Citation Nr: 0005040 Decision Date: 02/25/00 Archive Date: 03/07/00 DOCKET NO. 94-34 999 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Albuquerque, New Mexico THE ISSUE Whether new and material evidence has been submitted to reopen a claim for entitlement to service connection for residuals of an injury to the head and neck. REPRESENTATION Appellant represented by: Patricia Glazek, Attorney at Law ATTORNEY FOR THE BOARD Martin F. Dunne, Counsel INTRODUCTION The veteran served on active duty in the Armed Forces from September 1941 to July 1942. In March 1985, the Board of Veterans' Appeals (Board) denied the veteran entitlement to service connection for chronic residuals of an injury to the head and spine. In June 1993, he filed an application to reopen his claim. In an August 1993 rating decision, the Department of Veterans Affairs (VA) Regional Office (RO) in Albuquerque, New Mexico, denied service connection for chronic residuals of an injury to the veteran's head and neck on the basis that new and material evidence had not been submitted that would warrant reopening the claim. The veteran appealed to the Board, which issued a decision on August 2, 1996, holding that its March 1985 decision was final, and that new and material evidence had not been submitted to warrant reopening the claim. The veteran appealed the Board's August 1996 decision to the United States Court of Veterans Appeals (Court) [since renamed the United States Court of Appeals for Veterans Claims]. On October 15, 1998, the Court issued a decision vacating the Board's August 2, 1996, decision and remanding the matter for issuance of a readjudicated decision. Also, in October 1998 the veteran rescinded his power of attorney with his prior representative and, in November 1998, submitted a signed authorization appointing Patricia Glazek, Attorney at Law, as his representative for all issues at the VA as of that date. In February 1999, the Board remanded the case to the RO for development and adjudication. The RO found that new and material evidence had been submitted; reopened the veteran's claim of service connection for chronic residuals of an injury to the head and neck; and denied the claim on the merits. The veteran and his representative were furnished a Supplemental Statement of the Case and afforded the appropriate opportunity to submit written or other argument in response thereto. The case then was returned to the Board for appellate determination. FINDINGS OF FACT 1. In March 1985, the Board denied service connection for chronic residuals of an injury to the head and spine on the basis that permanent disabling residuals of a reported fall were not shown during the veteran's active duty service and were not demonstrated subsequent to service. 2. Evidence associated with the claims file since the Board's March 1985 decision is relevant and probative and, when viewed in conjunction with the evidence previously of record, is so significant that it must be considered in order to fairly decide the merits of the case. 3. There is no competent medical evidence of a nexus or link between the veteran's currently diagnosed psychomotor epilepsy, neuromuscular impairment, and service. CONCLUSIONS OF LAW 1. The Board's March 1985 decision that denied service connection for chronic residuals of an injury to the head and spine is final. 38 U.S.C.A. §§ 5108, 7104 (West 1991); 38 C.F.R. §§ 3.156(a), 20.1105 (1999). 2. New and material evidence sufficient to reopen the veteran's claim for service connection for chronic residuals of an injury to the head and neck has been submitted subsequent to the Board's March 1985 decision; the requirements to reopen the claim have been met. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1999). 3. The claim for service connection for chronic residuals of an injury to the head and neck is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. New and Material Evidence In March 1985, the Board denied service connection for chronic residuals of an injury to the head and spine. In reaching this determination, the Board had reviewed the veteran's service medical records, post-service medical treatment records from 1942 to 1983, statements from treating physicians and military comrades, copies of pages from a medical text, and testimony presented by the veteran at a hearing held before a travel section of the Board. In explaining its decision, the Board found that the veteran's service medical records revealed no documentation of a head or spine injury; therefore, any injury the veteran might have sustained was apparently an insignificant one and had resolved without leaving any residual disability. The Board further found that recent opinions by a psychologist and physiologist, recent recollections from the veteran, his service comrades and others did not provide sufficient probative value to overcome the lack of supporting clinical data in the extensive reports of evaluation and treatment the veteran had in service. In June 1993, the RO received the veteran's current application to reopen his claim for service connection for chronic residuals of an injury to his head and neck. Although the Board's March 1985 decision is final, if new and material evidence is presented or secured with respect to a claim that has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. See 38 U.S.C.A. § 5108; Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). As noted earlier in this decision, pursuant to the Board's February 1999 remand, the RO found that new and material evidence had been submitted warranting reopening the veteran's claim. The Board notes that under 38 