Citation Nr: 0003455 Decision Date: 02/10/00 Archive Date: 02/15/00 DOCKET NO. 97-31 929 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUES 1. Entitlement to service connection for scars of the right leg and buttocks. 2. Entitlement to service connection for Hodgkin's disease. 3. Entitlement to service connection for scars on the ears and neck. 4. Entitlement to service connection for a node behind the left ear. 5. Entitlement to service connection for an eye disorder. 6. Entitlement to service connection for a cardiovascular disorder manifested by a heart murmur and fluttering. 7. Entitlement to service connection for a back disability. 8. Whether new and material evidence has been received sufficient to reopen a claim of entitlement to service connection for dengue fever. 9. Whether new and material evidence has been received sufficient to reopen a claim of entitlement to service connection for mononucleosis and/or lymphadenitis. 10. Whether new and material evidence has been received sufficient to reopen a claim of entitlement to service connection for a right hand disability. 11. Whether new and material evidence has been received sufficient to reopen a claim of entitlement to service connection for residuals of a wound of the left chest. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Theresa M. Catino, Counsel INTRODUCTION The veteran served on active military duty from July 1942 to November 1945. This appeal arises in part from an August 1997 rating action of the Louisville, Kentucky, regional office (RO). In that decision, the RO, in pertinent part, denied the claim of entitlement to service connection for scars of the right leg and buttocks as well as the issues of whether new and material evidence had been received sufficient to reopen claims of entitlement to service connection for a right hand disability and for residuals of a wound to the left chest. Additionally, the current appeal arises from a March 1998 rating action of the Louisville, Kentucky, RO. In that decision, the RO denied the claims of entitlement to service connection for Hodgkin's disease, scars on the ears and neck, a node (claimed as "mastoid") behind the left ear, an eye disorder, a cardiovascular disorder manifested by a heart murmur and fluttering, and a back disability. In this rating action, the RO also denied applications to reopen claims of entitlement to service connection for dengue fever and for mononucleosis and/or lymphadenitis. The Board notes that, by an August 1996 rating action, the RO denied a claim of entitlement to a compensable evaluation for post-operative residuals of a left varicocele. The veteran thereafter perfected a timely appeal with respect to the denial of this claim. At a personal hearing conducted before a hearing officer at the Huntington, West Virginia, RO in February 1997, the veteran presented testimony regarding this rating issue. He specifically stated that an award of 10 percent would satisfy his appeal of this rating claim. February 1997 hearing transcript (1997 T.) at 8-9. Subsequently, by a February 1997 rating action, the hearing officer granted a 10 percent evaluation for the residual scar as a result of his left varicocele, effective from July 1996. The veteran was notified that this award was considered to be a full grant of benefits sought on appeal. The veteran did not thereafter express disagreement with the 10 percent rating assigned to this service-connected disability. Consequently, this rating issue is no longer in appellate status. Also, by the August 1997 rating action, the Louisville, Kentucky, RO denied an application to reopen a claim of entitlement to service connection for residuals of a wound of the left elbow. Following receipt of a notice of disagreement with this denial, the RO furnished the veteran with a statement of the case in September 1997. Thereafter, by a November 1997 rating action, the RO granted service connection for residuals of a wound of the left elbow and assigned a 10 percent evaluation, effective from October 1996. The veteran was notified that this allowance constituted a total grant of benefits sought on appeal. There is no indication that the veteran has expressed disagreement with the rating assigned to his service-connected left elbow disability. Consequently, there is no appellate issue with respect to the left elbow disability. In a statement received at the RO in June 1998, the veteran appeared to raise claims of service connection for malaria, jungle fever, and a nervous disorder. By a February 1946 rating action, the RO denied service connection for jungle fever. Furthermore, by an August 1958 rating action, the RO denied service connection for malaria and for a nervous disorder and continued the previous denial of service connection for jungle fever. Although the RO notified the veteran of these denials in the same month, the veteran failed to express disagreement with the decisions. Consequently, the veteran's June 1998 statements regarding malaria, jungle fever, and a nervous disorder must be construed as a petition to reopen previously disallowed claims. The issues of whether new and material evidence sufficient to reopen claims of entitlement to service connection for malaria, jungle fever, and a nervous disorder are therefore referred to the RO for appropriate action. (The decision below addresses issues 1 through 7 as noted on the title page above. The remaining issues-claims to reopen-are the subject of a remand that follows the decision below.) FINDINGS OF FACT 1. The record contains no competent evidence associating any scars that the veteran may have on his right leg and buttocks to his military service. 2. The record contains no competent evidence associating any Hodgkin's disease that the veteran may have to his military service. 