Citation Nr: 0002089 Decision Date: 01/27/00 Archive Date: 02/02/00 DOCKET NO. 98-17 639 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas THE ISSUES 1. Entitlement to service connection for adenocarcinoma of the prostate, status post bilateral orchiectomy with impotence and voiding dysfunction, including as secondary to the service-connected thyroid disability. 2. Entitlement to service connection for impaired vision, including primary open angle glaucoma with pseudoaphakia and posterior capsular opacification and cataract of the right eye as secondary to the service-connected thyroid disability. 3. Entitlement to service connection for hypertrophic joints of the knees and hips, and arthritis of the major joints, including as secondary to the service-connected ankle disability. 4. Whether new and material evidence has been presented to reopen the claim of entitlement to service connection for chronic prostatitis, myocarditis with circulation problems of the lower extremities, a nervous disorder, and diabetes mellitus. 5. Entitlement to an increased evaluation for hyperthyroidism, currently evaluated at 30 percent. 6. Entitlement to a compensable evaluation for arthritis of the ankles. REPRESENTATION Appellant represented by: Texas Veterans Commission WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD C. Crawford, Counsel INTRODUCTION The veteran had active service from August 1943 to February 1946. This appeal arises from November 1996 and February 1997 rating decisions. On substantive appeal in October 1998, the veteran indicated that he wanted to pursue a claim of entitlement to service connection for flat feet. It is noted that in November 1950, service connection was denied. Nonetheless, the matter is referred to the RO for any development deemed appropriate. On substantive appeal and in additional letters submitted at that time, the veteran indicated that he wanted to appear before a hearing officer at the RO level and appear before a hearing held by a member of the Board. In September 1999, the veteran had a hearing before a member of the Board, and during that hearing, the veteran stated that he did not desire a hearing at the RO level. As such, the Board finds that the veteran's request for a hearing has been satisfied. The issues of entitlement to an increased evaluation in excess of 30 percent for hyperthyroidism and a compensable evaluation for arthritis of the ankles are addressed in the remand portion of the decision. FINDINGS OF FACT 1. The medical evidence does not tend to etiologically relate the veteran's adenocarcinoma of the prostate, status post bilateral orchiectomy with impotence and voiding dysfunction to service or any service-connected disability. 2. The medical evidence does not suggest that the veteran's impaired vision, diagnosed as primary open angle glaucoma with pseudoaphakia and posterior capsular opacification and cataract of the right eye are related to service or to any service-connected disability. 3. The medical evidence fails to indicate that the veteran's hypertrophic joints of the knees and hips, and arthritis of the major joints are service related or occurred as secondary to the service-connected ankle disability. 4. The RO denied service connection for chronic prostatitis and myocarditis with circulation problems of the lower extremities in July 1947; service connection for diabetes mellitus in November 1959; and service connection for an anxiety reaction in June 1962. The veteran did not appeal the aforementioned rating determinations within a timely fashion. 5. Subsequent to the July 1947, November 1959, and June 1962 rating determinations, the RO received additional VA and non- VA medical reports and statements, as well as the veteran's hearing transcript. 6. While new, the evidence submitted does not bear directly and substantially on the specific matters under consideration and by itself or in conjunction with evidence previously assembled is not so significant that it must be considered to fairly decide the merits of the claims. CONCLUSIONS OF LAW 1. The claim of entitlement to service connection for adenocarcinoma of the prostate, status post bilateral orchiectomy with impotence and voiding dysfunction is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.159(a) (1999). 2. The claim of entitlement to service connection for impaired vision, diagnosed as primary open angle glaucoma with pseudoaphakia and posterior capsular opacification and cataract of the right eye is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.159(a) (1999). 3. The claim of entitlement to service connection for hypertrophic joints of the knees and hips, and arthritis of the major joints is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.159(a) (1999). 4. The July 1947, November 1959, and June 1962 rating determinations which denied entitlement to service connection for chronic prostatitis, myocarditis with circulation problems of the lower extremities, nervous disorder, and diabetes mellitus, respectively, are final, and new and material evidence has not been submitted to reopen them. 38 U.S.C.A. §§ 5108, 7105(c) (West 1991); 38 C.F.R. §§ 3.156, 20.1103 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran asserts that service connection is warranted for adenocarcinoma of the prostate with voiding dysfunction, impaired vision, and arthritis of the knees and hips, because the disorders occurred as secondary to his service-connected thyroid disability. He also maintains that he has submitted new and material evidence to reopen the claims for chronic prostatitis, myocarditis with circulatory problems of the lower extremity, a nervous disorder, and diabetes mellitus. It is noted that service connection may be established for a disability resulting from personal injury incurred in or disease contracted in the line of duty or for aggravation of a preexisting injury or disease. 