Citation Nr: 0002603 Decision Date: 02/02/00 Archive Date: 02/10/00 DOCKET NO. 98-07 067 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office in Jackson, Mississippi THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disability, including post-traumatic stress disorder. 2. Entitlement to service connection for a chancroid with lymphadenitis. 3. Entitlement to service connection for a disability manifested by occult blood/red blood cells in the urine or dysuria, including a kidney disorder. 4. Entitlement to service connection for a disability manifested by abdominal pain/vomiting, including dysentery and cholera. 5. Entitlement to service connection for a disability manifested by jaundice, including hepatitis and cirrhosis of the liver. 6. Entitlement to service connection for defective hearing. 7. Entitlement to service connection for hypertension. 8. Entitlement to service connection for a disability manifested by dizziness or fatigue. 9. Entitlement to service connection for a dental disability. 10. Whether appellant has filed a timely Substantive Appeal with respect to a June 6, 1979 rating decision (which denied service connection for a right knee disability, left ear otitis media, Gilbert's syndrome/disease with hyperbilirubinemia, residuals of fractures of the right 2nd, 3rd, and 4th toes, and tuberculosis) and an October 23, 1979 rating decision (which denied service connection for Gilbert's syndrome/disease with hyperbilirubinemia and tuberculosis). 11. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a liver disorder, classified as Gilbert's syndrome/disease with hyperbilirubinemia. 12. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for tuberculosis. 13. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for left ear otitis media. 14. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a right knee disability. ATTORNEY FOR THE BOARD R.P. Harris, Counsel INTRODUCTION Appellant had active service from June 1974 to June 1977. He reportedly was on inactive Army Reserve status for a period after service. This matter came before the Board of Veterans' Appeals (Board) on appeal from an April 1998 rating decision by the Jackson, Mississippi, Regional Office (RO), which denied service connection for an acquired psychiatric disability (including post-traumatic stress disorder), a chancroid with lymphadenitis, a disability manifested by dysuria, a kidney disorder, dysentery, cholera, a disability manifested by jaundice, hepatitis, defective hearing, and a dental disability; denied the issue of whether appellant has filed a timely Substantive Appeal with respect to a June 6, 1979 rating decision (which denied service connection for a right knee disability, left ear otitis media, Gilbert's syndrome/disease with hyperbilirubinemia, residuals of fractures of the right 2nd, 3rd, and 4th toes, and tuberculosis) and an October 23, 1979 rating decision (which denied service connection for Gilbert's syndrome/disease with hyperbilirubinemia and tuberculosis); and denied the issues of whether new and material evidence has been submitted to reopen claims of entitlement to service connection for a liver disorder (classified as Gilbert's syndrome/disease with hyperbilirubinemia), tuberculosis, and left ear otitis media. Appellant subsequently appealed a January 1999 rating decision which denied service connection for cirrhosis of the liver, hypertension, a disability manifested by dizziness, a disability manifested by fatigue, a disability manifested by abdominal pain/vomiting, and a disability manifested by occult blood/red blood cells in the urine; and denied the issue of whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a right knee disability. Although in certain written documents, appellant requested that a Board hearing be held, he subsequently submitted a September 1999 written statement wherein he expressly withdrew his hearing request. Thus, the matter has been referred to the Board for review of the evidence of record. Accordingly, the Board construes the issues on appeal as those delineated on the title page of this decision and will render a decision herein on said issues. To the extent the appellant may desire consideration of additional issues, he should raise them with specificity at the RO. The issues listed above are the only ones developed for appellate consideration at this time. FINDINGS OF FACT 1. It has not been shown, by competent evidence, that appellant has an acquired psychiatric disability, including post-traumatic stress disorder, a chancroid with lymphadenitis, a disability manifested by occult blood/red blood cells in the urine or dysuria, including a kidney disorder, a disability manifested by abdominal pain/vomiting, including dysentery and cholera, a disability manifested by jaundice, including hepatitis and cirrhosis of the liver, defective hearing, hypertension, or a disability manifested by dizziness or fatigue related to service or any in-service occurrence or event. 2. The appellant does not have a service-connected compensable dental condition. He did not apply for treatment for a noncompensable dental condition in a timely manner after separation from service. He does not have any dental condition due to a combat wound or other in-service dental trauma. He was not a prisoner-of-war. He does not have a dental condition aggravating a service-connected disability. A total disability compensation rating is not in effect. He is not participating in a VA rehabilitation program. He does not have a dental condition clinically determined to be complicating a medical condition currently under treatment. Outpatient emergency dental care has not been initiated. 3. By a June 6, 1979 rating decision, the RO denied service connection for a right knee disability, left ear otitis media, Gilbert's syndrome/disease with hyperbilirubinemia, residuals of fractures of the right 2nd, 3rd, and 4th toes, and tuberculosis. Later that month, appellant was sent written notice of that adverse rating decision with his procedural and appellate rights. In a July 31, 1979 letter to the RO, appellant referred to said claims as having been denied service connection; asserted that tuberculosis and a liver condition should be service-connected; and stated that his claim should be re-evaluated. However, he did not file a timely Notice of Disagreement in writing with the June 1979 rating decision in question. 4. By an October 23, 1979 rating decision, the RO referred to appellant's July 31, 1979 "reopened claim" for service connection for a liver condition and tuberculosis; and confirmed its denial of service connection for a liver condition/hyperbilirubinemia and tuberculosis. Appellant was sent written notice of that adverse rating decision the following month. 5. In a written statement dated and received in July 1980, appellant filed a timely Notice of Disagreement as to the October 23, 1979 rating decision's denial of his reopened claim for service connection for a liver condition. However, although later that month, the RO issued appellant a Statement of the Case that addressed the issues of service connection for liver and lung conditions and, in an accompanying notice of his appellate rights with respect to filing a substantive appeal, informed him that he should specifically identify the issues being appealed and respond within 60 days to perfect an appeal, a timely Substantive Appeal was not received by the RO. 6. The evidentiary record does not contain a document that may be construed as a timely Substantive Appeal with regard to said service connection issues denied by said June 6, 1979 and October 23, 1979 rating decisions. 7. Additional evidence submitted subsequent to said unappealed June 6, 1979 and October 23, 1979 rating decisions, insofar as they denied service connection for a right knee disability, left ear otitis media, Gilbert's syndrome/disease with hyperbilirubinemia, and tuberculosis, when viewed in the context of all the evidence, does not bear directly and substantially upon the specific matter under consideration and is not so significant that it must be considered in order to fairly decide the merits of the claims. CONCLUSIONS OF LAW 1. Appellant has not submitted evidence of well-grounded claims for entitlement to service connection for an acquired psychiatric disability, including post-traumatic stress disorder; a chancroid with lymphadenitis; a disability manifested by occult blood/red blood cells in the urine or dysuria, including a kidney disorder; a disability manifested by abdominal pain/vomiting, including dysentery and cholera; a disability manifested by jaundice, including hepatitis and cirrhosis of the liver; defective hearing; hypertension; or a disability manifested by dizziness or fatigue. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(a) (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1999). 2. The claim for service connection for a dental disability lacks legal merit or entitlement under the law. 38 U.S.C.A. § 1712 (West 1991); 38 C.F.R. §§ 3.381, 4.149, 17.161-17.165 (1999); Sabonis v. Brown, 6 Vet. App. 426 (1994). 3. A timely Substantive Appeal was not filed with respect to a June 6, 1979 rating decision (which denied service connection for a right knee disability, left ear otitis media, Gilbert's syndrome/disease with hyperbilirubinemia, residuals of fractures of the right 2nd, 3rd, and 4th toes, and tuberculosis) and an October 23, 1979 rating decision (which denied service connection for Gilbert's syndrome/disease with hyperbilirubinemia and tuberculosis). 38 U.S.C.A. §§ 7105 (West 1991); 38 C.F.R. §§ 38 C.F.R. §§ 20.200, 20.201, 20.202, 20.302(a),(b) (1999). 4. Evidence received subsequent to the final June 6, 1979 and October 23, 1979 rating decisions, to the extent they denied service connection for a right knee disability, left ear otitis media, Gilbert's syndrome/disease with hyperbilirubinemia, and tuberculosis, is not new and material, and the claims are not reopened. 38 U.S.C.A. §§ 5108, 7105 (West 1991); 38 C.F.R. §§ 3.104(a), 3.156(a), 20.302(a) (1999); Manio v. Derwinski, 1 Vet. App. 140 (1991); Hodge v. West, 155 F. 3d 1356 (Fed. Cir 1998). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Entitlement to Service Connection for an Acquired Psychiatric Disability, Including Post-traumatic Stress Disorder; a Chancroid with Lymphadenitis; a Disability Manifested by Occult Blood/Red Blood Cells in the Urine or Dysuria, Including a Kidney Disorder; a Disability Manifested by Abdominal Pain/Vomiting, Including Dysentery and Cholera; a Disability Manifested by Jaundice, Including Hepatitis and Cirrhosis of the Liver; Defective Hearing; Hypertension; and a Disability Manifested by Dizziness or Fatigue A threshold question to be answered is whether appellant has presented evidence of well-grounded claims with respect to the issues of service connection for an acquired psychiatric disability, including post-traumatic stress disorder; a chancroid with lymphadenitis; a disability manifested by occult blood/red blood cells in the urine or dysuria, including a kidney disorder; a disability manifested by abdominal pain/vomiting, including dysentery and cholera; a disability manifested by jaundice, including hepatitis and cirrhosis of the liver; defective hearing; hypertension; and a disability manifested by dizziness or fatigue. A well- grounded claim is one which is plausible, meritorious on its own, or capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78 (1990). In Tirpak v. Derwinski, 2 Vet. App. 609 (1992), the United States Court of Appeals for Veterans Claims (formerly the United States Court of Veterans Appeals) (Court) held that the appellant in that case had not presented a well-grounded claim as a matter of law. The Court pointed out that "unlike civil actions, the Department of Veterans Affairs (previously the Veterans Administration) (VA) benefits system requires more than an allegation; the claimant must submit supporting evidence." Id., at 611. If a well-grounded claim has not been presented, the appeal with respect to that issue must fail. King v. Brown, 5 Vet. App. 19, 21 (1993) held that "evidentiary assertions [by the veteran] must also be accepted as true for the purpose of determining whether the claim is well grounded. Exceptions to this rule occur when the evidentiary assertion is inherently incredible or when the fact asserted is beyond the competence of the person making the assertion." It should be added that with respect to these not well- grounded service connection claims, appellant and his then representative have been informed by the RO of the specific reasons that the claims were denied. See, in particular, a May 1998 Statement of the Case; and January and April 1999 Supplemental Statements of the Case. Additionally, those Statements included provisions of law with respect to veterans' responsibility for filing a well-grounded claim and service connection principles. It is therefore apparent that they were knowledgeable regarding the necessity of competent evidence to support these service connection claims. Thus, it is concluded that appellant and his then representative had notice of the type of information needed to support these claims and complete the application. See Robinette v. Brown, 8 Vet. App. 69, 77 (1995). See also Epps v. Brown, 9 Vet. App. 341, 344 (1996), wherein the Court explained that "[t]he Robinette opinion held that 38 U.S.C. § 5103(a) imposes an obligation upon the Secretary to notify an individual of what is necessary to complete the application in the limited circumstances where there is an incomplete application which references other known and existing evidence." It does not appear that appellant or his representative has informed the VA of the existence of any specific competent evidence that would, if obtained, render these service connection claims well grounded. It should be added that the RO has sought and obtained appellant's available service medical records and has attempted to obtain any other pertinent military records. Additionally, in December 1998, the RO scheduled appellant for a number of VA examinations with respect to the claimed service connection conditions. However, in written statements dated later that month, appellant alleged certain misconduct by the VA; referred to the scheduled VA examinations; and advised the RO that he would not attend any VA examinations. After receiving these December 1998 written statements from appellant, the VA examinations scheduled for January 1999 were canceled. Although it is conceivable that if appellant had cooperated and attended said VA examinations, additional medical information may have been obtained to support his service connection claims, in any event such examinations were not legally necessary because said service connection claims are not well grounded. Recently, the Court issued a decision holding that VA cannot assist a claimant in developing a claim which is not well grounded. Morton v. West, 12 Vet. App. 477 (July 14, 1999), req. for en banc consideration by a judge denied, No. 96-1517 (U.S. Vet. App. July 28, 1999) (per curiam). It should be added that, in a February 1999 written statement, appellant stated that he did not have any additional evidence to submit. In Caluza v. Brown, 7 Vet. App. 498, 506 (1995), the Court stated, in pertinent part, that "in order for a claim to be well grounded, there must be competent evidence of current disability (a medical diagnosis)...; of incurrence or aggravation of a disease or injury in service (lay or medical evidence)...; and of a nexus between the in-service injury or disease and the current disability (medical evidence)...." See also Wade v. West, 11 Vet. App. 302, 306 (1998), wherein the Court held that the claims in that case were not well grounded, since although service medical records were missing and there was evidence of present disability, the record did not contain medical evidence of a causal relationship between the current disability and service. Service connection for VA disability compensation purposes may be awarded for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131. In pertinent part, 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 only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic, or where the diagnosis of chronicity may legitimately be 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 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). A. Service Connection for an Acquired Psychiatric Disability, Including Post-traumatic Stress Disorder Appellant alleges having had certain difficulties during basic training. Additionally, he contends that during service, he did not adjust well to being assigned to Korea and that his nervous disorder was initially manifested therein. It is also asserted that he has a post-traumatic stress disorder. However, appellant is not competent to offer medical opinion or diagnosis. See Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1991). Appellant's service medical records reveal that in December 1975, after being assigned to Korea for 13 days, a psychiatric consultation was requested after he attempted to shoot two Korean soldiers (one of whom was on guard duty with appellant) on November 30th of that year. He appeared incoherent and under the influence of drugs and, while enroute to a hospital, twice jumped out of a jeep. The next day, he stated that he could not remember anything that had occurred the previous day; and he requested a service discharge. He appeared confused and indifferent to authority and complained of wanting to be discharged from service. He was hospitalized for two days in early December 1975 for diagnosed acute, transient situational disturbance, manifested by an inability to cope with assignment as a newly arrived guard in Korea; and he was placed on a temporary physical profile, restricting his access to weapons for 60 days with the recommendation for a transfer to another unit. Significantly, the remainder of his service medical records, including a March 1977 service separation examination, did not reveal any complaints, findings, or diagnoses pertaining to a chronic acquired psychiatric disability. An initial application for VA disability benefits dated in April 1978, VA clinical records dated in 1978, and a May 1979 VA examination report did not include any reference to a chronic acquired psychiatric disability. On December 1997 VA psychiatric examination, more than two decades after service, appellant reported that during service, he had "flipped out" and shot at two Korean soldiers and was treated a few days on a psychiatric ward; that in 1996, he was involved in two accidents and felt that someone was trying to kill him because the two accidents had happened close together; and that he had left a job in 1977 after sustaining an injury. On mental status evaluation, he appeared anxious. Anxiety disorder was diagnosed. However, the examiner did not relate the anxiety disorder to service. Furthermore, the examiner specifically opined that the appellant's symptomatology did not satisfy the criteria for a diagnosis of a post-traumatic stress disorder. Appellant has not submitted any medical evidence that indicates he has a chronic acquired psychiatric disability related to service or that a post-traumatic stress disorder has even been diagnosed. A grant of service connection for post-traumatic stress disorder requires, in part, a diagnosis of a post- traumatic stress disorder. See 38 C.F.R. § 3.304(f) (1999); and Cohen v. Brown, 10 Vet. App. 128 (1997). Thus, given the lack of competent clinical evidence showing that appellant has a post-traumatic stress disorder or any other chronic acquired psychiatric disability related to service, the claim for service connection for an acquired psychiatric disability, including post-traumatic stress disorder, is not well grounded. The claim is therefore denied. 38 U.S.C.A. § 5107(a). Grottveit v. Brown, 5 Vet. App. 91 (1993); Grivois v. Brown, 6 Vet. App. 136 (1994). See also, Edenfield v. Brown, 8 Vet. App. 384, 390 (1995). B. Service Connection for a Chancroid with Lymphadenitis Appellant alleges that he incurred a chancroid with lymphadenitis during service. While the Board has considered his statements, they do not constitute competent evidence with respect to medical causation, diagnosis and treatment. Espiritu. Appellant's service medical records reveal that in February 1976, a rash on the penile glans was reported after sexual contact. He complained of a "burning" sensation on urination. The assessment was rule out gonorrhea; and penicillin was prescribed. In April 1976, he complained of dysuria with penile lesion. Clinically, a small laceration of the penile foreskin with lymphadenopathy was noted. Laboratory studies confirmed gonorrhea; and gonorrhea was assessed. In June 1976, a penile knot was reported. On August 18th of that year, he complained of soreness in the groins for two days. Clinically, there were small, mildly tender lymph nodes and a small lesion on the penile head. The assessment was small ulcer/questionable chancroid. On August 23rd of that year, he was seen in an emergency room for groin swelling and was admitted to a hospital for a few days due to chancroid. The final diagnosis was lymphadenitis. Later that month, he was placed on a temporary physical profile for inflamed lymph nodes in the groin. Significantly, however, the remainder of appellant's service medical records, including a March 1977 service separation examination, did not reveal any complaints, findings, or diagnoses pertaining to a chancroid with lymphadenitis. An initial application for VA disability benefits dated in April 1978, VA clinical records dated in 1978, and a May 1979 VA examination report did not include any reference to a chancroid with lymphadenitis. In fact, on that May 1979 VA examination, no lymphadenopathy was clinically noted and the genitourinary system was described as unremarkable. On December 1997 VA general medical examination, more than two decades after service, appellant reported that he had a left inguinal area knot ever since service in 1976; and that an in-service knot on the right side had resolved. Clinically, there was a soft tissue mass noted as apparently a lipoma; and a probable left inguinal area lipoma was diagnosed. On December 1997 VA dermatologic examination, he alleged having had a left inguinal area knot and right scrotal cyst since service. Color photographs revealed a left groin mass and a scrotal lesion (apparently on the right). Parenthetically, in Anglin v. West, 11 Vet. App. 361, 365 (1998), a lipoma was defined as a benign tumor composed of fatty tissue. According to Dorland's Illustrated Medical Dictionary, 286 (24th ed. 1965), a chancroid is defined as "[a]n infection caused by Hemophilus ducreyi. It begins as a pustule on the genitals, forming soon after inoculation; it grows rapidly, and finally breaks down into a virulent ulcer, discharging pus." However, a chancroid or lymphadenitis has not been clinically reported or diagnosed post service. Appellant has not submitted any competent evidence indicating that the lipoma or scrotal lesion shown on December 1997 VA examination more than two decades after service is a manifestation or residual of the in-service chancroid/lymphadenitis. Thus, given the lack of competent clinical evidence showing that appellant has a chancroid with lymphadenitis related to service, the claim for service connection for a chancroid with lymphadenitis is not well grounded. The claim is therefore denied. 