BVA9504929 DOCKET NO. 93-10 403 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Whether there is new and material evidence to reopen a claim of entitlement to service connection for a back disorder, including arthritis of the spine. 2. Whether there is new and material evidence to reopen a claim of entitlement to service connection for arthritis of the knees. 3. Whether there is new and material evidence to reopen a claim of entitlement to service connection for cataracts of both eyes. 4. Entitlement to service connection for cardiovascular disease, including a heart disorder. 5. Entitlement to service connection for residuals of fractures of both legs. 6. Entitlement to service connection for hearing loss. 7. Entitlement to service connection for a respiratory disorder including chronic obstructive pulmonary disease with bronchitis and emphysema. 8. Entitlement to service connection for residuals of burns to the face, hands and chest. 9. Entitlement to service connection for shell fragment wounds of the left thigh. REPRESENTATION Appellant represented by: The American Legion INTRODUCTION The veteran served on active duty from December 1942 to December 1945. By rating action of September 1970, service connection was denied for the disorders addressed in issues 1, 2, and 3. While it appears that the regional office (RO) also denied service connection for an unspecified left leg disorder in the September 1970 rating action, the record lacks any specific notice as to that matter. Accordingly, the RO has developed issues of service connection for disorders of the left lower extremity, other than arthritis of the knees, on a de novo basis. In addition, following the September 1970 rating action, the RO notified the veteran that service connection for a heart disorder had been denied. However, a review of the rating action of September 1970 reflects that the issue of entitlement to service connection for a heart disorder was not actually considered as an issue. Apparently the basis for this notice was that, in determining the veteran's entitlement to pension benefits, arteriosclerosis was found to be a nonservice-connected disability. The current appeal involves congestive heart failure and cardiovascular disease. These issues were appropriately handled on a de novo basis by the RO and will be reviewed on the same basis on appeal. The Board notes that the veteran's notice of disagreement, filed in August 1992, vaguely referred to treatment for prostatitis. Service connection for this disorder was denied by a rating determination in July 1992. The issue was not included in the statement of the case. It appears that he did not intend such matter as an issue for appellate consideration, since neither he nor his representative have advanced any pertinent arguments on the matter. Accordingly, the Board considers the only issues on appeal as those stated on the title page. CONTENTIONS OF APPELLANT ON APPEAL It is contended by the veteran, in essence, that while he was part of the 147th Ordnance Services Company stationed at Sheltemham, England, during World War II, he developed an eye disorder due to welder's burns to the eyes. He also avers that he developed chronic bronchitis and fractures of both legs while working in a vehicle assembly plant which assembled jeeps for the invasion of France. Moreover, he argues that on June 9, 1944, he was part of the troops that landed on Omaha Beach, Normandy; he has reported that he incurred burns of the eyes, hands and face when gunpowder blew up in his face. He contends that he also incurred shell fragment wounds of the left thigh and fractures of the back and both legs at that time which resulted in chronic arthritis. The veteran also maintains that the lack of use of safety features, while working at plant in the service, contributed to the onset of eye problems and a hearing loss. Additionally, he maintains that he suffers from a heart ailment that is long standing. He argues that the VA does not have records of electrocardiograms because the United States Army did not have the equipment to take perform such studies when he reported to sick bay with a rapid and irregular heartbeat between December 1942 and December 1945. He also points out that while he complained of respiratory problems at the base hospitals, no X-rays were taken because it was not deemed a medical emergency at that time. Moreover, he contends that the documentary evidence submitted on his behalf supports his claims and constitutes new and material evidence sufficient to reopen claims previously denied. DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), following review and consideration of all the evidence and material of record in the veteran's claims files, and for the following reasons and bases, it is the decision of the Board that the veteran has not submitted new and material evidence to reopen claims of entitlement to service connection for residuals of a back injury including arthritis of the spine, arthritis of the knees, or cataracts; it is further the decision of the Board that the preponderance of the evidence is against the veteran's claim of service connection for residuals of fragment wound of the left thigh; it is further the decision of the Board that the veteran's claims of service connection for cardiovascular disease, residuals of fracture of both legs, hearing loss, respiratory disorder including chronic obstructive pulmonary disease with bronchitis and emphysema, residuals of burns of the face, hands and chest are not well grounded. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. No medical evidence demonstrating current residual disability resulting from burns to the face, hands and chest has been submitted. 3. No medical evidence demonstrating the presence of a current hearing loss disability has been submitted. 4. No medical evidence presently demonstrating residuals of fracture of both legs has been submitted. 5. No competent medical evidence to link a respiratory disorder, however diagnosed including chronic obstructive pulmonary disease, emphysema, and bronchitis to service has been submitted. 6. No medical evidence linking any currently diagnosed cardiovascular disease to the veteran's service has been submitted. 7. A shell fragment wound of the left thigh was not demonstrated in service; the X-ray evidence of a small metal "shot" in the left leg first noted in July 1970, has not been shown to be related to any incident of active duty. 8. A RO rating determination in September 1970 denied service connection for residuals of a back injury including arthritis, arthritis of the knees and cataracts; the veteran was notified of the denial of this claim but did not file a timely appeal therefrom. 9. The evidence received since the September 1970 rating determination consists of records from the Office of the Surgeon General and postservice private medical records dating between approximately 1991 and 1992; at best, this evidence reflects continued evidence of back and knee disorders, including arthritis, and cataracts first shown many years following separation from service without a demonstrated etiologic link to service. CONCLUSIONS OF LAW 1. The veteran's claim for service connection for cardiovascular disease, including a heart disorder is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The decision of the RO in September 1970 denied service connection for residuals of a back injury including arthritis of the spine is final and there is no new and material evidence to reopen the claim. 38 U.S.C.A. §§ 5107, 5108, 7105 (West 1991); 38 C.F.R. §§ 3.104, 3.156(a) (1994). 3. The decision of the RO in September 1970 denying service connection for cataracts of both eyes is final and there is no new and material evidence to reopen the claim. 38 U.S.C.A. §§ 5107, 5108, 7105 (West 1991); 38 C.F.R. §§ 3.104, 3.156(a) (1994). 4. The decision of the RO in September 1970 denying service connection for arthritis of the knees is final and there is no new and material evidence to reopen a claim. 38 U.S.C.A. §§ 5107, 5108, 7105 (West 1991); 38 C.F.R. §§ 3.104, 3.156(a) (1994). 5. Residuals of shell fragments wounds of the left thigh were not incurred in or aggravated by wartime service. 38 U.S.C.A. §§ 1110, 5107 (West 1991). 6. The veteran's claim for service connection for hearing loss disability is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 7. The veteran's claim for service connection for residuals of fractures of both legs is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 8. The veteran's claim for service connection for residuals of burns to the face, hands and chest is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 9. The veteran's claim for service connection for respiratory disorder, variously classified, including chronic obstructive pulmonary disease, bronchitis and emphysema is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection Service connection may be established for a disease resulting from personal injury suffered or disease contracted in line of duty or for aggravation of preexisting injury suffered or a disease contracted in line of duty. 38 U.S.C.A. § 1110 (West 1991). Regulations provide that service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 3.303(d) (1994). Further, we note that for the showing of chronic disease in service, there are required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or diagnoses, including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnoses of chronicity may be legitimately questioned. When the fact of chronicity is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1994). If the disorder is cardiovascular disease, arthritis or sensorineural hearing loss, service connection may be granted if manifest to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994). Refractive error is not considered a disease or injury within the meaning of applicable legislation for compensation benefits. 38 C.F.R. § 3.303(c)(1994). II. Not Well-Grounded Claims The threshold question that must be resolved with regard to each claim is whether the veteran has presented evidence that the claim is well grounded, that is, that the claim is plausible. If he has not, his appeal fails as to that claim, and we are under no duty to assist him in any further development of that claim. 