Citation Nr: 0003698 Decision Date: 02/11/00 Archive Date: 02/15/00 DOCKET NO. 98-05 476A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for a chronic viral disability. 2. Entitlement to service connection for a neck disability to include cervical spondylosis and C5-6 degenerative changes. 3. Entitlement to service connection for a lumbosacral spine disability to include degenerative joint disease. 4. Entitlement to service connection for a skin disorder to include a rash. 5. Entitlement to service connection for bilateral hearing loss disability. REPRESENTATION Appellant represented by: Department of Veterans Affairs, Alabama WITNESS AT HEARING ON APPEAL The veteran INTRODUCTION The veteran had active service from September 1969 to September 1971. This matter came before the Board of Veterans' Appeals (Board) on appeal from a July 1997 rating decision of the Montgomery, Alabama, Regional Office (RO) which, in pertinent part, determined that the veteran had not submitted a well-grounded claim of entitlement to service connection for a chronic viral disability; denied that claim; and denied service connection for a neck disability to include cervical spondylosis and C5-6 degenerative changes; a lumbosacral spine disability to include degenerative joint disease; a skin disorder to include a rash; and bilateral hearing loss disability. In April 1998, the veteran was afforded a hearing before a Department of Veterans Affairs (VA) hearing officer. In October 1998, the RO determined that the veteran had not submitted well-grounded claims of entitlement to service connection for a neck/cervical spine disability, a lumbar spine/back disability, a skin disability, and bilateral hearing loss disability. The veteran has been represented throughout this appeal by Alabama Department of Veterans Affairs. The veteran may have submitted informal claims of entitlement to service connection for bilateral tinnitus and an increased disability evaluation for his service-connected post-traumatic stress disorder (PTSD). It appears that the RO has not had an opportunity to act upon the claims. Absent an adjudication, a notice of disagreement, a statement of the case, and a substantive appeal, the Board does not have jurisdiction over the issues. Rowell v. Principi, 4 Vet. App. 9 (1993); Roy v. Brown, 5 Vet. App. 554 (1993); Black v. Brown, 10 Vet. App. 279, 284 (1997); Shockley v. West, 11 Vet. App. 208 (1998). Jurisdiction does matter and it is not "harmless" when the VA fails to consider threshold jurisdictional issues during the claim adjudication process. Furthermore, this Acting Board Member cannot have jurisdiction of the issues. 38 C.F.R. § 19.13 (1999). The United States Court of Appeals for Veterans Claims (Court) has noted that: Furthermore, 38 U.S.C.A. § 7105 (West 1991) establishes a series of very specific, sequential, procedural steps that must be carried out by a claimant and the RO or other "agency of original jurisdiction" (AOJ) (see Machado v. Derwinski, 928 F.2d 389, 391 (Fed. Cir. 1991)) before a claimant may secure "appellate review" by the BVA. Subsection (a) of that section establishes the basic framework for the appellate process, as follows: "Appellate review will be initiated by a notice of disagreement [(NOD)] and completed by a substantive appeal after a statement of the case is furnished as prescribed in this section." Bernard v. Brown, 4 Vet. App. 384 (1994). All steps required for jurisdiction have not been satisfied. More recently, the Court again established that jurisdiction counts. Specifically, the Court could not remand a matter over which it has no jurisdiction. Hazan v. Gober, 10 Vet. App. 511(1997). Therefore, the issues are referred to the RO for action as may be appropriate. Black v. Brown, 10 Vet. App. 279 (1997). If the veteran wishes to appeal from the decision, he has an obligation to file a timely notice of disagreement and a timely substantive appeal following the issuance of the statement of the case. 38 C.F.R. § 20.200 (1999). FINDINGS OF FACT 1. The veteran was treated for a viral illness during active service. 2. A chronic viral disability was not manifested during active service or at any time thereafter. The record contains no competent evidence attributing the veteran's post-service viral disorders to active service. 3. A neck/cervical spine disability was not shown during active service or for many years after service separation. The record contains no competent evidence attributing the veteran's current cervical spine degenerative disc disease and degenerative joint disease to active service. 4. A lumbosacral spine disability was not shown during active service or for many years after service separation. The record contains no competent evidence attributing the veteran's current lumbosacral spine degenerative disc disease and degenerative joint disease to active service. 5. A skin disability was not shown during active service or at the most recent VA examination for compensation purposes. CONCLUSIONS OF LAW 1. The veteran has not submitted a well-grounded claim of entitlement to service connection for a chronic viral disability. 38 U.S.C.A. § 5107 (West 1991). 2. The veteran has not submitted a well-grounded claim of entitlement to service connection for a neck disability to include cervical spondylosis and C5-6 degenerative changes. 