Citation Nr: 0006111 Decision Date: 03/07/00 Archive Date: 03/14/00 DOCKET NO. 94-31 485 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUES 1. Whether new and material evidence has been presented to reopen a claim for service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD). 2. Entitlement to service connection for a disability of the right hand. 3. Entitlement to a total disability evaluation based upon individual unemployability. REPRESENTATION Appellant represented by: Attorney Richard Paul Cohen ATTORNEY FOR THE BOARD M. A. Herman, Associate Counsel INTRODUCTION The veteran had active military service from April 1969 to December 1970. This appeal arises from a December 1993 rating decision of the Huntington, West Virginia, regional office (RO) which denied service connection for an acquired psychiatric disorder to include PTSD, the residuals of a right hand injury, and a total disability evaluation based upon individual unemployability. This matter was Remanded by the Board of Veterans' Appeals (Board) in September 1997 for the purpose of obtaining additional factual and medical evidence, and it has been returned to the Board for appellate review. FINDINGS OF FACT 1. In July 1984, the RO denied service connection for a nervous condition, to include PTSD, based on a finding that there was no evidence that the veteran had been diagnosed as having PTSD and because his diagnosed schizotypal personality disorder was a developmental abnormality and not a condition for which service connection could be granted. 2. The veteran did not timely appeal that determination, and it became final. 3. The evidence received since the RO's July 1984 decision shows that the veteran has been diagnosed as having PTSD. 4. The veteran's claim of entitlement to service connection for PTSD is plausible. 5. The preponderance of the evidence fails to clearly establish that the veteran has been diagnosed as having PTSD. 6. Medical evidence confirming a diagnosis of a disability of the right hand has not been presented. 7. The veteran's claim for service connection for a disability of the right hand is not plausible. 8. The veteran's service-connected disabilities are rated as noncompensable. 9. The veteran's service-connected disabilities, when evaluated in association with his educational attainment and occupational experience, do not preclude substantially gainful employment. CONCLUSIONS OF LAW 1. The July 1984 decision of the RO that denied service connection for a nervous condition, to include PTSD, is final. 38 U.S.C.A. § 7105(c) (West 1991); 38 C.F.R. §§ 3.104, 20.302 (1999). 2. New and material evidence has been presented to reopen the claim of entitlement to service connection for an acquired psychiatric disorder, to include PTSD. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1999). 3. The claim of entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 4. Service connection for an acquired psychiatric disorder, to include PTSD, is not warranted. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. §§ 3.303, 3.304(f) (1999). 5. The claim of entitlement to service connection for a disability of the right hand is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 6. The criteria for the assignment of a total disability evaluation based upon individual unemployability have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.341, 4.16 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background The veteran's enlistment and discharge examinations indicated that his upper extremities and psychiatric condition were normal. Service medical records contain no references to complaints or findings of a gunshot wound to the right arm and/or a psychiatric disorder. A review of the veteran's DD Form DD-214 (Report of Transfer or Discharge) indicates that his military occupational specialty (MOS) was as an infantryman. He was listed to have received a National Defense Service Medal, Republic of Vietnam Campaign Medal, a Vietnam Service Medal, a Vietnam Campaign Medal, the Air Medal, the Purple Heart Medal, and the Bronze Star Medal. No other medals, commendations, devices, or awards were reported. However, his service personnel records indicated that the aforementioned Bronze Star Medal was awarded with a "V" device. In March 1977, the veteran filed claims of service connection for the residuals of malaria, the residuals of scrub typhus, brain damage, and the residuals of a gunshot wound to his right arm. He stated he was shot in October 1970. He maintained that he had never regained 100 percent use of his right hand. The veteran was afforded a series of VA examinations in May 1977. At his general medical examination, he reported being shot in his right arm while serving in Vietnam, and that he had not regained full use of his right arm or hand since that time. There was a scar over the proximal flexor of the right arm measuring three-eighths of an inch by three-eighths of an inch. The scar was mildly depressed but not adherent. There was another scar of the proximal ulnar area of the right arm measuring half an inch by half an inch. The veteran had full range of motion of both wrists. There was a moderate loss of grip strength in his right hand. However, there was no muscle atrophy. X-rays of the right hand