Citation Nr: 0006695 Decision Date: 03/13/00 Archive Date: 03/17/00 DOCKET NO. 93-12 111 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Juan, Puerto Rico THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder. 2. Entitlement to service connection for a chronic, acquired psychiatric disorder, claimed as secondary to service- connected atrophic left testicle. 3. Whether new and material evidence has been submitted to reopen a claim for service connection for epilepsy. 4. Whether new and material evidence has been submitted to reopen a claim for service connection for a chronic, acquired psychiatric disorder, other than post-traumatic stress disorder or a disorder claimed as secondary to service connected atrophic left testicle. 5. Entitlement to an increased (compensable) disability evaluation for an atrophic left testicle. WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD Martin F. Dunne, Counsel INTRODUCTION The veteran served on active duty in the Armed Forces from October 1951 to August 1953. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 1991 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. The veteran appealed. In February 1995, the Board remanded the case to the RO for further development. Following such development, the RO denied the claim and the case is again before the Board for appellate review. In August 1999, the veteran's representative, Vietnam Veterans of America, submitted a motion to the Board requesting removal as the veteran's representative, pursuant to 38 C.F.R. § 20.608(b)(2). The Board granted the motion in September 1999. By letter dated in November 1999, the Board notified the veteran of the revocation of the power of attorney in his appeal; he was offered an opportunity to appoint another representative; and was informed that his appeal would be deferred for 30 days to permit him to respond. If he did not respond, the letter further advised him that the Board would thereafter proceed with its review without representation. The veteran has not responded and the Board is proceeding in its appellate review. The Board notes that changes were made to the schedular criteria for evaluation of the genitourinary system as set forth in 38 C.F.R. § 4.115b, effective from February 17, 1994. Under the revised criteria, effective from September 8, 1994, Diagnostic Codes 7523 and 7524 explicitly provide review for entitlement to special monthly compensation under 38 C.F.R. § 3.350. That is a separate issue raised in the rating schedule that must be addressed by the RO; however, it was not in the veteran's case. Inasmuch as the RO has failed to address that issue, it is referred back to the RO for consideration. Furthermore, as a separate issue, it is not intertwined with the issue currently before the Board, namely, entitlement to a compensable evaluation for atrophy of the left testicle. FINDINGS OF FACT 1. All relevant evidence necessary for the equitable determination of the veteran's appeal has been obtained by the RO. 2. There is no competent medical evidence of a diagnosis of post-traumatic stress disorder (PTSD) for which service connection may be granted. 3. There is no competent medical evidence of a current chronic, acquired psychiatric disorder, claimed as secondary to service-connected atrophic left testicle. 4. In an October 1968 rating decision, the RO denied service connection for epilepsy and, although notified of the decision and advised of his appellate rights in a VA letter dated in November 1968, the veteran did not file an appeal. 5. Evidence associated with the file subsequent to the October 1968 rating decision, when considered alone or in conjunction with the evidence previously of record, does not establish that the veteran had epilepsy in service, that he has epilepsy which was manifest to a compensable degree within the one-year presumptive period following his separation from active service, that he currently has epilepsy, or otherwise establish any material fact that was not of record at the time of the October 1968 rating decision. 6. In a February 1987 rating decision, the RO denied service connection for a chronic, acquired psychiatric disorder and, although notified of that decision and advised of his appellate rights in a VA letter dated in February 1987, the veteran did not file an appeal. 7. Evidence associated with the file subsequent to the February 1987 rating decision, when considered alone or in conjunction with the evidence previously of record, does not establish that the veteran had a chronic acquired psychiatric disorder in service, that he has a psychosis which was manifest to a compensable degree within the one-year presumptive period following his separation from active service, that the veteran currently has a chronic, acquired psychiatric disorder, or otherwise establish any material fact that was not of record at the time of the February 1987 rating decision. 8. The medical evidence confirms atrophy of only the veteran's left testis. CONCLUSIONS OF LAW 1. The claim for service connection for PTSD is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The claim for service connection for a chronic, acquired psychiatric disorder, claimed as secondary to service- connected atrophic left testicle, is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. The RO's October 1968 denial of service connection for epilepsy is final. 38 U.S.C.A. §§ 5107, 7105 (West 1991); 38 C.F.R. §§ 3.104, 20.201, 20.202, 20.302, 20.1103 (1999). 4. New and material evidence to reopen a claim for service connection for epilepsy has not been presented. 38 U.S.C.A. §§ 5107, 5108 (West 1991); 38 C.F.R. § 3.156 (1999). 5. The RO's February 1987 rating decision denying service connection for a chronic, acquired psychiatric disorder is final. 38 U.S.C.A. §§ 5107, 7105 (West 1991); 38 C.F.R. §§ 3.104, 20.201, 20.202, 20.302, 20.1103 (1999). 6. New and material evidence to reopen a claim for service connection for a chronic, acquired psychiatric disorder, other than claimed PTSD or a psychiatric disorder claimed as secondary to service-connected atrophic left testicle, has not been presented. 38 U.S.C.A. §§ 5107, 5108 (West 1991); 38 C.F.R. § 3.156 (1999). 