Citation Nr: 0003009 Decision Date: 02/07/00 Archive Date: 02/10/00 DOCKET NO. 98-07 907 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Juan, Puerto Rico THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for an acquired psychiatric disorder. 2. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for prostatitis. 3. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for tuberculosis of the left kidney. 4. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for left eye disorder. 5. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a back disorder. REPRESENTATION Appellant represented by: Rafael E. Delgado Roman, Attorney at Law WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD W. Yates, Associate Counsel INTRODUCTION The appellant served on active duty from February 1954 to February 1956. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 1998 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. That rating decision found that the appellant had not submitted new and material evidence to reopen his claims for service connection for the following conditions: (1) nervous disorder; (2) prostatitis; (3) tuberculosis of the left kidney; (4) left eye disorder; and (5) back disorder. FINDINGS OF FACT 1. In February 1981, the Board issued a decision that continued the denial of service connection for an acquired psychiatric disorder. 2. The evidence received since the Board's February 1981 decision is probative of a link between the veteran's current acquired psychiatric disorder and his active duty military service. 3. In July 1970, the Board issued a decision denying service connection for prostatitis. 4. No competent medical evidence has been presented since the Board's July 1970 decision which is relevant to or probative of an aggravation or incurrence of prostatitis during the veteran's active duty service and which is so significant that it must be considered in order to fairly decide the merits of the claim. 5. In July 1970, the Board issued a decision denying service connection for tuberculosis of the left kidney. 6. No competent medical evidence has been presented since the Board's July 1970 decision which is relevant to or probative of an aggravation or incurrence of tuberculosis of the left kidney during the veteran's active duty service and which is so significant that it must be considered in order to fairly decide the merits of the claim. 7. In February 1981, the Board issued a decision denying service connection for an eye disorder. 8. No competent medical evidence has been presented since the Board's February 1981 decision which is relevant to or probative of an aggravation or incurrence of an eye disorder during the veteran's active duty service and which is so significant that it must be considered in order to fairly decide the merits of the claim. 9. In February 1981, the Board issued a decision denying service connection for a back disorder. 10. No competent medical evidence has been presented since the Board's February 1981 decision which is relevant to or probative of an aggravation or incurrence of a back disorder during the veteran's active duty service and which is so significant that it must be considered in order to fairly decide the merits of the claim. CONCLUSION OF LAW 1. The Board's February 1981 decision denying service connection for an acquired psychiatric disorder is final. 38 U.S.C.A. § 7104(b) (West 1991). 2. Evidence received since the Board's February 1981 decision denying service connection for an acquired psychiatric disorder is new and material, and the appellant's claim for service connection for an acquired psychiatric disorder is reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. §§ 3.104(a), 3.156 (1999). 3. The July 1970 decision of the Board denying service connection for prostatitis is final. 38 U.S.C.A. § 7104(b) (West 1991). 4. Evidence received since the Board's July 1970 decision denying service connection for prostatitis is not new and material, and the veteran's claim for service connection for prostatitis has not been reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. §§ 3.104(a), 3.156(a) (1999). 5. The July 1970 decision of the Board denying service connection for tuberculosis of the left kidney is final. 38 U.S.C.A. § 7104(b) (West 1991). 6. Evidence received since the Board's July 1970 decision denying service connection for tuberculosis of the left kidney is not new and material, and the veteran's claim for service connection for tuberculosis of the left kidney has not been reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. §§ 3.104(a), 3.156(a) (1999). 7. The February 1981 decision of the Board denying service connection for an eye disorder is final. 38 U.S.C.A. § 7104(b) (West 1991). 8. Evidence received since the Board's February 1981 decision denying service connection for an eye disorder is not new and material, and the veteran's claim for service connection for a left eye disorder has not been reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. §§ 3.104(a), 3.156(a) (1999). 9. The February 1981 decision of the Board denying service connection for a back disorder is final. 38 U.S.C.A. § 7104(b) (West 1991). 