U.S.C.A. § 7104(a) all questions in a matter subject to a decision by the Secretary shall be subject to one review on appeal to the Board. See Barnett v. Brown, 83 F.3d 1380, 1383 (Fed.Cir. 1996); Marsh v. West, 11 Vet. App. 468, 471 (1998); Smith (Irma) v. Brown, 10 Vet. App. 330, 332 (1997). In the instant case, the Board must first determine whether it has jurisdiction to proceed by assessing the question of whether new and material evidence has been submitted to warrant reopening the veteran's claim seeking service connection for residuals of an injury to the head and neck. As defined by regulation, 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 the evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. See 38 C.F.R. § 3.156(a); Cox v. Brown, 5 Vet. App. 95, 98 (1993). In addition, for the purpose of determining whether a case should be reopened, the credibility of the evidence added to the record is to be presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). There is no requirement, however, that in order to reopen a claim, that the new evidence, when viewed in the context of all the evidence, both new and old, creates a reasonable possibility that the outcome of the case on the merits would be changed. See Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998) (expressly rejecting the standard for determining whether new and material evidence had been submitted sufficient to reopen a claim set forth in Colvin v. Derwinski, 1 Vet. App. 171 (1991)). The provisions of 38 U.S.C.A. § 5108 require a review of all evidence submitted by a claimant since the previously disallowed claim in order to determine whether a claim must be reopened and re-adjudicated on the merits. See Evans v. Brown, 9 Vet. App. 273, 282-83 (1993). If the Board's decision is favorable to the veteran, his claim must be reopened and decided on the merits. See Glynn v. Brown, 6 Vet. App. 523, 528-29. (1994). Inasmuch as the Board's March 1985 decision is the last final decision of record, the evidence that has been associated with the file since then is the evidence that must be considered in connection with the new and material evidence inquiry. The evidence associated with the claims file since the Board's March 1985 decision consists of duplicate copies of his service medical records, a duplicate copy of a VA social and industrial survey dated in 1949, duplicate copies of written statements from his parents dated in 1942, and VA outpatient treatment reports from December 1993 to November 1998. In April 1999, the VA received copies of the veteran's private EEG (electroencephalogram) report dated in 1982 and a 1989 neuropsychological consultation report. The veteran's private 1982 electroencephalogram report shows mild nonspecific abnormalities and his 1989 neuropsychological consultation report notes findings suggestive of temporal lobe epilepsy, based on the veteran's narrative of sustaining head and neck injuries in a fall while on active duty. Between late 1993 and late 1998, the veteran's VA outpatient treatment reports show that he has psychomotor epilepsy. In response to the previously mentioned Federal Circuit's decision in Hodge, the Court provided further guidance for the adjudication of previously denied claims to which finality had attached in Elkins v. West, 12 Vet. App. 209, 214-15 (1999) (en banc), and in Winters v West, 12 Vet. App. 203, 206 (1999) (en banc). In Elkins and Winters, the Court set forth a three-part test. Under the new Elkins test, the Secretary must first determine whether the veteran has presented new and material evidence under 38 C.F.R. § 3.156(a) in order to have a finally decided claim reopened under 38 U.S.C.A. § 5108. Second, if new and material evidence has been presented, immediately upon reopening the claim the Secretary must determine whether, based upon all the evidence of record in support of the claim, presuming its credibility, the claim as reopened is well grounded pursuant to 38 U.S.C.A. § 5107(a). Third, if the claim is well grounded, the Secretary may then proceed to evaluate the merits of the claim, but only after ensuring that his duty to assist under 38 U.S.C.A. § 5107(b) has been fulfilled. In light of the foregoing, the Board will consider the veteran's application to reopen his claim for service connection for residuals of an injury to his head and neck. In determining whether new and material evidence has been submitted since the previously disallowed final claim, the Board is mindful of the mandate in the recent Hodge precedent, discussed above. Therein, the Federal Circuit Court declared: "We certainly agree with the Court of Veterans Appeals 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 veteran's injury or disability, even where it will not eventually convince the Board to alter its ratings decision. Where so much of the evidence regarding the veterans' claims for service connection and compensation is circumstantial at best, the need for a complete and accurate record takes on even greater importance." See Hodge v. West, supra. In view of the change provided by the Federal Circuit Court, the Board concludes that the threshold for reopening a previously denied claim has been lowered. Accordingly, we find that the newly submitted evidence, in particular the veteran's private 1982 EEG report and his 1989 neuropsychological consultation report both showing current disability, in combination with the other medical and lay evidence now of record, meet the regulatory standard of evidence "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." See 38 C.F.R. § 3.156(a). Having determined that new and material evidence