38 U.S.C.A. § 5107(a); Caluza; Grottveit; Grivois; and Edenfield. C. Service Connection for a Disability Manifested by Occult Blood/Red Blood Cells in the Urine or Dysuria, Including a Kidney Disorder Appellant alleges that he incurred a disability manifested by occult blood/red blood cells in the urine or dysuria, including a kidney disorder, during service. Parenthetically, according to Dorland's, supra, at p. 460, dysuria is defined as "[p]ainful or difficult urination." While the Board has considered appellant's statements, they do not constitute competent evidence with respect to medical causation, diagnosis and treatment. Espiritu. Appellant's service medical records reveal that in February 1976, a rash on the penile glans was reported after sexual contact. He complained of a "burning" sensation on urination. The assessment was rule out gonorrhea; and penicillin was prescribed. In April 1976, he complained of dysuria with penile lesion. Clinically, there was a yellowish, thick urinary discharge. Gonorrhea was assessed. In May 1976, a urinalysis revealed some white and red blood cells. The impression was questionable hemorrhagic cystitis. An antibiotic was prescribed. In July and August 1976, he complained of dysuria and urinalyses revealed some white and red blood cells. An August 1976 urinalysis revealed "1+" occult blood and some white and red blood cells. An October 1976 urinalysis revealed some white blood cells but no occult blood. Significantly, however, the remainder of appellant's service medical records, including a March 1977 service separation examination, did not reveal any complaints, findings, or diagnoses pertaining to a disability manifested by dysuria, including a kidney disorder. In fact, a urinalysis was unremarkable. On February 1978 VA hospitalization, several months after service, a urinalysis revealed some red blood cells, but said finding was not confirmed on repeat urinalyses, which showed some white blood cells but no occult blood or red blood cells. At hospital discharge, a urinalysis revealed some red blood cells. Probable Gilbert's disease was diagnosed. Parenthetically, according to Dorland's, supra, at p. 460, Gilbert's disease [syndrome] is defined as "the congenital forms of hemolytic jaundice." However, a VA medical record dated in March 1978 assessed resolving hepatitis B and noted that he did not have Gilbert's syndrome. On May 1979 VA examination, appellant's genitourinary system was clinically unremarkable. A urinalysis revealed some red blood cells, but no occult blood. A disability manifested by occult blood/red blood cells in the urine or dysuria, including a kidney disorder, was not diagnosed. A December 1997 VA examination report did not contain any complaints, findings, or diagnoses pertaining to a disability manifested by occult blood/red blood cells in the urine or dysuria, including a kidney disorder. A February 1998 private renal ultrasound study was conducted because of hematuria. The kidneys were normal, except for a 1.2 cm, right upper pole cyst that was incidentally noted. However, there is no competent evidence of record indicating that the renal cyst, initially shown more than two decades after service, is related to service or the in-service dysuria/occult blood/red blood cells in the urine. In August 1998, appellant submitted a medical publication article pertaining to urinalyses. In part, the article stated that "[m]icroscopic examination may reveal the presence of red blood cells in the urine, indicating damage to the glomeruli (filtering units) of the kidneys or a disorder of the remaining kidney and upper and lower urinary tract." In Sacks v. West, 11 Vet. App. 314 (1998), the Court held that a medical article that included a generic statement to the effect that a disease usually presents with certain symptoms and that a certain symptom often is the first symptom of the condition was too general to satisfy the nexus element of a well-grounded service connection claim. In Sacks, at 11 Vet. App. 314, 316, the Court cited to Libertine v. Brown, 9 Vet. App. 521 (1996), which held that, for purposes of determining whether a claim is well grounded, medical treatise evidence proffered by an appellant in connection with his lay testimony was insufficient to satisfy the requirement of medical evidence of nexus because "'none of [the treatise evidence] provides medical evidence demonstrating a causal relationship between this appellant's service-connected [post-traumatic stress disorder] and his alcohol and drug abuse.'" An exception would be "where medical article or treatise evidence, standing alone, discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion. However, that is not the case here. The statement that pemphigus vulgaris 'usually presents...with erosion of mucous membranes...,' cannot be used by a lay person to evaluate meaningfully the facts of a specific case because it in no way addresses - let alone, eliminates - the possibility of the existence of other conditions that also often present with the same symptomatology." Sacks, at 317. The critical point is that there is no competent evidence indicating that appellant currently has a disability manifested by occult blood/red blood cells in the urine or dysuria, including a kidney disorder, related to service. Nor is there any competent evidence of record indicating with a degree of certainty that there is any nexus between the in- service occult blood/red blood cells in the urine or dysuria and the post-service renal cyst, such as evidence that addresses or eliminates the existence of other potential causes of occult blood/red blood cells in the urine or dysuria. Thus, given the lack of competent clinical evidence showing that appellant has a disability manifested by occult blood/red blood cells in the urine or dysuria, including a kidney disorder, related to service, the claim for service connection for a disability manifested by occult blood/red blood cells in the urine or dysuria, including a kidney disorder, is not well grounded. The claim is therefore denied. 38 U.S.C.A. § 5107(a); Caluza; Grottveit; Grivois; and Edenfield. D. Service Connection for a Disability Manifested by Abdominal Pain/Vomiting, Including Dysentery and Cholera Appellant alleges that he incurred a disability manifested by abdominal pain/vomiting, including dysentery and cholera, during service. Parenthetically, according to Dorland's, supra, at p. 455, dysentery is defined, in pertinent part, as "[a] term given to a number of disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen...." Additionally, in Dorland's, supra, at p. 297, cholera is defined, in pertinent part, as "[a] name applied to a condition marked by diarrhea and vomiting...." While the Board has considered appellant's statements, they do not constitute competent evidence with respect to medical causation, diagnosis and treatment. Espiritu. Appellant's service medical records reveal that in June 1976, he complained of diarrhea. Kaopectate was prescribed. Significantly, however, the remainder of appellant's service medical records, including a March 1977 service separation examination, did not reveal any complaints, findings, or diagnoses pertaining to a chronic disability manifested by abdominal pain/vomiting, including dysentery and cholera. An initial application for VA disability benefits dated in April 1978 and the post-service clinical evidence of record makes no reference to a chronic disability manifested by abdominal pain/vomiting, including dysentery and cholera. Appellant has not presented any competent evidence that indicates that a chronic disability manifested by abdominal pain/vomiting, including dysentery and cholera, is presently manifested and related to service. The Court, in Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992), held that, referring to the veteran in that case: He apparently is of the belief that he is entitled to some sort of benefit simply because he had a disease or injury while on active service. That, of course, is mistaken. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. § 1110 (formerly § 310). In the absence of proof of a present disability there can be no valid claim. Our perusal of the record in this case shows no claim of or proof of present disability. Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Thus, given the lack of clinical evidence showing that a chronic disability manifested by abdominal pain/vomiting, including dysentery and cholera, is presently manifested and related to appellant's service, the claim for service connection for a chronic disability manifested by abdominal pain/vomiting, including dysentery and cholera, is not well grounded. The claim is therefore denied. 