38 U.S.C.A. § 5107(a) (West 1991); Murphy v. Derwinski, 1 Vet.App. 78 (1990). Case law provides that, although a claim need not be conclusive to be well grounded, it must be accompanied by evidence. A claimant must submit supporting evidence that justified a belief by a fair and impartial individual that the claim is plausible. Tirpak v. Derwinski, 2 Vet.App. 609, 611 (1992), Dixon v. Derwinski, 3 Vet.App. 261, 262 (1992). In order for service connection to be warranted, there must be evidence of a present disability which is attributable to a disease or injury incurred during service. In Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992), where a veteran sought service connection for hypertension, the Court found that, "because of the absence of any evidence of current hypertension...the appellant's claim is not plausible and, therefore, not well grounded." Moreover, where the determinative issue involves a question of medical diagnosis or medical causation, competent medical evidence to the effect that the claim is plausible or possible is required to establish a well- grounded claim. Grottveit v. Brown, 5 Vet.App. 91, 93 (1993). Lay assertions cannot constitute evidence to render a claim well grounded under 38 U.S.C.A. § 5107(a), if no cognizable evidence is submitted to support a claim, the claim cannot be well grounded. Id. Evidence that requires medical knowledge must be provided by someone qualified as an expert by knowledge, skill, experience, training, or education. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). The Board notes that a variety of medical records have been associated with the veteran's claims folder. These records include the veteran's service medical records, consisting of a report of an entrance examination and subsequently dated service medical records, dating through May 1945. There are also records from the Office of the Surgeon General reflecting treatment in May 1944 solely for wounds characterized as abrasion, severe, right ankle, and contusion, strain, extensor muscles of the right leg incurred while working at a "T.U.P." plant. In addition, there are post service VA and private clinical data, dating between approximately March 1970 and July 1992, including a private medical statement dated in March 1970 reflecting physical findings from an examination at that time. Also on file are a report of a VA examination dated in July 1970 and subsequently dated clinical data essentially through Smith-Glynn-Callaway Clinic and St. John's Regional Health Center dating between approximately 1991 and 1992. In the case before us, the Board finds that the evidence does not demonstrate the presence of any fractures or residuals thereof of the legs, hearing loss disability or residuals of burns to the face, hands and chest currently. Moreover, we note that a respiratory disorder, however, diagnosed was not noted during service. The record lacks any competent medical evidence linking the respiratory disorder, variously diagnosed, including chronic obstructive pulmonary disease, emphysema and bronchitis first noted in the 1990's, many years following separation from service to any incident of active duty. Accordingly, the veteran's claims for service connection for hearing loss disability, respiratory disorder, variously classified, cardiovascular disease, residuals of burns to the face, hand and chest, and residuals of fractures of both legs are not well grounded, and therefore, must fail for the reasons and bases noted below. While the veteran maintains that he acquired such disorders during active duty, he is not medically qualified to render an opinion as to diagnosis and etiology. Espiritu, 2 Vet.App. 492 (1992). In accordance with Grottveit v. Brown, 5 Vet.App. 91 (1993), lay assertions of medical causation cannot constitute evidence to render a claim while grounded under 38 U.S.C.A. § 5107(a), if no cognizable evidence is submitted to support a claim, the claim cannot be well grounded. Furthermore, if there is no showing of the current existence of the disorder, the claim is not well grounded. Rabideau, 2 Vet.App. 141, 143, 38 U.S.C.A. § 5107. Since the evidence in the file does not show that the veteran has currently identifiable impairment associated with the claimed disabilities for which he seeks compensation, his claims are not well grounded. If a claim is not well grounded, the Board does not have jurisdiction to adjudicate the claim. Boeck v. Brown, 6 Vet.App. 14, 17 (1993). As such, the appeals must be dismissed. III. Hearing Loss The determination of whether the veteran has a ratable hearing loss as governed by 38 C.F.R. § 3.385, which states that hearing loss will be considered to be disability when the threshold level in any of the frequencies 500, 1,000, 2,000, 3,000 and 4,000 Hertz is 40 decibels or greater; or the thresholds for at least three of these frequencies are 26 decibels or greater; or speech recognition scores are less than 94 percent. Department of Veterans Affairs, 38 C.F.R. Part 3; disability due to impaired hearing, 59 Fed. Reg. 60560 (1994) (to be codified at 38 C.F.R. § 3.385). In view of the fact that the veteran is not shown to have directly participated in combat during active duty, the provisions of 38 U.S.C.A. § 1154 (West 1991) are not for application. The veteran's service medical records essentially show that he was assigned to an ordnance unit. He does not maintain that any of his decorations were for combat service nor does he