer of the pharynx, cancer of the esophagus, cancer of the stomach, cancer of the small intestine, cancer of the pancreas, multiple myeloma, lymphomas (except Hodgkin's disease), cancer of the bile ducts, cancer of the gall bladder, primary liver cancer (except if cirrhosis or hepatitis B is indicated), cancer of the salivary gland, and cancer of the urinary tract. 38 C.F.R. §§ 3.307, 3.309(d)(1), (2) (1999). Where the following criteria are met, a claim based on exposure to ionizing radiation will be referred to the Department of Veterans Affairs (VA) Under Secretary for Benefits for consideration if the veteran was exposed to ionizing radiation and subsequently developed a radiogenic disease which first became manifest as follows; bone cancer within 30 years of exposure, leukemia at any time after exposure, posterior subscapular cataracts six months or more after exposure, and other radiogenic diseases five or more years after exposure. 38 C.F.R. § 3.311(b)(1) (1999). Radiogenic disease shall include the following: All forms of leukemia except chronic lymphatic (lymphocytic) leukemia, thyroid cancer, breast cancer, lung cancer, bone cancer, liver cancer, skin cancer, esophageal cancer, stomach cancer, colon cancer, pancreatic cancer, kidney cancer, urinary bladder cancer, salivary gland cancer, multiple myeloma, posterior subcapsular cataracts, non-malignant thyroid nodular disease, ovarian cancer, parathyroid adenoma, tumors of the brain and central nervous system, cancer of the rectum, lymphomas other than Hodgkin's disease, prostate cancer, and any other cancer. 38 C.F.R. § 3.311(b)(2) (1999) Notwithstanding the foregoing, the United States Court of Appeals for the Federal Circuit determined that the Veterans' Dioxin and Radiation Exposure Compensation Standards (Radiation Compensation) Act, Pub. L. No. 98-542, § 5, 98 Stat. 2725, 2727-29 (1984) does not preclude a veteran from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039 (Fed.Cir. 1994). Exposure to the specified vesicant agents during active military service under the circumstances described below, together with the subsequent development of any of the indicated conditions, is sufficient to establish service connection for that condition: (1) Full-body exposure to nitrogen or sulfur mustard during active military service together with the subsequent development of chronic conjunctivitis, keratitis, corneal opacities, scar formation, or the following cancers; Nasopharyngeal; laryngeal; lung (except mesothelioma); or squamous cell carcinoma of the skin; (2) Full-body exposure to nitrogen or sulfur mustard or Lewisite during active military service together with the subsequent development of a chronic form of laryngitis, bronchitis, emphysema, asthma or chronic obstructive pulmonary disease; and (3) Full-body exposure to nitrogen mustard during active military service together with the subsequent development of acute nonlymphocytic leukemia. 38 C.F.R. § 3.316(a) (1999). The veteran's available service personnel records were discussed above. The veteran's service medical records do not refer to complaints of or treatment for a thyroid disorder, a gastrointestinal disorder, a hand disorder, an elbow disorder, a back disorder, arthritis of the cervical and lumbosacral spine and for a lipoma. A May 1949 physical examination report included notations that the veteran's spine and extremities, genitourinary system, neck, thyroid, trachea and larynx, and abdomen and pelvis were all normal. VA treatment records dated from March 1958 to November 1985 indicated that the veteran was treated for several disorders. An April 1973 hospital summary noted that the veteran was admitted with epigastric pain. The diagnosis was prepyloric ulcer, active. A November 1973 statement from a VA physician noted that the veteran had been hospitalized in November 1973 for treatment of gastrointestinal bleeding and studies had revealed a benign gastric ulcer. The veteran underwent a VA general medical examination in January 1974. The examiner noted that the veteran's genitourinary system, endocrine system and musculoskeletal system were all normal. A January 1974 VA gastrointestinal examination report indicated a diagnosis of gastric ulcer, residuals of frequent bleeding and activity. A May 1974 entry noted that the veteran had swelling in the left elbow. The examiner noted probable olecranon bursitis. A March 1979 VA hospital summary noted that the veteran was admitted with a lipoma of the left spermatic cord. The diagnoses included spermatic cord lipoma. An October 1982 VA consultation report indicated that the veteran reported low back pain since 1977. The