7. The criteria for a compensable disability evaluation for atrophic left testicle have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.1-4.7, 4.115b, Diagnostic Code 7523 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection To establish service connection for a claimed disability, the facts, as shown by the evidence, must demonstrate that a particular disease or injury resulting in current disability was incurred during active service or, of preexisting active service, was aggravated therein. See 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. When a disease is first diagnosed after service, service connection may nevertheless be established by evidence demonstrating that the disease was, in fact, incurred during the veteran's service, or by evidence that a presumption period applied. See 38 C.F.R. §§ 3.303, 3.307, 3.309; Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). In addition, service connection may by granted for a disability that is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310(a); see also Harder v. Brown, 5 Vet. App. 183, 187-89 (1993). That regulation has been interpreted to permit service connection for the degree of aggravation to a nonservice-connected disorder that is proximately due to or the result of a service-connected disorder. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). Under such circumstances, the veteran shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Id. The preliminary question to be answered, however, is whether the veteran has presented evidence of well-grounded claims for service connection. A well-grounded claim is not necessarily a claim that will ultimately be deemed allowable. It is a plausible claim, properly supported with evidence. See 38 U.S.C.A. § 5107(a); Epps v. Gober, 126 F.3d 1464 (1997); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). In the absence of evidence of a well-grounded claim, there is no duty to assist the veteran in developing the facts pertinent to the claim, and the claim must fail. See Slater v. Brown, 9 Vet. App. 240, 243 (1996); Gregory v. Brown, 8 Vet. App. 563, 568 (1996) (en banc); Grivois v. Brown, 6 Vet. App. 136, 140 (1994); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In order for a claim for service connection to be well- grounded, there must be competent evidence (lay or medical, as appropriate) of: (1) a current disability; (2) an in- service injury or disease; and (3) a nexus between the current disability and the in-service injury or disease. See Epps v. Gober, 126 F.3d 1464, 1468 (1997); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995). The nexus requirement may be satisfied by evidence that a chronic disease subject to presumptive service connection manifested itself to a compensable degree within the prescribed period. See Traut v. Brown, 6 Vet. App. 495, 497 (1994); Goodsell v. Brown, 5 Vet. App. 36, 43 (1993). Alternatively, a claim may be established as well grounded pursuant to the chronicity provision of 38 C.F.R. § 3.303(b). That provision is applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service, or during an applicable presumption period, and still has the condition. Such evidence must be medical unless it relates to a condition as to which, under he court's case law, lay observation is competent. If the chronicity provision is not applicable, a claim may still be well grounded or reopened on the basis of 38 C.F.R. § 3.303(b) if the condition is observed during service or any applicable presumption period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present condition to that symptomatology. See Savage v. Gober, 10 Vet. App. 488, 498 (1997). A. PTSD The Board notes that VA regulations pertaining to claims of service connection for PTSD were revised. Under the criteria in effect prior to March 7, 1997, the following regulations were in effect pertaining to PTSD. (f) Post-traumatic stress disorder. Service connection for post-traumatic stress disorder requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed inservice stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed inservice stressor. If the claimed stressor is related to combat, service department evidence that the veteran engaged in combat or that the veteran was awarded the Purple Heart, Combat Infantryman Badge, or similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor. Additionally, if the claimed stressor is related to the claimant having been a prisoner-of-war, prisoner-of-war experience which satisfies the requirements of § 3.1(y) of this part will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor. 38 C.F.R. § 3.304(f) (as in effect prior to March 7, 1997) In June 1999, revised regulations concerning post traumatic stress disorder were published in the Federal Register which reflected the decision in Cohen v. Brown, 10 Vet. App. 128 (1997). The regulations were made effective from the date of the Cohen decision. The proposed regulations provide as follows: (f) Post-traumatic stress disorder. Service connection for post-traumatic stress disorder requires medical evidence diagnosing the condition in accordance with Sec. 4.124(a) of this chapter; a link, established by medical evidence, between current symptoms and an in- service stressor; and credible supporting evidence that the claimed in-service stressor occurred. If the evidence establishes the veteran engaged in combat with the enemy and the claimed stressor is related to this combat, in the absence of clear and convincing evidence to the contrary, and provided that the clamed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. If the evidence establishes that the veteran was a prisoner-of-war under the provisions of Sec. 3.1(y) of this part and the claimed stressor is related to that prisoner-of-war experience, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f) (as in effect from March 7, 1997) As the new regulations merely codified an existing Court decision which the RO was bound by, there is no need to Remand this case to the RO for consideration of the revised regulations. The evidence necessary to establish the occurrence of a recognizable stressor during service to support a diagnosis of PTSD will vary depending upon whether the veteran engaged in "combat with the enemy." If VA