revealed normal bony structures and joints. The diagnosis was residuals of a gunshot wound of the right arm to include scars that had a mild cosmetic defect. A VA neurological examination was also conducted. The veteran stated that he had used drugs while he was overseas. However, he denied drug use prior to service. He reported being in a fight, being knocked unconscious, and having a problem with his short-term memory for "awhile." He made no reference to a disability of the right hand. On examination, the veteran was oriented times three. He was able to perform serial sevens with no problem. His speech was slow, halting, and seemed volitional. He was very slow to answer any question no matter how simple. He rarely smiled. Muscle strength was good. Tone and volume of the muscles was normal. Deep muscle reflexes of the right arm were active. The sensory system was normal. Nerve status was normal. There were no findings made with regard to there being any abnormality of the right arm or hand. By a rating action dated in June 1977, service connection for scars of the right arm was granted. Although service medical records contained no reference to a gunshot wound of the right arm, the RO determined that the presence of the scars on the veteran's right arm and his receipt of the Purple Heart supported the claim for service connection. A noncompensable disability rating was assigned. The other claims for service connection were denied on the basis that there was no current medical evidence pertaining to malaria, scrub typhus, or brain damage. The RO observed that the veteran's service medical records appeared to be incomplete. In January 1983, the veteran filed a claim for an increased evaluation of his service-connected gunshot wound. He said the shrapnel penetrated the muscle of his arm. He said the pinky of his right hand remained numb. The veteran also indicated that he wished to file a claim for service connection for post-traumatic stress disorder. He stated he was receiving treatment through the Brecksville VA Medical Center (VAMC). Medical records from the Brecksville VAMC dated from March 1982 to December 1982 were associated with the claims folder. A March 1982 discharge summary indicated that the veteran had been admitted due to feelings of nervousness and difficulties maintaining a job and relationships with others. He said he lived a nomadic life. He appeared unkempt and disheveled. His affect was not blunt and his mood was neither depressed nor elated. The veteran denied suicidal or homicidal ideation. He also denied hallucinations. His memory was good. His physical examination was within normal limits. The veteran was noted to have been previously hospitalized in November 1977. The diagnosis was schizotypal personality disorder. Similar findings were made in December 1982. Service connection for an acquired psychiatric disorder to include PTSD was denied in May 1983. The RO determined that the veteran's diagnosed personality disorder was a developmental abnormality and not a condition for which service connection could be granted. The RO also found that evidence of a diagnosis of PTSD had not been presented. The veteran was notified of the decision and his appellate rights in May 1983. An abbreviated medical record from the Brecksville VAMC shows that the veteran was briefly hospitalized in April 1983. He complained of having no place to stay and chronic diarrhea. There was no indication of any psychosis or agitation. The diagnosis was schizotypal personality disorder. Service connection for a nervous condition was denied in June 1983. The veteran was notified of this decision and his appellate rights in July 1983. In connection with an April 1984 claim for service connection for a nervous condition to include PTSD, medical records from the Clarksburg VAMC dated from February 1984 to April 1984 were associated with the claims folder. A February 1984 hospital summary indicated that the veteran was brought to the medical center under probable cause commitment. He had been charged with assault after an altercation at a local tavern. He was also noted to have been behaving in an unmanageable and belligerent fashion towards his mother. The veteran stated he had been drinking a lot and getting into frequent arguments with his mother. He acknowledged a history of drug use and prior psychiatric admissions. He was diagnosed as having a schizotypal personality disorder. The veteran was readmitted in March 1984. He was very vague about his own complaints other than the fact that he had no resources. He stated that he served in Vietnam. He showed some symptoms of PTSD such as a startled reaction, emotional numbing, psychic withdrawal, and a profound disruption of his ability to cope since his military service. The veteran was also noted to behave in a way that was slightly out of touch with current reality. The examiner observed that a determination of how much combat the veteran experienced and his reactions to the same had been difficult to elicit. The diagnoses were schizotypal personality disorder and possible PTSD. By a rating action dated in July 1984, the prior denial of service connection for an acquired psychiatric disorder to include PTSD was continued. The RO found that the most recent medical