impression included low back pain with no documentable neurologic defect by examination. A November 1985 hospital report noted diagnoses including prostatic carcinoma, bladder diverticulum, peptic ulcer disease and osteoarthritis of the back and cervical spine. Private treatment records dated from March 1985 to January 1989 indicated that the veteran continued to receive treatment for several disorders. A May 1988 statement from M. T. O'Neil, M.D., noted that the veteran had severe degenerative arthritis of the lumbar spine. A July 1988 treatment entry noted that the veteran complained of aching pains in both shoulders and numbness in his hands. At the January 1991 hearing on appeal, the veteran testified that he was aboard a destroyer that went to Japan and that he was transferred to a demolition team to clean out caves. The veteran reported that some of the caves had chemicals in them and that he cleaned the caves for eighteen to twenty months. At the October 1992 hearing on appeal, the veteran testified that he was exposed to Mercury while cleaning out the caves in Japan. He indicated that the would get the substance on his hands. The veteran reported that he had numbness and tingling in his hands. He also noted that he had a very stiff neck. The veteran indicated that his elbows didn't bother him much, but that he did have discoloration. He related that he had problems with his stomach since the late sixties or early seventies. The veteran testified that he did not have his thyroid checked until the early eighties. He noted that he had back problems in 1950. Private treatment records dated from March 1989 to January 1995 referred to continued treatment. VA treatment records dated from October 1988 to June 1995 indicated that the veteran was treated for multiple disorders. A September 1990 report noted diagnoses including hypothyroidism. Private treatment records dated from November 1995 to February 1996 also referred to additional treatment. At the September 1996 hearing on appeal the veteran testified as to other disorders. VA treatment records dated from July 1995 to February 1997 and private treatment records dated from June 1996 to April 1997 indicated that the veteran was treated for several disorders. In an April 1997 statement, Vernon G. Ward, noted that the veteran reported that his duties during service included cleaning out caves which the Japanese used for storage of toxic chemicals and that he believes that Mercury was present. It was noted that the veteran also believed that he was in Japan close enough after the atomic bomb explosions to have been affected by radioactivity. Dr. Ward noted that the veteran had raised a question as to whether such type of exposure could be a factor in his overall general health. At the June 1997 hearing on appeal, the veteran testified that he was part of a demolition team during service and that he was exposed to all types of chemicals. The veteran underwent a VA genitourinary examination in November 1997. It was noted that he had a history of a left spermatic cord lipoma excision in 1980. The impression included history of prostate cancer. A November 1997 VA orthopedic examination report related diagnoses including degenerative lumbar disc disease, carpal tunnel syndrome, bilaterally, left greater than the right, and mild cervical spine degenerative disc disease. The examiner stated that the feasibility that any of the veteran's problems were related to Mercury or radiation exposure was very difficult to ascertain. The examiner stated that the veteran's hand problem certainly began years after his exposure, that his neck pain etiology was not as clear and that the veteran was having back pain some time after his time in service. The examiner commented that the radiographs revealed mainly degenerative changes which, to his knowledge, were not associated with Mercury or radiation exposure. The veteran also underwent a VA gastrointestinal examination in November 1997. The diagnoses included history of gastric ulcer disease treated by antrectomy with Billroth II anastomosis, history of diarrhea following meals which may be consistent with dumping syndrome, possible lactose intolerance due to lactase-deficiency based on mild causing diarrhea and hypothyroidism by history. The veteran additionally underwent a VA thyroid examination in November 1997. The examiner noted that there was documentation in the VA records in the eighties and seventies that the veteran had been on Synthroid. It was noted that that the veteran reported that his thyroid problem began in 1950 or 1951 and that he started on medication in 1960. The examiner noted diagnoses