3. The record contains no competent evidence associating any scars on the ears and neck that the veteran may have to his military service. 4. The record contains no competent evidence associating any node behind the left ear that the veteran may have to his military service. 5. The record contains no competent evidence associating any eye disorder that the veteran may have to his military service. 6. The record contains no competent evidence associating any cardiovascular disorder that the veteran may have to his military service. 7. The record contains no competent evidence associating any back disability that the veteran may have to his military service. CONCLUSION OF LAW The claims of entitlement to service connection for scars of the right leg and buttocks, Hodgkin's disease, scars on the ears and neck, a node behind the left ear, an eye disorder, a cardiovascular disorder manifested by a heart murmur and fluttering, and a back disability are not well grounded. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION The threshold question that must be resolved is whether the veteran has presented evidence that his claims of service connection are well grounded. See 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1999); Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). A well-grounded claim is a plausible claim, one that appears to be meritorious. See Murphy, 1 Vet.App. at 81. An allegation that a disorder is service connected is not sufficient; the veteran must submit evidence in support of the claim that would "justify a belief by a fair and impartial individual that the claim is plausible." See 38 U.S.C.A. § 5107(a); Tirpak v. Derwinski, 2 Vet.App. 609, 611 (1992). The quality and quantity of the evidence required to meet this statutory burden will depend upon the issue presented by the claim. Grottveit v. Brown, 5 Vet.App. 91, 92-93 (1993). In order for a claim of service connection to be well grounded, there must be proof of present disability. Brammer v. Derwinski, 3 Vet.App. 223 (1992); see also Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992) (requiring, for a well-grounded claim, competent evidence that a veteran currently has the claimed disability). In addition, there must also be evidence of incurrence or aggravation of a disease or injury in service. See Caluza v. Brown, 7 Vet.App. 498 (1995). The veteran must also submit medical evidence of a nexus between the in-service disease or injury and current disability. Id. Where the issue is factual in nature (e.g., whether an incident or injury occurred in service), competent lay testimony, including the veteran's testimony, may constitute sufficient evidence to establish a well-grounded claim; however, if the determinative issue is one of medical etiology or a medical diagnosis, competent medical evidence must be submitted to make the claim well grounded. See Grottveit v. Brown, 5 Vet.App. 91, 93 (1993). A lay person is not competent to make a medical diagnosis or to relate a medical disorder to a specific cause. Espiritu v. Derwinski, 2 Vet.App. 492, 494 (1992). However, where the issue does not require medical expertise, lay testimony may be sufficient. See Layno v. Brown, 6 Vet.App. 465, 469 (1994). A. Scars Of The Right Leg And Buttocks With regard to the claim of entitlement to service connection for scars of the right leg and buttocks, the veteran asserted in a statement received at the RO in December 1996 that he has scars on his right leg and buttocks which were incurred during his active service. At a personal hearing conducted before the Board at the RO in June 1999, the veteran testified that, in July 1944 when his hand, elbow, and chest were injured by shell fragments, he also sustained a shell fragment wound to his right leg and buttocks. 1999 hearing transcript (1999 T) at 17. According to the veteran's testimony, pieces of metal were taken out of his right leg and buttocks, but scars remained. 1999 T. at 18. The veteran's representative noted that these scars were mentioned during the 1958 examination. 1999 T. at 18. The service medical records are negative for complaints of, treatment for, or findings of scars on the veteran's right leg or buttocks. In fact, the separation examination, which was conducted in November 1945, failed to note the presence of such scars and specifically indicated that the veteran's extremities were normal. The report of this discharge evaluation also noted that the veteran's only defect at that time was four missing teeth and that he had no abnormalities which were not otherwise noted or sufficiently described elsewhere in the record. According to post-service medical records, a private medical record dated in June 1958 shows that the veteran had reported sustaining shrapnel wounds to his left groin and left leg as well as a bayonet wound to his right small finger and to the area around his heart. The veteran did not report having sustained any injuries to his right leg or buttocks. Thus, even though the examining physician diagnosed multiple shrapnel and bayonet wound scars, neither he nor the veteran specifically mentioned the veteran's right leg or buttocks. At a VA examination conducted in July 1958, the veteran again made no mention of any scars on his right leg or buttocks. In fact, a skin evaluation was normal. The examiner specifically noted that, other than scars on the lateral aspect of the left side of the veteran's scrotum, his right little finger and his left lower leg, no other scars, ulcerations, or pigmentations were present. The Board acknowledges the veteran's contention that he sustained a shell fragment wound to his right leg and buttocks during his active duty, that pieces of metal were taken out of his right leg and buttocks, but that scars remained. See 