has been added to the record, the veteran's claim for service connection for residuals of an injury to the head and neck is reopened. II. Service connection As the veteran's claim has been reopened, the Board must now immediately determine whether, based upon all the evidence of record in support of the claim, presuming its credibility, the reopened claim is well grounded pursuant to 5107(a). See Elkins, 12 Vet. App. at 214-15; Winters, 12 Vet. App. at 206. To establish service connection for a claimed disability, the facts, as shown by the evidence, must demonstrate that a particular disease or injury resulting in current disability was incurred during active service or, if preexisting active service, was aggravated therein. See 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. When a disease is first diagnosed after service, service connection may nevertheless be established by evidence demonstrating that the disease was in fact incurred during the veteran's service, or by evidence that a presumption period applied. See 38 C.F.R. §§ 3.303, 3.307, 3.309; Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). A well-grounded claim is not necessarily a claim that will ultimately be deemed allowable. It is a plausible claim, properly supported with evidence. See 38 U.S.C.A. § 5107(a); Epps v. Gober, 126 F.3d 1464 (1997); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). In the absence of evidence of a well-grounded claim, there is no duty to assist the veteran in developing the facts pertinent to the claim, and the claim must fail. See Slater v. Brown, 9 Vet. App. 240, 243 (1996); Gregory v. Brown, 8 Vet. App. 563, 568 (1996) (en banc); Grivois v. Brown, 6 Vet. App. 136, 140 (1994); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Three types of evidence must be presented in order for a claim for service connection to be well grounded: (1) a medical diagnosis of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. Where the determinative issue involves medical causation, competent medical evidence to the effect that the claim is plausible is required. See Epps, 126 F.3d at 1468; Caluza v. Brown, 7 Vet. App. 498, 506 (1995). Alternatively, a claim may be established as well grounded pursuant to the chronicity provision of 38 C.F.R. § 3.303(b). That provision is applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service, or during an applicable presumption period, and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under he court's case law, lay observation is competent. If the chronicity provision is not applicable, a claim may still be well grounded or reopened on the basis of 38 C.F.R. § 3.303(b) if the condition is observed during service or any applicable presumption period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present condition to that symptomatology. See Savage v. Gober, 10 Vet. App. 488, 498 (1997). In the veteran's case, he is essentially asserting that, in October 1941, while in the Navy and sleeping in a hammock, someone flipped the hammock causing him to sustain injuries his head and neck, which eventually resulted in psychomotor epilepsy, a neuromuscular impairment affecting his upper extremities. Applying the relevant law and regulations to the facts of this case, the Board notes that, although the veteran asserts that in October 1941 he fell from his hammock sustaining injury to his head and neck, his service medical records do not reflect any symptomatology pertaining to psychomotor epilepsy or to a neuromuscular impairment affecting his upper extremities, nor is there any service medical report of such injury or treatment for injuries to the veteran's head or neck. In 1983, the veteran submitted copies of statements by several of his service comrades, to the combined effect that they were aware someone had fallen injuring his head, although no one actually saw the veteran fall or had first hand knowledge that it was the veteran who had fallen from a hammock during boot camp and that he had to be taken to sick bay. In September 1980, the VA received copies of military night sick logs reports showing only that the veteran was hospitalized in early October 1941 for routine treatment of catarrhal fever. In November 1941, the veteran was examined and found physically qualified for transfer from his naval training station. No reference is made to any head or neck injury. In January 1942, he was hospitalized for acute appendicitis. While hospitalized, he underwent physical evaluation, which revealed no head abnormality. Following an appendectomy, he was discharged to duty in early February 1942. In May 1942, the veteran was seen in sick bay for complaints of severe, recurrent occipital headaches, of one and a half years duration, following a fall where he had struck the back of his head. An X-ray taken of his skull revealed the bones to be of normal texture and density. The sella turcica appeared normal in size. No undue calcification was noted. He was given a diagnosis of constitutional psychopathic state, inadequate personality, and transferred to a military hospital in June 1942 for further observation and disposition by a Board of Medical Survey. At the time of the admission to the military facility, the veteran complained that "sometimes I get nervous and all mixed up." The hospital records note that, by history, he had recently reported to sick bay with complaints of persistent occipital headaches, which he dated to a fall at age twelve. He stated that, within the past year and a half, these headaches had become noticeably more severe, so that at times he had difficulty in concentration. On physical