Citation Nr: 0001361 Decision Date: 01/14/00 Archive Date: 01/27/00 DOCKET NO. 96-02 698 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Entitlement to service connection for residuals of chemical injury to eyes. 2. Entitlement to service connection for right ankle disability. 3. Entitlement to service connection for low back disability. 4. Entitlement to service connection for right arm disability. 5. Entitlement to service connection for headaches. 6. Entitlement to service connection for leg cramps. 7. Entitlement to service connection for left leg disability. 8. Entitlement to service connection for tinea of the toenails. 9. Entitlement to service connection for psychiatric disorder. REPRESENTATION Appellant represented by: Mississippi Veterans Affairs Commission WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. P. Simpson, Associate Counsel INTRODUCTION The appellant served on active duty from June 1946 to June 1949 and from April 1952 to April 1969. This case comes before the Board of Veterans' Appeals (the Board) on appeal from May 1995 and November 1995 rating decisions of the Jackson, Mississippi, Department of Veterans Affairs (VA) Regional Office (RO). In the May 1995 decision, the RO denied service connection for residuals of chemical injury to the eyes, residuals of right ankle injury, back condition, residuals of injury to right arm, headaches, residuals of injury to left leg, leg cramps, and acquired psychiatric disorder. In the November 1995 decision, the RO denied service connection for bad toenails. The Board remanded these claims in May 1998 and again in November 1998. The requested development has been accomplished, to the extent possible, and the case has been returned to the Board for further appellate review. The issue of service connection for a psychiatric disability is addressed in the remand appended to this decision. FINDINGS OF FACT 1. Competent evidence of a nexus between the diagnoses of blepharitis, macular degeneration, nuclear sclerotic cataract change, left hypertropia, retinal pigment epithelial changes, choroidal nevus in the left eye, exotropia, and hyperphoria and service is not of record. 2. Refractive error and presbyopia are developmental defects. 3. Competent evidence of a nexus between the diagnosis of arthritis of the right ankle and service is not of record. 4. Competent evidence of a nexus between the diagnoses of degenerative joint disease of the lumbar spine and degenerative disc disease of the lumbar spine and service is not of record. 5. Competent evidence of a diagnosis of right arm disability is not of record. 6. Competent evidence of a nexus between the diagnosis of headaches and service is not of record. 7. A diagnosis of leg pain is not a disability due to disease or injury for VA purposes. 8. Competent evidence of a nexus between the diagnosis of arthritis of the left knee and service is not of record. 9. Competent evidence of a nexus between the diagnosis of tinea of the toenails and service is not of record. CONCLUSIONS OF LAW 1. The claim for service connection for residuals of chemical injury to eyes, to include blepharitis, macular degeneration, nuclear sclerotic cataract change, left hypertropia, retinal pigment epithelial changes, choroidal nevus in the left eye, exotropia, and hyperphoria, is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. Refractive error and presbyopia are not diseases or injuries within the meaning of applicable law or regulations providing compensation benefits. 38 C.F.R. §§ 3.303(c), 4.9 (1999). 3. The claim for service connection for right ankle disability, to include arthritis of the right ankle, is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 4. The claim for service connection for low back disability, to include degenerative joint disease and degenerative disc disease, is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 5. The claim for service connection for right arm disability is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 6. The claim for service connection for headaches is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 7. The claim for service connection for leg cramps is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 8. The claim for service connection for left leg disability, to include arthritis of the left knee, is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 9. The claim for service connection for tinea of the toenails is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant contends that service connection is warranted for his eyes. He states that he got chemicals in his eyes and that his vision has been bad ever since to the extent that he has trouble reading and that he can no longer hunt. The appellant states that he injured his right ankle in February 1956, which still gives him trouble to the extent that he cannot stand for long periods of time and that he stumbles when he walks. He states that he injured his back in August 1960 and that he can lift only up to 40 pounds. The appellant states that he fell in service and injured his arms and legs, which injuries still hurt him. He states that the fall in November 1964 caused an injury to his left leg mainly, but that he injured his arms and right leg as well. He states that the fall in March 1966 was an injury to his arm. The appellant states that he has had headaches as far back as 1956 and that he does not think that they are due to hypertension. The appellant states that he had leg cramps in service and that he has them now. Finally, the appellant states that he had tinea of the toenails in service and still has it now. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Service connection for arthritis may be granted if manifest to a compensable degree within one year of separation from service. Service connection may be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). In making a claim for service connection, the appellant has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107(a). A well-grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). A well-grounded claim for service connection generally requires medical evidence of a current disability; evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, a nexus, or link, between the inservice disease or injury and the current disability as provided by competent medical evidence. Cohen v. Brown, 10 Vet. App. 128, 137 (1997); Caluza v. Brown, 7 Vet. App. 498 (1995) aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); see also 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303 (1999); Layno v. Brown, 6 Vet. App. 465 (1994); Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Alternatively, the nexus between service and the current disability can be satisfied by evidence of continuity of symptomatology and medical or, in certain circumstances, lay evidence of a nexus between the present disability and the symptomatology. See Savage v. Gober, 10 Vet. App. 488, 495 (1997). Establishing direct service connection for a disability that was not clearly present 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. Cuevas v. Principi, 3 Vet. App. 542 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). With a "chronic disease," such as arthritis, service connection may be warranted when the disease is manifested to a compensable degree within one year following service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309(a) (1999). Moreover, establishing a well-grounded claim for service connection for a particular disability requires more than an allegation that the particular disability had its onset in service. It requires evidence relevant to the requirements for service connection cited above and of sufficient weight to make the claim plausible and capable of substantiation. Tirpak v. Derwinski, 2 Vet. App. 609 (1992); see also Murphy, 1 Vet. App. at 81. The kind of evidence needed to make a claim well grounded depends upon the types of issues presented by the claim. Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993). For some factual issues, competent lay evidence may be sufficient. However, where the claim involves issues of medical fact, such as medical causation or medical diagnoses, competent medical evidence is required. Grottveit, 5 Vet. App. at 93. The appellant has not claimed that any of the disabilities for which he seeks service connection arose under combat situation. Thus, application of 38 U.S.C.A. § 1154(b) is not warranted. Service medical records reveal that in July 1946, the appellant reported that he had slipped and fallen on a bar of soap three and one-half years prior. He reported that he had had lumbar spine backache since that time. X-rays taken at that time of the lumbar spine revealed normal bone and joint structure. In February 1956, the appellant sprained his right ankle. There was moderate swelling and tenderness. X-rays taken at that time of the right ankle were negative. A couple of days later, the examiner noted that the swelling had gone down. In a March 1956 report of medical examination, clinical evaluations of the appellant's upper extremities, lower extremities, spine and other musculoskeletal system, and skin were normal. The ophthalmoscopic evaluation was normal. Visual acuity was 20/20 in each eye. The examiner noted that the appellant had sprained his right ankle in February 1956 but had "full recovery" and "no complication." In a report of medical history completed by the appellant at that time, he stated "no" to ever having or having now eye trouble; arthritis; and bone, joint, or other deformity. In November 1956, the appellant complained of headaches. The examiner stated that the headaches were probably due to the incision to remove a cyst rather than the diagnosis of pharyngitis. In a March 1957 report of medical examination, clinical evaluations of the appellant's upper extremities, lower extremities, spine and other musculoskeletal