1999 T. at 17-18. Significantly, however, the service medical records are negative for findings of residual scarring on the veteran's right leg or buttocks. Additionally, the post-service medical reports are negative for findings of residual scarring on the veteran's right leg or buttocks. Indeed, the claims folder contains no evidence associating any such scarring that the veteran may presently have on his right leg and buttocks to his military service. Competent medical evidence of a nexus between current disability and the veteran's military service is required for a finding of a well-grounded claim. See Jones v. Brown, 7 Vet.App. 134 (1994). Such evidence is lacking in this case. In other words, no one with sufficient expertise has provided an opinion that the veteran has scars on the right leg or buttocks as a residual of injury in service. Consequently, the veteran's claim of service connection for scars on his right leg and buttocks must be found to be not well grounded. Caluza, supra. B. Hodgkin's Disease With regard to the claim of entitlement to service connection for Hodgkin's disease, the veteran asserted in an undated statement received at the RO in November 1997 that he was hospitalized for mononucleosis during service in August 1943 and that "[t]he[y] changed the diagnosis from mononucleosis to Hodgkin's disease." In a statement received at the RO in August 1998, the veteran maintained that either mononucleosis, lymphadenitis, or Hodgkin's disease was diagnosed in August 1943. According to the veteran, "[t]hey were found by . . . [d]octors and placed in . . . [his] medical records." At the June 1999 personal hearing, the veteran asserted that Hodgkin's disease was suspected during his active duty due to enlarged lymph nodes around his neck and on his chest. 1999 T. at 23-24. When asked if he had Hodgkin's disease "right now," the veteran responded that he did not "even know what Hodgkin's disease" was. 1999 T. at 27. The veteran specifically stated that he has never heard a doctor tell him that he has Hodgkin's disease. 1999 T. at 28. The veteran did testify that his lymph nodes behind his ears and on his neck continue to hurt. 1999 T. at 27. When asked several times if any physician has associated Hodgkin's disease with his service, the veteran either failed to respond or stated that "[r]eally, truthfully I don't think that they've said it . . . but . . . I don't know." 1999 T. at 42-44. According to the service medical records, an examination completed in August 1943 demonstrated the presence of two firm pea-sized nodules in the post-auricular region, one similar swelling in the pre-auricular region on the left side, and a firm irregular mass in the posterior triangle of the neck. All swellings were tense, non-tender, and not inflamed. Evaluation of his right ear showed the presence of discrete enlargement of post-auricular and posterior cervical chain of lymph nodes. His epitrochlear and axillary lymph nodes were palpable. An undetermined diagnosis of infectious mononucleosis was made. X-rays taken of the veteran's chest several days later in September 1943 showed no evidence of enlargement of the mediastinal lymph nodes, but the nesial portion of the dome of the right diaphragm was slightly elevated. Following laboratory testing, the examiner explained that the diagnosis "lies between Hodgkin's disease and infectious mononucleosis, with the greater weight on Hodgkin's disease." Additional examinations completed in the same month showed swelling and tenderness of the anterior superior cervical gland on the right side. The diagnosis was changed from mononucleosis to lymphadenitis (pre- and post-auricular). In November 1943, a small non-infected cyst was found on the right side of the veteran's neck as well as an enlarged non-infected post-cervical gland on his left side. In the following month, the veteran again complained of swelling of the glands of his neck. An examination demonstrated enlarged and slightly tender anterior cervical nodes bilaterally as well as a lower node on the right which was indicative of early fluctuation. The diagnosis of purulent lymphadenitis of the cervical glands was made, subsequently changed to chronic tonsillitis, and then returned to lymphadenitis of the cervical gland. In February 1945, some enlargement and tenderness of the posterior cervical nodes (beginning about a week prior to the treatment session) were noted. Examination revealed a tender node below and posterior to the mastoid prominence on the left. The anterior cervical nodes on this side were also slightly enlarged and tender. A notation was made regarding the veteran's history of abscessed nodes just anterior and over the mastoid prominence behind the left ear which required incision and drainage. The etiology of the condition was unknown but "may be related to [the] previous trouble." The report of the November 1945 separation examination indicated that the veteran had a history of lymphadenitis in September 1943 and purulent lymphadenitis of the cervical glands in December 1943. Significantly, however, this evaluation report did not include any reference to Hodgkin's disease (either through a past medical history or by current findings at the time of the examination). The report of this discharge evaluation also indicated that the veteran's only defect at that time was four missing teeth and that he had no abnormalities which were not otherwise noted or sufficiently described elsewhere in the record. According to the post-service medical records, at the July 1958 VA examination, the veteran reported that he had cysts in his ear. Significantly, however, the veteran's ears and neck were found to be normal. No finding, or diagnosis, of Hodgkin's disease was made at this examination. The Board acknowledges