determines the veteran engaged in combat with the enemy, and one or more of his claimed stressors is combat-related, then his lay testimony or statement is accepted as conclusive evidence of the stressor's occurrence, and no further development or corroborative evidence is required - provided that such testimony is found to be "satisfactory," i.e., credible, and "consistent with the circumstances, conditions, or hardships of service." See 38 U.S.C.A. § 1154(b); 38 C.F.R. 3.304(f); Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). If, however, VA determines either that the veteran did not engage in combat with the enemy, or that he did engage in combat but that the alleged stressor is not combat-related, then his lay testimony, in and of itself, is not sufficient to establish the occurrence of the alleged stressor. Instead, the record must contain service records that corroborate his testimony or statements. See Zarycki, 6 Vet. App. at 98. A determination of combat status is to be made on the basis of the evidence of record, and that status may be determined through the receipt of certain recognized military citations, service department records, or other supportive evidence. However, mere presence in a combat zone, or the reporting of indirect experiences of an individual while there, are not sufficient to show that the veteran engaged in combat with the enemy. See Collette v. Brown, 82 F.3d 389, 392 (Fed. Cir. 1996); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). In the veteran's case, he served in Korea during the Korean Conflict and his awards and decorations include the Korean Service Medal with two Bronze Stars, and the Combat Infantryman's Badge. The veteran maintains that the stressors of combat, include witnessing his fellow soldiers being wounded and killed, have caused his PTSD. During his personal hearing, he stated that he remembered seeing a fellow soldier, named Perez who was from the veteran's hometown, blown up. The veteran also related that he was a member of a company consisting of 102 personnel, of which 92 ended up either wounded or killed. Since his stressors are related to combat and since he is the recipient of the Combat Infantryman's Badge, which is a combat-related award, the Board finds that the evidence establishes the occurrence of the claimed stressors. Nonetheless, the grant of service connection for PTSD also requires a medical diagnosis of PTSD supported by recognizable stressors. Unfortunately, there is no diagnosis of PTSD in the veteran's case. The veteran's records consist of numerous VA examination and medical treatment reports for various periods from 1954 to 1998. In August 1954, he underwent VA psychiatric examination and was diagnosed as having anxiety reaction. In November 1986, he again underwent VA psychiatric examination and was diagnosed as having generalized chronic, mild anxiety. The veteran's VA outpatient treatment report for October 1990 notes that he had never undergone treatment for a psychiatric disorder. During his personal hearing in October 1991, he testified that he has been nervous ever since his separation from service. He related that he dealt with his condition on his own. He claimed that he used to smoke, then he stopped smoking. He used to drink, then he stopped drinking. He then began looking for home remedies, such as drinking orange teas. He stopped drinking coffee and other things that would aggravate his condition. In 1994, the veteran underwent medical evaluations for the Commonwealth of Puerto Rico State Insurance Fund. In April 1994, the State Insurance Fund psychiatric evaluation of the veteran found no psychiatric disorder. The report of the veteran's October 1994 VA psychiatric examination notes a diagnosis of mild dysthymia. Pursuant to the Board's February 1995 remand, the veteran underwent VA psychiatric examination in November 1996, specifically to determine whether he has PTSD, or any other psychiatric disorder, and a board of three VA psychiatrists evaluated him in January 1997. On review of the veteran's records, the examiners noted that the veteran had not had any hospitalization for a psychiatric disorder or any psychiatric prescriptions. On examination, no psychiatric disorder was found. The board of psychiatrists unanimously found that the veteran does not suffer from PTSD. Under the circumstances, there is no competent medical evidence, nor has the veteran submitted such competent medical evidence, establishing that he has, or ever has had, PTSD. Thus, the veteran has not met the first criterion of establishing a well-grounded service connection claim, namely, a current medical diagnosis of PTSD based on combat stressors. In the absence of competent medical evidence of the currently claimed PTSD (and a nexus between that claimed disability and specifically claimed combat stressors), there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). While the veteran asserts that he has PTSD based on combat stressors, as a lay person without medical training, he is not competent to offer an opinion on medical matters, such as the diagnosis of a disability and an opinion as to the relationship between that disability and service. See Jones v. Derwinski, 7 Vet. App. 134, 137 (1994); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). A claim must be supported by evidence and sound medical principles, not just assertions. See Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). B. Psychiatric Disorder, Secondary to Service-connected Atrophic Left Testicle The veteran is contending that he has a psychiatric disorder, claimed as secondary to his service-connected atrophic left testicle, i.e., that his claimed psychiatric disorder is proximately due to or the result of the service-connected disability. In the veteran's case, there is no competent medical evidence establishing that the veteran has, or ever has had, a chronic acquired psychiatric disability that is etiologically related to his atrophic left testicle, either on the basis of causation or aggravation. The veteran's service medical records are devoid of any reference to an acquired psychiatric disorder. Post-service, he underwent psychiatric evaluation in August 1954, as part of an over-all VA examination