argue that he received a Purple Heart. The veteran's service medical records at no time mention any complaint or finding regarding a hearing loss disability. Moreover, we note that the post service evidence of record, consisting of VA and private clinical data dating between approximately March 1970 and July 1992, are similarly silent for any complaint or finding of hearing loss disability. No evidence of a hearing loss was specifically noted on a post service VA examination in July 1970. Thus, the medical evidence actually shows that a ratable hearing loss impairment is not present. IV. Residuals of Burns to the Face, Hands and Chest The veteran primarily argues that he incurred burns to the face, hand and chest from exploding powder while taking part in the Normandy invasion in June 1944. The veteran's service medical records are essentially negative for any pertinent complaint or findings until approximately October 30, 1944, when he was seen for first and second degree burns of the hands and face, mild, from powder explosion the day before. There was no mention of involvement of the chest area. He was assigned to an ordnance company at the time. He was returned to duty on that day. The next day, the dressings were changed and he was again returned to duty. No objective findings were noted. No additional follow-up treatment was noted. The post service private and VA clinical data of record, dating from March 1970 through July 1992, are silent for any objectively demonstrated residuals of powder burns of the hands and face on pertinent evaluations undertaken during such time. Thus, any burns of the face, hand or chest in service were not more than acute and transitory in nature since the medical evidence does not show that identifiable residuals of powder burns of the face, hands and chest are present. V. Residuals of Fractures of Both Legs The veteran's service medical records at no time mention any complaint or finding regarding fractures of both legs or residuals thereof. All pertinent clinical evaluations were normal. Importantly, the post service clinical evidence of record dating between approximately March 1970 through July 1992 including a report of a VA general medical examination with X-rays of the lower extremities are entirely silent for any mention of residuals of fractures of the legs. Since the evidence in the file does not show that the veteran currently has residuals of fractures of both legs for which he seeks compensation, his claim is not well grounded. If a claim is not well grounded, the Board does not have jurisdiction to adjudicate the claim. Boeck, 6 Vet.App. 14, 17 (1993). As such the appeal must be dismissed. VI. Respiratory Disorder, Variously Classified The veteran's service medical records at no time mention any complaint or finding regarding a respiratory disorder, however, classified. We note that the post service VA and private clinical data includes a private medical statement, dated in March 1970, as well as a report of a VA general medical examination in July 1970. These records are entirely silent for any evidence of a respiratory disorder, however classified, including chronic obstructive pulmonary disease, emphysema, and bronchitis. There is no evidence of such disorders until approximately 1990. There is no competent medical evidence linking the post service chronic respiratory disease to any incident of the veteran's remote period of active duty. Moreover, the records in the 1990's reflect that his respiratory symptoms were of recent onset. VII. Cardiovascular Disease Including A Heart Disorder The veteran's service medical records, consisting of an entrance examination dated in December 1942 and subsequently dated service medical records dating through May 1945. These records are entirely silent for any complaint, finding or diagnosis of cardiovascular disease. Significantly, a report of a post service private medical treatment, dated in March 1970, was likewise silent for any finding or cardiovascular pathology. A report of a VA examination dated in July 1970, with electrocardiogram, reflected for the first time the presence of a generalized arteriosclerotic process. This process was first manifested at a time dating many years following separation from service. There has been no etiologic link demonstrated by competent medical evidence to any incident of the veteran's remote period of active duty. Additionally, records from the Office of the Surgeon General which did not reflect any pertinent findings. Numerous private medical records through St. John's Regional Health Center and Smith-Glynn-Callaway Clinic reflect findings consistent with hypertensive cardiovascular disease and arteriosclerotic changes from 1991 to 1992, many years following separation from service. There is no etiologic link demonstrated to any incident of service. In fact, during such time, the veteran actually denied any history of hypertension, coronary artery disease or heart problems. Overall, the evidence shows the development of cardiovascular disease many years following separation from service without any etiologic link to the remote period of active duty. Accordingly, the claim is not well grounded. VIII. Well-Grounded Claims The Board finds that the veteran's claims with