38 U.S.C.A. § 1110 (West 1991). Service connection for a pre-existing disorder may be allowed on an aggravation basis, when the evidence demonstrates that there is an increase in disability during service, unless there is a showing that the increase is due to the natural progress of the disease. 38 U.S.C.A. § 1153 (West 1991); 38 C.F.R. § 3.306(a) (1999). However, the usual effects of medical treatment in service, having the effect of ameliorating conditions incurred before enlistment, will not be considered service-connected unless that injury is otherwise aggravated by service. 38 C.F.R. § 3.306(b)(1) (1999). Disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310 (1999). When aggravation of a veteran's non- service-connected condition is proximately due to or the result of a service-connected condition, the veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. Allen v. Brown, 7 Vet. App. 439 (1995). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). Continuity of symptomatology is required where the condition noted in service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection may also be granted for a chronic disease, including arthritis, hypertension, diabetes mellitus, and other organic diseases of the nervous system, if manifest to a degree of 10 percent or more within one year from the date of separation from such service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.307, 3.309 (1999). Background The service medical records show on 1942 entrance examination "enlarged heart and enlarge prostrate glands" was noted. Physical examination revealed no eye abnormalities as visual acuity was 20/20 bilaterally, or defects of the musculoskeletal, cardiovascular, mental and nervous systems. The report also shows that blood pressure reading was 130/84. "Chronic prostatitis" was found on genito-urinary examination. The February 1946 discharge examination report notes that no significant diseases, wounds and injuries were incurred in service. Physical examination of the genito-urinary, and musculoskeletal and cardiovascular system was normal. Findings of the feet and eyes were normal, as well as findings of the psychiatric examination. On VA examination in February 1947, complaints of heart fluttering, sleeplessness, nervousness, drying of the throat, and left stiffness were recorded. Ear, nose, and throat examination, however, showed normal findings. General examination of the heart showed that physical findings were not sufficiently positive to conclude organic heart disease at that time and examination of the bones, joints, and extremities showed no normal findings. X-ray reports of the ankles and left foot showed low-grade hypertrophic arthritis and an x-ray report of the chest showed no pathology. The diagnoses were no ear, nose, and throat disease; tachycardia; and hyperthyroidism (thyrotoxicosis) due to toxic adenoma; and chronic multiple hypertrophic arthritis of the ankles. In May 1947, the veteran was hospitalized for "thyrotoxicosis with heart disease." Physical examination detected tachycardia, but a diagnosis of a "thyrotoxicosis" was not made and on neuropsychiatric examination, a diagnosis of "hyperthyroidism" was made. Examination revealed a marked tachycardia with a cardiac rate of 140, marked tremors of the fingers, generalized apprehension and restlessness without eye signs or exophthalmos, and a loud systolic murmur but with a regular cardiac rhythm. X-rays of the veteran's ankles and feet demonstrated low grade hypertrophic arthritis and an electrocardiogram (EKG) showed sinus tachycardia with a rate of 124 without evidence of cardiac decompensation. The diagnoses were hyperthyroidism (thyrotoxicosis) due to toxic adenoma and chronic multiple hypertrophic arthritis of the ankles. In July 1947, the RO denied service connection for chronic prostatitis, reasoning that the disorder was noted on enlistment examination and had not been aggravated by service and also denied service connection for disease of the heart and hypertension, as disorders were not found on examination. In April 1948, D. J. C., M.D., wrote that since August 1947 the veteran had received treatment for severe thyrotoxicosis and associated myocarditis. In November 1948, J. G. D., M.D., recorded the veteran's complaints of "arthritis" with pain of the ankles, wrists, and other joints. After examination and reviewing x-ray findings showing that the bones of the ankles appeared normal without evidence of recent or old fractures, the diagnosis was no definite orthopedic disease can be diagnosed at this time. A November 1948 statement from J. H. L., M.D., shows that the veteran continued to received treatment for hyperthyroidism. VA examination in November 1948 documented complaints of arthritic pain, and pain, swelling and aches of the eyes, heart, and