examination, his head and neck were shown to be normal. Likewise, an X-ray taken of the veteran's skull revealed no abnormality. Neurological evaluation revealed no abnormality. On psychiatric evaluation, no definite mood or content disorders were elicited. He complained mainly of headaches and of occasional periods of subjective confusion. He dated his troubles to a fall from a bicycle at the age of twelve. He reported that, as far as he knew, he had not been knocked unconscious, although he claimed a doctor had said that the veteran had a slight concussion. He gave a history of having had occasional occipital headaches since the age of twelve. Mental examinations and observations revealed no psychotic trends or tendencies, but he displayed numerous manifestations of a profound personality disorder. He was found to be immature, and puerile and dependent in his attitude. In view of the Medical Board's findings of emotional immaturity, the veteran's history of maladjustment and nervousness since childhood, and his early experiences in a broken home, it was the Medical Board's opinion that the veteran had a defect in personality development which was both constitutionally and environmentally determined. He was found temperamentally unsuited for naval environment and routine. Pursuant to the Medical Board's recommendation that he be separated from service due to unsuitability, he was so discharged in July 1942. Under the above-mentioned circumstances, there is no competent medical evidence showing that the veteran exhibited a seizure disorder or neuromuscular impairment while he was on active duty service. Likewise there is no indication in the service medical records of an in-service head injury. In fact, the history recorded contemporaneous to the treatment and evaluation in service relates the origin of the veteran's complaints to a preservice falling injury. The next question is whether the exhibited a seizure or neuromuscular disorder within the one-year presumptive period following his separation from active duty service. In the veteran's case, his post-service medical records do not show any competent medical evidence of either psychomotor epilepsy or neuromuscular disorder until well beyond the one-year presumptive period following the veteran's separation from active duty service. A November 1942 medical statement from E. Zeilinger, M.D., shows that he had seen the veteran twice in August and once in October 1942 for complaints of severe cerebral headaches, dizziness, and periods of lapses of mind, as though he were in a daze. However, no medical records were submitted with the statement or underlying pathology given for the veteran's complaints. In November 1944, the veteran was hospitalized at VA facility after he fell from a motorcycle and injured his right shoulder. Medical examination revealed no head abnormality. An X-ray of the right shoulder showed no evidence of an old or recent disease or injury, with the exception of a slightly separated right acromioclavicular articulation, thought to be due to an old injury. No muscle atrophy was noted. He was discharged from the hospital after two days. The reports of the veteran's September to December 1945 VA hospitalization show that he was seen primarily for complaints of a right shoulder injury. At the time, he related that, ten days following the November 1944 hospital discharge, he had slipped on a waxed floor and fell approximately ten feet, striking his right shoulder against a post. Since that time, he had limitation of motion of the shoulder. Rather than seek medical attention, he had immobilized his arm for six weeks wearing a sling. On examination, there was atrophy of the right deltoid trapezius and slight atrophy of the right rhomboid muscle. There also was decreased mobility of the right shoulder joint. While hospitalized, he related a history of "temporary amnesia," of which he claimed he first really became aware in the spring of 1942 when he found that he had walked a few blocks "without knowing it." Following psychiatric evaluation, the diagnoses were constitutional psychopathic state and inadequate personality. He was discharged from the hospital with the neurological diagnoses of atrophy of the shoulder girdle and neuritis of the right circumflex nerve. The veteran was again hospitalized in March 1948 and was diagnosed with psychoneurosis conversion hysteria. He had been complaining of weakness, dizziness, fainting spells and frequent headaches. The medical records for that VA hospitalization note that he had symptoms for every system and was very verbose. The examining physician recorded the impression that there did not appear to be much organically wrong with the veteran. X-rays taken of his skull revealed that it was normal. The diagnosis was psychoneurosis with conversion hysteria. In October 1948, the veteran was hospitalized with complaints of right shoulder pain and weakness. At the time, he gave a detailed history of sustaining injuries in October 1941 when he fell out of a hammock. He related that he had not noticed any symptoms until several months later when there was an onset of weakness in movements of his right shoulder. He also complained of spells, which were considered similar to epileptiform equivalents, but, on further questioning, these more closely resembled functional states. The VA records show that a herniated cervical disc was considered as a possibility, but none was found nor was there any sensory deficit. The final diagnoses included psychoneurosis, anxiety state. From late November 1949 to mid-January 1950 the veteran was hospitalized at a VA facility for complaints