system, and skin was normal. The ophthalmoscopic evaluation were normal. Visual acuity was 20/20 in each eye. In a report of medical history completed by the appellant at that time, he stated "no" to ever having or having now eye trouble; arthritis; and bone, joint, or other deformity. In August 1960, the appellant was treated for acute low back strain. In a May 1962 report of medical examination, clinical evaluations of the appellant's upper extremities, lower extremities, and spine and other musculoskeletal system were normal. Examination of the skin revealed two scars, on the left calf and left wrist. The ophthalmoscopic evaluation was normal. Visual acuity was 20/20 in each eye. In a report of medical history completed by the appellant at that time, he stated "no" to ever having or having now eye trouble; arthritis; and bone, joint, or other deformity. In November 1964, the appellant fell over a rock and hurt his left leg. The examiner stated that there was a contusion and abrasion over the left anterior mid tibia with minimal swelling and some pain. A couple of weeks later, it was noted that the appellant had a bruise over the left ankle and the medial lower leg. In March 1966, the appellant fell down and hurt his elbow. The treatment record is inconsistent in that it states that the appellant fell on his right arm and hurt his elbow. However, the examiner made clinical findings as to the left arm. The examiner stated that the appellant had tenderness in the left elbow and that x-rays were negative. The impression was sprained left elbow. In December 1966, the appellant was issued reading glasses. In a January 1968 report of medical examination, clinical evaluations of the appellant's upper extremities, lower extremities, and spine and other musculoskeletal system were normal. Examination of the skin revealed two scars and seborrheic dermatitis in the eyebrows. The ophthalmoscopic evaluation was normal. Visual acuity was 20/20 in each eye. In a September 1968 report of medical examination, clinical evaluations of the appellant's upper extremities, lower extremities, spine and other musculoskeletal system, and skin were normal. The examiner noted that the appellant had full range of motion in the spine. The ophthalmoscopic evaluation was normal. Visual acuity was 20/20 in each eye. The examiner stated that the appellant reported frequent headaches, but that he was asymptomatic at the time of examination. The examiner added that there were no complications as to the headaches and that there was no treatment required. The appellant also reported that he had occasional, mild cramps in his legs. He stated that he had not taken any medication for such nor had sought treatment. The examiner stated that there had been no complications. The examiner further noted that the appellant had had an episode of pain in the back in February 1968 and April 1968, but that the appellant had been treated with Davron and had had no complications and no sequelae. In a report of medical history completed by the appellant at that time, he stated "no" to ever having or having now eye trouble and recurrent back pain. He stated "yes" to ever having or having now frequent or severe headache and arthritis. In March 1969, the appellant reported persistent headaches. The impression was headaches, "tension probably." In March 1969, the appellant splashed a chemical in his eyes. He stated that he washed it immediately with water. Visual acuity was 20/30 in the right eye, and 20/20 in left eye. The other findings are not legible. The impression was chemical in eyes. Later that month, the appellant reported blurred vision. In April 1969, the appellant underwent an ophthalmologic consultation. He reported blurred vision and diplopia since getting paint remover in his eyes. The diagnoses were no pathology and presbyopia. The appellant complained numerous times during his second period of service of headaches. Diagnoses of sinusitis, allergic rhinitis, and the flu were entered. In a June 1993 private medical record, the appellant complained of leg pain. The examiner noted that there were no symptoms of claudication and no numbness, weakness, or trauma. The appellant had full range of motion in all joints. The impression was leg pain, possibly secondary to gout. In July 1993, the appellant complained of an intolerable ankle. The treatment report did not indicate which ankle. The appellant had 2+ ankle edema. The examiner thought it was an intolerance to medication. The appellant complained of headaches in August 1993. The appellant reported that he had fallen off a four-foot ladder onto his right side. The impression was hypertension and right neck pain, secondary to strain. In October 1993, an optometrist stated that the appellant had refractive error and presbyopia. In December 1993, the appellant reported low back pain radiating down to back of legs. The examiner noted that the appellant reported no history of back