the veteran's contention that, although he was unsure whether he currently has Hodgkin's disease, he was aware that this disorder was suspected during his active duty due to his enlarged lymph nodes around his neck and on his chest, and that his lymph nodes behind his ears and on his neck continue to hurt. See 1999 T. at 23-24, 27, 28. In this regard, the Board acknowledges that the service medical records indicate that Hodgkin's disease was suspected in September 1943. Importantly, however, a diagnosis of Hodgkin's disease was not specifically made, either in September 1943 or thereafter. Competent medical evidence of a nexus between current disability and the veteran's military service is required for a finding of a well-grounded claim. See Jones v. Brown, 7 Vet.App. 134 (1994). Such evidence is lacking in this case. In other words, no one with sufficient expertise has provided an opinion that the veteran has Hodgkin's disease, either having its onset during service or as the product of continued symptoms since service. Consequently, the veteran's claim of service connection for Hodgkin's disease must be found to be not well grounded. Caluza, supra. (The Board also notes that the presumption of service incurrence or aggravation of Hodgkin's disease set forth in 38 C.F.R. §§ 3.307, 3.309, does not aid the veteran without a diagnosis of Hodgkin's disease.) C. Scars On The Ears And Neck With regard to the claim of entitlement to service connection for scars on the ears and neck, the veteran asserted in a statement received in October 1997 that his medical records show that, from August 1943 to February 1945, doctors "performed incisions" on his neck behind both of his ears as well as on his face in front of his left ear, and on his neck. In the same statement, however, the veteran also stated that the "doctors did not even put these scars down on . . . [his] records." Additionally, in an August 1997 statement, the veteran maintained that, while he was hospitalized for mononucleosis during service, "they" operated on his ears and neck and that he has scars behind his ears and on his neck which are painful to the touch. At the June 1999 personal hearing, the veteran testified that he has scars behind his ears and neck following surgery for removal of "knots" behind his ears and neck. 1999 T. at 24-26. According to the service medical records, an examination completed in August 1943 (when an undetermined diagnosis of infectious mononucleosis was made and Hodgkin's disease was also suspected) demonstrated the presence of two firm pea-sized nodules in the post-auricular region, one similar swelling in the pre-auricular region on the left, discrete enlargement of post-auricular chain of lymph nodes on the right side. As already noted above, subsequently prepared medical records dated from September to November 1943 reflect the presence of swelling and tenderness of the anterior superior cervical gland on the right side, a small non- infected cyst on the right side of the veteran's neck, an enlarged non-infected post-cervical gland on his left side, enlarged and slightly tender anterior cervical nodes bilaterally, and a lower node on the right which was indicative of early fluctuation. A February 1945 entry noted a tender node below and posterior to the mastoid prominence on the left as well as anterior cervical nodes on this side which were also slightly enlarged and tender. A notation was made regarding the veteran's history of abscessed nodes just anterior and over the mastoid prominence behind the left ear which required incision and drainage. Moreover, the November 1945 separation examination failed to note any complaints of, treatment for, or findings of scars on the veteran's ears and neck. In fact, this evaluation specifically revealed that the veteran's skin was normal. The report of this discharge evaluation also indicated that the veteran's only defect at that time was four missing teeth and that he had no abnormalities which were not otherwise noted or sufficiently described elsewhere in the record. According to the post-service medical records, at the July 1958 VA examination, the veteran reported that he had cysts in his ear. He made no complaints regarding his neck. Significantly, this evaluation demonstrated that the veteran's ears and neck were found to be normal. Furthermore, the examiner specifically noted that, other than scars on the lateral aspect of the left side of the veteran's scrotum, his right little finger and his left lower leg, no other scars, ulcerations, or pigmentations were present. The examiner did not note the presence of, or diagnose, scars on the veteran's ears and neck. The Board acknowledges the veteran's contentions that, when he was hospitalized for mononucleosis during service, doctors operated on his ears and neck to remove "knots" and that he has resulting scars behind his ears and on his neck which are painful to the touch. See 1999 T. at 24-26. In this regard, the Board acknowledges that the service medical records reflect the presence of nodules around the veteran's ears and on his neck. Importantly, however, neither the separation examination nor the post-service medical records indicate the presence of such nodules or residual scars. Competent medical evidence of a nexus between current disability and the veteran's military service is required for a finding of a well-grounded claim. See Jones v. Brown, 7 Vet.App. 134 (1994). Such evidence is lacking in this case. In other words, no one with sufficient expertise has provided an opinion that the veteran has residual scars on his ears and neck. Consequently, the veteran's claim for service connection for scars on the ears and neck must be found to be not well grounded. Caluza, supra. D. Node Behind Left Ear With regard