of headaches, weakness, and dizziness. Medical evaluation found muscular dystrophy and schizophrenic personality. In a February 1950 medical statement, the veteran's private physician, R. Klemme, M.D., noted that the veteran had a definite muscular dystrophy, superimposed on personality changes, all of which the physician felt were exaggerated and aggravated by the veteran's military experiences. In May 1950, the veteran had cervical laminectomy for the preoperative diagnosis of syringomyelia; however, no pathology was found. His post-operative course was uneventful, but he persistently over emphasized his physical difficulties and always found excuses to get out of rehabilitation procedures. At hospital discharge, it was noted that there had been no progression of the neurological involvement since the operation. In the 1950's, he had several more admissions in VA hospitals for different complaints, and had different neurological diagnoses and psychiatric diagnoses, including latent schizophrenia, inadequate personality, constitutional psychopathic state, and psychophysiological gastrointestinal complaints. The final diagnoses on discharge from a period of hospitalization in 1961 were possible progressive muscular dystrophy, possible cervical syringomyelia, hypoglycemia of undetermined origin, and an inadequate personality. In October 1968, the veteran's private physician, H., Black, M.D., noted that the veteran had a partial paralysis of the right forearm and right hand and that he suffered from psychomotor epilepsy. In December 1976 letters, G. Phelan, M.D., related the veteran had severe osteopetrosis and E. Shakespeare, M.D., related the veteran had chronic bronchitis and residuals from spinal and head injuries; however, no elaboration was provided. In June 1977, Dr. Phelan wrote that he had been caring for the veteran since July 1975 when he was hospitalized for head trauma, described as being above the right eye. In early 1980, the veteran was hospitalized in a VA facility for recurrent back pain, atrophy of the hand muscles, secondary to an old spinal cord injury, and osteopetrosis. Affidavits submitted in 1981 and 1982 from the veteran's cousin and long-time acquaintance essentially related that, prior to the veteran's active duty service, he exhibited no medical problems, but following discharge from service, he had had headaches and seizures. In 1982, a statement from a private neurologist relates the results of a recent CT scan of the veteran's head and cervical spine were entirely normal. The physician commented that the results made it extremely unlikely that the veteran had syringomyelia. He related that it appeared the veteran had a brachial plexus lesion of uncertain etiology, and added that historically the lesion dated from the time the veteran had fallen out of the hammock. The report of the veteran's August 1982 private EEG revealed mild nonspecific abnormalities in the temporal areas, more so on the left. In a December 1982 letter, D. Feeney, Ph.D., a professor of psychology and physiology at the University of New Mexico, wrote that, based on the copies of the records given to him by the veteran, it seems extremely probable that the head injury the veteran received in 1941 during basic training caused the development of post-traumatic epilepsy. Based on a computer calculation, given that the veteran had a depressed skull fracture in the occipital-parietal area, was unconscious for more than one hour, has evidence of brain injury, and had a persisting EEG abnormality, the probability that he would develop post-traumatic epilepsy is .51 or 51% of such cases will have a seizure sometime after the injury. Also in December 1982, L. Partridge, Ph.D., an assistant professor of physiology at the same university reviewed the records given to him by the veteran and stated that, although he did not have any clinical training, his training in neurophysiology allowed him to make several observations with regard to the expected symptoms following injuries to the central nervous system, including that epileptic seizures and altered consciousness states are common results of central nervous system injuries and these can occur at any time following the injury. He also stated that from the standpoint of the neurophysiology involved, he felt that it was reasonable to ascribe the various symptoms exhibited by the veteran to the specific injury described. In a follow-up letter of April 1983, Dr. Partridge again emphasized that he did not have clinical expertise and that he was responding with regard to the neurophysiology of the veteran's case. As such, he related that it would be reasonable to expect both visual symptoms and epileptic seizures from a skull fracture and cortical depression in the occipital region, and the right arm weakness from a vertebral compression fracture. The claims file contains a copy of an article from a neurology publication by Dr. Feeney, and others, pertaining to the prognostic factors for the occurrence of post- traumatic epilepsy. Of record is a copy of a 1989 private neuropsychological consultation in which the veteran reiterated a report of head and neck injuries during his active duty service. Based on the veteran's self-reported history and psychological test results, the examiner offered that the results were suggestive of temporal lobe epilepsy. The veteran's VA outpatient treatment records for December 1993 to November 1998 show that he was being seen for disorders not under consideration. They also note that he has psychomotor epilepsy. The Board notes that the medical evidence of record shows that the veteran