evidence of record showed that the veteran had been diagnosed as having a schizotypal personality disorder and possible PTSD. The veteran was notified of the decision and his appellate rights. Following receipt of additional service medical records showing that the veteran was treated for scrub typhus, and that he had an inservice history of treatment for falciparum malaria, service connection was granted for the residuals of scrub typhus and malaria in February 1985. Noncompensable disability evaluations were assigned. The RO found there was no post-service medical evidence indicating that the veteran suffered from the residuals of either disease. In July 1991, the veteran appears to have filed a claim for increased evaluations of his service-connected disabilities. There is also an indication that he sought to reopen his claim of service connection for a nervous condition. He gave a history of treatment at the Clarksburg VAMC. However, the Clarksburg VAMC reported in September 1991 that the veteran had not been to its facility since 1986. Service connection for a nervous condition was denied in May 1992. The RO stated that it had no choice to deny the veteran's claim due to his failure to report for his scheduled VA examination. Specifically, the veteran did not report for VA psychiatric examinations scheduled in September 1991, November 1991, February 1992, and March 1992. The RO stated that it would be willing to reconsider the veteran's claim if he reported for his VA examination. In a statement received in December 1992, the veteran's attorney asked that the veteran be scheduled for VA examinations to evaluate the extent of his PTSD, malaria, scars, and typhus. The attorney stated that the veteran had previously experienced difficulty getting the notices of the examinations. He said the veteran's emotional condition prevented him from maintaining employment and a single residence. He stated the veteran's mail had not caught-up with him. The veteran's latest mailing address was provided. The attorney indicated that the veteran could be reached through his office. The attorney also raised a claim for service connection for a disability of the right hand as secondary to the veteran's service-connected right arm gunshot wound. He noted that a disability of the right hand had been reported at the veteran's May 1977 VA general medical examination. He asked that the RO perform a search for the veteran's service medical records in order to confirm that the veteran sustained a gunshot wound. The veteran appeared for a VA PTSD examination in February 1993. The veteran was reported to have gone through an initial screening and told to wait until the examiner was ready to see him. However, the veteran subsequently disappeared from the waiting room. The examiner stated that he searched for the veteran and had him paged, but that there was no response. An examination report from R.A. Pearse, M.A., dated in July 1985 and received in July 1993, shows that the veteran was evaluated for the purpose of determining his eligibility for Social Security Administration (SSA) disability benefits. At that time, he complained of depression and other anxieties especially as they pertained to his inability to maintain or obtain employment. He indicated that he had served in Vietnam and was wounded in action. Mr. Pearse noted that the veteran had been admitted to the Clarksburg VAMC in January 1985 and had been diagnosed as having chronic, undifferentiated schizophrenia accompanied with PTSD. Following a mental status examination, the veteran was diagnosed as having schizophrenic disorder undifferentiated type and chronic PTSD. A copy of an October 1991 letter from J.C. Coulter, M.A., to the SSA was associated with the claims folder. Ms. Coulter reported that the veteran visited her office usually once a year requesting a variety of services ranging from basic counseling and employment to transportation needs. She said the veteran had a history of alcohol abuse. She stated that the record contained evidence of a possible learning disorder, poor concentration, and an inability to effectively communicate with others. She indicated that the veteran had been referred to the Clarksburg VAMC for psychiatric treatment. Whether he followed through with this recommendation was unknown. Further, although she was unable to give an official diagnosis, Ms. Coulter stated that she believed the veteran suffered from PTSD resulting from his service in Vietnam. The veteran's receipt of the Air Medal, Purple Heart, and Bronze Star were noted. Due to his failure to report for the aforementioned VA psychiatric examination, the RO denied the veteran's claim. The RO stated that no further action could be taken unless he expressed a willingness to report for a VA examination. The veteran was mailed notice of this decision in April 1993 and apprised of his appellate rights. A statement pertaining to the veteran's inservice stressors was received in April 1993. He said there were numerous instances when he was involved in armed combat with the enemy. In one such instance, he recalled the circumstances surrounding the time he was shot and, while lying helpless, watched as a friend died. He discussed several other episodes when conflicts with the Viet Cong