38 U.S.C.A. § 5107 (West 1991). 3. The veteran has not submitted a well-grounded claim of entitlement to service connection for a lumbosacral spine disability to include degenerative joint disease. 38 U.S.C.A. § 5107 (West 1991). 4. The veteran has not submitted a well-grounded claim of entitlement to service connection for a skin disability to include a rash. 38 U.S.C.A. § 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS 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), and if so, whether the VA has properly assisted him in the development of his claims. In Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997), the Court of Appeals for the Federal Circuit held that the VA has a duty to assist only those claimants who have established well-grounded claims. The Court has clarified that the VA cannot assist a veteran in developing a claim which is not well-grounded. Morton v. West, 12 Vet. App. 477 (1999). Generally, a "well-grounded" claim is one which is plausible. The Court has directed 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. Caluza v. Brown, 7 Vet. App. 498 (1995). Once a veteran has submitted evidence sufficient to justify a belief by a fair and impartial individual that a claim is well-grounded, the veteran's initial burden has been met and the VA is obligated under 38 U.S.C. § 5107(a) to assist him in developing the facts pertinent to his claim. When a claim is determined to be not well-grounded, the VA does not have a statutory duty to assist him in developing the facts pertinent to his claim. However, the VA may be obligated under the provisions of 38 U.S.C.A. § 5103(a) (West 1991) to advise him of the evidence needed to complete his application. This obligation is dependent upon the particular facts of the claim and the extent to which the Secretary of the VA has advised the veteran of the evidence necessary to support a claim for VA benefits. Robinette v. Brown, 8 Vet. App. 69 (1995). The Board observes that the veteran testified at the hearing on appeal that he had applied for Social Security Administration (SSA) benefits. In reviewing a similar factual scenario, the Court has clarified that: Once a claimant has submitted a well-grounded claim, the Secretary has a duty to assist the claimant "in developing the facts pertinent to the claim." 38 U.S.C. § 5107(a). Included in this duty is the responsibility of VA to obtain any relevant records from the Social Security Administration (SSA). See Murincsak v. Derwinski, 2 Vet. App. 363, 370 (1992). However, the duty to obtain SSA records, as incorporated within the duty to assist, is not triggered until the appellant has submitted a well-grounded claim. Voerth v. West, 13 Vet. App. 117, 121 (1999). The veteran is seeking service connection for a chronic viral disability, a neck/cervical spine disability, a lumbosacral spine disability, and a skin disorder. Accordingly, it is necessary to determine if he has submitted a well-grounded claim with respect to each issue. Service connection may be granted for chronic disability arising from disease or injury incurred in or aggravated by wartime service. 38 U.S.C.A. § 1110 (West 1991). 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." When 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). Where a veteran served continuously for ninety days or more during a period of war and arthritis (degenerative joint disease) becomes manifest to a degree of ten percent within one year of termination of such service, such disease shall be presumed to have been incurred in service even becomes manifest to a degree of ten percent within one year of termination of such service, such disease 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 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.307, 3.309 (1999). If a veteran was exposed to an herbicide agent during active military, naval, or air service, service connection will be established for chloracne or other acneform disease consistent with chloracne; Hodgkin's disease; multiple myeloma; non-Hodgkin's lymphoma; acute and sub-acute peripheral neuropathy (The term "acute and sub-acute peripheral neuropathy" denotes transient peripheral neuropathy that appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset.); porphyria cutanea tarda; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx, or trachea); and soft tissue sarcoma other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma (The term "soft-tissue sarcoma" includes the following: adult fibrosarcoma, dermatofibrosarcoma protuberans, malignant fibrous histiocytoma, liposarcoma, lipomyosarcoma, epithelioid leiomyosarcoma (malignant leiomyoblastoma), rhabdomyosarcoma, etomesenchymoma, angiosarcoma (hemangiosarcoma and lymphangiosarcoma), proliferating (systemic) angioendotheliomatosis, malignant glomus tumor, malignant hemangiopericytoma, synovial sarcoma (malignant synovioma), malignant giant cell tumor of tendon sheath, malignant schwannoma including malignant schwannoma with rhabdomyoblastic differentiation (malignant triton tumor), glandular and epithelioid malignant schwannomas, malignant mesenchymoma, malignant granular cell tumor, alveolar soft part sarcoma, epithelioid sarcoma, clear cell sarcoma of tendons and aponeuroses, extraskeletal Ewing's sarcoma, congenital and infantile fibrosarcoma, and malignant ganglioneuroma.) even though there is no record of such disease during service if the requirements of 38 C.F.R. § 3.307(a)(6) and (d) are satisfied. 