wrists. Nevertheless, examination of the eyes was normal, and although the cardio-vascular system disclosed a systolic murmur, heard best over aortic area and transmitted to the apex, findings otherwise were normal. Findings of the nervous system and genito-urinary system were normal as well. The diagnosis was no orthopedic disability found. Findings on VA examination in November 1950 were essentially normal too. On special examination of the heart, J. E. M., M.D., stated that physical examination of the heart was normal, except at the left third interspace there was a rough systolic murmur which was not transmitted and not heard over the mitral area. Chest x-rays showed essentially normal findings and an EKG detected a tendency toward right axis deviation, but otherwise findings were normal. The diagnoses were congenital heart disease with patent interventricular septal defect but without manifestations; post-thyroidectomy hypothyroidism; and glycosuria, cause undetermined. A subsequent notation shows that glycosuria was not confirmed by laboratory reports. In December 1950, the RO confirmed and continued the denial for a heart disorder, noting that the veteran's congenital heart disease with patent interventricular septal defect was a constitutional or developmental abnormality, not a disability under the law. From 1954 to 1959, medical reports generally show that the veteran received treatment for complaints of aching of the joints and nervousness. On VA examinations in September 1959, the veteran stated that he had developed glaucoma and diabetes mellitus that year. He also stated that he was highly nervous and had difficulty with sleeping. Mental and neurological examinations were normal. The diagnoses were anxiety reaction; history of hyperthyroidism, not found now; diabetes mellitus; and hypertension without cardiac damage. In November 1959, service connection for diabetes mellitus was denied. While hospitalized in April and May of 1962, the veteran, among other things, complained of decreased vision of the left eye, episodes of nervousness, and diabetes mellitus. On admission examination, findings were essentially normal although finding revealed slight protrusion of the eyes suggesting an increased sized in the post orbital fat pad, a slight amount of generalized arteriosclerosis of the heart, and a slight amount of crepitus of the knees and shoulder joints. The diagnoses were anxiety reaction manifested by somatizations, apprehensions and a low threshold for pain. The precipitating cause was undetermined. Glaucoma of the left eye; arteriosclerosis, general; and potential diabetes mellitus were noted too. In June 1962, service connection for glaucoma of the left eye; diabetes mellitus; arteriosclerosis; and anxiety reaction were denied. The RO reasoned that not one of the disorders was shown to have been incurred in service or within the presumptive time period following service. Notice of the rating determination was mailed in July 1962. In August 1996, the veteran sought to reopen his claim for diabetes mellitus and arthritis of the lower extremities. As noted throughout VA treatment reports dated from January 1995 to August 1996, the veteran continued to complain of and receive treatment for arthritis, hypertension, and visual disorders diagnosed as pre-septal cellulitis, diabetes mellitus without diabetic retinopathy, and primary open-angle glaucoma. A June 1995 outpatient treatment record showing that the veteran provided of history of hyperthyroidism, hypertension, and glaucoma of the left eye and that a diagnostic impression of hypotension was made is also of record. The records also show that the veteran was hospitalized in August 1996. The hospital summary report shows that the veteran gave a history of non-insulin dependent diabetes mellitus and hypertension without cardiac problems. Physical examination at that time was normal. The diagnoses were lower gastrointestinal bleed; diverticular disease; and diverticulosis of the colon. In September 1996, the veteran sought service connection for chronic prostatitis, loss of or loss of use of both testicles, voiding difficulties, hypertrophic joints of the knees and hips, and impaired vision. To substantiate his claims, he later submitted duplicative evidence of record, including a copy of the April 1948 statement from D. J. C., M.D. On VA examination in March 1997, the veteran gave a history of diabetes mellitus which was diagnosed in 1940; hypertension over ten years; and carcinoma of the prostate in 1989 and consequently, undergoing an orchiectomy. Examination revealed that the veteran wore bifocals; examination of the heart showed a slight systolic murmur of the left sternal border of the apex; and absent testicles due to orchiectomy, resulting from past cancer of the prostate. The diagnoses were hypothyroidism, status post surgery, on replacement therapy, and incision scar on anterior aspect of the neck is well healed; non-insulin dependent diabetes mellitus; hypertension; glaucoma by history; and carcinoma of the prostate, status post orchiectomy by history. While hospitalized in March 1998 the veteran was treated for, inter alia, Type II diabetes, dizziness, and hypertension. On admission, cardiovascular findings showed a regular rate and rhythm with a 2/6 systolic ejection murmur head best at the left upper sternal border