to the claim of entitlement to service connection for a node (claimed as "mastoid") behind the left ear, the veteran asserted in an undated statement received at the RO in November 1997 that a "mastoid behind [his] left ear" was diagnosed in February 1945. The etiology was unknown but "may relate back to Guadalcanal disease." At the June 1999 personal hearing, the veteran explained that his claim for "mastoid" behind his left ear was the same as the scarring he has behind this ear. 1999 T. at 28. As noted above, abscessed nodes over the mastoid process were noted in service. Nevertheless, beyond the problem noted in service, there is no evidence that the veteran continued to have a chronic inflammation or node. Evidence of current disability due to the problem the veteran had in service has not been presented. Just as with the Board's analysis of the claims noted above, no one with sufficient expertise has provided an opinion that the veteran has a disability manifested by nodules behind his left ear, either having its onset during service or as the product of continued symptoms since service. Consequently, the veteran's claim for service connection for a node behind his left ear must be found to be not well grounded. Caluza, supra. E. Eye Disorder With regard to the claim of entitlement to service connection for an eye disorder, the veteran asserted, in the statement received at the RO in October 1997, that he was hospitalized and treated for a left eye problem in April 1992 and that this problem originated during service. In an undated statement received at the RO in November 1997, the veteran described painful eyes from August 1943 until 1997. At the June 1999 personal hearing, the veteran testified that, during service, he experienced burning in his eyes (due to the flashes from bombs exploding), decreased visual acuity (blurred vision), and headaches. 1999 T. at 29, 31. He denied incurring an injury to his eye involving a foreign object. 1999 T. at 29. According to the veteran's testimony, he experienced a burning sensation and blurred vision in his eyes at the time of his discharge from active duty and immediately thereafter. 1999 T. at 29. The veteran described his current eye problem to include blurred vision and headaches and maintained that he has had this symptomatology since 1946. 1999 T. at 30-31. The veteran stated that he is currently receiving treatment for his eye condition. 1999 T. at 22. According to the service medical records, in September 1944, the veteran complained of generalized aching as well as eye aches. The diagnosis of dengue was made. The November 1945 separation examination failed to note any complaints of, treatment for, or findings of an eye disorder. In fact, this evaluation specifically demonstrated that the veteran's pupils were normal, that he had distant vision of 20/20 in each eye, that his color perception was normal, and that he had no diseases or anatomical defects of his eyes. According to the post-service medical records, at the July 1958 VA examination, the veteran failed to make any complaints regarding his eyes. Furthermore, this evaluation demonstrated that the veteran's eyes, including pupil reaction, movements, and field of vision, were normal. No eye disorder was diagnosed. Subsequently, in February 1992, the veteran was hospitalized for almost one week for a four-day history of left eye swelling, redness, and pain as well as headache, coughing, congestion, but no change in vision. Citrobacter periorbital cellulitis was diagnosed. An October 1997 VA medical record includes the diagnoses of cataracts of both eyes with mild decrease in visual acuity, mild macular pucker of the left eye with decrease in visual acuity and vessel tortuosity, and hyperopia/presbyopia. The Board acknowledges the veteran's contentions that the cellulitis of his left eye, for which he was treated in April 1992, originated during service. The veteran has explained that, during service, he experienced burning in his eyes due to the flashes from bombs exploding, decreased visual acuity (blurred vision), and headaches. See 1999 T. at 29, 31. The veteran further stated that, at the time of his discharge from active duty and immediately thereafter, he experienced burning sensation and blurred vision in his eyes. See 1999 T. at 29. Additionally, the veteran has described his current eye problem to include blurred vision and headaches, symptoms which he insists he has had since 1946. See 1999 T. at 30-31. In this regard, the Board notes that the service medical records reflect complaints of eye aches in September 1944. Importantly, however, neither the remainder of the service medical records nor the separation examination provide any competent evidence of an eye disorder. The first competent evidence of an eye disorder is dated in February 1992, when the veteran was hospitalized for citrobacter periorbital cellulitis. An October 1997 VA medical record includes the diagnoses of cataracts of both eyes with mild decrease in visual acuity, mild macular pucker of the left eye with decrease in visual acuity and vessel tortuosity, and hyperopia/presbyopia. Significantly, however, the claims folder contains no competent evidence associating an eye disorder that the veteran experiences to his active military duty. Competent medical evidence of a nexus between current disability and the veteran's military service is required for a finding of a well-grounded claim. See Jones v. Brown, 7 Vet.App. 134 (1994). Such evidence is lacking in this case. In other words, no one with sufficient expertise has provided an opinion that the veteran has an eye disorder, either having its onset during service or as the product of continued symptoms since service. Consequently, the veteran's claim for service connection