10. Evidence received since the Board's February 1981 decision denying service connection for a back disorder is not new and material, and the veteran's claim for service connection for a back disorder has not been reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. §§ 3.104(a), 3.156(a) (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Preliminary Considerations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110, 1131 (West 1991); 38 C.F.R. §§ 3.303, 3.304 (1999). Direct service connection may be established for a disability resulting from diseases or injuries which are clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(a), (b), (d) (1999). Establishing direct service connection for a disability which has not been clearly shown in service requires the existence of a current disability and a relationship or connection between that disability and a disease contracted or an injury sustained during service. 38 U.S.C.A. § 1131 (West 1991); 38 C.F.R. § 3.303(d) (1999); Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Service connection may also be established on the basis of aggravation. 38 U.S.C.A. § 1131 (West 1991); 38 C.F.R. §§ 3.303(a), 3.304, 3.306 (1999). A preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 C.F.R. § 3.306(a) (1999). Clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the preservice disability underwent an increase in severity during service. This includes medical facts and principles which may be considered to determine whether the increase is due to the natural progress of the condition. 38 C.F.R. § 3.306(b) (1999). Service connection may also be granted for a disability that is proximately due to and the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (1999). Psychoses may be presumed to have been incurred during active military service if it is manifest to a degree of at least 10 percent within the first year following active service in the case of any veteran who served for 90 days or more. 38 U.S.C.A. §§ 1101, 1112, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). Reopening a claim for service connection which has been previously and finally disallowed requires that new and material evidence be presented or secured since the last final disallowance of that claim. 38 U.S.C.A. § 5108 (West 1991); Evans v. Brown, 9 Vet. App. 273, 285 (1996); see Graves v. Brown, 8 Vet. App. 522, 524 (1996). The law provides, If new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. 38 U.S.C.A. § 5108 (West 1991). The corresponding VA regulation provides, New and material evidence means evidence not previously submitted to agency decision makers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156 (1999) (final emphasis added). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has stated with regard to the meaning of the portion of the regulation that the Board has emphasized above, Although the regulation does require that the new evidence 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), it is not clear to what extent this addresses the final ratings decision rather than emphasizes the importance of ensuring that the evidentiary record is complete before a ratings decision is made. Hodge v. West, 155 F.3d 1356, 1361, 1363 (Fed. Cir. 1998). The Federal Circuit considered an explanation that had accompanied the proposed regulatory amendment which added the definition in section 3.156(a) and concluded, This passage suggests that the purpose behind the definition was not to require the veteran to demonstrate that the new evidence would probably change the outcome of the claim; rather, it emphasizes the importance of a complete record for evaluation of a veteran's claim. Hodge, 155 F.3d at 1363. The Federal Circuit also stated, We certainly agree with the [United States] Court of Veterans Appeals [now the United States Court of Appeals for Veterans Claims] that not every piece of new evidence is "material"; we are concerned, however, that some new evidence may well contribute to a more complete picture of the circumstances surrounding the origin of a appellant's injury or disability. Hodge, 155 F.3d at 1363. If the newly presented evidence is not "new," the claim to reopen fails on that basis and no further analysis of the evidence is required. Similarly, if "new" evidence is not "material," in the sense that does not bear directly and substantially upon the specific matter under consideration and which, by itself or in connection with evidence previously assembled, is so significant that it must be considered in order to fairly decide the merits of the claim, the claim to reopen fails on that basis and the inquiry ends. 38 C.F.R. § 3,156 (1999). In addition, The United States Court of Appeals for Veterans Claims (Court) has held that, if the Board reopens a claim for service connection based on new and material evidence under 38 C.F.R. § 3.156(a), the Board must then consider whether the claim for service connection is well grounded. Hickson v. West, 12 Vet. App. 247, 252 (1999); 38 U.S.C.A. § 5107(a) (West 1991). II. Analysis Review of the appellant's claims requires the Board to provide a written statement of the reasons or bases for its findings and conclusions on material issues of fact and law. 38 U.S.C.A. § 7104(d)(1) (West 1991). The statement must be adequate to enable a claimant to understand the precise basis for the Board's decision, as well as to facilitate review by the United States Court of Veterans Appeals. See Simon v. Derwinski, 2 Vet. App. 621, 622 (1992); Masors v. Derwinski, 2 Vet. App. 181, 188 (1992). A. Service Connection for an Acquired Psychiatric Disorder Initially, the Board observes that the last final denial of the veteran's claim for service connection for an acquired psychiatric disorder was the Board's February 1981 decision. The Board's February 1981 decision is final. 