38 U.S.C.A. §§ 1101, 1113, 1116 (West 1991 & Supp. 1999); 38 C.F.R. § 3.309(e) (1999). The provisions of 38 C.F.R. § 3.307(a)(6) and (d) (1999) provide, in pertinent part, that: (a)(6) Diseases associated with exposure to certain herbicide agents. (i) For the purposes of this section, the term "herbicide agent" means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the Vietnam era, specifically: 2,4-D; 2,4,5- T and its contaminant TCDD; cacodylic acid; and picloram. (ii) The diseases listed at § 3.309(e) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne and porphyria cutanea tarda shall have become manifest to a degree of 10 percent or more within a year, and respiratory cancers within 30 years, after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. (iii) A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era and has a disease listed at § 3.309(e) shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. The last date on which such a veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the Vietnam era. "Service in the Republic of Vietnam" includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. *** (d) Rebuttal of service incurrence. Evidence which may be considered in rebuttal of service incurrence of a disease listed in § 3.309 will be any evidence of a nature usually accepted as competent to indicate the time of existence or inception of disease, and medical judgment will be exercised in making determinations relative to the effect of intercurrent injury or disease. The expression "affirmative evidence to the contrary" will not be taken to require a conclusive showing, but such showing as would, in sound medical reasoning and in the consideration of all evidence of record, support a conclusion that the disease was not incurred in service. 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. Presumptive periods are not intended to limit service connection to diseases so diagnosed when the evidence warrants direct service connection. The presumptive provisions of the statute and VA regulations implementing them are intended as liberalizations applicable when the evidence would not warrant service connection without their aid. 38 C.F.R. § 3.303(d) (1999). I. Chronic Viral Residuals Army clinical documentation dated in November 1970 notes that the veteran presented a three day history of headaches, malaise, and fever. Impressions of a fever, "prob[able] malaria," "[ruleout] pneumonitis," "resolving febrile state," and "viral illness" were advanced. At the veteran's September 1971 physical examination for service separation, the Army examiner identified no chronic viral disabilities or chronic residuals thereof. In his September 1971 Veteran's Application for Compensation or Pension at Separation from Service (VA Form 21-526e), the veteran indicated that he was treated for a venereal disease during active service. A hospital summary and associated clinical documentation from Druid City Hospital dated in July 1975 states that the veteran was admitted upon a diagnosis of "fever of unknown etiology." He presented a two to three month history of malaise, coughing, and some night sweats. He was noted to have been hospitalized for "some unknown 'viral infection'" during active service and to have been exposed to meningitis in March or April 1975. Upon discharge from the hospital, the veteran was diagnosed with "probable viral pneumonia." An October 1993 VA treatment record notes that the veteran reported that he had been hospitalized with a 104 degree fever while in the Republic of Vietnam; was told by treating military medical personnel that he had an "unknown virus [which] settled in [his] back;" and had been treated for two relapses at the Druid City Hospital and the Tuscaloosa, Alabama, VA Medical Center in approximately 1983. A September 1995 VA psychiatric treatment record conveys that the veteran reiterated that he had been hospitalized with a temperature of 103 degrees during active service and had been hospitalized on two occasions since service separation with the same symptomatology. In his April 1996 Veteran's Application for Compensation or Pension (VA Form 21-526), the veteran advanced that he had been treated for an "unknown virus" during active service and "symptoms of [a] virus" at the Tuscaloosa, Alabama, VA Medical Center and Druid City Hospital. At a November 1996 VA examination for compensation purposes, the veteran neither complained of nor exhibited a chronic viral disability. At the April 1998 hearing on appeal, the veteran testified that he had been hospitalized for two weeks with a viral illness while serving in the Republic of Vietnam. His illness was manifested by a high fever, night sweats, and other malarial-like symptoms. Treating military medical personnel did not diagnosis the veteran with malaria or any other specific viral disability. The veteran related that he had suffered from several viral illnesses between service separation and 1977. He clarified that he had been diagnosed with delirium due to fever and diarrhea at the Tuscaloosa, Alabama, VA Medical Center in 1972 and 1977. He was not aware of whether his treating VA physicians had determined a specific etiology for his symptoms. The veteran concurrently advanced