resulted in the wounding or killing of his comrades. In April 1993, the veteran, through his attorney, filed a claim for a total disability evaluation based upon individual unemployability. He indicated that he was presently receiving Social Security benefits due to his diagnosed PTSD. He said he had not worked since 1977. He reported that he had two years of college education. A copy of a May 1986 decision from the SSA shows that the veteran was awarded disability benefits. His primary diagnosis was schizophrenic disorder undifferentiated type. His secondary diagnosis was chronic PTSD. The report from R.D. Pearse was referenced. The veteran's receipt of disability benefits was continued by a decision from the SSA dated in May 1989. However, the veteran's diagnoses were changed to personality disorder and alcohol abuse. The report of a February 1992 examination conducted by R.D. Pearse was attached to this decision. The report contained no findings pertaining to PTSD or to any of his service- connected disabilities. The veteran's inability to work was attributed to his personality disorder and alcohol abuse. In June 1993, the veteran was afforded a VA systemic examination. He stated that he continued to experience symptoms related to his service-connected malaria. He noted that he also contracted typhus in service, but that he did not currently suffer from any symptoms related to the same. With the exception of the scar in the proximal right ulnar area, he stated that he did not have any problems pertaining to his inservice gunshot wound to the right ulnar area. On examination, the veteran's musculoskeletal system was within normal limits. There was a half-inch scar anteriorly just below the right elbow on the medial side that was slightly darker than the surrounding skin color. The exit wound was posterior just behind the elbow. There was no keloid formation or local tenderness. An examination of the elbow did not reveal any abnormality. There was no evidence of inflammation in the area. There was also no evidence of limitation of function of the affected part. The diagnosis was gunshot wound with residual scar, proximal right ulnar area. The veteran was afforded a VA psychiatric examination in July 1993. He stated that he entered service when he was 23-years old. He said he served as a rifleman and was involved in several combat operations. He reported witnessing several friends get killed in battle. His psychiatric history was discussed. His main complaint was being homeless. On mental status examination, the veteran's attitude was suspicious. His speech was normal and coherent. His mood was dysphoric and his affect was restricted. He said he experienced difficulty falling asleep. He endorsed periodic nightmares (he dreamed about Vietnam once or twice a month) and auditory hallucinations. He denied suicidal ideation. The veteran did not display manic symptoms, pressured speech, racing thoughts, or grandiosity. He denied panic attacks, phobias, or agoraphobia. His thought process showed no tangentiality. However, his thought content showed paranoid delusions. The diagnoses were alcohol dependence, alcohol hallucinosis, and schizotypal personality disorder. The examiner said that the veteran's psychiatric problems were not related to his military service. He also stated that the veteran did "not meet the criteria of PTSD." By a rating action dated in December 1993, the RO reopened the claim of service connection for an acquired psychiatric disorder, to include PTSD. The RO held that the veteran's previous diagnosis of PTSD represented new and material evidence. However, the RO indicated that the claim for service connection for schizotypal personality disorder was denied because a personality disorder was a developmental abnormality and not a disease entity for which service connection could be assigned. The RO also observed that PTSD was not diagnosed at the veteran's most recent VA examination. Thus, while it was "clear" that the veteran served in combat in Vietnam and had a past diagnosis of PTSD, the RO found there was no evidence demonstrating that he had a current diagnosis of PTSD. Similarly, service connection for a disability of the right hand was denied because there was no current medical evidence of a disability of the right hand. The claim for a total disability evaluation based upon individual unemployability was denied because the veteran failed to meet the minimum schedular requirements. The RO also continued the noncompensable disability ratings assigned to the veteran's service-connected scars of the right arm, malaria, and scrub typhus. In September 1997, the Board denied increased (compensable) evaluations for service-connected residuals of malaria, residuals of scrub typhus, and right arm scars. The issues of service connection for an acquired psychiatric disorder, to include PTSD, and the residuals of a gunshot wound to the hand and a total disability evaluation based upon individual unemployability were Remanded for further development. In this regard, the RO was asked to afford the veteran a VA psychiatric examination to determine whether the veteran suffered from PTSD and, if so, the stressor(s) that caused the PTSD. The Board also requested that the RO consider the tenets of 38 