38 U.S.C.A. § 7104(b) (West 1991). Prior to that decision, the Board had previously issued decisions on this issue in August 1968, July 1970, and July 1976. The Board's August 1968 decision, which denied the veteran's original claim for service connection for a nervous disorder, noted a finding of fact that "[a] nervous disorder was not present in service, and not shown at discharge therefrom. This condition was first manifested a number of years after service." The Board's most recent decision, dated in February 1981, concluded that the veteran had failed to submit new and material evidence that his current psychiatric disability originated in or was the result of his period of active duty service. The Board's February 1981 decision denied the veteran's claim because the evidence of record did not reflect the incurrence or aggravation of an acquired psychiatric disorder during the veteran's active duty service or within the first post service year. This relates to the second and third elements of a well-grounded claim for service connection. (A claim for service connection for a disorder typically involves three issues or "elements": (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a causal nexus between the current disability and the disease or injury incurred or aggravated in service. Evans, at 284; Caluza v. Brown, 7 Vet. App 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996)). Therefore, the Board will consider whether evidence submitted since that decision is new and material to reopen the claim. The Board has reviewed all of the additional evidence received herein since the Board's February 1981 decision and concludes that there is evidence both new and material as it relates to the issue at hand and, therefore, the claim is reopened. Specifically, a copy of a VA medical treatment report, dated June 1975, noted that the veteran "is known to have chronic schizophrenia since 1954." A treatment summary report from E. R. Jiminez Olivio, M.D., noted that he had treated the veteran since 1965, and that the veteran "has been afflicted by his nerves since he was discharged from the army in the year 1956." A treatment report from the Department of Health Mental Health Center in Arecibo, Puerto Rico, dated April 1998, noted that the veteran's mental illness began "[f]rom when he left the army." Although these reports/opinions are clearly "new" evidence because they were not previously before Board at the time of its February 1981 decision, the remaining more difficult question is whether this evidence is "material" in that it is "so significant that it must be considered in order to fairly decide the merits of the claim." After reviewing the evidence of record, the Board concludes that the newly submitted medical evidence does add to the "completeness" of the record in the sense that it shows a current psychiatric disorder and relates that condition to the veteran's active duty service. In this regard, the Board's February 1981 decision concluded that there was no evidence of record establishing a relationship between a current psychiatric disorder and his active duty service. Thus, the newly submitted evidence is material because it contributes "to a more complete picture of the circumstances surrounding the origin of" the veteran's current acquired psychiatric disorder. See Hodge, 155 F.3d at 1356. Accordingly, without considering whether the evidence will change the outcome of the claim and presuming its credibility, the Board concludes that new and material evidence sufficient to reopen the claim for service connection for an acquired psychiatric disorder has been submitted. Thus, the Board reopens the claim for service connection for an acquired psychiatric disorder, and remands the claim below for further development. B. Claim for Service Connection for Prostatitis. In July 1970, the Board issued a decision that denied the veteran's claim for service connection for prostatitis. The Board's July 1970 decision is final. 38 U.S.C.A. § 7104(b) (West 1991). The Board notes that the prior July 1970 decision denied the veteran's claim for service connection for prostatitis because that condition "was not demonstrated in service and was first manifested in January 1967." See Board Decision, p. 4 (July 29, 1970). This relates to the second and third elements of a well-grounded claim for service connection. (A claim for service connection for a disorder typically involves three issues or "elements": (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a causal nexus between the current disability and the disease or injury incurred or aggravated in service. Evans, at 284; Caluza v. Brown, 7 Vet. App 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996)). Therefore, the Board will consider whether evidence submitted since the July 1970 decision is new and material to reopen the claim. Since the July 1970 decision, the veteran has submitted essentially only two types of evidence: (1) lay evidence consisting of his statements and testimony and the statements from his family and fellow servicemen, and (2) post service medical records of treatment. The veteran's own lay statements and testimony and those lay statements offered by others in support of the veteran's claim, are not new because they