for trauma to the left testicle and complaints of dizzy spells. During the examination, the prevailing mood was one of depression. He complained of dizzy spells, followed by short-lasting periods of unconsciousness. The veteran was also concerned about his capacity to impregnate women. He stated that he had an injury on the left testicle and, since then, felt that he could not have children. He further stated that he had recently given up his girl friend thinking that he would not be able to have children. At the time of the examination, he stated that he felt listless and completely disinterested in what was going on around him. He was living with his family and stated that his former girl friend still came around but, although he talked to her, he had discontinued an intimate friendship with her. The veteran felt that there had been no change in his condition because no treatment had been given. The diagnoses were anxiety reaction, chronic, and atrophy of the left testicle. The veteran's medical records, both VA and private, for various periods of time between 1954 and November 1986 do not reflect any psychiatric disorder etiologically related to the atrophy of his left testicle. The report of his November 1986 VA psychiatric examination diagnosed generalized anxiety disorder, chronic, mild under Axis I and listed left testicle atrophy under Axis III (general medical conditions). His VA outpatient treatment records for late 1989 to the end of December 1990 shown that he was seen for complaints of dizziness, but these records do not reflect any complaints pertaining to a psychiatric condition. During the veteran's personal hearing in October 1991, he attributed his claimed psychiatric disorder to stressors he experienced while on active duty in Korea. His VA outpatient treatment records for January 1993 to September 1994 do not reflect any treatment pertaining to his left testicle atrophy or for a psychiatric condition. As noted earlier in this decision, the veteran's April 1994 Commonwealth of Puerto Rico State Insurance Fund examination found no psychiatric disorder. The report of the veteran's October 1994 VA psychiatric examination reflects the diagnosis of mild dysthymia. A board of three VA psychiatrists evaluated him in January 1997. On review of the veteran's records, the examiners noted that the veteran had not had any hospitalization for a psychiatric disorder or any psychiatric prescriptions. On examination, no psychiatric disorder was found. No where in the record is there competent medical evidence of an etiological relationship between the veteran's claimed psychiatric disorder and his service-connected atrophic left testicle, and the veteran has presented none. More significantly, there is no competent medical evidence that the veteran currently even has a chronic, acquired psychiatric disorder. Hence, he has failed to meet the first criterion of establishing a well-grounded claim for service connection, namely, competent medical evidence of a current disability. Obviously, without a current disability, no psychiatric disorder is present either on the basis of causation or aggravation. In the absence of a psychiatric disorder, there can be no valid claim. See Brammer, 3 Vet. App. at 225; Rabideau, 2 Vet. App. at 144. Although the veteran claims he has a psychiatric disorder, secondary to his service-connected atrophic left testicle, the only support for his contentions is his own unverified statements. Because he is a person without medical training, he is not competent to establish the presence of medical disability and his statements as to medical causation are entitled to no probative weight. See Jones, 7 Vet. App. at 137; Espiritu, 2 Vet. App. at 494-95. A claim must be supported by evidence and sound medical principles, not just assertions. See Tirpak, 2 Vet. App. at 611. C. Conclusion The Board must conclude that the veteran has not submitted evidence sufficient to justify a belief by a fair and impartial individual that his claim for service connection for PTSD or for a chronic, acquired psychiatric disorder, other than PTSD, on the basis of either causation or aggravation due to his service-connected left testicle atrophy, is well grounded. As the duty to assist has not been triggered by evidence of a well-grounded claim, there is no duty to assist the veteran in developing the record to support his either of those claims for service connection. See Epps, 126 F.3d at 1468. Besides, in the absence of a diagnosis of a current, chronic psychiatric disability, including PTSD, further development would serve no useful purpose. Furthermore, the Board is aware of no circumstances that would put the VA on notice that any additional relevant evidence may exist which could be obtained that, if true, would well-ground the veteran's service connection claims on those issues. See McKnight v. Gober, 131 F.3d 1483, 1485 (Fed. Cir. 1997). Although the RO did not specifically deny the claims as not well grounded, "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). Moreover, as the veteran has been advised of the elements necessary to submit well-grounded claims for service connection for the claimed conditions, and the reasons why his current claims are inadequate, the duty to inform has been met. See 38 U.S.C.A. § 5103(a) (West 1991); Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995). II. New and Material Evidence to Reopen Claims If new and material evidence is presented or secured with respect to a claim that previously has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. See 38 U.S.C.A. § 5108; Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). As defined by regulation, new and material evidence means evidence not previously submitted to agency decision makers, which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with the evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. See 38 C.F.R. § 3.156(a); Cox v. Brown, 5 Vet. App. 95, 98 (1993). In addition, for the purpose of determining whether a case should be reopened, the credibility of the evidence added to the record is to be presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). There is no requirement, however, that in order to reopen a claim, that