Citation Nr: 0002384 Decision Date: 01/31/00 Archive Date: 02/02/00 DOCKET NO. 96-38 867 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to service connection for the residuals of a right wrist injury. 2. Entitlement to service connection for the residuals of a right hip injury. 3. Whether new and material evidence has been presented to reopen a claim for entitlement to service connection for a duodenal ulcer. 4. Whether new and material evidence has been presented to reopen a claim for entitlement to service connection for an adjustment disorder, with depression and migraine headaches. 5. Entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for duodenal ulcer. 6. Entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for sexual dysfunction. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD E. Pomeranz, Associate Counsel INTRODUCTION The appellant served on active duty from January 1969 to December 1970. The appellant also had additional periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) service as a member of the California National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal of November 1994, July 1996, and July 1997 rating actions by the Department of Veterans Affairs (VA) Regional Office (RO) located in Los Angeles, California. The issue of whether the appellant is entitled to additional compensation in light of receiving his VA benefit checks late will be discussed in the REMAND portion of this decision. The Board notes that in Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998), the United States Court of Appeals for the Federal Circuit held that the United States Court of Appeals for Veterans Claims (formally known as the United States Court of Veterans Appeal (hereinafter "the Court")) erred in adopting the "material evidence" test articulated in Colvin v. Derwinski, 1 Vet. App. 171 (1991). Hodge, 155 F.3d at 1363-64. In light of the holding in Hodge, the Board will analyze the evidence submitted in the instant case according to the standard articulated in 38 C.F.R. § 3.156(a). In view of the fact that the Court has held in Fossie v. West, 12 Vet. App. 1 (1998), that the standard articulated in 38 C.F.R. § 3.156(a) is less stringent than the one previously announced in Colvin, the Board determines that no prejudice will result to the appellant by the Board's consideration of this matter. See Bernard v. Brown, 4 Vet. App. 384, 393-94 (1993). FINDINGS OF FACT 1. There is no competent medical evidence of a current diagnosis of residuals of a right wrist injury. 2. There is no competent medical evidence of record to show that the appellant's residuals of a right hip injury were aggravated by military service. 3. In a February 1986 rating action, the RO denied the appellant's claims for entitlement to service connection for a duodenal ulcer and entitlement to service connection for an adjustment disorder, with depression and headaches. The appellant filed a timely appeal. 4. In an August 1987 decision, the Board denied the appellant's claims for service connection for a duodenal ulcer and service connection for migraine headaches. 5. In March 1993, the appellant requested that his claim for service connection for a duodenal ulcer be reopened. 6. In September 1996, the appellant requested that his claim for service connection for an adjustment disorder, with depression and migraine headaches, be reopened. 7. Evidence added to the record since the Board's August 1987 decision does not bear directly and substantially upon the subject matter now under consideration (i.e., whether there is a nexus between the appellant's duodenal ulcer and his period of active service, whether there is a nexus between the appellant's duodenal ulcer and his period of service in the California National Guard, whether there is a nexus between the appellant's adjustment disorder, with depression and migraine headaches, and his period of active service, and whether there is a nexus between the appellant's adjustment disorder, with depression and migraine headaches, and his period of service in the California National Guard) and, when considered alone or together with all of the evidence, both old and new, has no significant effect upon the facts previously considered. 8. The claim of entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for duodenal ulcer, claimed as due to or the result of the lack of VA treatment, is not supported by competent medical evidence showing that the claim is plausible or capable of substantiation. 9. The claim of entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for sexual dysfunction is supported by cognizable evidence showing that the claim is plausible or capable of substantiation. CONCLUSIONS OF LAW 1. The appellant's claim for service connection for the residuals of a right wrist injury is not well-grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The appellant's claim for service connection for the residuals of a right hip injury is not well-grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. The August 1987 Board decision denying the appellant's claim for entitlement to service connection for a duodenal ulcer is final. 38 U.S.C.A. § 7104 (West 1991 & Supp. 1999). 4. The evidence received since the August 1987 Board decision is not new and material, and the claim for this benefit is not reopened. 38 U.S.C.A. § 3.156(a). 5. The August 1987 Board decision denying the appellant's claim for entitlement to service connection for an adjustment disorder, with depression and migraine headaches, is final. 38 U.S.C.A. § 7104 (West 1991 & Supp. 1999). 6. The evidence received since the August 1987 Board decision is not new and material, and the claim for this benefit is not reopened. 38 U.S.C.A. § 3.156(a). 7. The claim of entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for duodenal ulcer is not well-grounded. 38 U.S.C.A. § 5107 (a) (West 1991 & Supp. 1999). 8. The claim of entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for sexual dysfunction is well-grounded. 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS A. Entitlement to service connection for (1) the residuals of a right wrist injury, and (2) the residuals of a right hip injury. I. Factual Background The appellant's service medical records are negative for any complaints or findings of a right hip injury or disability. The records show that in June 1970, the appellant was treated after complaining of pain and swelling in his right hand. At that time, he stated that his right hand had been hit in a baseball game. An x-ray of the appellant's right hand was interpreted as being "normal." The diagnosis was of a sprained hand. The remaining records are negative for any complaints or findings of a right wrist injury or disability. The appellant's separation examination, dated in November 1970, shows that at that time, in response to the question as to whether the appellant had ever had or if he currently had swollen or painful joints, history of broken bones, and/or bone, joint, or other deformity, the appellant responded "no." The appellant's upper and lower extremities were clinically evaluated as normal. The appellant's California National Guard medical records are sparse and essentially consist of a Statement of Medical Examination, dated in June 1984, two Individual Sick Slips, both dated in June 1984, outpatient treatment records, dated in June 1984, and a re-enlistment examination, dated in May 1985. The National Guard records are negative for any complaints or findings of a right wrist injury or disability. The May 1985 re-enlistment examination shows that at that time, the appellant was diagnosed as status-post right hip fracture in 1977, with no functional impairment. It was noted that he had a 40 centimeter residual scar on his right hip and thigh. In response to the question as to whether the appellant had ever had or if he currently had any broken bones, and/or bone, joint, or other deformity, the appellant responded "no." The remaining records are negative for any complaints or findings of a right hip disability. Private medical records from the Poly Clinic East, from June 1984 and from April 1991 to July 1996, all show treatment for unrelated disorders. A statement from E.P.B., M.D., of the Poly Clinic East, dated in May 1992, shows that at that time, Dr. B. indicated that the appellant was a regular patient at the Clinic and that he was being treated for peptic ulcer disease and depression. An Honorable Discharge Report from the Armed Forces of the United States of America shows that in July 1986, the appellant was honorably discharged from the Army National Guard of California. In September 1996, the appellant filed VA Form 21-4138 and the following claims: (1) entitlement to service connection for a right wrist injury, and (2) entitlement to service connection for a right hip injury. At that time, he stated that during service, he injured his right wrist, and that subsequently, he developed arthritis in his wrist. The appellant further indicated that in 1979, prior to his entrance into the California National Guard, he had surgery on his right hip at the VA Medical Center (VAMC) in Temple, Texas. He noted that he was "fine" in 1980 when he joined the California National Guard and that at that time, he was found fit for duty. According to the appellant, following his discharge from the National Guard, he was diagnosed with arthritis in his right hip. The appellant contended that his period of time in the California National Guard aggravated his pre-existing right hip disability. In October 1996, the RO requested outpatient and inpatient treatment records from the Temple VAMC. The Board notes that the record is negative for a reply from the Temple VAMC. In January 1997, the RO received outpatient treatment records from the West Los Angeles VAMC, from October 1994 to October 1996. The records are negative for any complaints or findings of a right wrist disability. The records show that in October 1996, an x-ray was taken of the appellant's right hip and femur. At that time, the examining physician stated that the appellant was status-post prior fracture and open reduction and internal fixation at the right proximal one- third of the femur. The x-ray was interpreted as showing four circlage wires. Post-traumatic and post-surgical changes were evident, and there was no evidence of new fracture, dislocation, or subluxation. The left hip and both sacroiliac joints were normal, and increased serpengitonous density was seen at the mid-femoral shaft representing a bone infarct. The diagnoses included the following: (1) status- post surgery with four circlage wires at the proximal one- third of the right femur, and (2) bone infarct at the mid right femoral shaft. The remaining records are negative for any complaints or findings of a right hip disability. In July 1997, the RO received VA outpatient treatment records, dated on June 16, 1977. The records show that at that time, the appellant was treated after complaining of pain on the site of his recent internal fixation of a subtrochantive fracture of the right femur. The records reflect that on April 19, 1977, the appellant underwent an open reduction and internal fixation of a subtrochantive fracture of the right femur. According to the records, the surgery was performed at the Bakersfield Memorial Hospital. The records show that the appellant currently had pain in the upper third of the right thigh. He noted that the pain was aggravated by putting weight on his right leg. The physical examination showed marked tenderness of the outer aspect of the upper third of the right thigh. In January 1999, the RO received outpatient treatment records from the West Los Angeles VAMC, from July 1996 to January 1999. The records show that in August 1997, the appellant had an x-ray taken of his pelvis after complaining of pain in that area. The x-ray was interpreted as showing a healed proximal right femoral fracture with four circlage wires within it. There was evidence of a bony infarct, and there was an old greater trochanter fracture. There was also phleboliths in the lower pelvis. The rest of the pelvic bones were within normal limits, without evidence for acute fracture dislocation or subluxation. The visualized joint spaces were within normal limits. The diagnoses included the