merely repeat the claim previous adjudicated by the Board's July 1970 decision. At the January 1999 hearing conducted herein, the veteran testified that he fell while on basic training in 1954 injuring his left side of his body. Following this incident, the veteran reported inservice treatment for several episodes of hematuria. He then testified that his current prostatitis is secondary to his injuries and treatment for hematuria. As noted in the Board's prior decision, dated in July 1970, the veteran contends that "during service he was treated for urinating blood which is also a symptom of prostatitis, and that these disabilities are service connected." See Board Decision, p. 2 (July 29, 1970). Therefore, the Board concludes that the newly submitted lay statements in support of the veteran's claim to reopen are merely cumulative, and not new. The Board also notes that as a layperson, the veteran is not competent to provide a medical diagnosis of his condition during service, or the etiology of his current disorder. See Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992); Moray v. Brown, 5 Vet. App. 211 (1993) (lay assertions of medical causation cannot serve as the predicate to reopen a claim under 38 U.S.C.A. § 5108); Chavarria v. Brown, 5 Vet. App. 468 (1993) (an appellant's own recitations of her medical history do not constitute new and material evidence sufficient to reopen her claim when this account has already been rejected by VA). The Board also notes that its decision, dated February 1981, concluded that the veteran did not manifest a chronic genitourinary abnormality during service. Thus, the statements and testimony submitted by the veteran and others in this matter are not new and material evidence. In addressing the newly submitted medical evidence herein, the Board notes that the veteran has submitted service medical records, dated October 8, 1954 and February 1, 1955. These medical records were previously considered by the Board's July 1970 decision, and are therefore, not new. As for the post service medical treatment reports received by the Board after its July 1970 decision, these records are "new" because this evidence was not before the Board when it denied service connection for prostatitis. The Board must now consider whether the identified evidence is "material" in the sense that it bears directly and substantially upon the specific matter under consideration and which is so significant that it must be considered in order to fairly decide the merits of the claim, in that it contributes to a more complete picture of the circumstances surrounding the origin of the veteran's prostatitis. After a thorough review of the veteran's claims file, the Board concludes that none of the newly submitted medical evidence is suggestive of an inservice incurrence or aggravation of prostatitis. This evidence consists primarily of records reflecting the veteran's medical condition in the years following his active service, and as such they do not relate to the issues at hand. There is no opinion suggestive of a link between any current prostate disorder and the veteran's active military service. A treatment report by J. Diaz Garcia, M.D., dated April 1998, noted that the veteran has a history of treatment "for some years because of different complaints of several ailments." The report also noted the veteran's history of a left nephrectomy in 1963 as sequela of renal tuberculosis, arterial hypertension, diabetes mellitus, constipation and mental disturbances. No reference to an inservice incurrence or aggravation of prostatitis was indicated. Based on the applicable law, regulations and Court decisions, the additional evidence received since the Board's July 1970 decision is not new and material and does not provide the required evidentiary basis to reopen the veteran's claim. The Board's July 1970 decision denying service connection for prostatitis remains final. See Hodge v. West, 155 F.3d 1356 (1998); 38 U.S.C.A. §§ 5108, 7105(c)(West 1991); 38 C.F.R. § 3.156 (1999). C. Claim of Entitlement to Service Connection for Tuberculosis of the Left Kidney In July 1970, the Board issued a decision that denied the veteran's claim for service connection for tuberculosis of the left kidney. The Board's decision is final. 38 U.S.C.A. § 7104(b) (West 1991). The Board's July 1970 decision denied the veteran's claim for service connection for tuberculosis of the left kidney because that condition "was not shown in service or for a number of years after discharge." Specifically, the decision stated: There were no symptomatic findings or manifestations reported during service that were diagnostic of a kidney disorder, including tuberculosis of the kidney. On his discharge examination the genitourinary system and neurologic and psychiatric evaluations were reported as normal. A urinalysis was essentially normal. See Board Decision, p. 2 (July 29, 1970). Thus, the specific considerations in this case relate to the second and third elements of a well-grounded claim for service connection. (A claim for service connection for a disorder typically involves three issues or "elements": (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a causal nexus between the current disability and the disease or injury incurred or aggravated in service. Evans, at 284; Caluza v. Brown, 7 Vet. App 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996)). Therefore, the Board will