U.S.C.A. § 1154(b) with regard to his claim for service connection for the residuals of a gunshot wound of the right hand. The issue of the veteran's entitlement to a total disability evaluation based upon individual unemployability was essentially held in abeyance pending the outcome of his service connection claims. In a Report of Contact dated in October 1997, the veteran's attorney stated that he had no idea where the veteran was. He said the veteran was homeless, and that he had been living under a bridge. He also indicated that the veteran had been in prison and the state hospital for short periods. The attorney subsequently provided the RO with the veteran's most recent mailing address. In November 1997, there is evidence that the RO attempted to contact the veteran at the address provided by his attorney. The correspondence was returned by the Post Office as unclaimed in December 1997. An attached note indicated that the RO decided to suspend the veteran's appeal pending learning his whereabouts. The veteran's attorney contacted the RO in October 1998. He inquired as to the status of the veteran's appeal. He said he had not heard from the RO since September 1997. The RO responded in November 1999 and told the attorney that the veteran's appeal had been suspended because his whereabouts were unknown. Later that month, the attorney provided the RO with the veteran's most current mailing address (the Martinsburg VAMC). In a letter dated in December 1998, the RO told the veteran that he could be scheduled for a VA examination. Pursuant to 38 C.F.R. § 3.655, he was advised that failure to report for a scheduled VA examination could have adverse consequences on his claim. He was also asked to provide information pertaining to his military service. There is no indication that the letter was returned by the Post Office. The record shows that the veteran was scheduled for a VA psychiatric examination in February 1999, but that the examination was canceled due to incorrect jurisdiction. Another examination was scheduled in March 1999. The veteran failed to report for this examination. A note from the RO indicated that the veteran's attorney had been contacted, and that the attorney did not have the veteran's current mailing address. In July 1999, service connection for PTSD and the residuals of a gunshot wound of the right hand was denied. The RO held that the veteran had failed to submit evidence showing that he had a current diagnosis of PTSD or a disability of the right hand. Entitlement to individual unemployability was denied because the veteran had not been found unable to secure or follow a substantially gainful occupation due solely to his service-connected disabilities. A supplemental statement of the case (SSOC) was mailed to the veteran in July 1999. The SSOC was returned by the Post Office as undeliverable that same month. In a letter dated in September 1999, the veteran's attorney reported that he had not had contact with the veteran in "some time," and that he was unable to supply his current mailing address. II. Analysis A. An Acquired Psychiatric Disorder, to include PTSD The veteran's claim for service connection for an acquired psychiatric disorder, to include PTSD, was last finally denied in July 1984, and he was notified of this denial at his address of record and provided his appellate rights. The notification was not returned as undeliverable. A determination on a claim by the agency of original jurisdiction of which a claimant is properly notified is final if an appeal is not filed as prescribed in Department regulations. 38 U.S.C.A. § 7105 (c) (West 1991). The veteran having failed to take any action with respect to the July 1984 denial of his claim, the decision became final a year after mailing of notification to him of the decision. 38 C.F.R. §§ 3.104, 20.302 (1999). The U.S. Court of Appeals for Veterans Claims (Court) has held that once a denial of a claim of service connection has become final, it cannot subsequently be reopened unless new and material evidence has been presented. This determination involves a two-step analysis. First, the Board must determine whether the evidence is "new and material." Second, if the Board determines that the claimant has produced new and material evidence, the claim is reopened and the Board must evaluate the merits of the veteran's claim in light of all the evidence, both old and new. Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). New and material evidence is evidence which has not been 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). In Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998), the United States Court of Appeals for the Federal Circuit affirmed this standard. For the purposes of establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The Court has held that to reopen a previously and finally disallowed claim there must be "new and material evidence presented or secured" since the time that the claim was finally disallowed on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). The Court further held that to reopen a finally denied claim, new evidence must be probative of the issue at hand, i.e., it must address the specified basis for the last disallowance. Evans at 283. The pertinent criteria provide that service connection may be granted for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C.A. § 1110 (West 1991). Further, service connection for PTSD requires (1) medical evidence establishing a current diagnosis of the condition in accordance with DSM-IV; (2) credible supporting evidence that the claimed inservice stressor actually occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific in-service stressor. 