for an eye disorder must be found to be not well grounded. Caluza, supra. F. Cardiovascular Disorder Manifested by a Heart Murmur and Fluttering With regard to the claim of entitlement to service connection for a cardiovascular disorder manifested by a heart murmur and fluttering, the veteran asserted in the statement received at the RO in October 1997 and in an undated statement received in November 1997 that, during active duty in August 1943, he was treated for a "blowing systolic heart murmur." In this same statement, the veteran also asserted that in December 1991 he was treated by a physician for his heart which was "skipping beats." In the undated statement received at the RO in November 1997, the veteran maintained that, during service in September 1944, he was diagnosed as having a "fluttering of the heart." In the notice of disagreement which was received at the RO in May 1998, the veteran explained that he was treated for his heart at the VA Hospital in Huntington, West Virginia from February to March 1998 and that he was scheduled to undergo an upper gastrointestinal series later in May 1998. In a June 1998 statement, the veteran again asserted that his heart trouble began during service. In a statement received at the RO in August 1998, the veteran maintained that his heart condition had been related to a sinus rhythm problem and that he had been placed on medication for this problem. At the June 1999 personal hearing, the veteran testified that, during service, he was treated for a heart murmur and a fluttering of his heart. 1999 T. at 31-33. According to the veteran's testimony, he had these symptoms in 1943 and continued to experience them at the time of his discharge in 1945. 1999 T. at 32. The veteran testified that he reported this symptomatology at a treatment session at a VA medical facility in 1946. 1999 T. at 33. He was given medication. 1999 T. at 33. Additionally, the veteran noted that he currently has an atrial fibrillation and that, in 1997, he underwent heart surgery. 1999 T. at 33-34. According to the veteran's testimony, he has received treatment since 1946, but only records from 1989 are available. 1999 T. at 34-35. The veteran also testified that, between 1958 and 1979, he was treated by a doctor but did not specify the disabilities for which he was treated and did not believe that the records were available. 1999 T. at 36-37. The veteran stated that he is currently receiving treatment for his heart condition. 1999 T. at 22. According to the service medical records, an August 1943 physical examination demonstrated the presence of a blowing systolic murmur at the apex, regular rhythm, and sounds of good quality. At a subsequent evaluation completed in September 1944, the veteran complained of a "fluttering" of his heart for the previous four months as well as some joint pain in his elbow. Examination revealed a normal heart rhythm and rate and the absence of a murmur. In January 1945, the veteran's heart had a normal rate and rhythm and was not enlarged to percussion. Chest x-rays taken in August 1945 were negative. The November 1945 separation examination failed to note any complaints of, treatment for, or findings of a cardiovascular disorder manifested by a heart murmur or fluttering. In fact, this evaluation specifically demonstrated that the veteran's cardiovascular system was normal. According to the post-service medical records, at the July 1958 VA examination, the veteran failed to make any complaints referable to his heart. Furthermore, this evaluation demonstrated that the veteran's cardiovascular system, including his thrust, size, rhythm, and sounds were normal. Chest x-rays were normal. While in the sitting position, the veteran had blood pressure of 130/80. No cardiovascular disorder was diagnosed. A December 1991 private medical record indicates that the veteran complained of his "heart skipping." Interpretations of a poor baseline and probable junctional rhythm were provided. Approximately one-and-a-half weeks later, the veteran returned for follow-up treatment. According to this report, the veteran had "phoned in" one telemetry strip which showed "just a PAC [premature atrial contraction]." At the December 1991 treatment session, the veteran reported that he continued to experience palpitations but no other symptoms. The examining physician, who had reviewed the veteran's laboratory results, explained that the veteran had a negative stress test at 10.1 METS, a Holter monitor which demonstrated only occasional atrial premature contractions and ventricular premature contractions, and an echocardiogram which reflected normal left ventricle function. A cardiopulmonary evaluation completed in February 1992 demonstrated no edema; flat neck veins; regular, unlabored, and clear breathing patterns and sounds; and no cough. Thereafter, in February 1998, the veteran was hospitalized for approximately one week with complaints of chest pain and palpitations while shoveling snow. He explained that his chest pain was a pressure-type pain across his chest with no radiation, shortness of breath, sweating, nausea, or vomiting. He reported that he felt his heart skip beats later that evening and that he had experienced such episodes in the past (approximately five times in the last 50 years). He stated that the last such episode occurred in 1989. In the following month, the veteran was hospitalized for approximately one-and-a-half weeks for an electrical cardioversion. Diagnoses included paroxysmal atrial conversion status post cardioversion (currently normal sinus rhythm), and hypertension. The Board acknowledges the veteran's contentions that he has a current heart problem which began during service. See 1999 T. at 22, 31-37. In this regard, the Board notes that the service medical