that he experienced chronic ongoing night sweats and fever blisters on his lips related to his prior inservice viral illness and denied having had any viral illnesses since 1977. An October 1998 VA psychiatric treatment record states that the veteran reported that he had injured his back in Vietnam; subsequently developed a fever, chills, and other symptoms of a systemic illness approximately four to five days after his back injury; and was hospitalized with similar symptoms on two occasions following service separation. The veteran believed that "something 'settled in his back' at the time." A diagnosis of recurrent sinus and "flu-like symptoms" was advanced. A June 1999 VA physical evaluation notes that the veteran denied experiencing fever, chills, fatigue, or night sweats. The Board has reviewed the probative evidence of record including the veteran's testimony and statements on appeal. The veteran was treated for a not otherwise specified viral illness in November 1970 while stationed in the Republic of Vietnam. Subsequent Army treatment records make no reference to a chronic viral disability. The report of the veteran's September 1971 physical examination for service separation relates that no chronic viral disability or chronic residuals thereof were identified. Such findings tend to establish that the veteran's inservice viral illness resolved without chronic residuals. The veteran asserts that he has had several post-service viral illnesses and exhibits chronic residuals of his inservice viral illness. The post-service clinical documentation of record reflects that the veteran was diagnosed with probable viral pneumonitis in 1975. While noting the veteran's prior inservice viral illness, the veteran's treating private physician at that time did not establish an etiological relationship between the veteran's inservice illness and his probable viral pneumonia. There is no competent evidence establishing that the veteran currently exhibits a chronic viral disability. In the absence of evidence of current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The veteran's claim is supported solely by the accredited representative's statements and his own testimony and statements on appeal. The Court has held that lay assertions of medical causation do not constitute competent evidence to render a claim well-grounded. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992); Savage v. Gober, 10 Vet. App. 488 (1997). The Court has commented that: Just as the BVA must point to a medical basis other than its own unsubstantiated opinion (Colvin [v. Derwinski, 1 Vet. App. 174, 175 (1991)]), the veteran cannot meet his initial burden by relying upon his own, or his representative's, opinions as to medical matters. Robinette v. Brown, 8 Vet. App. 69, 74 (1995). There is no indication that either the veteran or the accredited representative is a medical professional. To the extent that the lay statements attempt to question a medical diagnosis or other clinical determinations as to the origins or existence of the claimed disorder, they may not be considered as competent evidence. Statements as to what the veteran may have been told by a physician during or after service, standing alone, are insufficient to establish a medical diagnosis. Warren v. Brown, 6 Vet. App. 4, 6 (1993). As the record lacks competent evidence establishing that the veteran currently has a chronic viral disability, the Board concludes that the veteran's claim for service connection is not well-grounded. The veteran has not advanced that he sustained the claimed disorder in combat. In light of this fact, the Board finds that the provisions of 38 U.S.C.A. § 1154 (West 1991) do not serve to advance his claim. See Libertine v. Brown, 9 Vet. App. 521 (1996). Accordingly, the instant claim is denied. 38 U.S.C.A. § 5107 (West 1991). The veteran is informed that if he is able to produce competent evidence attributing the claimed disability to active service, he should petition to reopen his claim. II. Neck/Cervical Spine Disability The veteran's service medical records make no reference to a neck or cervical spine disability. At his September 1971 physical examination for service separation, the veteran was noted to exhibit a normal neck. In his April 1996 Veteran's Application for Compensation or Pension (VA Form 21-526), the veteran asserts that he sustained a neck injury while stationed in the Republic of Vietnam. A January 1996 magnetic resonance imaging study of the cervical spine from the University of Alabama-Birmingham University Hospital notes that the veteran complained of neck pain. The study revealed findings consistent with mild cervical spondylosis and C5-6 and C6-7 disc bulging and spinal stenosis. At the November 1996 VA examination for compensation purposes, the veteran complained of chronic neck pain. He reported that he had injured his neck and back after lifting a fifty-five gallon diesel fuel tank onto a truck while in Vietnam and was subsequently hospitalized for two weeks for treatment of his back. Contemporaneous X-ray studies of the cervical spine revealed early degenerative changes of the C5 and C6 with narrowing of the C5-6 interspace. The veteran was diagnosed with chronic neck pain secondary to cervical spondylosis and C5-6 spinal stenosis. At the hearing on appeal, the veteran testified that