including hypothyroidism, currently euthyroid on thyroid replacement and vitiligo. The examiner indicated that there was a potential relationship between vitiligo and thyroid disease. The examiner indicated that both could be caused by autoimmune mechanisms and that thyroid disease, did not, per se, cause vitiligo. The examiner stated that he was unaware that ionizing radiation causes vitiligo. At the June 1999 hearing before a member of the Board, the veteran testified that he was in Japan for eighteen months. He indicated that there had to be radiation in the caves he went into. The veteran indicated that his degenerative disc disease started to bother him in the sixties and that he currently had hypothyroidism. The Board has weighed the evidence of record. It is observed that the record is without sufficient objective evidence supportive of a finding that hypothyroidism, peptic ulcer disease, a hand disorder, an elbow disorder, a back disorder, arthritis of the cervical and lumbosacral spine and residuals of a lipoma originated during the veteran's period of service or that arthritis or peptic ulcer disease were manifested within one year of service separation. The veteran's service medical records make no reference to the claimed disorders. Further, the Board observes that the first clinical indication of treatment for each of the claimed disorders, as shown by the medical evidence listed above, was pursuant to records showing treatment many years after the veteran's separation from service. Additionally, the Board notes that a May 1988 statement from Dr. Ward noted that the veteran reported that his duties during service included cleaning out caves which the Japanese used for storage of toxic material. Dr. Ward indicated that the veteran believed that Mercury was present and that he was in Japan close enough after the atomic bomb explosions to have been affected by radioactivity. Dr. Ward noted that the veteran had raised a question as to whether such type of exposure could be a factor in his overall general health. Additionally, the Board notes that a November 1997 thyroid examination report noted that the veteran reported that his thyroid problem began in 1950 or 1951 and that he started medication in 1960. The examiner indicated that VA records in the eighties and seventies noted that the veteran had been on Synthroid. The diagnoses included hypothyroidism, currently euthyroid on thyroid replacement and vitiligo. The Board notes that the Court has held that evidence which is simply information recorded by a medical examiner, unenhanced by any additional medical comment by the examiner, does not constitute "competent medical evidence" satisfying the Grotveit v. Brown, 5 Vet.App. 91 (1993) requirement. Additionally, although an examiner can render a current diagnosis based on his examination of the veteran, without a thorough review of the record, his opinion regarding etiology can be no better than the facts alleged by the veteran. See Swann v. Brown, 5 Vet.App. 229, 233 (1993). The Board notes that Dr. Ward and the examiner, pursuant to the November 1997 VA thyroid examination report, did not relate any claimed disorders to the veteran's period of service or to exposure to radiation or to toxic chemical exposure. Also, the November 1997 VA genitourinary, orthopedic and gastrointestinal examination reports also fail to indicate any such relationship. The Board notes that the medical evidence of record simply fails to adequately establish any relationship or nexus between the claimed disorders and the veteran's period of service. See Caluza. Additionally, the Board notes that the veteran specifically claims that he has hypothyroidism, peptic ulcer disease, a hand disorder, an elbow disorder, a back disorder, arthritis of the cervical and lumbosacral spine, and residuals of a lipoma due to radiation exposure during service. However, these are not diseases for which service connection may be presumed in a radiation exposed veteran. Accordingly, even if the veteran participated in a radiation risk activity (which there is no evidence of), there is no evidence of a disease for which service connection may be presumed in a radiation exposed veteran. 38 C.F.R. §§ 3.307, 3.309(d) (1999). The Board also notes that there is no evidence of a radiogenic disease for which service connection could be established. 38 C.F.R. § 3.311 (1999). Service connection for a disability that is due to radiation exposure may be established with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039 (Fed.Cir. 1994). However, there is no evidence in the record that any of the veteran's claimed medical problems are due to radiation exposure during service. 