following: (1) healed proximal right femoral fracture, with bony infarct as above, (2) old right greater trochanteric fracture, and (3) phleboliths. The West Los Angeles VAMC records also reflect that in December 1996, the appellant was treated after complaining of pain in his right hip. At that time, he gave a history of his right hip disability, including his 1977 surgery. He stated that in November 1996, he underwent physical therapy for his right lower extremities. According to the appellant, he had a transcutaneous electrical nerve stimulation (TENS) unit. The appellant noted that he had visited a private physician who had informed him that there was nothing that could be done with his right hip. The diagnosis was of an "infarct necrosis femur." The appellant was directed to continue his home exercises and using his TENS unit. In September 1999, the appellant testified, via a video conference, before the undersigned Board member. At that time, he stated that during service, he injured his right wrist. (Transcript, p. 5). The appellant indicated that at the time of his injury, he received treatment, but that he did not receive any further treatment during the remainder of his time in the military or within one year following his discharge. (T.5,6). He noted that his first post-service treatment for his right wrist was in 1985 at the West Los Angeles VAMC. (T.6). According to the appellant, at present, he had osteoarthritis and constant pain in his right wrist. (T.7,8). The appellant stated that his right hand would lock up and that on those occasions, he could barely move his hand. (T.8). He reported that a private doctor had informed him that his current osteoarthritis of his right wrist was related to his in-service right wrist injury. (Id.). In the appellant's September 1999 video conference hearing, the appellant testified that he injured his hip in an automobile accident in 1967. (T.9). The appellant stated that in 1979, prior to his enlistment in the California National Guard, he underwent surgery for his right hip. (Id). He contended that his service in the California National Guard aggravated his right hip disability. (Id.). According to the appellant, he first received treatment for his right hip disability in 1985, at which time he was serving in the National Guard. (Id.). In response to the question as to whether or not the appellant was on inactive duty for training or active duty for training while he was in the National Guard, the appellant responded "both." (T.10). The appellant reported that during the summer, he was on active duty for training, and that he was also on inactive duty for training for five years as a cook. (Id). He indicated that he served in the California National Guard from 1980 to 1986. (Id.). According to the appellant, at the time of his 1985 treatment for his right hip disability, he was on inactive duty for training. (T.11). II. Analysis The threshold question to be answered is whether the appellant has presented evidence sufficient to justify a belief by a fair and impartial individual that his claims for service connection for the residuals of a right wrist injury and service connection for the residuals of a right hip injury, are well-grounded; that is, a claim which is plausible and capable of substantiation. See 38 U.S.C.A. § 5107(a); Chelte v. Brown, 10 Vet. App. 268, 270 (1997) (citing Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990)). If the claim is not well grounded, the appeal must fail and there is no further duty to assist in developing the facts pertinent to the claim. See Epps v. Gober, 126 F.3d 1464, 1469 (Fed.Cir. 1997). Generally, a well-grounded claim for service connection requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in- service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in- service disease or injury and the present disease or injury. Caluza v. Brown, 7 Vet. App. 489, 504, 506 (1995); see also Epps v. Gober, 126 F.3d at 1468 (expressly adopting definition of well-grounded claim set forth in Caluza, supra). For the purpose of determining whether a claim is well grounded, the credibility of the evidence in support of the claim must be presumed. Robinette v Brown, 8 Vet. App. 69, 75 (1995). Where the determinant issue involves a question of medical diagnosis or medical causation, competent medical evidence to the effect that the claim is plausible or possible is required to establish a well-grounded claim. Lay assertions of medical causation cannot constitute evidence to render a claim well grounded; if no cognizable evidence is submitted to support a claim, the claim cannot be well grounded. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a pre-existing injury suffered or disease contracted in line of duty. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Regulations also provide that 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). More specifically, a disability is service connected if it was incurred or aggravated in the line of duty in the active military, naval, or air service. 38 U.S.C.A. § 101(16); 38 C.F.R. § 3.1(k); see 38 U.S.C.A. § 1131 and 38 C.F.R. § 3.303(a) (stating basic requirements for entitlement to service connection). In addition, service connection may be granted for disability resulting from disease or injury incurred in or aggravated while performing ACDUTRA or from an injury incurred or aggravated during INACDUTRA. 38 U.S.C.A. §§ 101(24), 1131, 1137, 5107 (West 1991); 38 C.F.R. § 3.303 (1999). An injury is not incurred "in the line of duty" if it was the result of the veteran's own willful misconduct or was a result of his or her abuse of alcohol. 38 C.F.R. § 3.1(m). A service department finding that an injury occurred in the line of duty will be binding on the VA unless it is patently inconsistent with the requirements of laws administered by the VA. Id.; see Kinnaman v. Principi, 4 Vet. App. 20, 28 (1993) (Coast Guard determination that veteran's eye disease was incurred in the line of duty binding on the VA pursuant to regulation). Active military, naval, or air service includes any period of active duty for training (ACDUTRA) during which the individual concerned was disabled from a disease or injury incurred in the line of duty. 38 U.S.C.A. § 101(21) and (24); 38 C.F.R. § 3.6(a). ACDUTRA is, inter alia, full-time duty in the Armed Forces performed by Reserves for training purposes. 38 C.F.R. § 3.6(c)(1). The term "veteran" is defined as a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable. 38 U.S.C.A. § 101(2) (West 1991). A veteran is presumed to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated. 38 U.S.C.A. § 1111(West 1991). Only such conditions as are recorded in examination reports are to be considered as "noted." The veteran's reported history of the pre-service existence of a disease or injury does not constitute notations of such disease or injury, but is considered with all other evidence in determining if the disease or injury pre-existed service. See Paulson v. Brown, 7 Vet. App. 466, 470 (1995); 38 C.F.R. § 3.304(b). The presumption of soundness can be rebutted if clear and unmistakable evidence demonstrates that the disease or injury existed prior to induction and was not aggravated by active service. 38 U.S.C.A. §§ 1111, 1153. In each case, the Board is required to provide an adequate statement of reasons and bases for its any conclusion that the presumption of soundness is rebutted by clear and unmistakable evidence. See Crowe v. Brown, 7 Vet. App. 228, 245 (1994). Moreover, in rebutting the presumption of soundness, the Board must also produce independent medical evidence in support of its conclusion. See Paulson, 7 Vet. App. at 471. In the instant case, the appellant contends that during service, he injured his right wrist, and that subsequently, he developed arthritis in his wrist. The appellant further maintains that prior to his enlistment in the California National Guard, he injured his right hip and subsequently underwent surgery. According to the appellant, his period of service in the National Guard aggravated his pre-existing right hip disability. The appellant notes that at present, he has arthritis in his right hip. In this regard, lay statements are considered to be competent evidence when describing the features or symptoms of an injury or illness. Layno v. Brown, 6 Vet. App. 465 (1994); see also Falzone v. Brown, 8 Vet. App. 398, 405 (1995). However, when the determinative issues involves a question of medical causation, only individuals possessing specialized training and knowledge are competent to render an opinion. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The evidence does not show that the appellant possesses medical expertise, nor is it contended otherwise. Therefore, his opinion that his residuals of a right wrist injury are related to service, and his opinion that his pre-existing right hip disability was aggravated by his service in the California National Guard, are not competent evidence. In regards to the appellant's claim for service connection for the residuals of a right wrist injury, the Board notes that upon a review of the record, there is no competent medical evidence showing a current medical diagnosis of residuals of a right wrist injury, nor has it been reported that such evidence exists, so as to give rise to a duty under 38 U.S.C.A. § 5103(a). As previously stated, the appellant's service medical records show that in 1970, the appellant was treated after he injured his right hand in a baseball game. At that time, an x-ray of the appellant's right hand was interpreted as being "normal." The diagnosis was of a sprained hand. However, the Board notes that the remaining records are negative for any complaints or findings of a right wrist injury or disability. Moreover, the appellant's separation examination, dated in November 1970, shows that at that time, in response to the question as to whether the appellant had ever had or if he currently had swollen or painful joints, history of broken bones, and/or bone, joint, or other deformity, the appellant responded "no." In addition, the appellant's upper and lower extremities were clinically evaluated as normal. The Board further observes that the remaining evidence of record, including the VA outpatient treatment records, dated in June 1977, the private medical records from the Poly Clinic East, from June 1984 and from May 1991 to July 1996, and the outpatient treatment records from the West Los Angeles VAMC, from October 1994 to January 1999, are all negative for any complaints or findings of residuals of a right wrist injury. Because the appellant has not presented competent medical evidence of the current existence of residuals of a right wrist injury, this claim must be denied as not well grounded. In the absence of proof of a disability, there can be no valid claim. Caluza, 7 Vet. App. 498; Brammer v. Derwinski, 3 Vet. App. 223 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Here, the question as to whether the appellant currently has residuals of a wrist injury necessarily involves a medical diagnosis. Accordingly, competent medical evidence is required. As no competent medical evidence is of record showing a current diagnosis of residuals of a right wrist injury, the claim must be denied as not well grounded. The Board recognizes that in the appellant's September 1999 video conference hearing, the appellant testified that a private doctor had informed him that his current osteoarthritis in his right wrist was related to his in- service right wrist injury. (T.8). However, the Board observes that a statement by the appellant as to what a doctor told him is insufficient to establish a medical nexus. Warren v. Brown, 6 Vet. App. 4, 6 (1993). Accordingly, although the appellant has presented lay evidence alleging that he currently suffers from osteoarthritis in his right wrist, and that his current disability is related to his in- service right wrist injury, there is simply no competent medical evidence of record which supports his allegation. That notwithstanding, the Board has an obligation under 38 U.S.C.A. § 5103(a) to advise the appellant of the evidence necessary to complete his application for VA benefits. In this case, the appellant is hereby notified that, under the circumstances of this