38 U.S.C.A. § 5107(a). Caluza; Grottveit; Grivois; and Edenfield. E. Service Connection for a Disability Manifested by Jaundice, Including Hepatitis and Cirrhosis of the Liver Appellant alleges that he incurred a disability manifested by jaundice, including hepatitis and cirrhosis of the liver, during service. Parenthetically, according to Dorland's, supra, at p. 767, jaundice is defined, in pertinent part, as "[a] syndrome characterized by hyperbilirubinemia and deposition of bile pigment in the skin and mucous membranes with resulting yellow appearance of the patient." While the Board has considered appellant's statements, they do not constitute competent evidence with respect to medical causation, diagnosis and treatment. Espiritu. The service medical records, including a March 1977 service separation examination, did not reveal any complaints, findings, or diagnoses pertaining to a disability manifested by jaundice, including hepatitis and cirrhosis of the liver. It is of substantial import that the earliest post-service clinical evidence indicative of a disability manifested by jaundice, including hepatitis, was not until early 1978, several months after service. It should be pointed out that under 38 C.F.R. §§ 3.307 and 3.309, cirrhosis of the liver, but not hepatitis, is a disease for which service connection may be presumed to have been incurred or aggravated by service, if manifested to a compensable degree within a one- year post-service period, subject to certain rebuttable presumption provisions. During February 1978 VA hospitalization, serum blood studies revealed elevated indirect bilirubin; and the diagnoses included probable Gilbert's syndrome, rule out other causes of indirect hyperbilirubinemia. A liver/spleen nuclear isotope scan revealed mild hepatomegaly with some irregularity in the inferior border. It was noted that the irregularity in the inferior border might represent accentuation of the gall bladder fossa, although localized liver pathology could not be excluded. VA clinical records dated in March 1978 reflect that a liver biopsy was performed due to a preoperative diagnosis of indirect hyperbilirubinemia; and the liver biopsy pathologic diagnosis was chronic, nonspecific hepatitis, etiology undetermined. No hepatic cell necrosis was present; and there was no mention of any cirrhosis of the liver. A March 31, 1978 VA outpatient treatment report indicated that a liver biopsy had revealed nonspecific hepatitis with positive hepatitis B antibody but negative hepatitis B surface antigen; that appellant had a probable subclinical case of hepatitis B "at least 6 months ago"; and that his physician wanted to test liver enzymes at monthly intervals for "ongoing liver disease." The pertinent impressions were resolving hepatitis B; and that he did not have Gilbert's syndrome. An April 1978 VA outpatient treatment report noted that appellant complained of left upper quadrant tenderness. It was noted that appellant had previously been a VA employee and that jaundice and hepatitis had antedated VA employment. VA outpatient treatment reports reflect that in May 1978, liver enzymes were reported as "OK." In March 1979, the impression was status post hepatitis with slightly elevated indirect bilirubin. On May 1979 VA examination, nearly two years after service, the examiner noted that apparently appellant had had hepatitis that led to cirrhosis which caused hyperbilirubinemia; that currently, he had minimal jaundice of the sclerae with some liver enlargement; and that appellant felt that he had incurred it in Korea from food. The examiner remarked that the claims folder had not been made available to him. Clinically, the liver was slightly tender but without organomegaly. The examiner noted that although appellant felt his sclerae were yellowish in color, it was extremely mild, if in fact present. Laboratory studies revealed that total bilirubin was 1.2 (with normal values listed as .2 to 1.2). The diagnoses included "[l]iver condition, history primarily of cirrhosis with hepatomegaly associated with a hyperbilirubinemia." However, that diagnosis was crossed out and replaced by "[l]iver condition, Gilbert's syndrome w[ith] hyperbilirubinemia." A July 1985 VA outpatient treatment report indicates appellant complained of "chronic hepatitis." The assessment was rule out hepatitis. Clinically, there were no pertinent findings. The diagnoses included hyperbilirubinemia by history. It is significant that on December 1997 VA examination, there were no complaints, findings, or diagnoses pertaining to a disability manifested by jaundice, including hepatitis and cirrhosis of the liver. In fact, laboratory studies revealed that liver enzymes were within normal limits, including a total bilirubin value of .9. In August 1998, appellant submitted a medical publication article pertaining to hyperbilirubinemia, hepatitis, hepatomegaly, liver, cirrhosis, and jaundice. However, this medical publication article is too general to satisfy the nexus element of a well-grounded service connection claim with respect to this claim on appeal, since it does not provide information linking appellant's claimed jaundice, hepatitis, or cirrhosis to service or indicates that he currently has a disability manifested by jaundice, including hepatitis and cirrhosis of the liver. See Sacks. The critical point is that there is no competent evidence indicating that appellant currently has a disability manifested by jaundice, including hepatitis and cirrhosis of the liver related to service. It has not been shown from the record that he has disability due to hepatitis or cirrhosis or that he has active hepatitis/cirrhosis. As such, there is no entity to service connect. Thus, given the lack of competent clinical evidence showing that appellant has a disability manifested by jaundice, including hepatitis and cirrhosis of the liver, related to service, the claim for service connection for a disability manifested by jaundice, including hepatitis and cirrhosis of the liver, is not well grounded. The claim is therefore denied. 38 U.S.C.A. § 5107(a); Caluza; Grottveit; Grivois; and Edenfield. F. Service Connection for Defective Hearing It should be pointed out that under 38 C.F.R. §§ 3.307 and 3.309, sensorineural hearing loss (an organic disease of the nervous system) is a disease for which service connection may be presumed to have been incurred or aggravated by service, if manifested to a compensable degree within a one-year post- service period, subject to certain rebuttable presumption provisions. Entitlement to service connection for impaired hearing is subject to the additional requirements of 38 C.F.R. § 3.385, which provides: For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. Appellant contends that he has a defective hearing disability which is related to service. While the Board has considered his statements, they do not constitute competent evidence with respect to medical causation, diagnosis and treatment. Espiritu. Audiometric test scores for the appellant's ears, contained in the service entrance examination and a March 1977 service separation examination, were 25 decibels or less, except for a single 30 in the left ear on service enlistment examination. Although on clinical evaluation in November 1976, appellant's complaints included intermittent tinnitus of the left ear for 11 months and possible left ear sensorineural hearing loss was reported, later that month, clinical findings, including an audiogram, were unremarkable. The March 1977 service separation examination report is highly probative, since it recorded appellant's auditory acuity status at service separation. Although this is not determinative, since service connection for defective hearing may be awarded without in-service audiometric test scores meeting the § 3.385 threshold criteria, none of the post- service clinical evidence of record indicates that appellant has a defective hearing disability. In August 1998, appellant submitted a medical publication article pertaining to deafness. However, this medical publication article is too general to satisfy the nexus element of a well-grounded service connection claim with respect to this claim on appeal, since it does not provide information linking appellant's claimed defective hearing disability to service or indicates that he currently has a defective hearing disability. See Sacks. Appellant has not submitted any credible evidence to indicate that he has currently has a defective hearing disability. As such, there is no defective hearing disability to service connect. Thus, given the lack of competent clinical evidence showing that appellant has a defective hearing disability, the claim for service connection for a defective hearing disability is not well grounded. The claim is therefore denied. 38 U.S.C.A. § 5107(a); 38 C.F.R. § 3.385; Caluza; Grottveit; Grivois; and Edenfield. G. Service Connection for Hypertension It should be pointed out that under 38 C.F.R. §§ 3.307 and 3.309, hypertension is a disease for which service connection may be presumed to have been incurred or aggravated by service, if manifested to a compensable degree within a one- year post-service period, subject to certain rebuttable presumption provisions. Appellant alleges that he has hypertension related to service. While the Board has considered his statements, they do not constitute competent evidence with respect to medical causation, diagnosis and treatment. Espiritu. The service medical records, including a March 1977 service separation examination, do not reveal any complaints, findings, or diagnoses pertaining to hypertension. Furthermore, none of the post-service clinical evidence of record proximate to service indicates that appellant has hypertension. In fact, on May 1979 VA examination, blood pressure readings were 110/70 and 120/70 and the cardiovascular system was clinically described as normal. The earliest post-service clinical evidence of elevated blood pressure readings was not until February 1994, when private medical records recorded 144/98 and 140/80. Hypertension was not clinically diagnosed. In any event, even assuming appellant currently has hypertension, there is no competent evidence indicating that hypertension is related to service. Thus, given the lack of competent clinical evidence showing that appellant has hypertension related to service, the claim for service connection for hypertension is not well grounded. The claim is therefore denied. 38 U.S.C.A. § 5107(a); Caluza; Grottveit; Grivois; and Edenfield. H. Service Connection for a Disability Manifested by Dizziness or Fatigue Appellant contends that he has a disability manifested by dizziness or fatigue related to service. While the Board has considered his statements, they do not constitute competent evidence with respect to medical causation, diagnosis and treatment. Espiritu. The service medical records, including a March 1977 service separation examination, do not reveal any complaints, findings, or diagnoses pertaining to a disability manifested by dizziness or fatigue. Furthermore, none of the post- service clinical evidence of record indicates that appellant has a disability manifested by dizziness or fatigue. Although on May 1979 VA examination, he complained that on a "real hot day", he would feel "run down", that he had fatigability, and that he had had jaundice "at one time", there were no clinical findings or diagnoses pertaining to a chronic disability specifically manifested by dizziness or fatigue. In August 1998, appellant submitted a medical publication article pertaining to associated topics, such as tiredness, including as a symptom of hepatitis. However, this medical publication article is too general to satisfy the nexus element of a well-grounded service connection claim with respect to this claim on appeal, since it does not provide information linking appellant's claimed disability manifested by dizziness or fatigue to service or indicates that he currently has a disability manifested by dizziness or fatigue. See Sacks. Thus, given the lack of competent clinical evidence showing that appellant has a disability manifested by dizziness or fatigue related to service, the claim for service connection for a disability manifested by dizziness or fatigue is not well grounded. The claim is therefore denied. 