the new evidence, when viewed in the context of all the evidence, both new and old, creates a reasonable possibility that the outcome of the case on the merits would be changed. See Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998) (expressly rejecting the standard for determining whether new and material evidence had been submitting sufficient to reopen a claim set forth in Colvin v. Derwinski, 1 Vet. App. 171 (1991)). The provisions of 38 U.S.C.A. § 5108 require a review of all evidence submitted by a claimant since the previously disallowed claim in order to determine whether a claim must be reopened and re-adjudicated on the merits. See Evans v. Brown, 9 Vet. App. 273, 282-83 (1993). If the Board's decision is favorable to the veteran, his claim must be reopened and decided on the merits. See Glynn v. Brown, 6 Vet. App. 523, 528-29. (1994). A. Epilepsy In October 1968, the RO denied service connection for epilepsy. In reaching this determination, the RO had reviewed the veteran's service medical records, the results of his August 1954 VA examination, his August 1954 application for VA hospital treatment, and his VA hospitalization summary for August 5, 1968 to August 30, 1968. The veteran's service medical records are devoid of any complaints of dizziness or symptomatology associated with a seizure disorder. There is no indication of any head injury while he was in service. His August 1954 VA neurological examination found no objective evidence of neurological disorder. The veteran's August 1954 application for VA hospitalization notes negative physical findings and diagnoses which included seizures of unknown cause, based on the veteran's complaints of occasional seizures with losses of consciousness. In August 1968, he was hospitalized in a VA facility following a fall in which he sustained trauma to the right side of his skull, followed by a period of unconsciousness. X-rays taken of the skull revealed negative results. No history of dizziness or symptomatology associated with a neurologic disorder is noted in the hospital summary. His discharge diagnoses included brain concussion. The RO denied service connection for epilepsy in October 1968. In explaining its decision, the RO found that there were no complaints, symptomatology, treatment, or injury associated with or findings of a neurological disorder in service, nor were there medical findings of a neurological disorder within the one-year presumptive period following his separation from service. The veteran was notified of the RO's October 1968 decision; however, he did not submit a Notice of Disagreement. As such, the October 1968 rating decision became final based on the evidence then of record. See 38 U.S.C.A. § 7105; 38 C.F.R. §§ 3.104(a), 20.302. In December 1990, the RO received the veteran's current application to reopen his claim for service connection for epilepsy. Although the RO's October 1968 determination is final, if new and material evidence is presented or secured with respect to a claim that has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. See 38 U.S.C.A. § 5108; Manio, 1 Vet. App. at 145. Inasmuch as the RO's October 1968 rating decision is the last final decision of record on this issue, the evidence that has been associated with the file since then is the evidence that must be considered in connection with the new and material evidence inquiry. See Evans, 9 Vet. App. at 282-83. The evidence associated with the claims file since the RO's October 1968 final determination denying service connection for epilepsy consists of the veteran's private and VA medical records, including VA examination reports, for various periods from 1968 to 1998, and his testimony presented at his personal hearing in October 1991. The report of the veteran's January 1986 VA examination notes that there were unremarkable neurological findings. His VA medical records for February 1986 to April 1986 pertain to cardiac consultation. Those records do not contain any reference to neurological problems. In November 1986, he underwent psychiatric evaluation, during which he gave a history of past episodes of dizzy spells, of falling, and loss of consciousness; however, the examiner noted that the veteran had never been diagnosed as having a convulsive disorder. The veteran's VA outpatient treatment records for October 1989 to December 1990 show that he was seen for various complaints, including chest pains and hearing loss. In October 1990 he was complaining of headaches and gave a history of "epilepsy," and in December 1990, the diagnosis was rule out epilepsy. During the veteran's personal hearing held at the RO in October 1991, he related that he started having dizzy spell in service and that the symptoms continued after his release from service. He maintained that soon after his entrance onto active duty he developed an infection, went on sick call, was treated, but thereafter he began experiencing dizzy spells, which have since continued. In 1968, he maintained that he had the most serious seizure whereby he fell, struck his head, and sustained a concussion. The veteran's VA outpatient treatment records for January 1993 to April 1994 show that he was seen in January 1993 for complaints of constant headaches, which the examiner found to be consistent with tension headaches. The results of a February 1993 CT scan were normal. The balance of those records pertains to complaints other than neurologic, although he was given medication for headaches. From April 1994 to September 1994, his medical records from the Commonwealth of Puerto Rico State Insurance Fund reflect primarily psychiatric evaluation. These reports note a history of sinusitis, epilepsy, arthritis, and nephrolithiasis. The report of the veteran's December 1996 VA epilepsy and narcolepsy examination notes that he had not been taking anti-epileptic drugs since 1993 and that, since then, he has not had major seizure episodes or losses of consciousness, although he related that still experiences episodes of dizziness around once a month, during which he sits down until they subside. On neurological examination, no aphasia, apraxia or agnosia was found. There was no cranial nerve impairment. He had a normal gait. There was no focal