injury. The symptoms occurred when he would first get up from sitting. There was no weakness, numbness, or tingling. Examination of the back was normal to inspection and palpation with decreased range of motion secondary to tight hamstrings. The appellant had negative straight leg raising. Deep tendon reflexes were 1+ and equal. Motor strength was 4 to 5+/5+. The examiner stated that the appellant had normal gait and moderate arthritis. The diagnosis was low back pain secondary to arthritis. In December 1993, the appellant complained of double vision. The appellant reported that he had been seeing double for about two years. He stated that he thought it might be his glasses but that he had gotten new glasses and he still had the double vision. The assessment was questionable mild hyperphoria. In March 1994, the appellant reported right- sided headaches. He stated that he had had similar headaches in the past which had been well controlled with Tylenol. The examiner noted no history of trauma. The impression was hypertension. In March 1994, the appellant reported back pain for the past three days. He denied history of trauma. Examination of the back was normal upon inspection. The appellant had full range of motion without muscle spasm. In a May 1994 VA outpatient treatment report, the appellant reported occasional low back pain and occasional right ankle pain from old injuries. The VA examiner did not report clinical findings as to the back or the right ankle. In an August 1994 letter, Dr. J. Gilbert Alexander stated that the appellant had moderately severe low back pain with bilateral sciatica. Dr. Alexander stated that the appellant had 1+ edema in both lower legs. The diagnoses entered were arthritis of the left knee and low back pain-degenerative lumbar arthritis with degenerative disc. X-rays taken of the bilateral knee in November 1994 were normal. In December 1994, a diagnosis of chronic leg pain was entered. In January 1995, November 1995, and July 1996, the appellant was diagnosed with refractive error, presbyopia, blepharitis, and age-related macular degeneration. The appellant underwent a VA examination in March 1995. The appellant reported getting a chemical in his eyes while in service in the 1950 and getting pain remover in his eyes in 1969. He reported that his vision began decreasing after that time. The VA examiner examined the appellant's eyes and entered impressions of nuclear sclerotic cataract change, both eyes, and left hypertropia. The VA examiner stated that, upon examination, the appellant did not show any corneal or conjunctival scarring which could be attributed to a chemical injury in the past. He added that without evidence of external damage, it was not likely that any of the appellant's problems were due to any chemicals that might have gotten into his eyes 25 years ago or longer. It was the VA examiner's determination that the changes in the appellant's eyes were age related. The appellant underwent a VA examination in March 1995. The appellant reported hurting his back when lifting an oxygen tank. He reported injuring his right ankle in service. He further reported hurting his right arm in service. The VA examiner stated that the appellant had a variable limp more to the right side, but could get onto his heels and toes. The knee jerks were active, but the ankle jerks were absent. The VA examiner stated that he could not find any pattern of sensory or motor deficit. Both ankles had plantar flexion from 0 degrees to 30 degrees and inversion of 50 degrees with eversion of 15 degrees. The VA examiner stated that the appellant stood with a suggestion of pelvic tilt which was inconsistent in the right dorsal prominence and which disappeared with flexion of 60 degrees. Extension was 5 degrees, lateral bending was 30 degrees, and rotation was 15 degrees. The VA examiner stated that as the appellant lay prone, there was tenderness in the lumbosacral junction, but not well localized and without radiation pattern with pressure. There was no sciatic notch tenderness. The diagnoses were degenerative and traumatic changes in the spine without a neurological pattern, chronic postural foot and ankle strain with dorsal pronation bilaterally, history of right ankle injury and symptoms of traumatic arthritis, and mild atrophy of the right leg. X-rays taken of the bilateral knees, ankles, and feet in March 1995 revealed no bony injury. X-rays taken of the lumbosacral spine in March 1995 revealed mild levoscoliosis of the lumbar spine. The disc spaces were preserved. Degenerative changes were seen in the apophyseal joints in the lower lumbar spine. In a March 1995 examination report, the VA examiner stated that the appellant had tinea of the toenails. The appellant underwent a VA examination in April 1995. The appellant reported having injured his back in service. He stated that he had low back pain which radiated around to the sides on occasion and into the posterior