case, he must submit a medical statement from the physician who had diagnosed him with osteoarthritis of the right wrist, and the statement must be to the effect that his current right wrist disability is related to his in-service right wrist injury. As this medical evidence would be necessary to complete the appellant's application for service connection for the residuals of a right wrist injury, the appellant is further advised that he has an obligation to attempt to obtain that evidence. See Robinette v. Brown, 8 Vet. App. 69, 80 (1995); see also McKnight v. Gober, 131 F.3d 1483, 1484-85 (1997) (adopting the United States Court of Veterans Appeals' interpretation of § 5103(a) in Robinette, supra). In regards to the appellant's claim for service connection for the residuals of a right hip injury, the Board notes that it is unclear from the evidence of record as to exactly when the appellant enlisted with the California National Guard. However, the evidence of record does include the appellant's Discharge Report which shows that the appellant was honorably discharged from the Army National Guard of California in July 1986. The Board further observes that in the appellant's September 1999 video conference hearing, the appellant testified that he served in the California National Guard from 1980 to 1986. (T.10). Thus, in light of the above, the Board notes that VA outpatient treatment records, dated in June 1977, show that at that time, the appellant was treated after complaining of pain on the site of his recent internal fixation of a subtrochantive fracture of the right femur. The records reflect that in April 1977, the appellant underwent an open reduction and internal fixation of a subtrochantive fracture of the right femur. Moreover, the Board further observes that an x-ray taken in October 1996 was interpreted as showing four circlage wires at the proximal one-third of the right femur, status-post surgery, and an x-ray dated in August 1997 was interpreted as showing a healed proximal right femoral fracture with bony infarct. Therefore, in light of the above evidence, it is the Board's determination that the appellant had a right hip disability prior to his induction into the California National Guard. Accordingly, the Board finds that he is not entitled to the presumption of soundness, and that service connection may only be granted upon a showing of aggravation. See Paulson, 7 Vet. App. at 468. In this respect, as previously stated, the appellant's National Guard medical records are sparse and essentially consist of a Statement of Medical Examination, dated in June 1984, two Individual Sick Slips, both dated in June 1984, outpatient treatment records, dated in June 1984, and a re- enlistment examination, dated in May 1985. The May 1985 re- enlistment examination shows that at that time, the appellant was diagnosed as status-post right hip fracture in 1977, with no functional impairment. It was noted that he had a 40 centimeter residual scar on his right hip and thigh. In response to the question as to whether the appellant had ever had or if he currently had any broken bones, and/or bone, joint, or other deformity, the appellant responded "no." The remaining records are negative for any complaints or findings of a right hip disability. The post-National Guard evidence of record includes outpatient treatment records from the West Los Angeles VAMC, from October 1994 to January 1999. The records reflect that, as previously stated, an x-ray taken in October 1996 was interpreted as showing four circlage wires at the proximal one-third of the right femur, status-post surgery, and an x- ray dated in August 1997 was interpreted as showing a healed proximal right femoral fracture with bony infarct. The records further show that in December 1996, the appellant was treated after complaining of pain in his right hip. At that time, the appellant stated that in November 1996, he had undergone physical therapy for his right lower extremities. According to the appellant, he had been wearing a TENS unit. Following a physical examination, he was diagnosed with an "infarct necrosis femur," and he was instructed to continue his home exercises and using his TENS unit. In light of the above, the Board is of the opinion that the evidence of record strongly indicates that no permanent increase in the underlying pathology of the pre-existing residuals of a right hip injury occurred during the appellant's service in the California National Guard. See Verdon v. Brown, 8 Vet. App. 529, 536-37 (1996). Upon a review of the record, the evidence shows that the appellant underwent surgery for a subtrochantive fracture of the right femur prior to his entrance into the California National Guard. The appellant's National Guard medical records reflect that in the appellant's May 1985 re-enlistment examination, the appellant was diagnosed as status-post right hip fracture in 1977, with no functional impairment. Moreover, the Board further notes that post-National Guard evidence includes an August 1997 x-ray which shows a healed proximal right femoral fracture, with bony infarct. Thus, it is the Board's determination that the totality of the medical evidence of record does not show that the appellant's pre- existing residuals of a right hip injury worsened in any permanent manner during his period of service with the California National Guard. For these reasons, the Board has determined that the appellant's pre-existing residuals of a right hip injury were not aggravated by his service in the California National Guard, and that service connection for the residuals of a right hip injury is not warranted. 38 U.S.C.A. § 1110, 5107. The Board recognizes that these claims are being disposed of in a manner that differs from that used by the RO. The RO denied the appellant's claims on the merits, while the Board has concluded that the claims are not well grounded. However, the Court has held that "when an RO does not specifically address the question whether a claim is well grounded but rather, as here, proceeds to adjudication on the merits, there is no prejudice to the veteran solely from the omission of the well grounded analysis." See Meyer v. Brown, 9 Vet. App. 425, 432 (1996). Likewise, the Board finds that the RO has advised the appellant of the evidence necessary to establish a well grounded claim. Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995). B. Whether new and material evidence has been presented to reopen the claims for (1) entitlement to service connection for a duodenal ulcer, and (2) entitlement to service connection for an adjustment disorder, with depression and migraine headaches. I. Factual Background In a February 1986 rating action, the RO denied the appellant's claims for entitlement to service connection for duodenal ulcer and entitlement to service connection for an adjustment disorder, with depression and headaches. The appellant filed a timely appeal, and in an August 1987 decision, the Board denied the appellant's claims for service connection for duodenal ulcer and service connection for migraine headaches. At that time, the Board stated that neither duodenal ulcer disease nor a chronic headache disorder (migraine headaches) was demonstrated during active duty, at separation, or for several years following the appellant's separation from active duty. Accordingly, in regards to the Board's August 1987 decision, unless the Chairman of the Board orders reconsideration, all decisions of the Board are final on the date stamped on the face of the decision. 38 C.F.R. § 20.1100; see also 38 U.S.C.A. §§ 511(a), 7103, 7104(a) (West 1991). In the instant case, since there is no evidence of record which shows that the Chairman of the Board ordered reconsideration in regards to this case, the August 1987 Board decision is final. 38 U.S.C.A. § 7103 (a) (West 1991). The evidence of record at the time of the August 1987 Board decision consisted of the appellant's service medical records, private medical records from the Kern County Department of Mental Health Services, from September to November 1985, a VA examination, dated in December 1985, a VA neurologic examination, dated in December 1985, a Discharge Summary from the VAMC in Brentwood, California, showing that the appellant was hospitalized from November 1985 to January 1986, and VA outpatient treatment records, from February to June 1986. The appellant's service medical records show that in May 1969, the appellant was treated after complaining of abdominal cramps with nausea. At that time, he was given Maalox. The records reflect that in April 1970, the appellant was treated after complaining of headaches and a sore throat. At that time, he was diagnosed with acute pharyngitis; probably strep. According to the records, in July 1970, the appellant was hospitalized for eight days after he complained of a swollen face and frontal headaches. Upon physical examination, there was no abdominal pain. During that period of time, the appellant was diagnosed with the mumps. The records show that in December 1970, the appellant was treated after complaining of a weak stomach and slight nausea. Upon physical examination, the examining physician noted that there was tenderness in the left upper quadrant. The bowel sounds were normal. The appellant was given Maalox. The appellant's separation examination, dated in November 1970, shows that at that time, in response to the question as to whether the appellant had ever had or if he currently had stomach, liver, or intestinal trouble, frequent indigestion, frequent trouble sleeping, depression or excessive worry, or nervous trouble of any sort, he responded "no." The clinical examination showed that the appellant's head, face, neck, scalp, abdomen and viscera, and his gastrointestinal system were all clinically evaluated as normal. The appellant was also clinically evaluated as normal for psychiatric purposes. Private medical records from the Kern County Department of Mental Health Services, from September to November 1985, show intermittent treatment for the appellant's diagnosed depression and adjustment disorder. The records show that in September 1985, the appellant was treated after complaining of depression due to money problems. At that time, he stated that he had been having trouble sleeping and eating, and that he had poor concentration. The appellant indicated that he had recently lost his job. Upon mental status evaluation, the appellant's speech was low and hesitant, and his thoughts were well connected and logical. The appellant's affect was blunted, with occasional sardonic smile and laughter. The appellant was diagnosed with adjustment disorder, with mixed emotional features. In December 1985, the appellant underwent a VA examination. At that time, he complained of depression and diarrhea. The appellant underwent an upper gastrointestinal (GI) series which showed that his distal esophagus was normal, and the stomach was of normal size and position. The mucosal folds were thickened throughout the stomach, with marked thickening and distortion on the greater curvature aspect of the gastric body. The duodenal bulb was normal. The impression was of the thickening of the mucosal fold involving the stomach, which possibly represented gastritis. Following the physical examination and a review of the upper GI series, the examining physician diagnosed the appellant with the following: (1) no duodenal ulcer found, and (2) an umbilical hernia. In December 1985, the appellant underwent a VA neurologic examination. At that time, he stated that he had been having headaches since his separation from the military. The appellant indicated that the headaches were caused by noise and pressure. According to the appellant, at times, the headaches occurred as frequently as one to two times a week, but that most of the time they occurred one to two times a month. The appellant noted that he had been recently hospitalized for depression, and that he had been depressed since August 1985. The physical examination showed that the appellant's gait was normal. The appellant's coordination, sensation, motor, and reflexes were also all normal. The diagnoses included the following: (1) muscle contraction headaches which could possibly develop a late vascular component, and (2) depression. A Discharge