with 2+ pitting edema on the left and 1+ pitting edema on the right. During admission, testing for adverse heart pathology was accomplished, but findings were essentially negative. Discharge diagnoses of no evidence of coronary artery disease; hypothyroidism; Type II diabetes; hypertension; degenerative joint disease; and glaucoma were made. In October 1998, E. H. B., M.D., stated that the veteran had received medical services for numerous occasions since 1962. The veteran was initially noted to have essential hypertension in early 1970 and was placed on antihypertensive medication. He remains on hypertension medication and the cardiomegaly is secondary to his hypertension. On VA general examination in December 1998, the examiner observed that the veteran wore glasses and detected bilateral arcus senilis, along with an irregular and dilated left pupil. Examination of the heart showed a regular rhythm with Grade 1/6 systolic ejection murmur. The assessments included arthritis of the ankles; impaired vision; chronic prostatitis; loss of use of both testicles; bladder problems; and arthritis of the knees and hips. On examination of the joints, the relevant diagnoses were severe arthritis of the knees, bilaterally and moderately symptomatic degenerative arthritis of the hips, bilaterally. Examination of the eyes found that the veteran's primary open angle glaucoma, intraocular pressures was currently well controlled and cup to disc ratio appeared stable compared to previous examinations; diabetes mellitus without evidence of diabetic retinopathy; and pseudoaphakia of the left with posterior capsular opacification; and cataract of right eye. Genitourinary examination showed that he veteran had a long history of prostatic adenocarcinoma which was currently treated with androgen deprivation therapy and presently stable. Nephroureterolithiasis which had inactive for more than ten years, was also noted. At his personal hearing in September 1999, the veteran testified that his disorders became manifest as secondary to treatment received for his service-connected hyperthyroid disability. During the hearing, the veteran's representative argued that his thyroid disability caused visual problems, and after surgery, symptoms such as difficulty with sleeping and nervousness manifested. The veteran added that he had blockage of the heart which was productive of pain of the shoulder and headaches and that he had developed a prostate disorder as secondary to his thyroid disability. Analysis Service Connection As noted above, the veteran seeks service connection for adenocarcinoma of the prostate, status post bilateral orchiectomy with impotence and voiding dysfunction, impaired vision, and arthritis of the knees, hips, and other major joints. A person who submits a claim for benefits under a law administered by the Secretary shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107(a). A well-grounded claim is "a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of [section 5107(a)]." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). Generally, for a service-connection claim to be well grounded a claimant must submit evidence of each of the following: (1) medical evidence of a current disability; (2) medical evidence, 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 asserted in- service injury or disease and the current disability. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); see also Elkins v. West, 12 Vet. App. 209, 213 (1999) (en banc) (citing Caluza, supra, and Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997) (expressly adopting definition of well-grounded claim set forth in Caluza, supra), cert. denied sub nom. Epps v. West, 118 S. Ct. 2348 (1998) (mem.). Alternatively, either or both of the second and third Caluza elements can be satisfied, under 38 C.F.R. § 3.303(b), by the submission of (a) evidence that a condition was "noted" during service or during an applicable presumption period; (b) evidence showing post-service continuity of symptomatology; and (c) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. See Savage v. Gober, 10 Vet. App. 488, 495-97 (1997). The credibility of the evidence presented in support of a claim is generally presumed when determining whether it is well grounded. See Elkins, 12 Vet. App. at 219 (citing Robinette v. Brown, 8 Vet. App. 69, 75-76 (1995)). Adenocarcinoma of the prostate, status post bilateral orchiectomy with impotence and voiding dysfunction Review the medical evidence in this regard does not tend to etiologically relate the veteran's adenocarcinoma of the prostate, status post bilateral orchiectomy with impotence and voiding dysfunction to service, any event of service, or to the veteran's service-connected thyroid disability. Thus, the veteran's claim is not well grounded. Although chronic prostatitis was noted on entrance examination, the service medical records are completely silent with respect to any complaints of or findings associated with adenocarcinoma of the prostate and resulting impotence and voiding dysfunction. Also, on discharge examination in 1946, clinical evaluation of the genito-urinary system was normal. Except for the veteran's own recitations, the post-service medical evidence is also devoid of evidence suggesting that his adenocarcinoma of the prostate and associated symptoms to include impotence and voiding