records reflect the presence of a blowing systolic murmur at the apex in August 1943 as well as a "fluttering" of the veteran's heart in September 1944. Importantly, however, neither the remainder of the service medical records nor the separation examination provide any competent evidence of a cardiovascular disorder. In fact, the first competent evidence of a heart disorder is dated in December 1991, when, following complaints of "heart skipping," interpretations of a poor baseline and probable junctional rhythm were provided. Approximately one-and-a-half weeks later, a telemetry strip showed "just a PAC" and a Holter monitor demonstrated only occasional atrial premature contractions and ventricular premature contractions. In March 1998, the veteran was hospitalized for approximately one-and-a-half weeks for an electrical cardioversion. Diagnoses included paroxysmal atrial conversion status post cardioversion (currently normal sinus rhythm), and hypertension. Significantly, however, the claims folder contains no competent evidence associating a cardiovascular disorder that the veteran may currently have to his active military duty. Competent medical evidence of a nexus between current disability and the veteran's military service is required for a finding of a well-grounded claim. See Jones v. Brown, 7 Vet.App. 134 (1994). Such evidence is lacking in this case. In other words, no one with sufficient expertise has provided an opinion that what the veteran has now is attributable to military service, or more specifically to the murmur or fluttering noted in service. Consequently, the veteran's claim for service connection for a cardiovascular disorder must be found to be not well grounded. Caluza, supra. The provisions allowing for a presumption of service incurrence or aggravation of cardio-vascular renal disease or hypertension, 38 C.F.R. §§ 3.307, 3.309, do not aid the veteran in this case because no competent evidence showing such a problem to a compensable degree within a year of service has been presented. G. Back Disability With regard to the claim of entitlement to service connection for a back disability, the veteran asserted, in the statement received at the RO in October 1997, that he was treated in April 1996 for pulled back and groin muscles and that in June 1996 he was treated for lower back strain and groin strain. The veteran expressed his belief that his back problems "stemmed from . . . service." In the undated statement received at the RO in November 1997, the veteran maintained that, during service in December 1944, he was diagnosed as having sharp pains in his lower back. In the June 1998 statement, the veteran asserted that he injured his back as a result of a bomb explosion. In a statement received at the RO in August 1998, the veteran referred to arthritis in his lower back. Thereafter, at the June 1999 personal hearing, the veteran testified that, on at least three occasions during his active service, he complained of, and was treated for, a low back condition. 1999 T. at 37-38. According to the veteran's testimony, he has the same low back symptoms now that he had during service and at the time of his discharge from active duty. 1999 T. at 38. The veteran described this symptomatology to include pain on walking. 1999 T. at 38-39. He stated that he is currently receiving treatment for his back condition. 1999 T. at 22. According to the service medical records, following treatment for acute epididymitis in December 1944, the veteran complained of pain (of moderate distress) radiating into his back and lower abdomen. He reported little improvement with bed rest and elevation. Two days later, the veteran stated that he continued to experience a sharp pain over the "small" of his back when he walked. The November 1945 separation examination failed to note any complaints of, treatment for, or findings of a back disability. In fact, this evaluation specifically revealed that the veteran's spine and extremities were normal. A private medical record dated in April 1996 indicates that the veteran was treated for a groin strain which began when his right foot slipped while he was digging. The veteran, however, made no complaints of back symptomatology at that time. Additionally, no back pathology was noted, or diagnosed, on this treatment record. The Board acknowledges the veteran's contentions that he has a low back disorder which originated during his active military duty. See 1999 T. at 22, 37-39. In this regard, the Board notes that the service medical records reflect complaints of back pain following treatment for acute epididymitis in December 1944. Importantly, however, the remainder of the service medical records, the separation examination, and the post-service medical records fail to provide any competent evidence of a back disability. Significantly, the claims folder contains no competent evidence associating any back disability to the veteran's active military duty. As discussed above, competent medical evidence of a nexus between current disability and the veteran's military service is required for a finding of a well-grounded claim. See Jones v. Brown, 7 Vet.App. 134 (1994). Such evidence is lacking in this case. Additionally, despite the veteran's argument to the contrary, no competent evidence has been presented to show arthritis, especially a diagnosis of arthritis within a year of the veteran's separation of service. 