38 C.F.R. § 3.303 (1999). While the veteran has asserted, in essence, that his claimed disabilities are due to radiation exposure during service, there is no competent evidence in the record to support his assertion. As a lay person, he is not considered competent to offer an opinion as to medical diagnosis or causation. See Moray v. Brown, 5 Vet.App. 211 (1993); Grottveit v. Brown, 5 Vet.App. 91 (1993); Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Furthermore, lay assertions of medical causation cannot constitute evidence to render a claim well-grounded. Grottveit v. Brown, 5 Vet.App. 91, 93 (1993). The veteran has not submitted evidence that would justify a belief by a fair and impartial individual that his claims are plausible. There is no evidence that the veteran has a disease that is presumed to be caused by radiation nor is there any evidence that he has a radiogenic disease. There is also no competent evidence of a nexus between any present disability and any radiation exposure during service. The Board further notes that the veteran's claimed disorders are not listed disabilities entitled to presumptive service connection pursuant to the regulations governing exposure to vesicant agents, identified as Lewisite, nitrogen or sulfur mustard. 38 C.F.R. § 3.316(a) (1999). In fact, the veteran in testimony on appeal, has solely indicated that he was exposed to Mercury. Accordingly, entitlement to service connection for such disorders under presumptive service regulations is not warranted. Further, as noted above, the veteran has not established service connection with proof of actual direct causation. See Combee. Therefore, the Board concludes that the veteran's claims for service connection for hypothyroidism, peptic ulcer disease, a hand disorder, a back disorder, arthritis of the cervical and lumbosacral spine, and residuals of a lipoma, are not plausible and, therefore, not well-grounded. Further, the Board finds the information provided in the statement of the case and other correspondence from the RO sufficient to inform the veteran of the elements necessary to complete his application for service connection. Moreover, the veteran has not put the VA on notice of the existence of any specific, particular piece of evidence that, if submitted, might make the claim well-grounded. Robinette v. Brown, 8 Vet.App. 69 (1995). Although the RO did not specifically state that it denied the veteran's claim on the basis that it was not well grounded, the Board concludes that this was not prejudicial to the veteran. See Edenfield v. Brown, 8 Vet.App 384 (1995) (en banc) (when the Board decision disallowed a claim on the merits where the Court finds the claim to be not well grounded, the appropriate remedy is to affirm, rather than vacate, the Board's decision, on the basis of nonprejudicial error). The Board, therefore, concludes that denying the appeal on these issues because the claims are not well grounded is not prejudicial to the veteran. See Bernard v. Brown, 4 Vet.App. 384 (1993). III. Entitlement to an Effective Date Prior to November 13, 1997, for a 40 Percent Evaluation for Bilateral Hearing Loss A. Historical Review On December 7, 1995, the RO received the veteran's claim for service connection for bilateral hearing loss. A November 1995 private audiological examination report from the Midwest Ear, Nose and Throat Clinic, P.C., noted pure tone thresholds in the veteran's right ear of 30 decibels at 1,000 Hz, 35 decibels at 2,000 Hz, 65 decibels at 3,000 Hz and 65 decibels at 4,000 Hz. As to his left ear, pure tone thresholds were 30 decibels at 1,000 Hz, 35 decibels at 2,000 Hz, 60 decibels at 3,000 Hz and 70 decibels at 4,000 Hz. The speech recognition ability was not provided. In a November 1996 statement, Gerald B, Simons, M.D., stated that the veteran was followed for primary problems of high frequency sensorineural hearing loss. The veteran underwent a VA audiological examination in February 1996. The examiner noted pure tone thresholds in the veteran's right ear of 25 decibels at 1,000 Hz, 40 decibels at 2,000 Hz, 55 decibels at 3,000 Hz and 60 decibels at 4,000 Hz. The average pure tone threshold for the veteran's right ear was 45 decibels. The speech recognition ability was 78 percent. As to the veteran's left ear, pure tone thresholds were 15 decibels at 1,000 Hz, 25 decibels at 2,000 Hz, 50 decibels at 3,000 Hz and 60 decibels at 4,000 Hz. The average pure tone threshold for the left ear was 37 decibels and the speech recognition ability was 84 percent. The examiner indicated that there was a mild to moderately- severe