consider whether evidence submitted since that July 1970 decision is new and material to reopen the claim. Since the July 1970 decision, the veteran has submitted essentially only two types of evidence: (1) lay evidence consisting of his statements and testimony and lay statements from his family and fellow servicemen, and (2) post service medical records of treatment. The veteran's own lay statements and testimony, and those statements offered by others in support of the veteran's claim, are not new because they merely repeat the claim previous adjudicated by the Board's July 1970 decision. At the January 1999 hearing conducted herein, the veteran testified that he sustained a fall in 1954 while on basic training with injuries to his left side of his body. As a result of this incident, he claimed he received inservice treatment for hematuria and that he developed tuberculosis of the kidney. As noted in the Board's July 1970 decision, the veteran complained on pain in the flanks and back on urination while in the service. Therefore, the Board concludes that the lay statements and testimony in support of the veteran's claim to reopen are merely cumulative, and not new. The Board further notes that as a layperson, the veteran and his fellow supporters are not competent to provide a medical diagnosis of his condition during service, or the etiology of his current disorder. See Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992); Moray v. Brown, 5 Vet. App. 211 (1993) (lay assertions of medical causation cannot serve as the predicate to reopen a claim under 38 U.S.C.A. § 5108); Chavarria v. Brown, 5 Vet. App. 468 (1993) (an appellant's own recitations of her medical history do not constitute new and material evidence sufficient to reopen her claim when this account has already been rejected by VA). Thus, the statements and testimony submitted by the veteran and others in this matter are not new and material evidence. As for the medical treatment reports received by the Board after its July 1970 decision, these records are "new" because this evidence was not before the Board when it denied service connection for a prostate disorder. The Board must now consider whether the identified evidence is material. After a thorough review of the veteran's claims file, the Board concludes that none of the newly submitted medical evidence relates the veteran's left kidney disorder to an injury or disease incurred during his active duty service. This evidence consists primarily of records reflecting his medical condition in the years following his active service, and as such they do not relate to the issues at hand. A treatment report by J. Diaz Garcia, M.D., dated April 1998, noted the veteran's history of a left nephrectomy in 1963 as sequela of renal tuberculosis, arterial hypertension, diabetes mellitus, constipation and mental disturbances. No reference to an inservice incurrence or aggravation of the tuberculosis of the left kidney was indicated. The Board also notes that treatment summary report, dated May 1998, noted the veteran's narrative "history of a renal and ocular condition which as he says are connected with the service." However, a bare transcription of a lay history is not transformed into competent medical evidence merely because the transcriber happens to be a medical professional. LeShore v. Brown, 8 Vet. App. 406 (1995). Based on the applicable law, regulations and Court decisions, the additional evidence received since the Board's July 1970 decision is not new and material and does not provide the required evidentiary basis to reopen the veteran's claim. The Board's July 1970 decision denying service connection for tuberculosis of the left kidney remains final. See Hodge v. West, 155 F.3d 1356 (1999); 38 U.S.C.A. §§ 5108, 7105(c)(West 1991); 38 C.F.R. § 3.156 (1999). D. Claim of Entitlement to Service Connection for Left Eye Disorder In February 1981, the Board issued a decision that denied the veteran's original claim for service connection for an eye disorder. The Board's decision is final. 38 U.S.C.A. § 7104(b) (West 1991). Specifically, service connection an eye disorder was denied because the veteran failed to show evidence of incurrence or aggravation of an eye disorder during service. The decision also noted that the veteran's service medical treatment records revealed treatment for a chronic lesion of the left eye, but that the veteran's separation examination revealed visual acuity of 20/20 in each eye. Accordingly, the "issue at hand" in this case is whether the veteran incurred or aggravated a chronic eye disorder during his active duty service. During the development of his claim, the veteran has presented testimony and numerous statements in support of his claim to reopen. The veteran also submitted statements in support of his claim from family members and fellow servicemen. After a thorough review of the veteran's various statements and testimony herein and those statements submitted by others, the Board concludes that this additional evidence is merely cumulative of evidence previously considered. Chavarria v. Brown, 5 Vet. App. 468 (1993). In this regard, all of these statements essentially allege that the veteran initially developed a chronic eye disorder during his active duty service. Therefore, the Board concludes that the veteran's statements and testimony and the statements offered by others are merely cumulative, and not