respect to entitlement to service connection for residuals of shell fragment wounds of the left thigh and whether there is new and material evidence to reopen claims of service connection residuals of a back injury including arthritis of the spine, arthritis of the knees, and cataracts of both eyes are "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, the veteran has presented claims that are plausible. He has not asserted that any records of probative value that may be obtained and which are not already associated with the claims folder are available. The Board accordingly finds that all relevant facts have been properly developed, and that the duty to assist him, mandated by 38 U.S.C.A. § 5107(a) (West 1991), has been satisfied. IX. Residuals of Back Injury Including Arthritis of the Spine With regard to the veteran's requests to reopen his claims for issues 1, 2, and 3, on the title page, the law provides a notice of disagreement was to be filed within one year from the date of mailing of notification of the initial review and determination as well as filing of a substantive appeal within 60 days from the mailing of the statement of the case or within the remainder of the one-year period from the date of the mailing of the notification of the initial review and determination being appealed, whichever period ended later; otherwise, that determination became final. 38 U.S.C.A. § 7105 (West 1991); 38 C.F.R. § 3.104 (1994). If new and material evidence is presented or secured with respect to a claim which has been disallowed, the claim can be reopened and the former disposition of the claim reviewed. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1994). Evidence is considered new when it is not merely cumulative of other evidence in the record and is considered material when it is relevant and probative of the issue at hand. To justify a reopening of a claim on the basis of new and material evidence, there must be a reasonable possibility that the new evidence, when viewed in context of all the evidence, both new and old, would change the outcome. Colvin v. Derwinski, 1 Vet.App. 171 (1991). The evidence is "new" when it is not cumulative of evidence already of record, and is not "material" when it cannot possibly change the outcome of the case. Godwin v. Derwinski, 1 Vet.App. 419 (1991). When all the evidence is assembled, the Secretary is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet.App. 49 (1990). Importantly, we note that reopening or readjudication of a finally denied claim by the RO or by the Board in the absence of new and material evidence must be considered "in excess of statutory jurisdiction, authority and limitations," and will be held "unlawful and set aside." McGinnis v. Brown, 4 Vet.App. 239, 243-45 (1993). The denial of service connection for arthritis of the spine in 1970 was based upon a claim of service connection for residuals of a back injury in service. The veteran's service medical records were essentially unremarkable until December 1943, when he was treated for an acute moderate sprain of the sacroiliac area while lifting heavy boxes at the ordnance depot. The remaining service medical records were silent for any pertinent follow-up findings. The post service medical evidence of record consisted of a private medical statement dated in March 1970 referring to examination findings at that time. The veteran complained of back pain. An X-ray reflected osteoarthritis of the lumbar spine. The examiner indicated that he felt that the arthritis process had in part forced the veteran to give up work as a plumber and that the veteran was presently cutting timber and firewood for work to support his family. On a report of a post service VA examination dated in July 1970, the veteran complained of arthritic pain in the joints and spine. He noted that he was a self-employed wood cutter. He also indicated that he used to be a plumber but had to quit that kind of work because of the discomfort and that he could no longer crawl under houses. X-rays revealed the presence of degenerative arthritis of the spine. The unappealed RO rating determination dated in September 1970 essentially held that the evidence at the time reflected no more than an acute and transitory episode of low back pain in service; it was also found that his back pain in service was not related to the arthritis process of the spine first noted in July 1970, many years following separation from active duty. Evidence added to the record included records from the Office of the Surgeon General which did not refer to any pertinent findings. Other evidence added to the record consisting of private medical reports through St. John's Regional Health Center and Smith-Glynn-Callaway Clinic, dating between 1991 and 1992. These records primarily refer to treatment and history of disorders other than arthritis of the spine. There is no evidence linking the arthritis of the spine, first noted many years post service, to any incident of service. The Board concludes that the evidence added to the record, therefore, does not raise a reasonable possibility in changing the outcome of the case. While the veteran maintains that he acquired such disorder during active duty, he is not medically qualified to render an