Summary from the VAMC in Brentwood, California, shows that the appellant was hospitalized, from November 1985 to January 1986, after complaining of feeling overwhelmed by anxiety, fearfulness, and depression. At that time, the appellant stated that he had been recently fired from his job of five years. The appellant indicated that in his opinion, the reason why he was fired was because all of his co- workers, except him, had agreed to work overtime. He reported that he started smoking marijuana and was getting increasingly afraid of being on a "high base" and hurting someone. According to the appellant, he had lost weight and was not able to sleep or eat. Upon mental status evaluation, the appellant denied any hallucinations, and he was highly anxious and somewhat depressed. He had feelings of being overwhelmed and was unable to cope. During his hospitalization, he was given anti-anxiety medication. Upon his discharge, he was diagnosed with the following: (Axis I) brief reactive psychosis, alcohol dependence, in remission, and (Axis III) peptic ulcer by history. VA outpatient treatment records, from February to June 1986, show intermittent treatment for the appellant's diagnosed depression and anxiety. According to the records, the appellant received counseling for his psychiatric disabilities. The records also reflect that in June 1986, the appellant was treated after complaining of epigastric pain. At that time, he stated that Mylanta occasionally relieved his pain. The physical examination showed that his abdomen was soft and non-tender. The diagnosis was of abdominal pain, with negative upper endoscopy in February 1986. Evidence submitted subsequent to the August 1987 Board decision includes outpatient treatment records from the Brentwood VAMC, from January 1986 to May 1988, private medical records from A.M., M.D., from July 1988 to June 1989, a Discharge Summary from the Brentwood VAMC, showing that the appellant was hospitalized from July to August 1989, a private medical statement from E.B., M.D., dated in April 1991, a statement from the appellant's former employer, the Boynton Brothers, dated in August 1985, a duplicative copy of a service medical record, dated in December 1970, copies of the appellant's California National Guard medical records, private medical records from the Kern County Clinic, from September 1985 to October 1991, a medical statement from Ms. K.S., M.S.W., of the VA Outpatient Clinic in Bakersfield, dated in October 1992, a VA Discharge Summary, showing that the appellant was hospitalized for one day in November 1992, photographs from the appellant's September 1993 endoscopy at the Bakersfield Memorial Hospital, private medical records from R.L.B., M.D., from February 1984 and from September 1993 to June 1994, a statement from Mr. N.D., director of the Mental Health Services at the Good Samaritan Hospital, dated in May 1995, outpatient treatment records from the Sepulveda VAMC, from July 1992 to May 1995, private medical records from the Poly East Clinic, from April 1991 to July 1996, outpatient treatment records from the West Los Angeles VAMC, from October 1994 to November 1998, and hearing testimony. Outpatient treatment records from the VAMC in Brentwood, from January 1986 to May 1988, show that in January 1988, the appellant underwent an upper panendoscopy with biopsy. At that time, the diagnoses included the following: (1) a one centimeter gastric ulcer which did not appear to have healed since last endoscopy, and (2) prepyloric erosions. The records also reflect that in April 1988, the appellant underwent an esophagogastrodudenoscopy (EGD). At that time, the impression was of mild erosions on angularis, with evidence of scar, suggesting healed ulcer disease. According to the records, in May 1988, the appellant was diagnosed with a gastric ulcer which was benign by biopsy. Private medical records from A.M., M.D., from July 1988 to June 1989, include a Radiology Consultation Report, dated in August 1988, which shows that at that time, the appellant underwent a small bowel follow-through. The impression was of a negative small bowel follow through study. The records reflect that in July 1988, the appellant underwent an EGD. At that time, he gave a history of multiple GI complaints, including a history of an ulcer disease for approximately three years. The appellant indicated that at present, he had epigastric pain, burning, constipation, nausea, and vomiting, and that he took Mylanta II in order to relieve his symptoms. He noted that his appetite had diminished and that he had lost approximately five pounds. Following the EGD, the appellant was diagnosed with no ulcer or inflammation. Dr. M. noted that the gastric folds were somewhat prominent. The records also show that in July 1988, the appellant underwent a computed tomography (CT) of his abdomen. The CT was interpreted as showing a five millimeter cyst in the lower pole of the left kidney, with otherwise normal CT scan of the abdomen. The records further reflect that in July 1988, the appellant underwent a colonoscopy to the cecum, with polypectomy. At that time, the appellant complained of rectal bleeding and constipation. The appellant's diagnosis was of multiple small polyps in the rectum. Dr. M. noted that the appellant had constipation and hemorrhoids, and he directed the appellant to begin a high fiber diet and to use Anusol HC suppositories. According to the records, in October 1989, the appellant underwent a Magnetic Resonance Imaging (MRI) of his brain. At that time, the MRI was interpreted as normal. The private medical records from Dr. M. include a Report of Operation, dated in May 1989, which shows that at that time, the appellant underwent an EGD, with biopsy. At the time of the operation, the appellant complained of abdominal pain and weight loss. Following the operation, the appellant was diagnosed with a normal upper endoscopy. The records show that in May 1989, the appellant underwent a gallbladder ultrasound which was interpreted as normal. According to the records, also in May 1989, the appellant's biopsy from his May 1989 EGD was examined and evaluated. The diagnosis was of "edema, biopsy, duodenum." According to the records from Dr. M., in June 1989, the appellant underwent a psychiatric evaluation which was conducted by S.R., M.D. In the psychiatric evaluation report, Dr. R. stated that according to the appellant, he had a history of stomach problems, including an ulcer, and that as a result, he was depressed. The appellant stated that in 1985, he had a nervous breakdown and he started hearing voices and feeling paranoid. He noted that he was hospitalized for approximately 30 days, and that he was hospitalized a second time in 1986 for approximately 15 days for similar symptoms. According to the appellant, since his nervous breakdown, he had been taking medication and intermittently visiting a VA psychiatrist. Upon mental status evaluation, the appellant was cooperative and oriented to time, place, and person. The appellant's speech was hesitant, but coherent and relevant, and his mood was moderately anxious with an inappropriate smile at times. The appellant denied any suicidal or homicidal ideations. He noted that on occasion, he heard voices, especially when he was around other people and somebody aggravated him. According to the appellant, at times, the voices were command hallucinations. There was no evidence of any looseness of associations or delusions, and the appellant's concentration was adequate. The diagnoses included the following: (Axis I) schizophrenia, chronic, undifferentiated, adjustment disorder with depressed mood, (Axis III) history of gastric problems, and (Axis V) a Global Assessment of Functioning (GAF) score of 50. Dr. R. stated that the appellant's depression appeared to be related to his current physical suffering. According to Dr. R., the appellant did not have any severe debilitative signs such as sleep disturbance or suicidal ideations, and as such, no urgent intensive treatment was warranted. Dr. R. recommended that the appellant continue his treatment with his VA physician. A Discharge Summary from the Brentwood VAMC shows that the appellant was hospitalized from July to August 1989. At the time of his admission, the appellant noted that he had been previously hospitalized in 1986 and 1988. The appellant stated that at present, he felt overwhelmed because of escalating conflicts with his wife. Upon mental status evaluation, the appellant was very delusional with marked delusions of persecution by his wife. The appellant reported drinking and marijuana abuse. He indicated that he had a history of peptic ulcer disease and stomach problems. The examining physician noted that the appellant's peptic ulcer disease, along with alcoholism, psychiatric problems, and marijuana use, had all aggravated his stomach problems. According to the Summary, during the appellant's hospitalization, it was discovered that he had Giardia in his stools. The examiner noted that the appellant's complaints of headaches and diarrhea were possibly related to the appellant's Giardia. The appellant was treated and upon his discharge, he was diagnosed with the following: (Axis I) (a) paranoid schizophrenia, chronic, with acute exacerbation, and (b) alcohol and marijuana dependence, (Axis III) (a) Giardiasis, and (b) peptic ulcer disease, and (Axis V) poor. A private medical statement from E. B., M.D., of the Truxtun Radiology Medical Group, dated in April 1991, shows that at that time, the appellant underwent an upper GI series. The diagnoses included the following: (1) small sliding hiatal hernia, and (2) marked gastric mucosal prominence and suspicious gastric ulcers. In October 1991, a hearing was conducted at the RO. At that time, the appellant testified that during service, he was treated for a weak stomach and loss of appetite. (Transcript, p. 1). The appellant stated that years later, following his discharge, he was diagnosed with an ulcer and a hernia. (Id.). He indicated that in his opinion, he was misdiagnosed during service, and that at the time of his treatment for a weak stomach, he actually had an ulcer. (Id.). The appellant reported that he also served in the California National Guard from 1980 to 1985, and that during that period of time, he was hospitalized for an ulcer. (Id.). He revealed that from 1970, the time of his separation from the military, to 1980, he did not seek medical treatment for his ulcer. (T.3). The appellant stated that he treated his ulcer with Mylanta. (T.6). According to the appellant, in 1983, he was diagnosed with an ulcer by a private physician. (Id.). The appellant testified that he could not remember the name of the physician. (Id.). He indicated that he currently took Mylanta and Tagamet for his stomach problems. (Id.). In the appellant's October 1991 hearing, the appellant stated that his first psychiatric hospitalization was in 1985. (T.9). The appellant indicated that prior to his hospitalization, he had lost his job. (T.9,10). It was the appellant's opinion that he had lost his job because of his service in the California National Guard, and that because he lost his job, he developed feelings of stress. (Id.). In October 1991, the RO received a statement from the appellant's former employer, the [redacted], dated in August 1985. The statement shows that at that time, the appellant's former employer stated that the appellant was not terminated as a result of his re-enlistment in the National Reserves, and that there were numerous reasons for his termination, including tardiness and lack of interest in his job. In October 1991, the RO also received a duplicative copy of a service medical record, dated in December 1970, and copies of the appellant's California National Guard medical records. As previously stated, the December 1970 service medical records shows that at that time, the appellant was treated for a weak stomach and slight nausea. According to the record, he was given Maalox for treatment. In addition, as previously stated, the appellant's California National Guard medical records are sparse and essentially consist of a Statement of Medical Examination, dated in June 1984, two Individual Sick Slips, both dated in June 1984, outpatient treatment records, dated in June 1984, and a re-enlistment