sensorineural loss present from 1,500 Hz to 8,000 Hz in the veteran's right ear. There was a moderate to moderately-severe sensorineural loss present from 2,000 Hz to 8,000 Hz in the veteran's right ear. A March 1996 rating decision denied service connection for bilateral hearing loss. A June 1996 audiological examination report from the Otoneurologic Services at Clarkson Hospital noted pure tone thresholds in the veteran's right ear of 45 decibels at 1,000 Hz, 50 decibels at 2,000 Hz, 60 decibels at 3,000 Hz and 65 decibels at 4,000 Hz. The speech recognition ability was 84 percent. The veteran's left ear had pure tone thresholds of 40 decibels at 1,000 Hz, 45 decibels at 2,000 Hz, 55 decibels at 3,000 Hz and 60 decibels at 4,000 Hz. The speech recognition ability was 84 percent. In a June 1996 statement, Dr. Simons noted that the audiological examination report demonstrated high frequency, sloping, moderate to severe sensorineural hearing loss, which was symmetrical. A September 1996 rating decision denied service connection for bilateral hearing loss. In an October 1996 statement, Dr. Simons stated that it was his opinion that the cause of the veteran's sensorineural hearing loss was due to his service related exposure to noise damage from gunfire. VA treatment records dated from December 1996 to February 1997 and private treatment records dated from June 1996 to April 1997 indicated that he was treated for several disorders. In a February 1997 statement, Dr. Simons noted that the veteran was exposed to loud gun noise on naval battleships. Dr. Simons stated that it was his opinion that such noise exposure was consistent with the sensorineural hearing loss that the veteran suffered as a causative event. The veteran underwent a VA audiological examination on November 13, 1997. The examiner noted pure tone thresholds in the veteran's right ear of 30 decibels at 1,000 Hz, 50 decibels at 2,000 Hz, 65 decibels at 3,000 Hz and 65 decibels at 4,000 Hz. The average pure tone threshold in the veteran's right ear was 52 decibels. The speech recognition ability was 50 percent. As to the veteran's left ear, pure tone thresholds of 30 decibels at 1,000 Hz, 40 decibels at 2,000 Hz, 60 decibels at 3,000 Hz and 65 decibels at 4,000 Hz were noted. The average pure tone threshold for the left ear was 48 decibels and the speech recognition ability was 56 percent. A November 1997 VA ear examination report noted diagnoses of moderate to severe sensorineural hearing loss, bilaterally in the high frequencies which was symmetric. The examiner stated that he believed that the hearing loss experienced by the veteran was secondary to the noise exposure he had in service. It was noted that test results were such that the veteran would be expected to encounter communication difficulties in difficult listening situations and would derive benefit from hearing aids. A January 1998 rating decision granted service connection for bilateral hearing loss and assigned a noncompensable disability evaluation effective December 7, 1995 and a 40 percent disability evaluation effective November 18, 1997. An April 1999 rating decision continued a noncompensable disability evaluation effective December 7, 1995 and assigned a 40 percent disability evaluation effective November 13, 1997. At the June 1999 hearing on appeal, the veteran testified as to his claimed disorders. VA treatment records dated from April 1997 to October 1999 referred to continued treatment. II. Earlier Effective Date The veteran advances, essentially, that the effective date for the 40 percent evaluation for the veteran's service- connected bilateral hearing loss should be December 7, 1995, the date of the veteran's claim for service connection. The Board observes that the assignment of effective dates for increased disability evaluations is governed by 38 U.S.C.A. § 5110 (West 1991 & Supp. 1999) and 38 C.F.R. § 3.400 (1999). The statute provides, in pertinent part, that: (a) Unless specifically provided otherwise in this chapter, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. * * * (b)(2) The effective date of an award of increased compensation shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year from such date. 38 U.S.C.A. § 5110 (West 1991 & Supp. 1999). The pertinent provisions of 38 C.F.R. § 3.400 (1999) clarify that: Except as otherwise provided, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. * * * (o)(2) Disability compensation. Earliest date as of which it is factually ascertainable that an increase in disability had occurred if the claim is received within 1 year from such date otherwise, date of receipt of claim. The provisions of 38 