new. Additionally, the Board notes that while lay testimony and statements are competent to establish the occurrence of an injury, they are not competent to provide a medical diagnosis of the veteran's condition during service, or the etiology of his current disorder. In regard to the post service medical evidence submitted by the veteran, and not in the claims file at the time of the Board's February 1981 decision, the Board concludes that this evidence is new. Therefore, the Board now considers whether the identified evidence is "material," bearing directly and substantively upon the specific matter under consideration and so significant that it must be considered in order to fairly decide the merits of the claim. In reviewing the post service medical evidence of record, there is no medical evidence relating any current eye disorder to an inservice disease or injury. Accordingly, the veteran has not submitted any medical evidence material to the issue at hand, i.e. the incurrence or aggravation of a chronic left eye disorder during active duty service. Based on the applicable law, regulations and Court decisions, the additional evidence received since the Board's February 1981 decision is not new and material and does not provide the required evidentiary basis to reopen the veteran's claim. The Board's February 1981 decision denying service connection for an eye disorder remains final. See Colvin, 1 Vet. App. 171; 38 U.S.C.A. §§ 5108, 7105 (West 1991); 38 C.F.R. § 3.156 (1999). E. Claim of Entitlement to Service Connection for a Back Disorder In February 1981, the Board issued a decision that denied the veteran's original claim for service connection for a back disorder. The Board's decision is final. 38 U.S.C.A. § 7104(b) (West 1991). Specifically, the veteran's claim for service connection a back disorder was denied because the veteran failed to show evidence of incurrence or aggravation of a chronic back disorder during service. Accordingly, the specific matter under consideration is whether the veteran incurred or aggravated a chronic back disorder during his active duty service. In this case, the Board will consider whether evidence submitted since the Board's February 1981 rating decision is new and material to reopen the claim. Since the February 1981 rating decision, the veteran has submitted essentially only two types of evidence: (1) lay evidence consisting of statements from the veteran, his family and his friends, and (2) post service medical records of treatment. The veteran's own lay statements and those offered by his family and friends are not new because they merely repeat claims already decided by the Board, i.e. that the veteran injured his back from a fall during service. Therefore, the Board concludes that the lay statements in support of veteran's claim to reopen are merely cumulative, and not new. Additionally, the Board notes that while lay testimony is competent to establish the occurrence of an injury, it is not competent to provide a medical diagnosis of the veteran's condition during service, or the etiology of his current disorder. See Hickson v. West, 12 Vet. App. 247 (1999); Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992); Moray v. Brown, 5 Vet. App. 211 (1993) (lay assertions of medical causation cannot serve as the predicate to reopen a claim under 38 U.S.C.A. § 5108); Chavarria v. Brown, 5 Vet. App. 468 (1993) (an appellant's own recitations of her medical history do not constitute new and material evidence sufficient to reopen her claim when this account has already been rejected by VA). In support of his claim, the veteran has submitted service medical records, dated in October 1954 and in February 1955, that were previously before the Board at the time of its February 1981 decision. These treatment records are not new and cannot serve as the basis to reopen the veteran's claim. The remaining post service medical evidence, however, is "new" because this evidence was not before the Board when it denied service connection for a back disorder in February 1981. However, the Board notes that the February 1981 decision denied the veteran's claim because he was not shown to have incurred or aggravated a chronic back disorder during service. Accordingly, for this medical evidence to be material, it must indicate the presence during service of a chronic back disability. After a thorough review of the veteran's claims file, the Board concludes that none of the newly submitted medical evidence is indicative of a chronic back disorder having been incurred in or aggravated by the veteran's active duty service. Medical records describing the veteran's current condition are not material to the issue of incurrence during service and are not sufficient to reopen a claim for service connection based on new and material evidence. Morton V. Principi, 3 Vet. App. 508, 509 (1992). Based on the applicable law, regulations and Court decisions, the additional evidence received since the Board's February 1981 decision is not new and material and does not provide the required evidentiary basis to reopen the veteran's claim. The Board's February 1981 decision denying service connection for a back disorder remains final. See Hodge v. West, 155 F.3d 1356 (1998); 38 U.S.C.A. §§ 5108, 7105(c)(West 1991); 38 C.F.R. § 3.156 (1999). III. Conclusion Where new and material evidence has not been submitted to reopen a finally denied claim, VA does not have a statutory duty to assist a claimant in developing facts pertinent to the claim, but VA may be obligated under 38 U.S.C.A. § 5103(a) to advise a claimant of evidence needed to complete his application. This obligation depends on the particular facts of the case and the extent to which the Secretary has advised the claimant of the evidence necessary to be submitted with a VA benefits claim. See Graves v. Brown, 8 Vet. App. 522, 524-25 (1996); Robinette v. Brown, 8 Vet. App. 69, 78 (1995). Here, unlike the situation in Graves, the veteran has not put the VA on notice of the existence of any specific, particular piece of evidence which is not only relevant to his claims, but is so significant that it must be considered in order to fairly decide the merits of the claims. 