38 C.F.R. § 3.304(f) (1999); See also Gaines v. West, 11 Vet. App. 353 (1998). Here, while the RO reopened the veteran's claim for service connection for service connection for an acquired psychiatric disorder, to include PTSD, and considered that issue on a de novo basis, the Board is not bound by that determination and is, in fact, required to conduct an independent new and material evidence analysis in claims involving final rating decisions. See Barnett v. Brown, 8 Vet. App. 1 (1995). In this regard, using the guidelines noted above, the Board finds that new and material evidence has been presented. Hence, the claim concerning service connection for service connection for an acquired psychiatric disorder, to include PTSD, may be reopened. As the Board is reopening the claim, it need not consider whether the RO considered the standard set forth in Hodge. The specified basis for the RO's denial in July 1984, in part, was that the evidence of record did not show that the veteran had been diagnosed as having PTSD. The additional evidence submitted, specifically the July 1985 examination report from R.D. Pearse, indicates that the veteran has been diagnosed as having PTSD. Moreover, the examiner appears to have attributed the PTSD to the veteran's combat experiences in Vietnam. This evidence is new and material because it establishes that the veteran has been diagnosed as having PTSD. Accordingly, the new evidence is not merely cumulative of other evidence of record, and must be considered in order to fairly decide the merits of the veteran's claim. As new and material evidence has been presented, it must immediately be determined whether, based upon all the evidence and presuming its credibility, the reopened claim is well grounded pursuant to 38 U.S.C.A. § 5107(a). See Hodge; see also Winters v. West, 12 Vet. App. 203 (1999) and Elkins v. West, 12 Vet. App. 209 (1999). A well-grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of proof of 38 U.S.C.A. § 5107 (a). Murphy v. Derwinski, 1 Vet. App. 78, 81. However, to be well grounded, a claim need not be conclusive but must be accompanied by evidence that suggests more than a purely speculative basis for granting entitlement to the requested benefits. Dixon v. Derwinski, 3 Vet. App. 261, 262-263 (1992). Evidentiary assertions accompanying a claim for VA benefits must be accepted as true for purposes of determining whether the claim is well grounded, unless the evidentiary assertion is inherently incredible or the fact asserted is beyond the competence of the person making the assertion. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). When the question involved does not lie within the range of common experience or common knowledge, but requires special experience or special knowledge, then the opinions of witnesses skilled in that particular science to which the question relates are required. Questions of medical diagnosis or causation require such expertise. A claimant would not meet this burden merely by presenting lay testimony, because lay persons are not competent to offer medical opinions. Id. at 495. As referenced above, service connection may be granted for PTSD when there is (1) medical evidence establishing a current diagnosis of the condition; (2) credible supporting evidence that the claimed inservice stressor actually occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific in-service stressor. See Gaines. In the present case, there is evidence that the veteran has been diagnosed as having PTSD. The 1985 report from R.D. Pearse indicated that the veteran suffered from undifferentiated type schizophrenic disorder and chronic PTSD. The examiner also appears to have attributed the veteran's PTSD to his military service. Thus, two of the elements under Gaines have been satisfied. The Board recognizes that a diagnosis of PTSD was not found on a subsequent July 1993 VA psychiatric examination. However, for purposes of establishing a well-grounded claim, the Board finds that the conclusion made in the July 1985 examination report meets the standard of a diagnosis of PTSD. Finally, with regard to evidence of inservice stressors, the veteran asserts that he participated in multiple combat operations during his service in Vietnam. 38 C.F.R. § 3.304(f) states that, if the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. The evidence of record shows that the veteran's MOS was as an infantryman, and that he was a recipient of the Air Medal, the Purple Heart Medal, and the Bronze Star Medal with a "V" device. As these medals serve as evidence that he engaged in combat, the Board is satisfied that evidence of the veteran's in-service stressors has been presented. Accordingly, the Board finds that the veteran's claim for service connection for PTSD is well grounded. The VA has a duty to assist a veteran in the development of facts pertinent to his well-grounded claims. 