C.F.R. § 3.157 (1999) direct further, in pertinent part, that: (a) General. Effective date of pension or compensation benefits, if otherwise in order, will be the date of receipt of a claim or the date when entitlement arose, whichever is the later. A report of examination or hospitalization which meets the requirements of this section will be accepted as an informal claim for benefits under an existing law or for benefits under a liberalizing law or Department of Veterans Affairs issue, if the report relates to a disability which may establish entitlement. (b) Claim. Once a formal claim for pension or compensation has been allowed or a formal claim for compensation disallowed for the reason that the service-connected disability is not compensable in degree, receipt of one of the following will be accepted as an informal claim for increased benefits or an informal claim to reopen. (1) Report of examination or hospitalization by Department of Veterans Affairs or uniformed services. The date of outpatient or hospital examination or date of admission to a VA or uniformed services hospital will be accepted as the date of receipt of claim. . . . The provisions of this paragraph apply only when such reports relate to examination or treatment of a disability for which service-connection has previously been established or when a claim specifying the benefit sought is received within one year from the date of such examination, treatment or hospital admission. Additionally, disability evaluations are determined by comparing the veteran's present symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C.A. § 1155 (West 1991 & Supp. 1999); 38 C.F.R. Part 4 (1999). Evaluations of bilateral defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests together with the average hearing threshold level as measured by pure tone audiometry tests in the frequencies 1,000, 2,000, 3,000 and 4,000 cycles per second. To evaluate the degree of disability from bilateral service-connected defective hearing, the rating schedule establishes eleven auditory acuity levels designated from level I for essentially normal acuity through level XI for profound deafness. 38 C.F.R. § 4.85 and Part 4, Diagnostic Codes 6100 to 6110. The "assignment of disability ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered." Lendenmann v. Principi, 3 Vet.App. 345, 349 (1992). The Board observes that the effective date of an evaluation is based upon a variety of factors, including the date of claim, date entitlement is shown, date of informal claims, reports of VA hospitalization or treatment, finality of decisions, and date of "new claim". In order to apply the above statutory and regulatory provisions to the instant appeal, it is necessary to determine the date of the veteran's claim and the date that it became ascertainable that the veteran's service-connected bilateral hearing loss was productive of a 40 percent disability evaluation. The Board notes that the veteran submitted a formal claim for service connection for bilateral hearing loss on December 7, 1995. The Board notes that a November 1995 private audiological examination report from the Midwest Ear, Nose and Throat Clinic, P.C., noted an average pure tone thresholds in the veteran's right and left ear of 49 decibels. However, speech recognition ability was not provided. The Board observes that the provisions of 38 C.F.R. §§ 3.157(b)(1) (1999), provide that the date of outpatient or hospital examination or the date of admission to a VA hospital will be accepted as the date of receipt of an informal claim which such reports relate to examination or treatment of a disability for which service-connection has previously been established. The Board notes that service- connection for bilateral hearing loss had not been previously established. Further, the December 1995 private audiological examination report was not from a VA facility. Consequently such report does not constitute an ultimately perfected claim. See Quarles v. Derwinski, 3 Vet.App. 129 (1992). Therefore, the Board concludes that the claim submitted on December 7, 1995 constitutes the perfected claim in this matter. The Board observes that a February 1996 VA audiological examination report noted an average pure tone threshold in the veteran's right ear of 45 decibels with speech recognition ability of 78 percent. The average pure tone threshold in the veteran's left ear was 37 decibels with a speech recognition ability of 84 percent. Such results translate to a numeric designation of hearing impairment of level III in the right ear and level II in the left ear. Therefore, the veteran's degree of hearing impairment, at that time, equated to a noncompensable disability evaluation. 