dysfunction are related to service, any events of service, or to his service-connected thyroid disability. On VA examination in March 1997, after the veteran gave a history of undergoing an orchiectomy in 1989, the diagnosis was carcinoma of the prostate, status post orchiectomy by history. At that time, no reference to service, any events from service, or to the veteran's service-connected thyroid disability was made. Additionally, not one of the veteran's post-service treatment reports relates his adenocarcinoma of the prostate or any claimed residuals thereof to service or to the veteran's service-connected thyroid disability. In this case, the veteran's statements are the only evidence indicating a link between his disorders and service. However, as previously indicated, the veteran is not competent to make that determination. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Thus, in spite of the veteran's assertions and testimony presented on appeal, because there is no medical evidence indicating that his adenocarcinoma of the prostate, status post bilateral orchiectomy with impotence and voiding dysfunction are related to service, any event of service, or to the service-connected thyroid disability, his claim is not well grounded. Caluza, supra. Impaired vision The medical evidence also does not suggest that the veteran's impaired vision, including primary open angle glaucoma with pseudoaphakia and posterior capsular opacification and cataract of the right eye are related to service occurred as secondary to his service-connected thyroid disability. Thus, the veteran's claim in this regard is not well grounded as well. Here, although current diagnoses of visual impairment have been made, the service medical records show no adverse findings associated with visual impairment. In fact, throughout service, particularly on entrance and discharge examinations, clinical evaluation of the eyes was normal. Further, the evidence shows that the veteran's visual disorders, except for glaucoma of the left eye, were initially diagnosed in December 1998, more than fifty-two years after service, and even at that time, the examiner did not attribute any of them to service or to his service- connected thyroid disability. In this case, the medical evidence merely shows that diagnoses of primary open angle glaucoma with pseudoaphakia and posterior capsular opacification and cataract of the right eye have been made and at times the veteran receives treatment. Because the veteran is not competent to etiologically relate any of his visual disorders to service or to his service-connected disability, the Board must find the claim not well grounded. Caluza and Espiritu, both supra. Hypertrophic joints of the knees and hips and arthritis of the major joints With respect to the veteran's disorders of the knees, hips, and other major joints, the Board acknowledges that service connection for arthritis of the ankles is in effect. It is also acknowledged that a diagnoses of arthritis of the knees and hips have been made. Nonetheless, in this case the medical evidence fails to indicate that these disorders had their onset in service, manifested to a compensable degree within a year after service, or are related to the service- connected arthritis of the ankle disability. Again, except for the veteran's statements and testimony presented on appeal, there is no evidence of record that tends to establish a nexus between the veteran's arthritis of the knees, hips, etc. and his service or service-connected bilateral ankle disability, and there is no medical evidence showing that the veteran's degenerative arthritis of the knees and hips had manifested to a compensable degree within the applicable presumptive period after service. Thus, the veteran's claim is not well grounded. New and Material As previously detailed, in July 1947, November 1959, and June 1962 rating determinations, the RO denied entitlement to service connection for chronic prostatitis, disease of the heart and hypertension, a nervous disorder, and diabetes mellitus. In those determinations, the RO, in essence, reasoned that the disorders were either not incurred in service or aggravated by service, or, where applicable, did not manifest to a compensable degree within a year after service. Additionally, as noted above, after each determination, the RO mailed notice to the veteran but timely appeals were not filed. VA law and regulation state that following notification of an initial review and determination by the RO, a notice of disagreement must be filed within one year from the date of mailing of notification; otherwise, the determination becomes final and it may not thereafter be reopened unless new and material evidence is presented with respect to the denied claim. 