38 C.F.R. § 3.156 (1999). Accordingly, the Board concludes that VA did not fail to meet its obligations under 38 U.S.C.A. § 5103(a) (West 1991). The benefit of the doubt doctrine need not be applied in the situation where an appellant has not fulfilled the threshold burden of submitting new and material evidence to reopen a finally disallowed claim. Annoni v. Brown, 5 Vet. App. 463 (1993). (CONTINUED ON NEXT PAGE) ORDER New and material evidence having been submitted, the veteran's claim for entitlement to service connection for an acquired psychiatric disorder is reopened; to this extent, the appeal is allowed. The appeal to reopen a claim of service connection for prostatitis is denied. The appeal to reopen a claim of service connection for tuberculosis of the left kidney is denied. The appeal to reopen a claim of service connection for left eye disorder is denied. The appeal to reopen a claim of service connection for a back disorder is denied. REMAND The appellant contends that he is entitled to service connection for an acquired psychiatric disorder. Specifically, the appellant alleges that this condition was incurred secondary to an inservice fall from a tank during basic training in May 1954. Although the claim for service connection for an acquired psychiatric disorder is now reopened, the Board finds that the case is not yet ready for final appellate review. In Elkins v. West, No. 97-1534 (U. S. Vet. App. Feb. 17, 1999) (en banc), the Court held that the two-step process set out in Manio v. Derwinski, 1 Vet. App. 140, 145 (1991), for reopening claims became a three-step process under the Federal Circuit's holding in Hodge, supra: VA must first determine whether new and material evidence has been presented under 38 C.F.R. § 3.156(a); second, if new and material evidence has been presented, immediately upon reopening VA must determine whether, based upon all the evidence and presuming its credibility, the claim as reopened is well grounded pursuant to 38 U.S.C. § 5107(a); and third, if the claim is well grounded, VA may evaluate the merits after ensuring the duty to assist under 38 U.S.C. § 5107(b) has been fulfilled. See also Winters v. West, No. 97-2180 (U. S. Vet. App. Feb. 17, 1999) (en banc). In light of the Board's action reopening the veteran's claim, the RO must adjudicate the veteran's claim based on all of the evidence of record, both old and new. Accordingly, this case is REMANDED to the RO for the following development: 1. The RO should determine whether the veteran's reopened claim for entitlement to service connection for an acquired psychiatric disorder is well grounded and, if so, adjudicate it on its merits, considering all of the evidence of record, both old and new. 2. If the claim is to be adjudicated on its merits, first the veteran should be asked to provide a list containing the names and addresses of all health care professionals and/or facilities (private and governmental) where he has been treated for an acquired psychiatric disorder since his discharge from the service. After securing the proper authorizations, the RO should attempt to obtain all of the records of treatment from all the sources listed by the appellant, which are not already on file. The Board is particularly interested in obtaining the complete records of Elias R. Jiminez Olivo, M.D., which form the basis for his opinion as stated in a letter dated Mary 26, 1998, and in the complete records from the Department of Health, Mental Health Center, which form the basis for the opinion from that organization dated April 8, 1998. All information obtained should be made part of the file. If deemed necessary by the RO, a medical opinion should be sought regarding the etiology of the veteran's current acquired psychiatric disorder and its relationship, if any, with the veteran's active duty service. Once the foregoing has been accomplished and, if the appellant remains dissatisfied with the outcome of the adjudication of the claim, both the appellant and his representative should be furnished a supplemental statement of the case covering all the pertinent evidence, law and regulatory criteria. They should be afforded a reasonable period of time in which to respond. Thereafter, the case should be returned to the Board for further appellate consideration. The appellant needs to take no action until so informed. The purpose of this REMAND is to assist the appellant and to obtain clarifying information. The Board intimates no opinion as to the ultimate outcome of this case. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44-8.45 and 38.02-38.03. BETTINA S. CALLAWAY Member, Board of Veterans' Appeals