he had injured his neck while he was hospitalized in Vietnam for his low back injury and viral illness. He stated that he had injured his neck when he "fell out" during a chest X-ray study and struck his head against a wall and his back on the floor. He acknowledged having received no inservice or post-service treatment for his neck injury. The veteran's service medical records make no reference to a neck or cervical spine disability. The first objective clinical documentation in the record of the claimed disorder is the January 1996 magnetic resonance imaging study from the University of Alabama-Birmingham University Hospital showing mild cervical spondylosis and C5-6 and C6-7 disc bulging and mild spinal stenosis. The veteran contends that he sustained his chronic neck/cervical spine disabilities in an inservice fall. He has acknowledged that he received no inservice or post-service medial treatment for the claimed disorder. The record contains no objective findings as to the etiology of the veteran's current cervical spine degenerative disc disease and degenerative joint disease. The veteran's claim is supported solely by the accredited representative's and his own testimony and statements on appeal. The Court has held that lay assertions of medical causation do not constitute competent evidence to render a claim well-grounded. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992); Savage v. Gober, 10 Vet. App. 488 (1997); Robinette v. Brown, 8 Vet. App. 69, 74 (1995). To the extent that the lay statements attempt to question a medical diagnosis or other clinical determinations as to the origins of the claimed disorder, they may not be considered as competent evidence. Statements as to what the veteran may have been told by a physician during or after service, standing alone, are insufficient to establish a medical diagnosis. Warren v. Brown, 6 Vet. App. 4, 6 (1993). As the record lacks competent evidence establishing that an etiological relationship exists between the veteran's current chronic cervical spine disabilities and active service, the Board concludes that the veteran's claim for service connection is not well-grounded. The veteran has not advanced that he sustained the claimed disorder in combat. In light of this fact, the Board finds that the provisions of 38 U.S.C.A. § 1154 (West 1991) do not serve to advance his claim. See Libertine v. Brown, 9 Vet. App. 521 (1996). Accordingly, the instant claim is denied. 38 U.S.C.A. § 5107 (West 1991). The veteran is informed that if he is able to produce competent evidence attributing the claimed disability to active service, he should petition to reopen his claim. III. Lumbosacral Spine The veteran's service medical records make no reference to a lumbosacral spine disability. At his September 1971 physical examination for service separation, the veteran exhibited a normal spine. An October 1993 VA treatment record states that the veteran reported injuring his back while in Vietnam. He conveyed that he had been told that a virus had "settled" into his back. A July 1995 VA treatment record indicates that the veteran complained of chronic back pain. He stated that he had injured his back in Vietnam and subsequently experienced chronic back problems. Impressions of chronic back pain and '[ruleout] herniated disc" were advanced. A January 1996 VA treatment record reported that a contemporaneous magnetic resonance imaging study of the lumbar spine had revealed L4-5 lumbar stenosis and disc bulging. In his April 1996 Veteran's Application for Compensation or Pension (VA Form 21-526), the veteran advanced that he had sustained an inservice back injury in 1970 while he was stationed in the Republic of Vietnam. At the November 1996 VA examination for compensation purposes, the veteran complained of chronic back pain. He reported that he had injured his back in Vietnam while loading a fifty-five gallon diesel fuel tank. Diagnostic impressions of "chronic low back pain, sciatic right leg secondary to lumbar disc disease" and lumbosacral spine degenerative joint disease were advanced. At the hearing on appeal, the veteran testified that he had injured his back during active service while loading a fifty-five gallon drum of diesel fuel. The veteran concurrently denied having received any post-service treatment for his back injury and advanced that he received "some spinal taps" to block his back pain while a patient at Druid City Hospital. He believed that his current lumbosacral spine disabilities had been precipitated by his inservice back injury. The veteran's service medical records make no reference to either a back injury or a lumbosacral spine disability. The first objective clinical documentation of the claimed disorder is dated in 1995, some twenty-four years after service separation. The veteran contends that he sustained his current chronic lumbosacral disabilities as the result of an inservice lifting injury. The record contains no objective findings as to the etiology of the veteran's lumbosacral spine degenerative disc disease and degenerative joint disease. The veteran's claim is supported solely by the accredited representative's and his own testimony and statements on appeal. The Court has held that lay assertions of medical causation do not constitute competent evidence to render a claim well-grounded. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992); Savage v. Gober, 10 Vet. App. 488 (1997); Robinette v. Brown, 8 Vet. App. 69, 74 (1995). To the extent that the lay statements attempt to question a medical diagnosis or other clinical determinations as to the origins of the claimed disorder, they may not be considered as competent evidence. Statements as to what the veteran may have been told by a physician during or after service, standing alone, are insufficient to establish a medical diagnosis. Warren v. Brown, 6 Vet. App. 4, 6 (1993). As the record lacks competent evidence establishing that an etiological relationship exists between the veteran's current lumbosacral spine disabilities and active service, the Board concludes that the veteran's claim for service connection is not well-grounded. The veteran has not advanced that he sustained the claimed disorder in combat. In light of this fact, the Board finds that the provisions of 38 U.S.C.A. § 1154 (West 1991) do not serve to advance his claim. See Libertine v. Brown, 9 Vet. App. 521 (1996). Accordingly, the instant claim is denied. 38 U.S.C.A. § 5107 (West 1991). The veteran is informed that if he is able to produce competent evidence attributing the claimed disability to active service, he should petition to reopen his claim. IV. Skin Disorder The veteran's service medical records do not refer to a skin disability. At his September 1971 physical examination for service separation, the veteran exhibited normal skin. The veteran's service personnel records indicate that he served in the Republic of Vietnam. VA clinical documentation dated in October 1993 notes that the veteran complained of a rash of eight months' duration. The veteran was diagnosed with eczema. A June 1995 VA treatment record relates that the veteran complained of an intermittent generalized rash of five years' duration. A diagnostic impression of dermatitis was advanced. The VA physician commented that "possibly his rash is related to Vietnam, will give him benefit of doubt for now 'sc' service-connected." A September 1995 VA psychiatric treatment record notes that the veteran complained of a chronic rash since serving in Vietnam. He reported that he had been exposed to Agent Orange. A November 1995 VA treatment record states that the veteran was diagnosed with a benign right thigh seborrheic keratosis and a history of dermatographism of two years' duration. A May 1996 VA treatment record indicates that the veteran had a large wart on his right index finger and subsequently underwent removal of the growth. At the November 1996 VA examination for compensation purposes, the veteran complained of chronic skin rashes which were exacerbated by hot weather and well-controlled by Amitriptyline, an antidepressant medication. On examination, the veteran exhibited no rash or other skin abnormalities. A diagnostic impression of "skin rash resolved at the present time on Amitriptyline" was advanced. At the hearing on appeal, the veteran testified that he initially began to have rashes in approximately 1988 or 1990. He acknowledged that he never experienced nor was treated for a rash or other skin disorder while in Vietnam. He was unaware of having ever been exposed to Agent Orange. A June 1999 VA physical evaluation notes that the veteran reported a history of an occasional skin rash and denied any current skin disability. On examination, the veteran exhibited no rashes or other skin abnormalities. The veteran's service medical records make no reference to a chronic skin disability. There is no competent evidence establishing that the veteran currently exhibits a chronic skin disability. The veteran testified at the hearing on appeal that he did not have any skin disabilities during active service and initially manifested the claimed disorder in approximately 1988, some seventeen years after service separation. In the absence of evidence of current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The veteran's claim is supported solely by the accredited representative's and his own testimony and statements on appeal. The Court has held that lay assertions of medical causation do not constitute competent evidence to render a claim well-grounded. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992); Savage v. Gober, 10 Vet. App. 488 (1997); Robinette v. Brown, 8 Vet. App. 69, 74 (1995). To the extent that the lay statements attempt to question a medical diagnosis or other clinical determinations as to the origins of the claimed disorder, they may not be considered as competent evidence. Statements as to what the veteran may have been told by a physician during or after service, standing alone, are insufficient to establish a medical diagnosis. Warren v. Brown, 6 Vet. App. 4, 6 (1993). As the record lacks competent evidence establishing that the veteran has a chronic skin disability, the Board concludes that the veteran's claim for service connection is not well-grounded. The veteran has not advanced that he sustained the claimed disorder in combat. In light of this fact, the Board finds that the provisions of 38 U.S.C.A. § 1154 (West 1991) do not serve to advance his claim. See Libertine v. Brown, 9 Vet. App. 521 (1996). Accordingly, the instant claim is denied. 