38 U.S.C.A. § 5107(a); 38 C.F.R. § 3.159 (1999). The VA's duty to assist includes obtaining medical records and medical examinations where indicated by the facts and circumstances of the case. Littke v. Derwinski, 1 Vet. App. 90 (1990). However, the Court has held that "the duty to assist is not always a one- way street," and that, if the veteran wishes help, "he cannot passively wait for it in the circumstances where he may or should have information that is essential in obtaining the putative evidence." Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Further, in Hyson v. Brown, 5 Vet. App. 262, 265 (1993), the Court stated that "[i]n the normal course of events, it is the burden of the veteran to keep the VA apprised of his whereabouts. If he does not do so, there is no burden on the part of the VA to turn up heaven and earth to find him." In the present case, the veteran has a long history of being transient and not notifying the VA or his attorney of changes in his mailing address. The record shows that the RO made numerous attempts to contact the veteran and afford him a VA examination. Moreover, he was reported by his attorney to be homeless. The Board finds that VA has taken the appropriate actions in its duty to afford the veteran the VA examination requested in the September 1997 Remand. The Board will therefore render a decision on this appeal based upon the evidence of record. In this regard, the United States Court of Appeals for the Federal Circuit has recognized the Board's "authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence." Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). In this case, the Board finds that persuasive medical evidence demonstrates that the veteran does not currently suffer from PTSD. Upon examining the veteran in July 1993, a VA psychiatrist diagnosed the veteran as having alcohol dependence, alcohol hallucinosis, and a schizotypal personality disorder. The psychiatrist further determined that the veteran's symptomatology did not "meet the criteria of PTSD." Although the July 1985 report from R.D. Pearse indicated that the veteran suffered from PTSD, the Board notes that the same examiner subsequently made no findings pertaining to PTSD in his February 1992 psychological assessment. Further, J.C. Coulter qualified the October 1991 determination that the veteran had PTSD as being only possible. Ms. Coulter stated that an official diagnosis could not be rendered because the veteran had not been thoroughly examined. The only other evidence pertaining to a diagnosis of PTSD stems from the opinions rendered by the veteran and his attorney. In this regard, there is no evidence that either the veteran or his attorney is competent to provide a diagnosis because this requires specialized medical knowledge. See Espiritu v. Derwinski. With respect to the numerous diagnoses of personality disorder subsequent to service, the Board notes that personality disorders are not diseases or injuries within the meaning of applicable legislation and that service connection cannot be established therefor. 38 C.F.R. § 3.303(c) (1999). The veteran has also received diagnoses of acquired psychiatric disorders, such as schizophrenia, alcohol dependence and alcohol hallucinosis, but competent medical evidence does not relate any such disorder to his military service. In fact, the July 1993 VA examiner specifically indicated that the veteran's psychiatric problems were not related to his military service. When all the evidence is assembled, the Secretary, is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). In this case, the Board finds the preponderance of the evidence is against the claim for service connection for an acquired psychiatric disorder, to include PTSD. B. Disability of the Right Hand As previously referenced, service connection may be granted for a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, in the active military, naval, or air service. 38 U.S.C.A. § 1110 (West 1991). Service connection may also 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). VA regulations further provide that service connection may be established on a secondary basis for a disability which is shown to be proximately due to or the result of a service- connected disease or injury. 38 C.F.R. § 3.310(a) (1999). Establishing service connection on a secondary basis requires evidence sufficient to show that (1) a current disability exists and (2) the current disability was either (a) caused or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a); See also Allen v. Brown, 7 Vet. App. 439 (1995). A claim for service connection requires three elements to be well grounded. There must be competent evidence of a current disability (a medical diagnosis); incurrence or aggravation of a disease or injury in service (lay or medical evidence); and a nexus between the in service injury or disease and the current disability (medical evidence). The third element may be established by the use of statutory presumptions. Caluza v. Brown, 7 Vet. App. 498, 506 (1995); See also Jones v. Brown, 7 Vet. App. 134, 137 (1994) (noting that a well-grounded claim for secondary service connection requires medical evidence to render plausible a connection or relationship