38 U.S.C.A. § 5107(a); Caluza; Grottveit; Grivois; and Edenfield. II. Service Connection for a Dental Disability With respect to the issue of entitlement to service connection for a dental disability, in addition to general service connection principles, specific regulatory provisions limit service connection for certain dental conditions. See e.g., 38 C.F.R. § 3.381. Under 38 C.F.R. § 4.149, effective January 18, 1994, treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, periodontal disease (pyorrhea), and Vincent's stomatitis are not disabling conditions, and may be considered service-connected solely for the purpose of determining entitlement to dental examinations or outpatient dental treatment under the provisions of § 17.160 or § 17.161 of this chapter. Section 4.149, effective January 18, 1994, applies in the instant case, since appellant's initial claim for service connection for a dental disability was filed in 1997. This section is moved to 38 C.F.R. § 3.381 in 1999. There was no legal change in pertinent part. With respect to entitlement to service connection for the purpose of VA dental outpatient treatment, the applicable provisions of 38 U.S.C.A. § 1712 and 38 C.F.R. § 17.161 state, in pertinent part: Outpatient dental treatment may be authorized by the Chief, Dental Service, for beneficiaries defined in 38 U.S.C. § 1712(b) and 38 C.F.R. § 17.93 to the extent prescribed and in accordance with the applicable classification and provisions set forth in this section. (a) Class I. Those having a service- connected compensable dental disability or condition, may be authorized any dental treatment indicated as reasonably necessary to maintain oral health and masticatory function. There is no time limitation for making application for treatment and no restriction as to the number of repeat episodes of treatment. (b) Class II. (2)(i) Those having a service- connected noncompensable dental condition or disability shown to have been in existence at time of discharge or release from active service, which took place before October 1, 1981, may be authorized any treatment indicated as reasonably necessary for the one-time correction of the service connected noncompensable condition, but only if: (B) Application for treatment is made within 90 days after such discharge or release. (c) Class II (a). Those having a service-connected noncompensable dental condition or disability adjudicated as resulting from combat wounds or service trauma may be authorized any treatment indicated as reasonably necessary for the correction of such service-connected noncompensable condition or disability. (d) Class II(b). Those having a service-connected noncompensable dental condition or disability and who had been detained or interned as prisoners of war for a period of less than 90 days may be authorized any treatment as reasonably necessary for the correction of such service-connected dental condition or disability. (e) Class II(c). Those who were prisoners of war for 90 days or more, as determined by the concerned military service department, may be authorized any needed dental treatment. (g) Class III. Those having a dental condition professionally determined to be aggravating disability from an associated service connected condition or disability may be authorized dental treatment for only those dental conditions which, in sound professional judgment, are having a direct and material detrimental effect upon the associated basic condition or disability. (h) Class IV. Those whose service- connected disabilities are rated at 100% by schedular evaluation or who are entitled to the 100% rate by reason of individual unemployability may be authorized any needed dental treatment. (i) Class V. A veteran who is participating in a rehabilitation program under 38 U.S.C. chapter 31 may be authorized such dental services as are professionally determined necessary for any of the reasons enumerated in § 17.47(g). (j) Class VI. Any veterans scheduled for admission or otherwise receiving care and services under chapter 17 of 38 U.S.C. may receive outpatient dental care which is medically necessary, i.e., is for dental condition clinically determined to be complicating a medical condition currently under treatment. The provisions of 38 C.F.R. § 17.163 state: The Chief, Dental Service may authorize outpatient dental care which is reasonably necessary to complete treatment of a nonservice-connected dental condition which was begun while the veteran was receiving Department of Veterans Affairs authorized hospital care. The provisions of 38 C.F.R. § 17.165 state: When outpatient emergency dental care is provided, as a humanitarian service, to individuals who have no established eligibility for outpatient dental care, the treatment will be restricted to the alleviation of pain or extreme discomfort, or the remediation of a dental condition which is determined to be endangering life or health. The provision of emergency treatment to persons found ineligible for dental care will not entitle the applicant to further dental treatment. Individuals provided emergency dental care who are found to be ineligible for such care will be billed. Appellant's service medical records clearly show that on service entrance dental examination in June 1974, teeth #2, 3, 4, 5, 12, 14, 15, 18, 19, 20, 30, and 31 were marked as carious and nonrestorable. Teeth#17 and 32 were marked as carious and restorable. The service medical records reveal that in June and July 1975, teeth #2, 3, 4, 5, 18, 20, 30, and 31 were surgically extracted. In November 1976, he failed to report for an appointment and that was the last recorded dental entry. There was no indication of any dentures/bridges. A May 1979 VA examination report indicated that he had multiple missing molars/lower teeth and carious teeth. There was no indication of any dentures/bridges on that examination or in any other post-service clinical evidence of record. Appellant has no adjudicated compensable service-connected dental condition. Therefore, Class I eligibility is not warranted. Even assuming arguendo that a dental condition, such as teeth extraction, was granted service connection, this would not necessarily require that compensation or VA outpatient dental treatment eligibility be awarded. Specifically, under 38 C.F.R. § 4.150 (1999), for rating dental conditions, Diagnostic Code 9913 provides that loss of teeth due to loss of substance of body of the maxilla or mandible, without loss of continuity, may be assigned a noncompensable rating when the loss of masticatory surface can be restored by a suitable prosthesis. A 10 percent rating requires that the lost masticatory surface cannot be restored by suitable prosthesis in all missing upper anterior teeth, all missing lower anterior teeth, or all missing upper and lower teeth on one side. Such rating applies only to bone loss through trauma or disease such as osteomyelitis, and not to loss of the alveolar process as a result of periodontal disease, since such loss is not considered disabling. Thus, even assuming arguendo that appellant's extracted teeth were service-connected, a compensable rating under Code 9913 would not be appropriate since the extracted teeth primarily involved certain molars, not all anterior upper/lower teeth or all upper and lower teeth on one side (one-half of all teeth). Additionally, there is no clinical evidence indicating that lost masticatory surface cannot be restored by suitable prosthesis. Consequently, Class I eligibility would not be warranted under this analysis. The appellant's 1997 application for service connection for a dental disability was not timely filed for Class II eligibility, since he was discharged from service in 1977. It should be added that the procedural requisites for a written explanation of treatment eligibility under 38 U.S.C.A. § 1712(a),(1),(B),(iv) were not applicable in the instant case, since that law became effective in 1981 and was not in effect at the time of appellant's service discharge. Additionally, for Class II eligibility purposes, the term "service trauma" does not include the intended effects of therapy or restorative dental care and treatment provided during a veteran's military service, including tooth extractions. See VA O.G.C. Prec. Op. No. 5-97 (Jan. 22, 1997) (Precedent Opinion of the VA General Counsel). Thus, Class II eligibility would not be warranted. In short, appellant does not meet any of the requisites for VA dental outpatient treatment eligibility set forth in the aforementioned regulations since (1) he does not have a compensable dental disability, (2) he has not applied for treatment for a noncompensable dental disability within one year after service, (3) he does not have a compensable dental injury or service dental trauma, (4) he was not a former prisoner-of-war, (5) he does not have a dental condition aggravating a service-connected disability, (6) a total disability compensation rating is not in effect, (7) he is not participating in a VA rehabilitation program, (8) he does not have a dental condition clinically determined to be complicating a medical condition currently under treatment, and (9) outpatient emergency dental care has not been initiated; nor has it been otherwise alleged. Consequently, since appellant's claim of entitlement to service connection for a dental disability lacks legal merit or entitlement under the law, the claim is denied. 38 U.S.C.A. § 1712; 38 C.F.R. §§ 3.381, 4.149, 17.161-17.165; and Sabonis. III. Whether Appellant has Filed a Timely Substantive Appeal with Respect to a June 6, 1979 Rating Decision (Which Denied Service Connection for a Right Knee Disability, Left Ear Otitis Media, Gilbert's Syndrome/Disease with Hyperbilirubinemia, Residuals of Fractures of the Right 2nd, 3rd, and 4th Toes, and Tuberculosis) and an October 23, 1979 Rating Decision (Which Denied Service Connection for Gilbert's Syndrome/Disease with Hyperbilirubinemia and Tuberculosis). A perfected appeal consists of a timely filed Notice of Disagreement in writing and, after a Statement of the Case has been furnished, a timely filed Substantive Appeal. 