examination, dated in May 1985. The Statement of Medical Examination shows that the appellant was treated in June 1984 after complaining that he had developed stomach problems after eating some "beef in B-ration." He was diagnosed with a history of peptic ulcer disease, and the examining physician stated that the appellant's peptic ulcer disease was worsened by "mess hall food." The appellant was given Tagamet and Mylanta for treatment. The Individual Sick Slips reflect that in June 1984, the appellant was diagnosed with a gastric ulcer and with peptic ulcer disease. According to the Slips, the appellant was advised to avoid irritating foods. The appellant's re-enlistment examination, dated in May 1985, shows that at that time, the appellant's abdomen and viscera, and gastrointestinal system were all clinically evaluated as normal. In October 1991, the RO received private medical records from the Kern County Clinic, from September 1985 to October 1991. The records show intermittent treatment for the appellant's psychiatric disorders, including depression. The records reflect that in August 1991, the appellant was evaluated after complaining of depression and insomnia. At that time, he stated that he only slept for approximately two to three hours a night, and that he had poor appetite and concentration. The appellant indicated that he was currently homeless, and that at times, he stayed with his wife with whom he was separated. Upon mental status evaluation, the appellant had a depressed mood and affect. The appellant had a slow, halted, and hesitant speech, and his thoughts were connected. The appellant denied any suicidal ideation and his insight was poor. The examining physician noted that the appellant had increased depression and related physical problems which were creating stress on relationships and job functioning. The diagnoses included the following: (Axis I) dysthymia, primary type, moderate; rule out major depression, recurrent, (Axis III) ulcer, hernia, impotency, Giardiasis, and (Axis V) GAF score of 40. A medical statement from Ms. K.S., M.S.W., of the VA Outpatient Clinic in Bakersfield, dated in October 1992, shows that at that time, Ms. S. indicated that the appellant had been receiving VA social work services. Ms. S. noted that she had been helping the appellant live on his current income of $600 dollars a month. A VA Discharge Summary shows that the appellant was hospitalized for one day in November 1992. At the time of his admittance, the appellant stated that he believed that his wife was trying to kill him. The examining physician indicated that the appellant had a number of vague, suspicious notions, all of them vaguely formed. Upon mental status evaluation, the appellant was oriented in all spheres, with intact orientation and memory. The appellant's affect was flat with a mildly anxious mood, and his thoughts were moderately disorganized. The appellant denied any hallucinations, and he had some suspicious ideas regarding his family plotting against him. He was not suicidal. During his hospitalization, he was given medication. Upon his discharge, he was diagnosed with the following: (Axis I) schizophrenic disorder, and (Axis III) history of peptic ulcer disease. In September 1993, the appellant submitted photographs from his recent endoscopy, which was conducted in September 1993 at the Bakersfield Memorial Hospital. The photographs show that at that time, the appellant had a gastric ulcer. In January 1995, the RO received private medical records from R.L.B., M.D., from February 1984 and from September 1993 to June 1994. The records show that in February 1984, the appellant underwent an upper GI series. At that time, the impression was of probable active duodenal ulcer crater with deformity of the antrum, which was compatible with antral gastritis, without definite ulceration. In addition, a biopsy, labeled "gastric ulcer" was taken at the time of the upper GI series, and the diagnosis was that the biopsy was consistent with acute gastric ulcer. There was no evidence of malignancy. The records also show that in September 1993, the appellant underwent an EGD, with biopsy. At that time, the appellant complained of severe abdominal pain and heartburn. The appellant also noted that he had constipation which alternated with diarrhea. He gave a history of gastric ulcer disease. The results of the EGD were interpreted as showing a large gastric ulcer in the stomach. There was a visible vessel in the middle, but not actively bleeding. The stomach was markedly deformed. The duodenum was unremarkable, and the esophagus was normal. The impression was of a gastric ulcer with hypersecretory state. The records from Dr. B. show that in October 1993, the appellant underwent a colonoscopy. No polyps or mass lesions were noted. The impression was that the colonoscopy was significant for no major medical findings. The records further reflect that in December 1993, the appellant underwent a second EGD, with biopsy. At that time, it was noted that the appellant had a large, deep ulcer. The results of the EGD were interpreted as showing a marked healing of the ulcer disease. The appellant's ulcer was only five to seven millimeters and it was markedly shallow. There was a large amount of deformity created by the healing process, making examination of the stomach difficult. Gastritis was noted and the duodenal bulb, second portion, was normal. The impression was of marked healing of the ulcer disease. According to the records, in February 1994, the appellant underwent a third EGD. At that time, it was noted that he had a gastric ulcer with poor healing. The appellant's pre-operative diagnosis was to rule out ulcer disease. The results of the EGD were interpreted as showing a normal esophagus and an unremarkable duodenum. There was total healing of the previously described ulcer disease. Bile reflux gastritis was present, and no ulcer was seen. The stomach was deformed due to previous ulcer. The impression was of total healing of ulcer disease. The records also show that in April 1994, the appellant underwent a computed tomography (CT) scan of the abdomen. At that time, the impression was of no evidence of a mass. A statement from Mr. N.D., director of the Mental Health Services at the Good Samaritan Hospital, dated in May 1995, shows that at that time, Mr. D. indicated that the appellant had been receiving treatment from a S.A.M., M.D., since April 1995. Mr. D. noted that Dr. M. was treating the appellant for depression and other psychiatric problems. According to Mr. D., the appellant was hospitalized in April 1995 as part of his treatment. Upon admission, the appellant was very distraught and disorganized due to many outside stressors, as well as deteriorated physical health. While hospitalized, the appellant was placed on psychiatric medications and encouraged to participate in group therapy. Mr. D. stated that the appellant was to be discharged in May 1995. In June 1995, the RO received outpatient treatment records from the VAMC in Sepulveda, California, from July 1992 to May 1995. The records show intermittent treatment for the appellant's psychiatric problems, including schizophrenia, and for his gastrointestinal problems, including peptic ulcer disease. The records reflect that in September 1992, the appellant was treated after complaining of anxiety and anger. At that time, he gave a history of schizophrenia and previous psychiatric hospitalizations. The appellant stated that at the time of his first hospitalization in 1985, he was suffering from depression and the "fact that [his] wife was trying to kill" him. According to the appellant, at the time of his hospitalization, he had lost his job and he had not been employed since. The appellant indicated that at the time of his second hospitalization in 1990, he attempted suicide by shotgun, but was unable to pull the trigger because of his religious beliefs. Upon mental status evaluation, the examining physician stated that the appellant was preoccupied with delusions involving threats to his well being by his wife and others. According to the examiner, the appellant neither displayed nor reported any of the first rank symptoms of schizophrenia. The diagnoses included the following: (Axis I) schizophrenia, paranoid type, chronic, (Axis III) hiatal hernia, stomach ulcers, and (Axis V) GAF score of 60. In July 1996, the RO received private medical records from the Poly East Clinic, from April 1991 to July 1996. The records show intermittent treatment for the appellant's peptic ulcer disease. According to the records, in October 1991, the appellant was treated after complaining of abdominal pain and bloating. At that time, he was diagnosed with peptic ulcer disease. The records include a statement from E.P.B., M.D., dated in May 1992, which shows that at that time, Dr. B. indicated that the appellant was a regular patient at the Clinic and that he was being treated for peptic ulcer disease and depression. In January 1997, the RO received outpatient treatment records from the West Los Angeles VAMC, from October 1994 to October 1996. The records reflect intermittent treatment for the appellant's psychiatric problems, including bipolar depression. The records also show that in July 1996, the appellant underwent an upper GI series. At that time, double contrast examination of the stomach showed marked fold thickening involving a greater portion of the proximal half of the stomach and particularly the greater curvature aspect. There was no discrete mass lesion and definite ulcers were identified. The distal half of the stomach showed normal fold pattern. Double contrast stomach of the duodenal bulb was unremarkable. There was redundancy noted in the second part of the duodenum. The remainder of the duodenal sweep was unremarkable, as was the visualized proximal small bowel. The impression was of marked gastric fold thickening as described above. Endoscopy was suggested, and differential diagnoses included neoplasm, gastritis, and Menetrier's Disease. In January 1999, the RO received outpatient treatment records from the West Los Angeles VAMC, from July 1996 to November 1998. The records show intermittent treatment for the appellant's psychiatric disorders, including depression. The records reflect that the appellant was hospitalized, from July to November 1996, after complaining of weight loss and depression. Upon admission, the appellant stated that he first suffered from depression in 1985 when he was "wrongfully" discharged from a job he had held for five years. The appellant indicated that at that time, he was hospitalized and diagnosed with paranoid schizophrenia. He reported that in 1989, his father died and his ex-wife moved out, and he again became depressed. According to the appellant, he was subsequently hospitalized after he attempted suicide with a shotgun under his chin. The appellant revealed that he had been taking medication for his symptoms. He also noted that he had a history of a duodenal ulcer in 1983. During the appellant's hospitalization, he was given medication and diet supplements to help him gain weight. Upon his discharge, he was diagnosed with the following: (Axis I) major depression, and (Axis III) duodenal ulcer disease. The West Los Angeles VAMC records also reflect that in November 1998, the appellant underwent an abdominal ultrasound. At that time, the impression was of a normal abdominal ultrasound. In September 1999, the appellant testified, via a video conference, before the undersigned Board member. At that time, he testified that during his service with the California National Guard, he developed an ulcer. (T.11,12). According to the appellant, he was hospitalized for nine days "while on active duty in heavy training" in a field hospital. (T.12). The appellant further maintained that his first psychiatric hospitalization occurred in 1985, while he was in the California National Guard. (T.3). The appellant indicated that during his hospitalization, he was diagnosed with schizophrenia. (T.4). He contended that his current psychiatric disorder was related to his service in the California National Guard. (T.4,5). II. Analysis As previously stated, in an August 1987 decision, the Board denied the appellant's claims for service connection for duodenal ulcer and service connection for migraine headaches. At that time, the Board stated that neither duodenal ulcer disease nor a chronic headache disorder (migraine headaches) was demonstrated during active duty, at separation, or for several years following the appellant's separation from active duty. Accordingly, the Board's August 1987 decision is final. 