38 C.F.R. §§ 3.307, 3.309. Consequently, the veteran's claim for service connection for a back disability must be found to be not well grounded. Caluza, supra. ORDER Service connection for scars of the right leg and buttocks is denied. Service connection for Hodgkin's disease is denied. Service connection for scars on the ears and neck is denied. Service connection for a node behind the left ear is denied. Service connection for an eye disorder is denied. Service connection for a cardiovascular disorder manifested by a heart murmur and fluttering is denied. Service connection for a back disability is denied. REMAND Previously, by an August 1958 rating action, the RO confirmed a previous denial of service connection for dengue fever and also denied service connection for mononucleosis and lymphadenitis. In the same month, the RO notified the veteran of the denial. However, the veteran failed to submit a timely notice of disagreement with this denial. Consequently, the August 1958 decision as to these issues became final. 38 C.F.R. § 19.2 (1958). Additionally, by a December 1958 decision, the Board denied service connection for residuals of a bayonet wound of the fifth finger of the right hand and of the left anterior chest. The Board's December 1958 denial of these claims is final. 38 U.S.C.A. § 7104(b) (West 1991); 38 C.F.R. § 20.1100 (1999). Claims of service connection for dengue fever, mononucleosis, and lymphadenitis may now be considered on the merits only if "new and material" evidence has been received since the time of the RO's August 1958 rating action. Additionally, claims of service connection for a right hand disability and for residuals of a wound to the left chest may now be considered on the merits only if "new and material" evidence has been received since the time of the Board's December 1958 decision. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156 (1999); Manio v. Derwinski, 1 Vet.App. 140, 145 (1991); Evans v. Brown, 9 Vet.App. 273 (1996). In this regard, the Board notes that, in September 1998, the United States Court of Appeals for the Federal Circuit (Federal Circuit) issued an opinion which overturned the test for materiality established in Colvin v. Derwinski, 1 Vet.App. 171, 174 (1991) (the so-called "change in outcome" test). See Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). The Federal Circuit in Hodge mandated that materiality be determined solely in accordance with the definition provided in 38 C.F.R. § 3.156(a). Review of the record in the present case reveals that the RO, in its rating actions, statements of the case, and supplemental statement of the case, employed the now-invalidated Colvin test when addressing the veteran's claims to reopen. This is significant because the Court has held that, when the Board proposes to address in its decision a question that has not yet been addressed by the RO, the Board must consider whether the claimant has been given adequate notice of the need to submit evidence or argument on the question, whether he has been given an adequate opportunity to actually submit such evidence and argument, and whether the SOC and/or supplemental statement of the case (SSOC) fulfills the regulatory requirements. See 38 C.F.R. § 19.29 (1999). If not, the matter must be remanded in order to avoid prejudice to the claimant. Bernard v. Brown, 4 Vet.App. 384, 393 (1993). In this regard, the Board notes that the veteran has not yet been afforded an opportunity to present his case solely within the context of § 3.156(a). Nor has the RO considered the § 3.156(a) standard alone, without consideration the Colvin "change in outcome" test. Consequently, in order to ensure that the veteran receives full due process of law and that the possibility of prejudice is avoided, the Board will remand the claims to reopen to the RO. 38 C.F.R. § 19.9 (1999). For the reasons stated, the claims to reopen are REMANDED to the RO for the following actions: 1. The RO should contact the veteran and inform him of his right to present additional argument and/or evidence on his claims to reopen (i.e., the issues of whether new and material evidence has been received sufficient to reopen previously denied claims of entitlement to service connection for dengue fever, mononucleosis, lymphadenitis, a right hand disability and residuals of a wound to the left chest). The additional material received, if any, should be associated with the claims folder. 2. The RO should make an effort to ensure that all relevant records of VA treatment have been obtained for review, including records of any recent follow-up treatment that the veteran may have received. The additional material received, if any, should be associated with the claims folder. 3. Thereafter, the RO should take adjudicatory action on the veteran's claims to reopen. In so doing, the RO should consider and apply the provisions of 38 C.F.R. § 3.156(a) as the sole definition of new and material evidence. If any benefit sought with respect to these four claims is denied, a SSOC should be issued. The SSOC should contain, in particular, a summary of the provisions of 38 C.F.R. § 3.156(a) and a discussion of how they affect the RO's determination. 38 C.F.R. §§ 19.29, 19.31 (1999). Consideration should be given to the entire record, including evidence submitted since issuance of the latest SSOC. After the veteran and his representative have been given an opportunity to respond to the SSOC, the claims folders should be returned to this Board for further appellate review. No action is required by the veteran until he receives further notice, but he may furnish additional evidence and argument while the case is in remand status. Booth v. Brown, 8 Vet.App. 109 (1995); Quarles v. Derwinski, 3 Vet.App. 129, 141 (1992); Kutscherousky v. West, 12 Vet. App. 369 (1999). The purpose of this remand is to comply with governing adjudicative procedures. The Board intimates no opinion, either legal or factual, as to the ultimate disposition of these remanded issues. These claims must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44- 8.45 and 38.02-38.03. MARK F. HALSEY Member, Board of Veterans' Appeals