opinion as to diagnosis and etiology. Espiritu, 2 Vet.App. 494. Since the additional evidence is not both new and material, it does not support a reopening of the veteran's claim. Accordingly, the RO's September 1970 rating determination remains final. X. Arthritis of the Knees The evidence on file at the time of the unappealed rating determination dated in September 1970 denying service connection for arthritis of the knees included the veteran's service medical records, which were silent for any complaint or findings of arthritis on the knees. While the veteran was seen in May 1944 for wounds characterized as abrasion, severe, right ankle, and contusion, strain, extensor muscles of the right leg following a "hyster" running into the veteran's right foot and leg while working at a "T.U.P." plant, there was no indication of involvement of either knee. The remaining service medical records were silent for any pertinent finding. A post service private medical statement, dated in March 1970, referring to findings of an examination at that time, was silent for any pertinent knee complaints or findings. On a report of a VA examination, dated in July 1970, the veteran complained of knee pain which he attributed to an arthritic process. He noted that he had been receiving treatment for joint pain from approximately 1970. He indicated that he used to be a plumber but had to quit work because of the discomfort in his knees and that he could no longer crawl under houses and work on his knees any further. He stated that both knees had been operated upon; however, the examiner could not find any surgical scars thereof. The veteran described it as an incision directly over the patellar tendon. However, the examiner indicated that this was not an appropriate arthrotomy incision for anything. The examiner noted that he did not know why the operation was performed. Following an objective examination with X-rays, diagnosis was degenerative arthritis of the knees. The unappealed rating action of September 1970, it was determined that the evidence of record essentially failed to demonstrate the presence of any arthritis of the knees in service; there was also no etiologic link, demonstrated by competent medical evidence, to the arthritic changes of the knees first noted many years following separation from service. The evidence added to the record since that time includes records from the Surgeon General's Office which did not refer to any evidence of arthritis of the knees. The remaining evidence added to the record consisting of private medical records through various sources as noted above dating between approximately 1991 and 1992, which primarily refer to treatment and history of disorders other than arthritis of the knees and without any competent medical evidence linking arthritis of the knees first noted many years post service to any incident of active duty. While the veteran maintains that he acquired such disorder during active duty, he is not medically qualified to render an opinion as to diagnosis and etiology. Espiritu, 2 Vet.App. 494. The Board concludes that the evidence added to the record, therefore, does not raise a reasonable possibility in changing the outcome of the case. Since the additional evidence is not both new and material, it does not support a reopening of the veteran's claim. Accordingly, the RO's September 1970 rating determination remains final. XI. Cataracts The evidence on file at the time of the unappealed rating determination in September 1970 denying service connection for cataracts included the veteran's service medical records. On the veteran's examination in December 1942 for purposes of entry onto active duty an objective evaluation of the eyes was negative for any pertinent disease including cataracts. Uncorrected visual acuity was measured at 20/25 in the right eye and 20/40 in the left eye. Remaining service medical records are negative for any pertinent finding of ocular pathology including cataracts. The post service evidence of record consisting of a private medical statement dated in March 1970 referring to physical findings on examination at that time was silent for any evidence of ocular pathology including cataracts. On a report of an initial post service VA examination dated in July 1970 a special eye examination showed that the veteran reported being told sometime ago that he had cataracts which he felt had come on in the last few months. Last October, his vision measured 20/20 in either eye. He had no service-connected eye problem. On objective examination at that time uncorrected vision in the right eye was measured at 20/400. Uncorrected vision in the left eye was measured at 20/20. Following additional examination diagnosis was cataracts, bilateral, with best visual acuity of 20/15 in the right eye and 20/20 in the left eye. The examiner commented that cataracts of the veteran's sort usually progressed readily and that the veteran would probably need cataract extraction. The unappealed RO rating determination in September 1970 essentially found that cataracts were not present in service and that the record lacked any competent medical evidence demonstrating an etiologic relationship between the cataracts first noted many years post service to any incident of