38 U.S.C.A. § 7103 (a) (West 1991). "If new and material evidence is presented or secured with respect to a claim which has been disallowed, the Board shall reopen the claim and review the former disposition of the claim." 38 U.S.C. § 5108 (1998). Except as provided by 38 U.S.C. § 5108, when a claim is disallowed by the Board, it may not thereafter be reopened and allowed, and no claim based on the same factual basis shall be considered. 38 U.S.C.§ 7104(b) (1998). When a claimant seeks to reopen a claim after an appellate decision and submits evidence in support of that claim, a determination must be made as to whether this evidence is new and material and, if it is, whether it provides a new factual basis for allowing the claim. 38 C.F.R. § 20.1105 (1998); see also 38 U.S.C. §§ 5108, 7104. Therefore, once a Board decision becomes final under section 7104(b), "the Board does not have the jurisdiction to consider [the previously adjudicated claim] unless new and material evidence is presented, and before the Board may reopen such claim, it must so find." Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996). "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 or redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a) (1998). With regard to petitions to reopen previously and finally disallowed claims, the Board must conduct a three-step analysis. Winters v. West, 12 Vet. App. 203 (1999) (explaining the holding in Elkins v. West, 12 Vet. App. 209 (1999)). First, the Board must determine whether the appellant has submitted new and material evidence under 38 C.F.R. § 3.156(a). If the Board determines that the submitted evidence is not new and material, then the claim cannot be reopened. Second, if new and material evidence has been presented, then immediately upon reopening the claim the Board must determine whether, based on all the evidence of record in support of the claim, presuming the credibility, see Robinette v. Brown, 8 Vet. App. 69, 75-76 (1995), the claim as reopened (and as distinguished from the original claim) is well grounded pursuant to 38 U.S.C.A. § 5107(a). Third, if the claim is well grounded, the Board may then proceed to evaluate the merits of the claim but only after ensuring that the VA's duty to assist under 38 U.S.C.A. § 5107(b) has been fulfilled. Winters and Elkins, both supra; see also Manio v. Derwinski, 1 Vet. App. 140, 145-46 (1991). Under the laws administered by the VA, service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty. 38 U.S.C.A. §§ 1110, 1131 (West 1991 & Supp. 1998); 38 C.F.R. § 3.303 (1998). Regulations also provide that 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). The Court has held that, in order for a claim to be service connected, there must be a current disability which is related to an injury or disease which was present during service. Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). In addition, service connection may be granted for disability resulting from disease or injury incurred in or aggravated while performing ACDUTRA or from an injury incurred or aggravated during INACDUTRA. 38 U.S.C.A. §§ 101(24), 1131, 1137, 5107 (West 1991); 38 C.F.R. § 3.303 (1999). An injury is not incurred "in the line of duty" if it was the result of the veteran's own willful misconduct or was a result of his or her abuse of alcohol. 38 C.F.R. § 3.1(m). Active military, naval, or air service includes any period of active duty for training (ACDUTRA) during which the individual concerned was disabled from a disease or injury incurred in the line of duty. 38 U.S.C.A. § 101(21) and (24); 38 C.F.R. § 3.6(a). ACDUTRA is, inter alia, full-time duty in the Armed Forces performed by Reserves for training purposes. 38 C.F.R. § 3.6(c)(1). To summarize, the appellant contends that during service, he was treated for a weak stomach and loss of appetite. The appellant states that following his separation from the military, he was diagnosed with an ulcer. It is the appellant's opinion that he was misdiagnosed during service, and that at the time of his treatment for a weak stomach, he actually had an ulcer. The appellant also maintains that during his service with the California National Guard, he was hospitalized for an ulcer. In addition, the appellant further contends that his first psychiatric hospitalization occurred while he was serving in the California National Guard. The appellant notes that prior to the hospitalization, he had lost his job. It is his opinion that he had lost his job because of his service in the California National Guard, and that because he lost his job, he developed feelings of stress. In this regard, lay statements are considered to be competent evidence when describing the features or symptoms of an injury or illness. Layno, 6 Vet. App. at 465; see also Falzone, 8 Vet. App. at 398, 405. However, when the determinative issues involves a question of medical causation, only individuals possessing specialized training and knowledge are competent to render an opinion. Espiritu, 2 Vet. App. at 492. The evidence does not show that the appellant possesses medical expertise, nor is it contended otherwise. Therefore, his opinion that his current gastrointestinal disorders, to include a duodenal ulcer, and his current psychiatric disabilities, to include depression and headaches, are related to his period of active duty service and to his service in the California National Guard, is not competent evidence. In regards to the evidence submitted in support of reopening the appellant's claims for service connection for a duodenal ulcer and service connection for an adjustment disorder, with depression and migraine headaches, the copy of the service medical record, dated in December 1970, is not "new" in that it was of record at the time of the Board's denial in August 1987. However, the remaining evidence submitted in support of reopening the appellant's claims, including outpatient treatment records from the Brentwood VAMC, from January 1986 to May 1988, private medical records from A.M., M.D., from July 1988 to June 1989, a Discharge Summary from the Brentwood VAMC, showing that the appellant was hospitalized from July to August 1989, a private medical statement from E.B., M.D., dated in April 1991, a statement from the appellant's former employer, the Boynton Brothers, dated in August 1985, copies of the appellant's California National Guard medical records, private medical records from the Kern County Clinic, from September 1985 to October 1991, a medical statement from Ms. K.S., M.S.W., of the VA Outpatient Clinic in Bakersfield, dated in October 1992, a VA Discharge Summary, showing that the appellant was hospitalized for one day in November 1992, photographs from the appellant's September 1993 endoscopy at the Bakersfield Memorial Hospital, private medical records from R.L.B., M.D., from February 1984 and from September 1993 to June 1994, a statement from Mr. N.D., director of the Mental Health Services at the Good Samaritan Hospital, dated in May 1995, outpatient treatment records from the Sepulveda VAMC, from July 1992 to May 1995, private medical records from the Poly East Clinic, from April 1991 to July 1996, outpatient treatment records from the West Los Angeles VAMC, from October 1994 to November 1998, and hearing testimony, is all "new" evidence in that it was not of record at the time of the RO's denial in August 1987. However, while the above evidence is "new," it is not so significant that it addresses the specific matter under consideration, which includes whether there is a nexus between the appellant's duodenal ulcer and his period of active service, whether there is a nexus between the appellant's duodenal ulcer and his period of service in the California National Guard, whether there is a nexus between the appellant's adjustment disorder, with depression and migraine headaches, and his period of active service, and whether there is a nexus between the appellant's adjustment disorder, with depression and migraine headaches, and his period of service in the California National Guard. See 38 C.F.R. § 3.156(a) (1999). As previously stated, "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 or redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a) (1999). Thus, upon a review of the "new" evidence, while the evidence shows treatment for gastrointestinal disorders, including a duodenal ulcer, and treatment for psychiatric disabilities, including an adjustment disorder and depression, the evidence does not show a nexus between any current gastrointestinal disorder or psychiatric disability and the appellant's period of active service. The evidence also does not show a nexus between any current gastrointestinal disorder or psychiatric disability and the appellant's service in the California National Guard. Specifically, the Board notes that upon a review of the appellant's California National Guard medical records, the records are negative for any complaints or findings of a psychiatric disability, to include an adjustment disorder with depression and migraine headaches. In addition, according to the records, in June 1984, the appellant was treated after complaining that he had developed stomach problems after eating some "beef in B-ration." He was diagnosed with a history of peptic ulcer disease, and the examining physician stated that the appellant's peptic ulcer disease was worsened by "mess hall food." Moreover, the Individual Sick Slips reflect that in June 1984, the appellant was diagnosed with a gastric ulcer and with peptic ulcer disease. However, the Board observes that the appellant's re-enlistment examination, dated in May 1985, shows that at that time, the appellant's abdomen and viscera, and gastrointestinal system were all clinically evaluated as normal. The Board further notes that in an August 1985 statement, the appellant's former employer indicated that the appellant was not terminated as a result of his re-enlistment in the National Reserves, and that there were numerous reasons for his termination, including tardiness and lack of interest in his job. In addition, in the appellant's June 1989 psychiatric evaluation, which was conducted by Dr. S.R., the appellant was diagnosed with the following: (Axis I) schizophrenia, chronic, undifferentiated, adjustment disorder with depressed mood, and (Axis III) history of gastric problems. At that time, Dr. R. stated that the appellant's depression appeared to be related to his current physical suffering. Moreover, a Discharge Summary from the Brentwood VAMC shows that during the appellant's hospitalization from July to August 1989, the examining physician noted that the appellant's peptic ulcer disease, along with alcoholism, psychiatric problems, and marijuana use, had all aggravated his stomach problems. The examiner further noted that the appellant's complaints of headaches and diarrhea were possibly related to the appellant's Giardia. Therefore, in light of the above, because the "new" evidence is not so significant that it addresses the specific matter under consideration, it is not material. Id. In light of the foregoing, the Board concludes that the appellant has not submitted new and material evidence to reopen his claims for service connection for a duodenal ulcer and service connection for an adjustment disorder, with depression and migraine headaches. Id. He has presented no new, significant evidence showing a nexus between any current duodenal ulcer or adjustment disorder, with depression and migraine headaches, and his period of active service. The appellant has also presented no new, significant evidence showing a nexus between any current duodenal ulcer or adjustment disorder, with depression and migraine headaches, and his period of service in the California National Guard. Therefore, because the additional evidence is not new and material, his claims must be denied. C. Entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for duodenal ulcer. A Discharge Summary