between the service-connected disorder and the new disorder). In the instant case, there is no current medical evidence which establishes that the veteran has been diagnosed as having any type of disorder of the right hand. While reference was made to moderate strength loss of the right hand at his April 1977 VA general medical examination, a current diagnosis of a disability of the right hand has not been rendered. The opinion expressed by the veteran and his attorney that he suffers from a disability of the right hand does not meet the requirement that there must be competent evidence of a current disability (a medical diagnosis) in order to establish a well-grounded claim. See Caluza. There is no evidence that the veteran or his attorney are health care professionals and, thus, their opinions that he suffers from any type of right hand disorder must fail. Questions of medical diagnosis or causation require the expertise of a medical professional. See Espiritu v. Derwinski. An appellant's belief that he or she is entitled to some sort of benefit simply because he or she had a disease, injury, or exposure while on active service is mistaken, as Congress specifically limited entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. Brammer v. Derwinski, 3 Vet. App. 223 (1992). In other words, in the absence of proof of a present disability, there can be no valid claim for service connection. The veteran's claim for service connection for a disability of the right hand on a direct basis or as secondary to the service-connected residuals of a right arm gunshot wound is denied. If medical evidence becomes available showing the presence of a disability of the right hand and that that disability is related to his military service or the service-connected residuals of his right arm gunshot wound, the veteran may request that his claim be reopened. C. Total Disability Rating The veteran has claimed that he is entitled to a total disability evaluation, based on individual unemployability due to his service-connected disabilities. Total ratings for compensation may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 4.16 (1999). In this case, the basic schedular criteria set forth in 38 C.F.R. § 4.16(a) (1999) have not been met. As set forth above, the record shows that the veteran is currently in receipt of noncompensable disability evaluations for his service-connected right arm scars, residuals of malaria, and residuals of scrub typhus. These evaluations were in fact confirmed by the Board in its September 1997 decision. The veteran is not service-connected for any other disabilities. Nevertheless, the Board must consider 38 C.F.R. § 4.16(b), permitting such rating on an extraschedular basis. In determining whether the veteran is entitled to a total disability rating based upon individual unemployability, neither the veteran's non-service-connected disabilities nor his advancing age may be considered. Van Hoose v. Brown, 4 Vet. App. 361 (1993). For a veteran to prevail on a claim based upon unemployability, it is necessary that the record reflect some factor which places his case in a different category than other veterans with equal rating of disability. Id. Furthermore, the question is whether the veteran is capable of performing physical and mental acts required by employment, not whether the veteran can find employment. Id. A review of the record reveals that the veteran has a 12th grade education with two years of college studies. Further, there is no probative evidence in the record to suggest that he is incapable of working due solely to the established service-connected conditions. As referenced above, the most recent VA examinations indicated that the veteran stated that he was not experiencing any problems pertaining to his service-connected gunshot wound or scrub typhus. Although he claimed that he continued to experience residuals of malaria, no findings pertaining to malaria were made. Further, the Board notes that there is no evidence that the veteran's receipt of Social Security disability benefits is predicated on any of his service-connected disabilities. The most recent decision for the Social Security Administration indicated that the veteran was receiving disability benefits due to a personality disorder and alcohol abuse, non-service- connected disabilities. In other words, there is no evidence to suggest that the veteran's service-connected disabilities prevent all substantially gainful employment for which he is qualified by reason of his education and work experience. The veteran does not meet the extraschedular requirement for individual unemployability. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable, and the claim must be denied. 38 U.S.C.A. § 5107(b) (West 1991). Accordingly, entitlement to a total rating based on individual unemployability is denied. ORDER The claim of service connection for an acquired psychiatric disorder, to include PTSD, is reopened but denied. Entitlement to service connection for a disability of the right hand, including as secondary to the service-connected residuals of a right arm gunshot wound, is denied. Entitlement to a total disability evaluation based upon individual unemployability is denied. BARBARA B. COPELAND Member, Board of Veterans' Appeals