38 C.F.R. Part 4, including §§ 4.85, 4.86, 4.87 and Diagnostic Code 6100 (1999). A June 1996 audiological examination report from Clarkson Hospital noted an average pure tone threshold in the veteran's right ear of 55 decibels with a speech recognition ability of 84 percent. As to the left ear, the average pure tone threshold was 50 decibels and the speech recognition ability was 84 percent. Such results translate to a numeric designation of hearing impairment of level II in the right ear and level II in the left ear. Such results also equate to a noncompensable evaluation. The November 13, 1997 audiological examination report noted an average pure tone threshold of 52 decibels in the veteran's right ear and a speech recognition ability of 50 percent. The average pure tone threshold was 48 decibels with a speech recognition ability of 56 percent in the veteran's left ear. Such results translate to a numeric designation of hearing impairment of level VIII in the right ear and level VI in the left ear. Therefore, the veteran's degree of hearing impairment, at that time, equated to a 40 percent disability evaluation. Accordingly, the Board must conclude that the increase in symptomatology as to the veteran's bilateral hearing loss, became ascertainable at the time of the November 13, 1997, VA audiological examination, a date subsequent to the December 7, 1995, date of claim. Therefore, the veteran is not entitled to an effective date prior to the date that entitlement arose to an increased evaluation. 38 U.S.C.A. § 5110 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.157, 3.400 (1999). The Board notes that the veteran has been afforded a noncompensable disability evaluation from December 7, 1995, the date of claim. An increased evaluation was not factually ascertainable until November 13, 1997. Accordingly, the Board concludes that the effective date for a 40 percent evaluation for bilateral hearing loss is November 13, 1997. ORDER The veteran has not submitted new and material evidence sufficient to reopen his claim for service connection for a hyperpigmented skin disorder, secondary to radiation exposure or to toxic chemical exposure. Service connection for hypothyroidism, peptic ulcer disease, a hand disorder, an elbow disorder, a back disorder, arthritis of the cervical and lumbosacral spine, and residuals of a lipoma, is denied. Entitlement to an effective date prior to November 13, 1997, for a 40 percent evaluation for bilateral hearing loss is denied. REMAND The veteran asserts on appeal that he is entitled to service connection for residuals of prostate cancer, secondary to radiation exposure or to toxic chemical exposure. In reviewing the record, the Board notes that the RO did not fully comply with the Board's March 1995 remand instructions. The March 1995 remand, requested in part, that the RO attempt to obtain copies of the veteran's service personnel records, and once obtained, should provide the Defense Nuclear Agency with copies of such records and the veteran's statements concerning the circumstances of his alleged radiation exposure. The RO was to request that the Defense Nuclear Agency provide a description of the veteran's service duties that would have included any risk of radiation exposure and an estimate of the veteran's service radiation exposure. The Board notes that the RO made numerous attempts to obtain the veteran's service personnel records. However, there is no indication that the Defense Nuclear Agency was ever contacted. Additionally, the Board notes that the veteran has been diagnosed with prostate cancer. A November 1997 VA genitourinary examination report indicated an impression of history of prostate cancer. The examiner noted that the veteran underwent a curative prostatectomy 12 years earlier. The Board observes that prostate cancer was recently recognized as a radiogenic disease under the provisions of 38 C.F.R. § 3.311(b)(2). According to the Federal Register dated on September 24, 1998, VA amended by final rule that prostate cancer and any other cancer shall be included in the list of radiogenic diseases in 38 C.F.R. § 3.311(b)(2). See 63 Fed. Reg. 50993-50995 (1998) (to be codified at 38 C.F.R. § 3.311). Moreover, in a recent decision, Hilkert v. West, No. 96-208 (U.S. Vet. App. July 16, 1998), the United States Court of Veterans Appeals (Court) held that the Under Secretary of Benefits must consider the factors set forth under the provisions of 38 C.F.R. § 3.311(e). Under that regulation, the factors to be considered in determining whether a veteran's disease resulted from exposure