from the Brentwood VAMC shows that the appellant was hospitalized from July to August 1989. The Summary reflects that upon admission, the appellant was tearful and feeling overwhelmed because of escalating conflicts with his wife. The appellant also gave a history of peptic ulcer disease. According to the Summary, during the appellant's hospitalization, he was given Haldol which was gradually increased to 30 milligrams a day. The Summary shows that Haldol Decanoate was added gradually which the appellant tolerated well. Upon his discharge, he was diagnosed with the following: (Axis I) (a) paranoid schizophrenia, chronic, with acute exacerbation, and (b) alcohol and marijuana dependence, (Axis III) (a) Giardiasis, and (b) peptic ulcer disease, and (Axis V) poor. The appellant's discharge medications included Haldol Decanoate and Haldol, which was to be tapered off gradually as an outpatient. In October 1991, a hearing was conducted at the RO. At that time, the appellant testified that when he was hospitalized in 1989 at the Brentwood VAMC, he was given the medication Haldol for treatment. (T.3). The appellant stated that as a result of his taking the Haldol, he developed a duodenal ulcer. (T.3,4). He further indicated that in 1989, he received VA treatment for Giardiasis. (T.5). The appellant noted that during his treatment for Giardiasis, he was told that he did not have any ulcers, but that in 1991, he was diagnosed with an ulcer by a private physician. (Id.). The appellant stated that he did not know the name of the physician who had diagnosed him. (T.5,6). In the appellant's September 1999 video conference hearing, the appellant testified that in 1985, he had received medical treatment at the Brentwood VAMC. (T.14). The appellant stated that at that time, he was informed that he did not have a duodenal ulcer. (Id.). He indicated that in 1994, he again received treatment at the Brentwood VAMC, and was once again told that he did not have a duodenal ulcer. (T.15). According to the appellant, he was later informed by a private physician that he did have an ulcer. (Id.). The appellant noted that he could not recall the name of the physician who had diagnosed his ulcer. (T.15,16). He reported that at present, he was receiving treatment at the Brentwood VAMC for his ulcer, and that his condition was "pretty much under control" with medication. (T.16,17). In the instant case, the appellant's claim for compensation benefits pursuant to 38 U.S.C. § 1151 was filed in October 1991, before the effective date of the amended section 1151 which reincorporates the fault requirement. 38 U.S.C. § 1151(a)(1) (1997); Pub. L. No. 104-21, Title IV, § 422(a), Sept. 26, 1996, 110 Stat. 2926. Congress specifically provided that the amendments to section 1151 would be applicable to all claims filed on or after October 1, 1997. Id. Therefore, the new statute is not applicable to the appellant's claim. VAOPGCPREC 40-97 (December 31, 1997). Accordingly, the Board will consider the appellant's claim without regard to fault of the VA. See Gardner v. Derwinski, 1 Vet. App. 584 (1991), aff'd sub nom Brown v. Gardner, 5 F.3d 1456 (Fed. Cir. 1993), aff'd , 513 U.S. 115 (1994). In pertinent part, 38 U.S.C.A. § 1151 provides that where any veteran shall have suffered an injury, or an aggravation of an injury, as the result of hospitalization, medical or surgical treatment, not the result of such veteran's own willful misconduct, and such injury or aggravation results in additional disability or in death, disability compensation shall be awarded in the same manner as if such disability, aggravation, or death were service-connected. In Brown v. Gardner, 115 S.Ct. 552 (1994), the United States Supreme Court held that VA's interpretation of 38 U.S.C. § 1151 as encompassing only additional disability resulting from VA negligence or from accidents during treatment was unduly narrow. The Supreme Court found that the statutory language of 38 U.S.C.A. § 1151 simply required a causal connection between VA hospitalization and additional disability, and that there need be no identification of "fault" on the part of VA. The Supreme Court further found that the then implementing regulation, 38 C.F.R. § 3.358(c)(3) (1991), was not consistent with the plain language of 38 U.S.C.A. § 1151 with respect to the regulation's inclusion of a fault or accident requirement. However, the Court further held that not every "additional disability" was compensable. The validity of the remainder of 38 C.F.R. § 3.358 was not questioned. See Gardner, 115 S.Ct. 552, 556 n.3 (1994): "We do not, of course, intend to cast any doubt on the regulations insofar as they exclude coverage for incidents of a disease's or injury's natural progression, occurring after the date of treatment. . . .VA's action is not the cause of the disability in those situations." In sum, the Supreme Court found that the statutory language of 38 U.S.C.A. § 1151 simply requires a causal connection between VA medical treatment and additional disability, but that not every additional disability is compensable. Thereafter, the Secretary of Veterans Affairs sought an opinion from the Attorney General of the United States as to the full extent to which § 1151 benefits were authorized under the Supreme Court's decision. The requested opinion was received from the Department of Justice's Office of Legal Counsel on January 20, 1995. In essence, the Department of Justice opined that "our conclusion is that the [Supreme] Court intended to recognize only a narrow exclusion [to the "no fault" rule], confined to injuries that are the necessary, or at most, close to certain results of medical treatment." On March 16, 1995, amended VA regulations were published to conform with the Supreme Court's decision. Section (c)(3) of 38 C.F.R. § 3.358 was amended to remove the "fault" requirement which was struck down by the Supreme Court. 38 C.F.R. § 3.358(c)(1) provides that "[i]t will be necessary to show that the additional disability is actually the result of such disease or injury or an aggravation of an existing disease or injury and not merely coincidental therewith." Further, 38 C.F.R. § 3.358(b)(2) provides that compensation will not be payable for the continuance or natural progress of disease or injuries. 38 C.F.R. § 3.358(c)(3) now provides that "[c]ompensation is not payable for the necessary consequences of medical or surgical treatment or examination properly administered with the express or implied consent of the veteran, or, in appropriate cases, the veteran's representative." "Necessary consequences" are those which are certain to result from, or were intended to result from, the examination or medical or surgical treatment administered." Under the amended 38 C.F.R. § 3.358, compensation is precluded where disability (1) is not causally related to VA hospitalization or medical or surgical treatment, or (2) is merely coincidental with the VA hospitalization or medical or surgical treatment, or (3) is the continuance or natural progress of diseases or injuries for which VA hospitalization or medical or surgical treatment was authorized, or (4) is the certain or near certain result of the VA hospitalization or medical or surgical treatment. Where a causal connection exists, there is no willful misconduct, and the additional disability does not fall into one of the above-listed exceptions, the additional disability will be compensated as if service connected. 38 C.F.R. § 3.358(b)-(c) (effective prior to Oct. 1, 1997). The Board notes that the threshold question to be answered is whether the appellant has presented evidence sufficient to justify a belief by a fair and impartial individual that his claim is well-grounded; that is, a claim which is plausible and capable of substantiation. See 38 U.S.C.A. § 5107(a); Chelte v. Brown, 10 Vet. App. 268, 270 (1997) (citing Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990)). If the claim is not well grounded, the appeal must fail and there is no further duty to assist in developing the facts pertinent to the claim. See Epps v. Gober, 126 F.3d 1464, 1469 (Fed.Cir. 1997). Generally, a well-grounded claim for service connection requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in- service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in- service disease or injury and the present disease or injury. Caluza v. Brown, 7 Vet. App. 489, 504, 506 (1995); see also Epps v. Gober, 126 F.3d at 1468 (expressly adopting definition of well-grounded claim set forth in Caluza, supra). For the purpose of determining whether a claim is well grounded, the credibility of the evidence in support of the claim must be presumed. Robinette v Brown, 8 Vet. App. 69, 75 (1995). Where the determinant issue involves a question of medical diagnosis or medical causation, competent medical evidence to the effect that the claim is plausible or possible is required to establish a well-grounded claim. Lay assertions of medical causation cannot constitute evidence to render a claim well grounded; if no cognizable evidence is submitted to support a claim, the claim cannot be well grounded. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Thus, in light of the above, two discrete types of evidence must be present in order for a veteran's claim for § 1151 benefits to be well grounded. First, there must be competent evidence of a current disability, usually shown by a medical diagnosis. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). Second, there must be competent evidence of a nexus between the medical treatment provided and the current disability. Such a nexus must be shown by medical evidence. See Lathan v. Brown, 7 Vet. App. 359, 365 (1995); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). To summarize, the appellant contends that he developed an ulcer as a result of taking the medication Haldol, which was provided by the VA. The appellant further maintains that the VA provided inadequate treatment because they failed to diagnose his ulcer correctly. In this regard, lay statements are considered to be competent evidence when describing the features or symptoms of an injury or illness. Layno, 6 Vet. App. at 465; see also Falzone, 8 Vet. App. at 398, 405. However, when the determinative issues involves a question of medical causation, only individuals possessing specialized training and knowledge are competent to render an opinion. Espiritu, 2 Vet. App. at 492. The evidence does not show that the appellant possesses medical expertise, nor is it contended otherwise. Therefore, his opinion that he developed a duodenal ulcer because he took the medication Haldol, and that the VA failed to diagnose his ulcer, is not competent evidence. As stated above, the evidence of record shows that the appellant was given Haldol during his hospitalization at the Brentwood VAMC, which was from July to August 1989. In addition, as previously discussed, the evidence of record also reflects that the appellant has a history of gastrointestinal problems, including duodenal ulcer and peptic ulcer disease. However, the Board observes that there is no competent medical evidence of record showing that the appellant's ulcers are the result of his taking the medication Haldol. Moreover, the Board further notes that there is also no competent medical evidence of record indicating that the VA provided inadequate treatment because they failed to diagnose his ulcer correctly. As previously stated, under 38 U.S.C.A. § 1151, where any veteran shall have suffered an injury or an aggravation of an injury, as the result of hospitalization, medical or surgical treatment, not the result of such veteran's own willful misconduct, and such injury or aggravation results in additional disability or in death, disability compensation shall be awarded in the same manner as if such disability, aggravation, or death were service-connected. In light of the above, the Board concludes that the evidence of record does not show any relationship between VA care, or lack thereof, and any current diagnosis of a duodenal ulcer. At best, the evidence of record shows intermittent treatment for the appellant's duodenal ulcer. However, the Board observes that the evidence of record does not indicate a nexus between the appellant's duodenal ulcer and his use of the medication Haldol. The