motor deficit. The diagnosis was seizure disorder, by history. The examiner noted that, based on the evidence, she was unable to offer an opinion as to the onset of the veteran's neurologic condition and /or seizure disorder. Pursuant to the Board's February 1995 remand, the RO requested VA medical records reflective of the veteran's alleged treatment in 1953 and 1954. In response to the request, VA medical center personnel noted that the records for that period of time were not available. Applying the relevant law and regulations to the facts of this case, the Board notes that the medical evidence that has been associated with the claims file since the RO's October 1968 decision is new, in the sense that it was not previously considered. While it shows that the veteran was treated for complaints of headaches and dizzy spells, and contain notations of a history of epilepsy, this evidence is not material because it does not contain competent medical evidence that the veteran has, or ever has had, epilepsy. As for the veteran's testimony, it is basically a reiteration of his written contentions that were considered by the RO in reaching its October 1968 decision. Furthermore, the veteran's statements, in and of themselves, do not constitute new and material evidence for purposes of reopening the claim. While the veteran may well believe that he has epilepsy, as a lay person without medical training or expertise, he is not competent to render a probative opinion of the central issue in the case, i.e., whether he currently has the claimed disability, namely, epilepsy. See Jones, 7 Vet. App. at 137; Espiritu, 2 Vet. App. at 294-95. Moreover, where, such as here, medical evidence is needed to establish service connection, the veteran's statements, without more, even if they were considered as new, cannot serve as a predicate to reopen a previously disallowed claim. See Moray v. Brown, 5 Vet. App. 211, 214 (1993). Since the evidence submitted subsequent to the RO's final determination in October 1968 is not material, in that it is not probative of the question of whether the veteran has a current epileptic disability (and a nexus between the claimed disability and service), that evidence provides no basis for reopening the claim. The RO's October 1968 decision denying the veteran entitlement to service connection for epilepsy remains final. B. Psychiatric Disorder (other than PTSD or secondary to atrophic left testicle) In February 1987, the RO denied service connection for a chronic, acquired psychiatric disorder. In rendering its decision, the RO reviewed the veteran's service medical records and his post-service private and VA medical records from 1954 through late 1986. The veteran's service medical records contain no indications of any complaints or symptomatology associated with any acquired psychiatric disorder. The report of his August 1953 separation examination shows that he was psychiatrically normal and the report does not contain any complaints or history of psychiatric problems. His post-service VA examination report of August 1954 notes that his prevailing mood was one of depression and that he was concerned about dizzy spells and the results of an injury to his left testicle. On examination, the diagnosis was chronic anxiety reaction. In August 1968, he was hospitalized after falling and hitting his head. The diagnoses included brain concussion. The report of his VA psychiatric examination in November 1986 notes that he had never asked for psychiatric treatment nor had he been evaluated for a psychiatric disorder. The diagnosis was generalized anxiety disorder, chronic, mild. In its February 1987 decision, the RO found that a chronic, acquired psychiatric disorder had not been incurred in or aggravated by active service and that a psychosis was not show within the one-year presumptive period following the veteran's separation from service. The veteran was notified of that decision, along with his appellate rights, in February 1987. He did not file an appeal. In December 1990, the RO received the veteran's application to reopen his claim for service connection for a psychiatric disorder. Although the RO's February 1987 decision is final, as noted earlier in this decision, if new and material evidence is presented or secured with respect to a claim that has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. See 38 U.S.C.A. § 5108; Manio, 1 Vet. App. at 145. The evidence associated with the veteran's claims file since the RO's February 1987 final determination consists of his VA medical records from 1989 to 1998, including reports of various medical evaluations, and his testimony presented at a personal hearing in October 1991. The VA medical report of October 1990 notes that he had never received treatment for a psychiatric disorder. During his October 1991 hearing, he contended that he has PTSD as a result of his Korean combat experiences. The veteran's VA outpatient treatment records for January 1993 to April 1994 do not reflect any treatment for a psychiatric disorder. In October 1994, the veteran underwent VA psychiatric evaluation, which diagnosed mild dysthymia. The April 1994 psychiatric evaluation, performed by the Commonwealth of Puerto Rico State Insurance Fund, found no psychiatric disorder. The VA psychiatric examination of November 1996 found no psychiatric disorder and a board of three VA psychiatrists, after examination and review of the veteran's records, opined in January 1997 that they unanimously found the veteran was not suffering from PTSD, nor from any psychiatric condition secondary to his service-connected atrophic left testicle. In view of the foregoing, the Board must conclude that none of the evidence received since the RO's February 1987 final determination denying service connection for a psychiatric disorder, when viewed either alone or in light of the evidence previously of record, tends to indicate that a chronic, acquired psychiatric disorder was incurred in or aggravated by active duty, or that a psychosis was manifest within the one-year presumptive period following the veteran's separation from active duty service. In making this determination, the Board notes that the evidence submitted in support of