active duty. The evidence added to the record includes records from the Surgeon General's Office which are silent for any evidence of an eye abnormality including cataracts. The remaining evidence primarily consists of private medical records, through various sources, noted above, without any medical evidence demonstrating an etiologic link between any incident of service and the cataracts first noted many years post service. The veteran's reported history dated his cataracts from approximately a time dating in 1970. Overall, the added post service evidence submitted contains no medical evidence linking the veteran's cataracts to service. While the veteran maintains that he acquired such disorder during active duty, he is not medically qualified to render an opinion as to diagnosis and etiology. Espiritu, 2 Vet.App. 494. The Board concludes that the evidence added to the record, therefore, does not raise a reasonable possibility in changing the outcome of the case. Since the additional evidence is not both new and material, it does not support a reopening of the veteran's claim. Accordingly, the RO's September 1970 rating determination remains final. XII. Residuals of a Shell Fragment Wound of the Left Thigh The veteran argues that he incurred residuals of shell fragment wounds of the left thigh as shown by X-rays of metal fragments in that area due to injuries sustained during the invasion of Normandy at Omaha Beach in June 1944. A review of the veteran's service medical records including records from the Surgeon General's Office are entirely silent for any pertinent complaint finding or diagnosis of residuals of shell fragment wounds of the left thigh. The post service evidence of record shows that on the veteran's initial application for service-connected compensation benefits filed in April 1970 is without any allegation of shell fragment wound injuries of the left thigh. A private medical statement reflecting findings of an examination in March 1970 that was submitted in support of his claims at that time was similarly silent for any mention of shell fragment wounds of the left thigh or history thereof. Importantly, when the veteran was examined by the VA in July 1970, there was no mention of any complaint of shell fragment wounds of the left thigh either on general medical or special orthopedic examinations. Rather, the veteran primarily complained of back and knee pain of arthritic origin. An examination was negative for any pertinent finding with respect to any identifiable residuals of shell fragment wound of the left thigh. However, an incidental finding on X-ray of the knees revealed the presence of a small metal "shot" anterior to the left tibial plateau and soft tissues posteriorly to the left lower femoral shaft of unknown origin. No other pertinent finding was noted in the left lower extremity. The remaining post service evidence of record primarily consisting of treatment records dating between 1991 and 1992 are essentially silent for any pertinent history or findings of shell fragment wounds of the left thigh. As it stands, the record does not reflect that the veteran directly participated in combat during active duty nor does he claim that he received any medals for combat service including the Purple Heart. His service medical records are entirely silent for any mention of injury of the left thigh including shell fragment wounds. The post service evidence of record lacks any competent medical evidence linking the metal "shot" noted by X-ray, standing alone, and dating more than 25 years following separation from service to any incident of active duty. It's presence must also be considered along with the fact that he never mentioned such type of injury until he filed his current claim in June 1992. Overall, the preponderance of the evidence is negative and does not support the veteran's claim for entitlement to service connection for residuals of shell fragment wounds of the left thigh. ORDER New and material evidence not having been submitted to reopen a claim of entitlement to service for residuals of a back injury including arthritis of the spine, the appeal is denied. New and material evidence not having been submitted to reopen a claim of entitlement to service for arthritis of the knees, the appeal is denied. New and material evidence not having been submitted to reopen a claim of entitlement to service for cataracts of both eyes, the appeal is denied. The veteran's claim for service for cardiovascular disease including a heart disorder, the appeal is dismissed. The veteran's claim for entitlement to service connection for residuals shell fragment wound of the left thigh is denied. The veteran's claim for entitlement to service connection for residuals of fractures of both legs is dismissed. The veteran's claim for entitlement to service connection for hearing loss disability is dismissed The veteran's claim for entitlement to service connection for a respiratory disorder, variously diagnosed, including chronic obstructive pulmonary disease with bronchitis and emphysema is dismissed. The veteran's claim for entitlement to service connection for residuals of burns of the face, hands and chest is dismissed. V. L. JORDAN Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.