38 U.S.C.A. § 7105; 38 C.F.R. § 20.200. As the Court held in Talbert v. Brown, 7 Vet. App. 352, 356 (1995), "[t]he 'liberal reading' requirement does not require the Board to conduct an exercise in prognostication, but only requires that it consider all issues reasonably raised by the appellant's substantive appeal." By a June 6, 1979 rating decision, the RO denied service connection for a right knee disability, left ear otitis media, Gilbert's syndrome/disease with hyperbilirubinemia, residuals of fractures of the right 2nd, 3rd, and 4th toes, and tuberculosis. Later that month, appellant was sent written notice of that adverse rating decision with his procedural and appellate rights. In a July 31, 1979 letter to the RO, appellant referred to said claims as having been denied service connection; asserted that tuberculosis and a liver condition should be service-connected; and stated that "therefore, I request that my claim be re-evaluated." However, he did not specifically express disagreement with the June 1979 rating decision in question. A timely Notice of Disagreement in writing was not subsequently received on said service connection claims. The provisions of 38 C.F.R. § 20.201 state, in pertinent part, that: A written communication from a claimant or his or her representative expressing dissatisfaction or disagreement with an adjudicative determination by the agency of original jurisdiction and a desire to contest the result will constitute a Notice of Disagreement. While special wording is not required, the Notice of Disagreement must be in terms which can be reasonably construed as disagreement with that determination and a desire for appellate review. If the agency of original jurisdiction gave notice that adjudicative determinations were made on several issues at the same time, the specific determinations with which the claimant disagrees must be identified. With respect to time limits for filing a Notice of Disagreement, the provisions of 38 C.F.R. § 20.302(a) state, in pertinent part: A claimant, or his or her representative, must file a Notice of Disagreement with a determination by the agency of original jurisdiction within one year from the date that the agency mails notice of the determination to him or her. Otherwise, that determination will become final. The date of mailing the letter of notification of the determination will be presumed to be the same as the date of that letter for purposes of determining whether an appeal has been timely filed. In September 1979, the RO requested and obtained certain additional VA treatment records. In an October 23, 1979 rating decision, the RO referred to a July 31, 1979 "reopened claim" for service connection for a liver condition and tuberculosis, and confirmed its denial of service connection for a liver condition/hyperbilirubinemia and tuberculosis. Appellant and his then representative were sent written notice of that adverse rating decision the following month. In a written statement dated and received in July 1980, appellant stated, in pertinent part, that "I disagree with the decision made on my claim for service connected disability on my liver condition." The RO marked that statement as a Notice of Disagreement; and later that month, issued appellant a Statement of the Case that addressed the issues of service connection for liver and lung conditions; and, in an accompanying notice of his appellate rights with respect to filing a substantive appeal, informed him that he should specifically identify the issues being appealed and respond within 60 days to perfect an appeal. However, a timely Substantive Appeal was not received by the RO. The provisions of 38 C.F.R. § 20.202 state, in pertinent part: A Substantive Appeal consists of a properly completed VA Form 1-9, "Appeal to Board of Veterans' Appeals," or correspondence containing the necessary information. If the Statement of the Case and any prior Supplemental Statements of the Case addressed several issues, the Substantive Appeal must either indicate that the appeal is being perfected as to all of those issues or must specifically identify the issues appealed. The Substantive Appeal should set out specific arguments relating to errors of fact or law made by the agency of original jurisdiction in reaching the determination, or determinations, being appealed....The Board will construe such arguments in a liberal manner for purposes of determining whether they raise issues on appeal, but the Board may dismiss any appeal which fails to allege specific error of fact or law in the determination, or determinations, being appealed....Proper completion and filing of a Substantive Appeal are the last actions the appellant needs to take to perfect an appeal. With respect to time limits for filing a Substantive Appeal, or response to a Statement of the Case, the provisions of 38 C.F.R. § 20.302(b) state: [A] Substantive Appeal must be filed within 60 days from the date that the agency of original jurisdiction mails the Statement of the Case to the appellant, or within the remainder of the 1-year period from the date of mailing of the notification of the determination being appealed, whichever period ends later.... The Board has liberally reviewed and analyzed the written statements submitted by the appellant and his then representative since the June 6, 1979 and October 23, 1979 rating decisions. However, even with a liberal reading, none of these statements may be reasonably considered a timely Notice of Disagreement with the June 6, 1979 rating decision or a timely Substantive Appeal with the October 23, 1979 rating decision. In short, appellant did not expressly disagree with that June 6, 1979 adverse rating decision or submit any written appeal with respect to the liver and lung service connection issues within one-year from notification of the October 23, 1979 rating decision or within 60-days from issuance of the July 1980 Statement of the Case. Although appellant has vaguely alleged that the RO has engaged in various deceptive and discriminatory practices with respect to his case, he has not substantiated such allegations. There is a presumption of regularity of government process that can only be rebutted by clear evidence to the contrary. Ashley v. Derwinski, 2 Vet. App. 62 (1992). See also YT v. Brown, 9 Vet. App. 195 (1996); Mason v. Brown, 8 Vet. App. 44 (1995) (citing Mendenhall v. Brown, 7 Vet. App. 271, 274 (1994)). There is no such clear evidence to rebut the presumption of notification in this case. The adverse ratings notification letters and the July 1980 Statement of the Case were not returned as undeliverable; appellant has not directly alleged that he did not receive said letters and Statement of the Case; and he has not specifically alleged that he submitted a timely Substantive Appeal with respect to the June 6, 1979 and October 23, 1979 rating decisions in question. To the contrary, appellant's July 1979 written letter and July 1980 Notice of Disagreement indicate that he received actual notice of both adverse rating decisions. The claims folder does not contain any correspondence from him between the date of the July 1980 Statement of the Case and 1997, at which time he initially inquired as to the status of said service connections claims filed in the late 1970's. In a November 1997 written statement, he merely stated that he wanted to claim service connection for various disabilities; and there was no allegation that he did not receive proper notice of the prior June 6, 1979 and October 23, 1979 adverse rating decisions in question. Although in a February 1999 letter, appellant appeared to cast blame on his former service organization representative for failing to explain the appellate process to him, even assuming that this were true, it would not constitute a legal basis for exempting him from the procedural steps necessary to perfect an appeal. Thus, the Board concludes that appellant failed to perfect an appeal with respect to a June 6, 1979 rating decision (which denied service connection for a right knee disability, left ear otitis media, Gilbert's syndrome/disease with hyperbilirubinemia, residuals of fractures of the right 2nd, 3rd, and 4th toes, and tuberculosis) and an October 23, 1979 rating decision (which denied service connection for Gilbert's syndrome/disease with hyperbilirubinemia and tuberculosis). 38 C.F.R. §§ 20.200, 20.201, 20.202, 20.302(a),(b). These June 6, 1979 and October 23, 1979 rating decisions represent the last final decisions on said service connection issues. Evans v. Brown, 9 Vet. App. 273, 285 (1996). IV. Whether New and Material Evidence has been Submitted to Reopen Claims of Entitlement to Service Connection for a Liver Disorder, Classified as Gilbert's Syndrome/Disease with Hyperbilirubinemia; Tuberculosis; Left Ear Otitis Media; and a Right Knee Disability With respect to the issues of whether new and material evidence has been submitted to reopen the claims of entitlement to service connection for a liver disorder (classified as Gilbert's syndrome/disease with hyperbilirubinemia), tuberculosis, left ear otitis media, and a right knee disability, "new" evidence means more than evidence which was not previously physically of record, and must be more than merely cumulative. To be "material" evidence, it must by itself or in connection with evidence previously assembled be so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a); and Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). The June 6, 1979 rating decision, to the extent it denied service connection for a right knee disability, left ear otitis media, Gilbert's syndrome/disease with hyperbilirubinemia, and tuberculosis and an October 23, 1979 rating decision, which denied service connection for Gilbert's syndrome/disease with hyperbilirubinemia and tuberculosis, are final, since appellant did not perfect an appeal as to those issues, as discussed in detail above in Part III of the Board's decision herein. Thus, said final June 6, 1979 and October 23, 1979 rating decisions may not be reopened, in the absence of new and material evidence. 38 U.S.C.A. §§ 5108, 7105; 38 C.F.R. §§ 3.104(a), 3.156(a), 20.302(a); Manio. With regards to a preliminary matter, the Board must examine the record and determine whether the VA has any further obligation to assist in the development of these claims to reopen service connection for a right knee disability, left ear otitis media, Gilbert's syndrome/disease with hyperbilirubinemia, and tuberculosis. 38 U.S.C.A. § 5107(a). After reviewing the record, the Board is satisfied that all relevant facts have been properly developed and that no useful purpose would be served by remanding these issues with directions to provide additional assistance to the appellant. See Counts v. Brown, 6 Vet. App. 473 (1994) and Graves v. Brown, 8 Vet. App. 522, 525 (1996), wherein the Court held that: [W]hen a veteran has made an application to reopen a claim and the Secretary is on notice of evidence which may prove to be new and material but has not been submitted with the application, the Secretary has a duty under section 5103 to inform a claimant of the evidence that is "necessary to complete the application." The Board finds that appellant was knowledgeable regarding the necessity of competent evidence showing that said disabilities are related to military service or that a preexisting right knee disability was aggravated by service or is otherwise related to service. See, in particular, May 1998 and April 1999 Statements of the Case, which set out the applicable provisions of 38 C.F.R. § 3.156(a) and the need for "new and material" evidence to reopen said claims at issue. Additionally, it does not appear that appellant has informed the VA of the existence of any specific competent evidence that might prove to be new and material concerning said appellate issues. See Graves, at 8 Vet. App. 525. A. Whether New and Material Evidence has been Submitted to Reopen a Claim of Entitlement to Service Connection for a Liver Disorder, Classified as Gilbert's Syndrome/Disease with Hyperbilirubinemia The evidence previously considered in the final June 6, 1979 and October 23, 1979 rating decisions, which denied service connection for Gilbert's syndrome/disease with hyperbilirubinemia, included appellant's service medical records. The service medical records, including a March 1977 service separation examination, did not reveal any complaints, findings, or diagnoses pertaining to Gilbert's syndrome/disease with hyperbilirubinemia. It is of substantial import that the earliest post-service clinical evidence indicative of Gilbert's syndrome/disease with hyperbilirubinemia was not until early 1978, several months after service. It should be pointed out that Gilbert's