currently has psychomotor epilepsy and a neuromuscular impairment affecting his upper extremities; however, neither condition was shown while he was on active duty service or for many years after he was separated from active duty. Although the veteran contends he injured his head and shoulder in a fall from his hammock in service, there is no medical record of such injury. Indeed, the only head injury referenced on several occasions by service medical records was related by the contemporaneously recorded history to a preservice injury due to a fall. Nevertheless, even were the Board to assume, arguendo, that the veteran did sustain a fall as some of his service comrades have stated in statements submitted forty years after the alleged fall, there is still no competent medical evidence or opinion showing that he sustained permanent injury to his head or neck. In fact, when his head and neck were examined, including X-rays taken of the affected areas, both in service and for many years after service, his head and neck were consistently shown to have no abnormalities. It was not until after the veteran's fall from a motorcycle in 1944 and a slip and fall on a waxed floor shortly thereafter, that he began experiencing upper extremity difficulties, and not until 1949 - 1950 that symptoms suggestive of epilepsy were first noted. In the early 1980's the veteran submitted his medical records to a university professor of psychology and physiology and to an assistant professor of physiology at the same university. Based on those records, and on the veteran's narrative of his alleged October 1941 fall (the service medical records do not record any treatment or reference the alleged fall), opinions were offered that hypothetically, if the facts were correct, there was a good probability, based on computer computations and past training in neurophysiology, that someone could develop symptomatology such as the veteran's of psychomotor epilepsy and neuromuscular impairment. In effect, the professors have offered theoretical or general opinions and applied them to the veteran's scenario, as opposed to making specific findings based on documented facts and incidents that actually occurred. See Bloom v. West, 12 Vet. App. 185, 187 (1999). Further, opinions based on questionable history or theoretical prepositions are inadequate for rating purposes. See West v. Brown, 7 Vet. App. 70, 77 (1994). Although the professors have had training in physiology and psychology, neither professor is a physician specializing in neurology nor has either professor participated in the veteran's treatment. See Black v. Brown, 10 Vet. App 279, 284 (1997). The 1982 electroencephalogram report reflects mild nonspecific abnormalities but does not link such findings to the veteran's service. The 1989 neuropsychological consultation report contains results suggestive of temporal lobe epilepsy, again based on the veteran's "self-report" of a head and neck injury while in service. See West, 7 Vet. App. at 77. In the absence of competent medical evidence of a nexus between the veteran's psychomotor epilepsy and neuromuscular impairment and his military service, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). While the veteran asserts that his psychomotor epilepsy and neuromuscular impairment are the result of an alleged fall while in service, as a lay person without medical training, he is not competent to offer an opinion on medical matters, (here, medical causation); hence, his contentions in this regard have no probative value. See Jones v. Brown, 7 Vet. App. 134, 137 (1994); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1991). A claim must be supported by evidence and sound medical principles, not just assertions. See Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). Thus, the Board must conclude that the veteran has not submitted evidence sufficient to justify a belief by a fair and impartial individual that his claim for service connection for chronic residuals of a head and neck injury is well grounded. As the duty to assist has not been triggered by evidence of a well-grounded claim, there is no duty to assist the veteran in developing the record to support his claim for service connection. See Epps, 126 F.3d at 1468. Furthermore, the Board is aware of no circumstances that would put the VA on notice that any additional relevant evidence may exist which could be obtained that, if true, would well-ground the veteran's service connection claim. See McKnight v. Gober, 131 F.3d 1483, 1485 (Fed. Cir. 1997). Although the RO did not specifically deny the claim as not well grounded, "when a RO does not specifically address the question whether a claim is well grounded but rather, as here, proceeds to adjudication on the merits, there is no prejudice to the veteran solely from the omission of the well-grounded analysis." See Meyer v. Brown, 9 Vet. App. 425, 432 (1996). Moreover, as the veteran has been advised of the elements necessary to submit a well-grounded claim for service connection for the claimed condition, and the reasons why his current claim is inadequate, the duty to inform has been met. See 38 U.S.C.A. § 5103(a) (West 1991); Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995). ORDER To the extent the Board has determined that new and material evidence has been submitted to reopen the veteran's claim seeking service connection for residuals of an injury to the head and neck, the appeal is granted. In the absence of evidence of a well-grounded claim, service connection for chronic residuals of a head and neck injury is denied. D. C. Spickler Member, Board of Veterans' Appeals