to ionizing radiation in service include: (1). The probable dose, in terms of dose type, rate and duration as a factor in inducing the disease, taking into account any known limitations in the dosimetry devices employed in its measurement or the methodologies employed in its estimation; (2). The relative sensitivity of the involved tissue to induction, by ionizing radiation, of the specific pathology; (3). The veteran's gender and pertinent family history; (4). The veteran's age at time of exposure; (5). The time-lapse between exposure and onset of the disease; and (6). The extent to which exposure to radiation, or other carcinogens, outside of service may have contributed to development of the disease. The Board observes that the Court has held that the RO must comply with the Board's remand instructions or explain its failure to complete the requested action. Talley v. Brown, 6 Vet.App. 72, 74 (1993). Also, the Court recently issued a decision vacating and remanding a Board decision on the ground that the RO failed to follow the directives contained in the Board remand. In concluding that a further remand was required, the Court noted the following regarding the VA 's failure to comply with the terms of the prior Board remand: [A] remand by this Court or the Board confers on the veteran or other claimant, as a matter of law, the right to compliance with the remand orders. We hold further that a remand by the Court or the Board imposes upon the Secretary of Veterans Affairs a concomitant duty to ensure compliance with the terms of the remand. Stegall v. West, No. 97-78 (U.S. Vet.App. June 26, 1998). Given the nature of the veteran's contentions, the lack of evidence of an attempt to contact the Defense Nuclear Agency, and in consideration of the holdings in the cases noted above, the Board concludes that additional development would be helpful prior to completion of appellate review. In light of the VA's duty to assist the veteran in the proper development of his claim as mandated by the provisions of 38 U.S.C.A. § 5107(b) (West 1991) and as interpreted by the United States Court of Veterans Appeals (hereinafter "the Court") in Littke v. Derwinski, 1 Vet.App. 90, 92-93 (1990), this case is REMANDED for the following action: 1. The RO should notify the veteran that he may submit additional evidence and argument in support of his claim. Kutscherousky v. West, 12 Vet. App. 369 (1999). 2. The RO should provide the Defense Nuclear Agency with the veteran's statements concerning the circumstances of his alleged radiation exposure. The RO should request that the Defense Nuclear Agency provide a description of the veteran's service duties that would have included any risk of radiation exposure, an estimate of the veteran's service radiation exposure, and copies of any available records pertinent to assessing the veteran's service radiation exposure including his Record of Occupational Exposure to Ionizing Radiation (DD Form 1141) if maintained. 3. The RO should undertake all appropriate evidentiary development under the provisions of 38 C.F.R. § 3.311, to include obtaining an advisory medical opinion from VA's Under Secretary for Health, prior to a complete review by VA's Under Secretary for Benefits, who should consider the factors set forth in 38 C.F.R. § 3.311(e), and any further development felt to be appropriate by that official. 4. After undertaking any additional development deemed appropriate, including any indicated medical examinations, the RO should readjudicate the issue of entitlement to service connection for prostate cancer due to exposure to ionizing radiation. 5. This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Veterans Appeals for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1998) (Historical and Statutory Notes). In addition, VBA's ADJUDICATION PROCEDURE MANUAL, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44- 8.45 and 38.02-38.03. When the requested action has been completed, and if his claim continues to be denied, the veteran should be afforded a reasonable period of time in which to respond to a supplemental statement of the case. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration if appropriate. The veteran need not take any action unless he is further informed. The purpose of this REMAND is to allow for further development of the record. No inference should be drawn from it regarding the final disposition of the veteran's claim. While regretting the delay involved in again remanding this case, it is felt that to proceed with a decision on the merits at this time would not withstand Court scrutiny. JEFF MARTIN Member, Board of Veterans' Appeals