syndrome/disease with hyperbilirubinemia is not a disease for which service connection may be presumed to have been incurred or aggravated by service under 38 C.F.R. §§ 3.307 and 3.309. During February 1978 VA hospitalization, serum blood studies revealed elevated indirect bilirubin; and the diagnoses included probable Gilbert's syndrome, rule out other causes of indirect hyperbilirubinemia. A liver/spleen nuclear isotope scan revealed mild hepatomegaly with some irregularity in the inferior border. It was noted that the irregularity in the inferior border might represent accentuation of the gall bladder fossa, although localized liver pathology could not be excluded. VA clinical records dated in March 1978 reflect that a liver biopsy was performed due to a preoperative diagnosis of indirect hyperbilirubinemia; and the liver biopsy pathologic diagnosis was chronic, nonspecific hepatitis, etiology undetermined. Gilbert's syndrome was not diagnosed on that liver biopsy. A March 31, 1978 VA outpatient treatment report indicated that the pertinent impressions were resolving hepatitis B; and that he did not have Gilbert's syndrome. An April 1978 VA outpatient treatment report noted that appellant complained of left upper quadrant tenderness. It was noted that appellant had previously been a VA employee and that jaundice and hepatitis had antedated VA employment. VA outpatient treatment reports reflect that in May 1978, liver enzymes were reported as "OK." In March 1979, the impression was status post hepatitis with slightly elevated indirect bilirubin. On May 1979 VA examination, the examiner noted that apparently appellant had had hepatitis that led to cirrhosis which caused hyperbilirubinemia; that currently, he had minimal jaundice of the sclerae with some liver enlargement; and that appellant felt that he had incurred it in Korea from food. Clinically, the liver was slightly tender but without organomegaly. The examiner noted that although appellant felt his sclerae were yellowish in color, it was extremely mild, if in fact present. Laboratory studies revealed that total bilirubin was 1.2 (with normal values listed as .2 to 1.2). The diagnoses included "[l]iver condition, history primarily of cirrhosis with hepatomegaly associated with a hyperbilirubinemia." However, that diagnosis was crossed out and replaced by "[l]iver condition, Gilbert's syndrome w[ith] hyperbilirubinemia." Based on this evidence then of record, the RO in its final June 6, 1979 rating decision, denied service connection for Gilbert's syndrome with hyperbilirubinemia essentially on the basis that the service medical records did not reveal a liver condition and the post-service medical evidence showed that bilirubin was within normal limits without a confirmed diagnosis for said liver condition. The evidence received subsequent to said final June 6, 1979 and October 23, 1979 rating decisions is not new and material. The clinical evidence includes VA outpatient treatment records indicating that in July 1985, years after service, a VA outpatient treatment report included appellant's complaints of "chronic hepatitis." The assessment was rule out hepatitis. Clinically, there were no pertinent findings. The diagnoses included hyperbilirubinemia by history. It is significant that on December 1997 VA examination, there were no complaints, findings, or diagnoses pertaining to Gilbert's syndrome with hyperbilirubinemia. In fact, laboratory studies revealed that liver enzymes were within normal limits, including a total bilirubin value of .9 (with normal values listed as .2 to 1). In August 1998, appellant submitted a medical publication article pertaining to liver disease and hyperbilirubinemia. However, this medical publication article is too general to satisfy the nexus element of a well-grounded service connection claim with respect to this claim on appeal, since it does not provide information linking appellant's claimed Gilbert's syndrome with hyperbilirubinemia to service or indicates that he currently has Gilbert's syndrome with hyperbilirubinemia. See Sacks. Copies of other clinical evidence previously of record, including service medical records, have been submitted. The critical point is that none of the competent evidence submitted subsequent to said final June 6, 1979 and October 23, 1979 rating decisions indicates that appellant currently has Gilbert's syndrome with hyperbilirubinemia related to service. The Board has considered appellant's contentions. However, lay assertions of medical causation are not sufficient to reopen a claim under 38 U.S.C.A. § 5108. Moray v. Brown, 5 Vet. App. 211, 214 (1993). Thus, additional evidence submitted subsequent to said final June 6, 1979 and October 23, 1979 rating decisions, which denied service connection for Gilbert's syndrome with hyperbilirubinemia, when viewed in the context of all the evidence, does not bear directly and substantially upon the specific matter under consideration and is not so significant that it must be considered in order to fairly decide the merits of the claim. Since new and material evidence has not been submitted, the claim for service connection for Gilbert's syndrome with hyperbilirubinemia is not reopened. 38 U.S.C.A. §§ 5108, 7105; 38 C.F.R. §§ 3.104(a), 3.156(a), 20.302(a). The benefit-of-the-doubt doctrine is inapplicable, since new and material evidence has not been submitted to reopen the claim. Annoni v. Brown, 5 Vet. App. 463 (1993). B. Whether New and Material Evidence has been Submitted to Reopen a Claim of Entitlement to Service Connection for Tuberculosis In addition to the aforementioned VA laws and regulations pertaining to claims for service connection, the Board notes that other regulatory provisions set forth the nature and extent of proof necessary to establish service connection for pulmonary tuberculosis. See 38 C.F.R. §§ 3.370, 3.371, 3.372, 3.374, 3.375, and 3.378 (1999). In particular, 38 C.F.R. §§ 3.370 and 3.371 set forth certain criteria for grants of service connection for pulmonary tuberculosis shown by in-service radiographic evidence or on a presumptive basis. Under 38 C.F.R. §§ 3.307 and 3.309, active (emphasis added) tuberculosis is a disease for which service connection may be presumed to have been incurred or aggravated by service, if manifested to a compensable degree within a three-year post-service period, subject to certain rebuttable presumption provisions. The evidence previously considered in the final June 6, 1979 and October 23, 1979 rating decisions, which denied service connection for tuberculosis, included appellant's service medical records. The service medical records reflect that in January 1975, he had complaints of coughing with an upper respiratory infection; a possible "strep" throat was reported in January 1976; and upper respiratory infection symptoms were reported in January and August 1976 and March 1977. However, the service medical records, including a March 1977 service separation examination with negative chest x-ray study, did not reveal any complaints, findings, or diagnoses pertaining to tuberculosis. Although February and March 1978 VA hospitalization reports indicate that appellant had a history of a positive tuberculosis skin test, chest x-ray studies and evaluation of the lungs were negative. Tuberculosis was not diagnosed; rather, the pertinent diagnosis was a "22 mm. positive tuberculosis skin test." However, it was noted that "INH" [isoniazid] therapy would be considered due to the positive tuberculosis skin test. On May 1979 VA examination, it was reported by history that in early 1978, appellant had a positive tuberculosis skin test and tuberculosis had been diagnosed and treated at a VA hospital. Currently, the respiratory system was unremarkable, except for a few inspiratory wheezes. Although a chest x-ray study was planned, the examination report section which listed laboratory studies/x-rays (section 45A) was crossed out. Thus, it appears that said study may not have actually been conducted. The pertinent diagnosis was "[t]uberculosis, treatment and arrested at the present time." The examiner remarked that the claims folder had not been made available to him. In a July 1979 written statement, appellant asserted that while he was employed by the VA, active tuberculosis was found by the VA. VA outpatient treatment reports received by the RO in September 1979 revealed that in October 1978, he had completed the eighth month of "INH" therapy, status post a positive tuberculosis skin test. In March 1979, it was reported that he had completed one year of "INH" therapy. The impression noted that he had completed one year of "INH" therapy for conversion of "IPPD" skin test without other evidence of tuberculosis. Based on this evidence then of record, the RO in its final June 6, 1979 and October 23, 1979 rating decisions, denied service connection for tuberculosis essentially on the basis that although a post-service skin test had been positive for tuberculosis, active tuberculosis had not been shown or diagnosed. The evidence received subsequent to said final June 6, 1979 and October 23, 1979 rating decisions is not new and material. The clinical evidence includes VA outpatient treatment records received in June 1998. In a March 1978 VA outpatient treatment report, it was noted that appellant had had a 22 mm. positive tuberculosis skin test as an employee two months ago; that a tuberculosis workup had been completely negative, except for the skin test; that a 1975 skin test had been negative; and that he would therefore be treated prophylactically (emphasis added) with one year of "INH" therapy. On December 1997 VA examination, there were no complaints, findings, or diagnoses pertaining to tuberculosis. Duplicative copies of other clinical evidence previously of record, including service medical records, have been submitted. In August 1998, appellant submitted a medical publication article pertaining to tuberculosis. However, this medical publication article is too general to satisfy the nexus element of a well-grounded service connection claim with respect to this claim on appeal, since it does not provide information linking appellant's claimed tuberculosis to service, nor does it indicate that he had active tuberculosis within the three-year presumptive period post service or currently has tuberculosis. See Sacks. Although appellant had a positive tuberculosis skin test several months after service, there is no current medical evidence indicating that he has ever been diagnosed with active tuberculosis nor is there any radiographic evidence thereof. A mere positive tuberculosis skin test is not a diagnosis of a disability; and his "INH" therapy was clearly medically prescribed for prophylactic purposes, not as treatment for active tuberculosis. The critical point is that none of the competent evidence submitted subsequent to said final June 6, 1979 and October 23, 1979 rating decisions indicates that appellant currently has tuberculosis. The Board has considered appellant's contentions. However, lay assertions of medical causation are not sufficient to reopen a claim under 38 U.S.C.A. § 5108. See Moray. Thus, additional evidence submitted subsequent to said final June 6, 1979 and October 23, 1979 rating decisions, which denied service connection for tuberculosis, when viewed in the context of all the evidence, does not bear directly and substantially upon the specific matter under consideration and is not so significant that it must be considered in order to fairly decide the merits of the claim. Since new and material evidence has not been submitted, the claim for service connection for tuberculosis is not reopened. 