38 U.S.C.A. §§ 5108, 7104; 38 C.F.R. § 3.156. "New" evidence "means evidence not previously submitted to agency decision makers ... which is neither cumulative nor redundant"; "material" evidence is new evidence "which bears directly and substantially upon the specific matter under consideration" 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 U.S.C.A. § 5108; Fossie v. West 12 Vet. App. 1 (1998); Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998); 38 C.F.R. § 3.156(a). Chronic prostatitis and Myocarditis with circulation problems of the lower extremities With regard to reopening the veteran's claim of entitlement to service connection for chronic prostatitis and myocarditis with circulation problems of the lower extremities, the Board finds that the evidence submitted since the July 1947 decision does not tend to establish that the veteran's chronic prostatitis was aggravated by service. The evidence submitted since July 1947 also does not suggest that the veteran's heart disorder had its onset in service, manifested to a compensable degree within the requisite time period subsequent to service, or is related to service or to the service-connected thyroid disability. As such, although the evidence received subsequent to the 1947 rating action is new in that it was not of record when the RO initially denied the claim, it is not material because it does not bear directly and substantially upon the specific matter under consideration and thereby, which by itself or in connection with evidence previously assembled, is not so significant that it must be considered in order to fairly decide the merits of the claim. In fact, except when reviewing the veteran's prior medical history, the newly submitted evidence does not reference the veteran's chronic prostatitis and not one of the reports attribute the veteran's heart disorders to service, any events of service, or to his service-connected thyroid disability. The evidence attributes the veteran's heart disability to hypertension and a congenital defect. Thus, in this regard, new and material evidence has not been submitted and the July 1947 rating determinations remain final. 38 C.F.R. § 3.156. Nervous disorder and Diabetes mellitus Regarding these matters, the Board finds that the evidence received subsequent to November 1959, when service connection for diabetes mellitus was denied, and June 1962, when service connection for a nervous disorder was denied, is new, as the evidence was not of record when the RO initially considered the claims. Nevertheless, the Board finds that although new, the evidence is not material because it does not tend to demonstrate that the veteran's diabetes mellitus and nervous disorder had their onset in service, manifested to a compensable degree within a year post service, or are related to any events from service or any service-connected disability. The newly submitted evidence in this case merely shows that the veteran receives treatment for symptoms associated with the disabilities. The record is devoid of any evidence suggesting that any of the diagnosed disorders are related to service, directly, secondarily, or presumptively. As such, the newly submitted evidence does not bears directly and substantially upon the specific matters under consideration and which by itself or in connection with evidence previously assembled is not so significant that it must be considered in order to fairly decide the merits of the claims. New and material evidence in this regard has not been submitted and the November 1959 and June 1962 determinations remain final. With respect to all of the aforementioned claims, the Board acknowledges that the veteran has presented testimony in which he etiologically relates his disorders to service and his service-connected thyroid disability. However, the veteran's statements are not new in that his contentions are essentially the same as those considered when the RO initially denied his claims in July 1947, November 1959 and June 1962. Further, evidence that requires medical knowledge must be provided by someone qualified as an expert by knowledge, skill, experience, training, or education. Espiritu, supra; see also Moray v. Brown, 5 Vet. App. 211, 214 (1993) (holding that lay assertions of medical causation cannot serve as the predicate to reopen a claim). Here, there is no evidence showing that the veteran is competent to render such opinions. Thus, new and material evidence in this respect also has not been submitted. In light of the foregoing, the Board finds that new and material evidence associated with the veteran's claims of service connection for chronic prostatitis, myocarditis with circulation problems of the lower extremities, a nervous disorder, and diabetes mellitus has not been submitted. Thus, the rating determinations of July 1947, November 1959, and June 1962 are final and the veteran's appeal is denied. 38 U.S.C.A. § 7105(c); 38 C.F.R. §§ 3.156. Additional Matters With respect to the veteran's claims for service connection, it is noted that even when a claim is not well grounded, the Secretary had imposed upon himself a further duty to advise the appellant of what additional evidence was necessary to complete the application for the benefit sought under 38 U.S.C.A. § 5103(a) (West 1991). For claims being adjudicated on a finality basis, although finding that a claim is well grounded prior to finding that new and material evidence has been submitted is a legal nullity, see Butler v. Brown, 9 Vet. App. 167, 171 (1996), in accordance with Graves v. Brown, 8 Vet. App. 522 (1996), the Secretary must also apprise the appellant of evidence necessary to complete the application for the benefit sought. Id. In this regard, it is noted that the veteran asserts that he received treatment at Saint Vincent's Hospital, University of South Alabama Hospital, and VA Medical Centers (MC) at Texas, Alabama, and California. VA outpatient treatment