Board further notes that the evidence of record does not include competent medical evidence showing that the VA provided inadequate treatment of the appellant's duodenal ulcer by not properly diagnosing his disability. Accordingly, in light of the above, the appellant's claim for compensation under the provisions of 38 U.S.C.A. § 1151 is denied. D. Entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for sexual dysfunction. In the instant case, the appellant contends that while he was receiving treatment at the VA, he was given the medication Haldol. The appellant states that he subsequently developed sexual problems. He maintains that his sexual problems are related to his Haldol use. As previously stated, a Discharge Summary from the Brentwood VAMC shows that the appellant was hospitalized from July to August 1989. According to the Summary, during the appellant's hospitalization, he was given Haldol which was gradually increased to 30 milligrams a day. The Summary shows that Haldol Decanoate was added gradually which the appellant tolerated well. Upon his discharge, he was diagnosed with the following: (Axis I) (a) paranoid schizophrenia, chronic, with acute exacerbation, and (b) alcohol and marijuana dependence, (Axis III) (a) Giardiasis, and (b) peptic ulcer disease, and (Axis V) poor. The appellant's discharge medications included Haldol Decanoate and Haldol, which was to be tapered off gradually as an outpatient. Private medical records from the Kern County Clinic, from September 1985 to October 1991, show that in August 1991, the appellant was diagnosed with the following: (Axis I) dysthymia, and (Axis III) ulcer, hernia, impotency, and giardiasis. In addition, outpatient treatment records from the West Los Angeles VAMC, from July 1996 to January 1991, show that in August 1996, the appellant was treated after complaining of erectile dysfunction for the past seven years. At that time, the appellant stated that he had weak erections. He noted that his sexual problems began when he started taking Haldol. According to the appellant, he continued to have sexual problems even after he stopped using Haldol. Following the physical examination, the appellant was diagnosed with erectile dysfunction, medication versus etiology, questionable. As previously stated, two discrete types of evidence must be present in order for a veteran's claim for § 1151 benefits to be well grounded. First, there must be competent evidence of a current disability, usually shown by a medical diagnosis. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). Second, there must be competent evidence of a nexus between the medical treatment provided and the current disability. Such a nexus must be shown by medical evidence. See Lathan v. Brown, 7 Vet. App. 359, 365 (1995); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). The Board observes that, in light of the above, the appellant has presented evidence of a current disability. A review of the record shows that the appellant has been diagnosed with impotence and erectile dysfunction. The Board further observes that the appellant has presented evidence of a medically based opinion suggesting a nexus between the appellant's use of the medication Haldol, which was provided by the VA, and his sexual dysfunction. Therefore, since there is evidence sufficient to lend plausible support to the claim, the Board is of the opinion that the appellant's claim of entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for sexual dysfunction is well-grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1999). Caluza, 7 Vet. App. at 498, 506. ORDER Entitlement to service connection for the residuals of a right wrist injury is denied. Entitlement to service connection for the residuals of a right hip injury is denied. New and material evidence having not been submitted, service connection for a duodenal ulcer is denied. New and material evidence having not been submitted, service connection for an adjustment disorder, with depression and migraine headaches, is denied. Entitlement to compensation benefits for duodenal ulcer pursuant to 38 U.S.C.A. § 1151 is denied. The claim of entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for sexual dysfunction is well- grounded. REMAND In regards to the appellant's claim for compensation under the provisions of 38 U.S.C.A. § 1151 for sexual dysfunction, as the appellant has submitted a well-grounded claim, the VA has a duty to assist him in developing the facts pertinent to his claim. 38 U.S.C.A. § 5107(a). A private medical record from J.J.M., M.D., dated in May 1991, shows that at that time, the appellant was treated after complaining of premature ejaculation for the past year. The appellant stated that he had been taking Haldol and that he was currently taking Tagamet and Mylanta. The assessment was of a probable psychogenic problem. In October 1991, a hearing was conducted at the RO. At that time, the appellant testified that when he was hospitalized in 1989 at the Brentwood VAMC, he was given the medication Haldol for treatment. (T.3). The appellant stated that as a result of his taking the Haldol, he developed sexual problems. In October 1991, the RO received private medical records from the Kern County Department of Mental Health Services, from September 1985 to October 1991. The records show that in September 1991, the appellant sought treatment after complaining of stress. At that time, he noted that from 1989 to 1990, he took Haldol which, in his opinion, caused him to develop sexual problems. According to the appellant, he stopped taking the medication. Outpatient treatment records from the Sepulveda VAMC, from July 1992 to May 1995, show that in September 1992, the appellant was treated after complaining of anxiety and anger. At that time, he stated that he had a history of a hernia and stomach ulcers, and he noted that he was unable to maintain an erection. The appellant indicated that in 1990, he was hospitalized at the Brentwood VAMC for psychiatric reasons. According to the appellant, at that time, he was given Haldol and he subsequently developed sexual problems. The appellant noted that he currently used Navane. He was diagnosed with schizophrenia, paranoid type, chronic. A Discharge Summary from the Brentwood VAMC shows that the appellant was hospitalized for one day in November 1992. The Summary reflects that upon his hospitalization, the appellant stated that he believed that his wife was trying to kill him. The examining physician indicated that the appellant had previously been treated at the Brentwood VAMC with Haldol and Proxlixin, with what was probably a good response. During the appellant's hospitalization, he was treated with Navane. Upon his discharge, he was diagnosed with schizophrenic disorder. In the appellant's September 1999 video conference hearing, the appellant testified that in 1989, while he was receiving treatment at the Brentwood VAMC for his schizophrenia, he was given the medication Haldol. (T.18). The appellant stated that the Haldol caused him to develop sexual problems. (T.17,18). The statutory duty to assist the appellant in the development of evidence pertinent to his claim includes a contemporaneous and thorough examination when appropriate. Littke v. Derwinski, 1 Vet. App. 90 (1990). Therefore, in light of the above, the Board is of the opinion that a VA examination, as specified in greater detail below, should be performed. In addition, the Board also notes that in a December 1998 decision letter, the RO denied the appellant's claim for additional compensation in light of receiving his VA benefit checks late. In December 1998, the appellant submitted VA Form 21-4138, Statement in Support of Claim. At that time, he stated that he disagreed with the Board's December 1998 decision denying his claim for additional compensation in light of receiving his VA benefit checks late, and he requested a Statement of the Case (SOC). In light of the above, it is the Board's determination that the RO should have construed the appellant's statement as a timely Notice of Disagreement (NOD) in regards to the issue of whether the appellant is entitled to additional compensation in light of receiving his VA benefit checks late. The Board notes that the above statement was filed within one year from the date of mailing of the December 1998 decision letter denying the appellant's claim for additional compensation, which thereby, would have triggered the RO's responsibility to furnish the appellant with an SOC. 38 U.S.C.A. § 7105(b)(1), (2) (West 1991 & Supp. 1999). See Tomlin v. Brown, 5 Vet. App. 355, 357 (1993). The RO failed to do so, creating a procedural defect which requires a remand of the above claim under 38 C.F.R. § 19.9 (1999). See Godfrey v. Brown, 7 Vet. App. 398, 408-410 (1995). Accordingly, this issue is remanded to the RO for the issuance of an SOC and such further development as may be necessary. The remanding of this issue must not be read as an acceptance of jurisdiction over the same by the Board. The Board may only exercise jurisdiction over an issue after an appellant has filed both a timely notice of disagreement to a rating decision denying the benefit sought, and a timely substantive appeal. 38 U.S.C.A. § 7105 (West 1991); Roy v. Brown, 5 Vet. App. 554 (1994). The RO should return this issue to the Board only if the appellant perfects his appeal in full accordance with the provisions of 38 U.S.C.A. § 7105. In view of the foregoing, the Board determines that further development is required before final action may be taken on the appellant's claims. Accordingly, these matters are REMANDED to the RO for the following actions: 1. The appellant should be issued an SOC on the issue of whether the appellant is entitled to additional compensation in light of receiving his VA benefit checks late. In addition, the appellant should be apprised of his right to submit a substantive appeal and to have his claim reviewed by the Board. 2. The RO should request that the appellant identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who have treated him since 1989 for any sexual dysfunction. With any necessary authorization from the appellant, the RO should attempt to obtain copies of pertinent treatment records identified by the appellant in response to this request, which have not been previously secured. 3. Thereafter, the RO should schedule the appellant for a comprehensive VA examination, by an appropriate specialist, to determine the nature, severity, and etiology of any diagnosed sexual dysfunction. All testing deemed necessary should be performed. The examiner is requested to review the claims folder prior to the examination for use in the study of the case. After reviewing the available medical records, it is requested that the examiner render an opinion as to whether the appellant currently has a sexual dysfunction. If he does, the examiner is requested to offer an opinion as to the etiology of the sexual dysfunction, to include any relationship between the appellant's sexual dysfunction and his use of the medication Haldol. If there is a relationship between the appellant's sexual dysfunction and his use of Haldol, the examiner is requested to provide an opinion as to whether the appellant's sexual dysfunction is a "necessary consequence" of the drug. "Necessary consequences" are those which are certain to result from, or were intended to result from, the examination or medical or surgical treatment administered. 38 C.F.R. § 3.358 (c) (1999). 4. Thereafter, the RO should readjudicate the issue of entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for sexual dysfunction. The case should then be reviewed by the RO. If the benefit sought is not granted, or if a Notice of Disagreement is received with respect to any other issue, the appellant and his representative should be furnished a Supplemental Statement of the Case (SSOC) and an opportunity to respond. The case should then be returned to the Board for further appellate consideration. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). 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 Appeals for Veterans Claims 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. 1999) (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. DEBORAH W. SINGLETON Member, Board of Veterans' Appeals