38 U.S.C.A. §§ 5108, 7105; 38 C.F.R. §§ 3.104(a), 3.156(a), 20.302(a). The benefit-of-the-doubt doctrine is inapplicable, since new and material evidence has not been submitted to reopen the claim. See Annoni. C. Whether New and Material Evidence has been Submitted to Reopen a Claim of Entitlement to Service Connection for Left Ear Otitis Media The evidence previously considered in the final June 6, 1979 rating decision, which denied service connection for left ear otitis media, included appellant's service medical records. The service medical records reveal that in October 1974, appellant complained of earache for two months with hearing impairment. Clinically, the tympanic membrane was cloudy. Serous otitis was assessed. Several days later, an inflamed ear canal was noted; and otitis externa was assessed. In September 1976, his complaints included left ear pain for three days. Clinically, the left tympanic membrane was moderately swollen with drainage/pus; otitis media was assessed; and an antibiotic was prescribed. Chronic left ear otitis was noted the following month and an antibiotic was prescribed. On clinical evaluation in November 1976, his complaints included intermittent tinnitus of the left ear for 11 months with left ear hearing impairment. The tympanic membranes were unremarkable. Although possible left ear sensorineural hearing loss was suspected, later that month, clinical findings, including an audiogram, were unremarkable. Moreover, a March 1977 service separation examination did not reveal any complaints, findings, or diagnoses pertaining to chronic left ear otitis. VA clinical records in 1978 did not reflect complaints, findings, or diagnoses pertaining to chronic left ear otitis. Although on May 1979 VA ear, nose, and throat (ENT) examination, appellant reported having had in-service left ear infections, none recently were alleged; and clinically, the tympanic membranes and ear canals were described as well- healed and clear, respectively. No left ear disorder was diagnosed. Although a "left ear condition" was diagnosed on May 1979 VA general medical examination, this was conducted on May 9th prior to the May 1979 VA ENT examination which was conducted on May 11th. Based on this evidence then of record, the RO in its final June 6, 1979 rating decision, denied service connection for left ear otitis on the basis that since the condition had not been shown on post-service VA examination, there was no such condition to service- connect. The evidence received subsequent to said final June 6, 1979 rating decision is not new and material. The additional clinical evidence includes VA outpatient treatment records and a December 1997 VA examination, none of which includes any complaints, findings, or diagnoses pertaining to chronic left ear otitis. In August 1998, appellant submitted a medical publication article pertaining to otitis and deafness. However, this medical publication article is too general to satisfy the nexus element of a well-grounded service connection claim with respect to this claim on appeal, since it does not provide information indicating that he currently has chronic left ear otitis. See Sacks. Duplicative copies of other clinical evidence previously of record, including service medical records, have been submitted. The critical point is that none of the competent evidence submitted subsequent to said final June 6, 1979 rating decision indicates that appellant currently has chronic left ear otitis related to service. The Board has considered appellant's contentions. However, lay assertions of medical causation are not sufficient to reopen a claim under 38 U.S.C.A. § 5108. Moray. Thus, additional evidence submitted subsequent to said final June 6, 1979 rating decision, which denied service connection for left ear otitis media, when viewed in the context of all the evidence, does not bear directly and substantially upon the specific matter under consideration and is not so significant that it must be considered in order to fairly decide the merits of the claim. Since new and material evidence has not been submitted, the claim for service connection for left ear otitis media is not reopened. 38 U.S.C.A. §§ 5108, 7105; 38 C.F.R. §§ 3.104(a), 3.156(a), 20.302(a). The benefit-of-the-doubt doctrine is inapplicable, since new and material evidence has not been submitted to reopen the claim. Annoni. D. Whether New and Material Evidence has been Submitted to Reopen a Claim of Entitlement to Service Connection for a Right Knee Disability The evidence previously considered in the final June 6, 1979 rating decision, which denied service connection for a right knee disability, included appellant's service medical records. The service medical records reveal that in April 1975, appellant complained of the right knee "giving way." It was divulged that he had sustained a right knee sprain while playing football in high school, with medial joint line pain, locking, and giving way. On orthopedic evaluation, he reported that he had sustained a valgus stress injury to the right knee while playing high school football; and that two months ago, the right knee had been hit by a box with resultant pain especially while playing basketball. Clinically, there was medial joint line tenderness; and the assessment was questionable medial collateral ligamentous strain, old versus anterior cruciate or meniscal tear (old). In August 1975, he reported having struck the right lower anterior thigh while playing ball. The impression was bruise. Significantly, however, the remainder of the service medical records, including a March 1977 service separation examination, did not reveal any complaints, findings, or diagnoses pertaining to a chronic right knee disorder. VA clinical records in 1978 did not reflect complaints, findings, or diagnoses pertaining to a chronic right knee disorder either. Although on May 1979 VA examination, a history was reported of a preservice right knee injury with treatment during service in 1975 for a chronic knee condition noted as probably ligamentous, current clinical findings did not reveal any right knee abnormality and gait was unimpaired. Although a right knee x-ray study was planned, the examination report section which listed laboratory studies/x-rays (section 45A) was crossed out. Thus, it appears that said study may not have actually been conducted. The pertinent diagnosis was "[c]hronic ligamentous quadriceps expanse injury to the right knee, with no limitation of motion-only history of giving way." Based on this evidence then of record, the RO in its final June 6, 1979 rating decision, denied service connection for a right knee disorder on the basis that appellant had a history of a preservice injury to that knee; that the service medical records contained no radiographic evidence of in-service fracture/trauma; and a service separation examination and a post-service VA examination did not reveal any right knee abnormality. The evidence received subsequent to said final June 6, 1979 rating decision is not new and material. The additional clinical evidence includes VA outpatient treatment records and a December 1997 VA examination, none of which includes any complaints, findings, or diagnoses pertaining to a chronic right knee disorder. In August 1998, appellant submitted a medical publication article pertaining to ligamentous injuries. However, this medical publication article is too general to satisfy the nexus element of a well-grounded service connection claim with respect to this claim on appeal, since it does not provide information indicating that he currently has a right knee disorder related to service. See Sacks. In August 1998, appellant also submitted February 1994 private clinical records, which indicated that he complained of right knee swelling for one week. Right knee effusion was assessed. However, the following month, he divulged that the right knee problem was job-related. Clinically, there was mild right medial tenderness; and resolving right knee effusion was assessed. Copies of other clinical evidence previously of record, including service medical records, have been submitted. The critical point is that none of the competent evidence submitted subsequent to said final June 6, 1979 rating decision indicates that appellant currently has a chronic right knee disorder related to service. The Board has considered appellant's contentions. However, lay assertions of medical causation are not sufficient to reopen a claim under 38 U.S.C.A. § 5108. Moray. Thus, additional evidence submitted subsequent to said final June 6, 1979 rating decision, which denied service connection for a chronic right knee disorder, when viewed in the context of all the evidence, does not bear directly and substantially upon the specific matter under consideration and is not so significant that it must be considered in order to fairly decide the merits of the claim. Since new and material evidence has not been submitted, the claim for service connection for a chronic right knee disorder is not reopened. 38 U.S.C.A. §§ 5108, 7105; 38 C.F.R. §§ 3.104(a), 3.156(a), 20.302(a). The benefit-of-the-doubt doctrine is inapplicable, since new and material evidence has not been submitted to reopen the claim. Annoni. (CONTINUED ON NEXT PAGE) ORDER Since appellant has not submitted evidence of well-grounded claims for entitlement to service connection for an acquired psychiatric disability, including post-traumatic stress disorder; a chancroid with lymphadenitis; a disability manifested by occult blood/red blood cells in the urine or dysuria, including a kidney disorder; a disability manifested by abdominal pain/vomiting, including dysentery and cholera; a disability manifested by jaundice, including hepatitis and cirrhosis of the liver; defective hearing; hypertension; and a disability manifested by dizziness or fatigue, these claims are denied. Since the claim for entitlement to service connection for a dental disability lacks legal merit or entitlement under the law, the claim is denied. Appellant did not file a timely Substantive Appeal with respect to a June 6, 1979 rating decision (which denied service connection for a right knee disability, left ear otitis media, Gilbert's syndrome/disease with hyperbilirubinemia, residuals of fractures of the right 2nd, 3rd, and 4th toes, and tuberculosis) and an October 23, 1979 rating decision (which denied service connection for Gilbert's syndrome/disease with hyperbilirubinemia and tuberculosis). New and material evidence has not been submitted to reopen claims of entitlement to service connection for a liver disorder, classified as Gilbert's syndrome/disease with hyperbilirubinemia; tuberculosis; left ear otitis media; and a right knee disability. The appeal is denied in its entirety. MICHAEL D. LYON Member, Board of Veterans' Appeals