38 U.S.C.A. § 5107 (West 1991). The veteran is informed that if he is able to produce competent evidence attributing the claimed disability to active service, he should petition to reopen his claim. V. Doctrine of Doubt At the merits stage, there is weighing and balancing of the evidence of record. When addressing whether a claim is well-grounded, after establishing the competency of the evidence, the veracity of the evidence is accepted. The doctrine of doubt is not applicable where a claim is not well-grounded as there is no evidence to weigh or balance. ORDER Service connection for a chronic viral disorder is denied. Service connection for a neck disability to include cervical spondylosis and C5-6 degenerative changes is denied. Service connection for a lumbosacral spine disability to include degenerative joint disease is denied. Service connection for a skin disorder to include a rash is denied. REMAND The veteran asserts on appeal that service connection is warranted for bilateral hearing loss disability as the claimed disorder was precipitated by his inservice noise exposure. He stated that the artillery pieces at his base in Vietnam were constantly being fired in close proximity to him. In reviewing the report of the veteran's July 1969 physical examination for service entrance, the Board observes that the veteran was reported to exhibit normal right ear auditory acuity and left ear hearing loss for VA purposes. At his September 1971 physical examination for service separation, the veteran exhibited bilateral auditory acuity of 15/15. The Court has directed that auditory acuity of 15/15 is normal. Smith v. Derwinski, 2 Vet. App. 137, 140 (1992). The report of a December 1996 VA audiological evaluation states that the veteran complained of decreased bilateral auditory acuity since 1970. He presented both a history of inservice noise exposure associated with the firing of loud guns and a 20 year history of post-service noise exposure without the use of ear protection. On audiological evaluation, the veteran exhibited bilateral hearing loss disability for VA purposes. The veteran was diagnosed with severe bilateral high frequency sensorineural hearing loss disability. The examiner did not advance an opinion as to the etiology of the veteran's hearing loss disability. It is not apparent that the examiner reviewed the veteran's claims file prior to the examination. The Court has held that examinations for compensation purposes conducted without contemporaneous review of the veteran's claims file are deficient for rating purposes. Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). Accordingly, this case is REMANDED for the following action: 1. The RO should schedule the veteran for a VA audiological examination which is sufficiently broad to accurately determine the current nature and severity of his bilateral hearing loss disability. All indicated tests and studies should be accomplished and the findings then reported in detail. The examiner should express an opinion as to the etiology of the veteran's hearing loss disability and its relationship, if any, to his reported inservice noise exposure. The examiner should also expressly state whether the veteran's current left ear hearing loss disability existed prior to service entrance and, if so, whether it increased in severity beyond its natural progression. The claims file, including a copy of this REMAND, should be made available to the examiner prior to the examination. The examination report should reflect that such a review was conducted. 2. In representing the VA before the Court, the General Counsel of the VA has noted that the RO has duties. Pursuant to 38 C.F.R. § 3.655 (1999), when the veteran without good cause fails to report for examination, his original claim for service connection will be decided upon the evidence then of record. However, the Secretary of the VA must show a lack of good cause for failing to report. Further, the VA has a duty to fully inform the veteran of the consequences of the failure to undergo the scheduled examination. Reference was made to the Veterans Benefits Administration's ADJUDICATION PROCEDURE MANUAL, M21-1, Part IV, paragraph 28.09(b) (3). The RO must comply with all notification requirements regarding the duty to report and the failure to report for examination. 3. The RO should then readjudicate the veteran's claim of entitlement to service connection for bilateral hearing loss disability. The veteran is free to submit additional evidence and argument while the case is in remand status. See Kutscherousky v. West, 12 Vet. App. 369 (1999). The veteran's claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board or the Court for additional development or other appropriate action must be handled in an expeditious manner. See the Veterans' Benefits Improvement Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994) and 38 U.S.C.A. § 5101 (West 1991 and Supp. 1998) (Historical and Statutory Notes). In addition, the Veterans Benefits Administration's ADJUDICATION PROCEDURE MANUAL, M21-1, Part IV, directs the RO is 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. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration if appropriate. The purpose of this REMAND is to allow for additional development of the record and due process of law. No inference should be drawn from it regarding the final disposition of the veteran's claim. J. T. HUTCHESON Acting Member, Board of Veterans' Appeal