reports from VAMC's at Houston, Texas and San Diego, California are of record and by correspondence dated in August 1997, a clerk of the University of South Alabama noted that they were not able to locate any records associated with the veteran. Additionally, in April 1998, Providence Hospital noted that they only retained records over 22-years and in October 1998, the VAMC at Alabama stated that they were unable to locate the requested medical records. In light of the veteran's not well-grounded claims and the VA's attempts to obtain the veteran's medical reports, the Board finds that the duty imposed under 38 U.S.C.A. § 5103 has been satisfied. It is also noted that VA examination in December 1998 showed that he veteran continued to receive treatment for adenocarcinoma of the prostate and that an appointment had been scheduled in 1999. If accomplished this report is not of record. Nonetheless, the Board finds that additional development in this regard is not warranted. The veteran has merely indicated that he will receive treatment at a later date, he has not alleged that his physician has related his disorder to service or to his service-connected disability. Thus, no further action is warranted. Because the veteran has failed to submit a well-grounded claims, the VA is under no duty to assist in any further development of the matters. 38 U.S.C.A. § 5107(a); Morton v. West, 12 Vet. App. 477 (1999); Epps v. Gober, 126 F.3d. 1464 (Fed. Cir. 1997); Grottveit, supra; 38 C.F.R. § 3.159(a). Additionally, regarding the new and material evidence claims, the veteran has not indicated that the evidence would tend to show that his disorders were incurred in service, aggravated by service, manifest to a compensable degree within a year after service, or related to the service-connected thyroid disability. As such, no additional development is warranted. At his personal hearing in September 1999, the veteran, through his representative, stated that the examination conducted in December 1998 was inadequate. Therefore, a contemporaneous examination should be accomplished. For the reasoning discussed above, the Board finds that no action in this respect is warranted. Here, there is no duty to assist. Morton, supra. The veteran has been informed of what evidence is required to establish a well-grounded claim and during the pendency of the appeal, he was informed of the evidence necessary to complete his case. Robinette, supra. The veteran's appeals are denied. ORDER Entitlement to service connection for adenocarcinoma of the prostate, status post bilateral orchiectomy with impotence and voiding dysfunction is denied. Entitlement to service connection for impaired vision, diagnosed as primary open angle glaucoma with pseudoaphakia and posterior capsular opacification and cataract of the right eye is denied. Entitlement to service connection for hypertrophic joints of the knees and hips, and arthritis of the major joints is denied. Not having submitted new and material evidence, the claims of entitlement to service connection for myocarditis with circulation problems of the lower extremities, chronic prostatitis, a nervous disorder, and diabetes mellitus remain final; thus, the appeal is denied. REMAND Regarding the veteran's claims for an increased rating in excess of 30 percent for hyperthyroidism, (which recently has been diagnosed as hypothyroidism), and a compensable rating for residuals of arthritis of the ankles, the Board acknowledges that a VA examination was accomplished in December 1998. However, it does not appear as though the RO readjudicated the veteran's increased rating claims in light of the recent examination findings, and, if so, the record does not show that the veteran was issued a pertinent supplemental statement of the case. Without such information, the veteran's ability to pursue his claims could potentially be compromised. Thus, additional development is warranted. To ensure that the VA has met its duty to assist the veteran in developing the facts pertinent to his claim and to ensure full compliance with due process requirements, the case is REMANDED for the following action: The veteran should be issued a supplemental statement of the case pertaining to the issues of entitlement to an increased rating in excess of 30 percent for hyperthyroidism and entitlement to a compensable rating for residuals of arthritis of the ankles. The supplemental statement of the case should include any additional pertinent law and regulations, e.g. 38 C.F.R. § 4.119, Diagnostic Code 7903 (1996 & 1999), and a full discussion of action taken on the claim, consistent with the United States Court of Appeals for Veterans Claims' (formerly known as the United States Court of Veterans Appeals) (hereinafter referred to as the Court) instruction in Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The applicable response time should be allowed. Thereafter, the case should be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The veteran need take no action unless otherwise notified.. The veteran 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 or by the Court for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1998) (Historical and Statutory Notes). In addition, Veterans' Benefits Administration (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. V. L. Jordan Member, Board of Veterans' Appeals