reopening the veteran's claim is new, in that the medical evidence has not been seen before. However, the evidence does not contain competent medial evidence of a current, chronic, acquired psychiatric disorder. Without competent medical evidence of the existence of a current, chronic, acquired psychiatric disorder, obviously there can be no nexus between the claimed psychiatric disorder and the veteran's service. The veteran's testimony presented at his personal hearing is essentially a reiteration of his previously considered written contentions. Although he believes that he currently has a psychiatric disorder that is related to service, he as not presented such evidence, and his statements alone are not sufficient to service as a predicate to reopen a previously disallowed claim. See Moray, 5 Vet. App. at 214. As a lay person, he is not competent to render a probative opinion on a medical matter, such as a diagnosis or etiology thereof. See Jones, 7 Vet. App. at 137; Espiritu, 2 Vet. App. at 294- 95. The new evidence is not probative in that it does not contain medical opinion that the veteran currently has a chronic, acquired psychiatric disorder. Under the circumstances, the none of the evidence is new and material for purpose of reopening the claim of service connection for a psychiatric disorder (other than PTSD or secondary to service-connected atrophic left testicle), and the RO's February 1987 decision remains final. C. Conclusion The Board is aware of no circumstances in the matter of attempting to reopen the veteran's claim of service connection for either epilepsy or for a chronic, acquired psychiatric disorder (other than PTSD or secondary to a service-connected disorder) that would put the VA on notice of the existence of any additional relevant evidence that, if obtained, would provide a basis to reopen either claim. See McKnight, 131 F.3d at 1485; Robinette, 8 Vet. App. at 77-78. Additionally, the Board finds that the duty to inform the veteran of the evidence necessary to complete his application to reopen his claim for service connection for either disorder has been met. Id; 38 U.S.C.A. § 5103 (West 1991); Graves v. Brown, 8 Vet. App. 522, 524 (1996). This is particularly true in light of the fact that the RO informed the veteran of the legal requirement of submitting new and material evidence in its September 1998 Supplemental Statement of the Case. See Robinette, 8 Vet. App. at 77-78. Furthermore, as veteran has not fulfilled his threshold burden of submitting new and material evidence to reopen his finally disallowed claims, the benefit-of-the-doubt doctrine is not applicable. See Annoni v. Brown, 5 Vet. App. 463, 467 (1993). As a final note, the Board points out that, in the July 1998 Supplemental Statement of the Case, in addition to considering whether the veteran had submitted evidence that was new, and relevant and probative, the RO also referred to the third criterion that in order to reopen a claim, the new evidence, when viewed in the context of all the evidence, both new and old, must create a reasonable possibility of a change in outcome of the case on the merits. See Evans, 9 Vet. App. at 283, citing Colvin. As earlier noted in this decision, the United States Court of Appeals for the Federal Circuit held in Hodge that there was no such legal requirement. See Elkins v. West, 12 Vet. App. 209 (1999) (en banc). That notwithstanding, the Board finds that the RO's actions are not prejudicial to the veteran since, for the reasons noted above (i.e., that no new and probative evidence has been submitted), the outcome of the case is the same whether the claim is considered under either the appropriate two- or formerly utilized three-prong tests for reopening claims. Thus, to remand this case to the RO for consideration of the correct legal standard for reopening claims would be pointless and, in light of the above discussion, would not result in a determination favorable to him. See VAOGCPREC 16-92 (O.G.C. Prec. 16-92), 57 Fed. Reg. 49747 (1992). III. Increased Rating The veteran's service medical records show that, in May 1952, he fell injuring his left scrotum. He went to sick call complaining of markedly swollen, tender and warm epididymis. The diagnosis was left epididymitis. His separation physical examination report notes atrophy of the left testicle, secondary to trauma. The RO granted service connection for atrophy of the left testicle, effective from the first day following the veteran's separation from active service, and assigned the disability a noncompensable evaluation, which has since been in effect. In December 1990, the VA received the veteran's application for a compensable evaluation for his left testicle, on the basis of pain. The veteran's VA outpatient treatment records for October 1989 to December 1990 do not reflect any complaints or treatment pertaining to his service-connected atrophic left testicle. During his personal hearing in October 1991, the veteran's testimony pertained to his service connection claims for psychiatric conditions and epilepsy, with no testimony presented pertaining to his increased rating claim for his atrophic left testicle. His VA outpatient treatment records for January 1993 to April 1994 show treatment for complaints of sexual dysfunction. The veteran's April 1994 Commonwealth of Puerto Rico State Insurance Fund medical records contain no findings or indicate any complaints pertaining to the veteran's atrophic left testicle. The report of the veteran's October 1994 VA examination note the presence of his atrophic left testicle, but no findings pertaining to the disability. The report of his December 1996 VA genitourinary examination notes he related no difficulty with urinating or urgency. On examination, left testicular atrophy was noted. An addendum to the veteran's December 1996 neurologic examination, dated in March 1998, contains no reference to his atrophic left testicle. As a preliminary matter, the Board finds that the veteran's claim for an increased disability evaluation for his service- connected left testicle atrophy is well grounded within the meaning of 38 U.S.C.A. § 5107(a). A mere allegation that a service-connected disability is more severe than reflected in the current evaluation is sufficient to establish a well- grounded claim for an increased rating. See Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). The Board is satisfied that all relevant facts have been properly developed, including actions requested in the Board's February 1995 remand, and that no further assistance to the veteran is required in order to comply with the duty to assist on this issue. Id. The VA utilizes a rating schedule as a guide in the evaluation of disabilities resulting from all types of diseases and injuries encountered as a result of or incident to military service. The disability evaluations are determined by comparing a veteran's present symptomatology with criteria set forth in the VA's Schedule for Rating Disabilities. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1, Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. It is thus essential, both in the examination and in the evaluation of disability, that each disability be reviewed in relation to its history. See 38 C.F.R. § 4.41. However, the current level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Board notes that, effective from February 17, 1994, the rating criteria for evaluating genitourinary disorders under 38 C.F.R. § 4.115b were revised; however, in this veteran's case, the revisions affecting testes were not affected in that there were no changes in the substantive content of the rating criteria under either Diagnostic Code 7523 or 7524. Hence, neither the former nor the revised version of the criteria is "more favorable" to the veteran as to the issue of an increased rating. Accordingly, the Board finds that the veteran will not be prejudiced if the Board considers his claim based on the new criteria for evaluating and analyzing his left testicle atrophy. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993); Karnas v. Derwinski, 1 Vet. App. 308, 312-13 (1991). Further, as noted in earlier in this decision, under the revised criteria for genitourinary conditions, effective from September 8, 1994, Diagnostic Codes 7523 and 7524 explicitly provide for review for entitlement to special monthly compensation under 38 C.F.R. § 3.350. Nevertheless, since that is a separate issue, which is not intertwined with the issue at hand of an increased rating, it has been referred to the RO for appropriate action. The veteran's service-connected left testicle atrophy is evaluated pursuant to 38 C.F.R. § 4.115b, Diagnostic Code 7524 for removal of a testis. The Board notes that the assignment of a particular diagnostic code is completely dependent on the facts of a particular case. See Butts v. Brown, 5 Vet. App. 532, 538 (1993). In the veteran's case, he has an atrophied left testicle, without surgical excision. As such, his left testicle disability is more appropriately evaluated under Diagnostic Code 7523 for complete atrophy of the testis. Under Diagnostic Code 7523, complete atrophy of one testicle warrants a noncompensable evaluation. For a 20 percent evaluation, there must be complete atrophy of both testes. In the veteran's case, he is service connected for only one atrophied testicle. There is no indication in any of his records that his other testis is abnormal. Under the circumstances, a noncompensable evaluation for left testicle atrophy is appropriate, in the absence of medical evidence of, and entitlement to service connection for, complete atrophy of both testes. Also, a compensable evaluation is not warranted under any other potentially applicable diagnostic code. Even if his disability were considered under Diagnostic Code 7524, for a compensable evaluation he would have to have had one testis removed as the result of a service-incurred injury or disease, with the absence or nonfunctioning of the other testis unrelated to service. As for the veteran's complaint of pain on urination, which only was made at the time he filed his application for an increase in disability evaluation in 1990, the Board notes that his medical records, including VA examination reports from the late 1980's to present do not reflect any notation of left testicle pain, let alone treatment for complaints thereof. On recent VA examination, he related that he had no difficulty with pain on urinating or with urgency. Hence, the Board finds that the currently assigned noncompensable evaluation for the veteran's left testicle atrophy fully comports with the applicable schedular criteria. However, in the absence of medical evidence establishing more significant loss, there is no basis for more that the currently assigned evaluation. The above discussion is based on application of pertinent provisions of the VA's Schedule for Rating Disabilities. Additionally, the Board notes that there is no indication that the schedular criteria are inadequate to evaluate the veteran's service-connected disability. The evidence does not show, nor has the veteran contended, that his service- connected atrophic left testicle has caused marked interference with employment (i.e., beyond that contemplated in the assigned evaluation), or that his service-connected atrophic left testicle has necessitated frequent periods of hospitalization, or that the disability otherwise has rendered impracticable the application of the regular schedular standards. In the absence of evidence of such factors, the Board is not required to remand this mater to the RO for the procedural actions outlined in 38 C.F.R. § 3.321(b)(1). See Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). ORDER Service connection for post-traumatic stress disorder is denied. Service connection for a chronic, acquired, psychiatric disorder, claimed as secondary to service-connected atrophic left testicle, is denied. In the absence of new and material evidence, the petition to reopen a claim for service connection for epilepsy is denied. In the absence of new and material evidence, the petition to reopen a claim for service connection for a chronic, acquired, psychiatric disorder, other than post-traumatic stress disorder or a disorder claimed as secondary to service connected atrophic left testicle, is denied. A compensable disability evaluation for an atrophic left testicle is denied. N.R. ROBIN Member, Board of Veterans' Appeals