portions of his legs. The appellant reported constant headaches, which were basically generalized and nonthrobbing. There were no other symptoms associated with the headaches. The VA examiner noted that the appellant was hypertensive and on medication. Examination of the head was unremarkable. Cranial nerves two through 12 were unremarkable with no signs of increased intracranial pressure or focal deficits. Motor examination revealed normal muscle tone and strength without atrophy, fasciculation, or abnormal movements detectable. Sensory examination was unremarkable with the exception of somewhat elevated vibratory threshold in the distal lower extremities. Straight leg raising was negative. Gait, station, and Romberg were normal. Deep tendon reflexes were 1 to 2+ and symmetrical with no pathological findings. The impression was that the neurologic examination was unrevealing. The VA examiner stated that the appellant's headaches appeared to be muscle contraction type headaches, were possibly related to hypertension and were not disabling. The VA examiner added that the appellant had low back pain without any significant neurologic deficits. The appellant had an RO hearing in April 1996. The appellant stated that his eyes had continuously gotten worse since getting out of service. He stated that he injured his ankle and back in service and that he continued to have pain. He stated that he injured his right arm, which still bothered him. The appellant stated that he got headaches almost every day. He stated that he injured his left knee, left thigh, and left lower leg in service, which still bothered him a lot. The appellant testified that he would get leg cramps every week, sometimes more than once. In an April 1997 letter, Dr. Jeffrey Cook stated that the appellant had been complaining of double vision and blurred vision "since 1969." Dr. Cook examined the appellant's eyes and determined that the appellant had sclerotic cataract and retinal pigment epithelial changes involving the macula, which he stated could be early aging degeneration versus a dystrophic process. There was a moderate-size choroidal nevus in the left eye and an exotropia with vertical nystagmus. On VA dermatology examination in July 1998, the diagnoses included onychomycosis, both feet. The Board notes that the appellant has not alleged that any of the disabilities for which he seeks service connection were incurred during his first period of service. I. Residuals of chemical injury to eyes After having reviewed the evidence of record, the Board finds that the claim for service connection for residuals of chemical injury to eyes, to include blepharitis, macular degeneration, nuclear sclerotic cataract change, left hypertropia, retinal pigment epithelial changes, choroidal nevus in the left eye, exotropia, and hyperphoria, is not well grounded. See Caluza, supra. The appellant is competent to state that he got chemicals in his eyes and that he noted blurred vision following the incident. This is substantiated by the service medical records. The appellant has brought forth current diagnoses of blepharitis, age- related macular degeneration, nuclear sclerotic cataract change, left hypertropia, and hyperphoria; however, he has not brought forth medical evidence of a nexus between the any of these diagnoses and service. See id. In fact, there is evidence to the contrary. When examined in March 1995, the VA examiner stated that the appellant had nuclear sclerotic cataract change in both eyes and left hypertropia, but noted that there was no corneal or conjunctival scarring which could be attributed to a chemical injury in the past. The VA examiner stated that there was no external damage and thus that it was unlikely that the appellant's eye problems were due to a chemical injury. The VA examiner stated that the changes in the appellant's eyes were age related. Such evidence is against the appellant's claim for service connection for residuals of chemical injury to the eyes, and the claim is not well grounded. See id. At this time, the only evidence that supports the claim of a nexus to service is the appellant's own statements and testimony. The appellant is not a medical professional, and he is not competent to make a medical opinions as to the etiology of a diagnosis. See Espiritu v. Derwinski, 4 Vet. App. 492, 494 (1992); see also Edenfield v. Brown, 8 Vet. App. 384, 388 (1995) (en banc) ("[w]here the determinative issue involves either medical etiology or a medical diagnosis, competent medical evidence is ordinarily required to fulfill the well-grounded claim requirement of section 5107(a)"). His statements do not give rise to a well- grounded claim for service connection for residuals of chemical injury to the eyes. The Board is aware that diagnoses of presbyopia and refractive error have been entered; however, such diagnoses are not diseases or injuries within the meaning of applicable law or regulations providing compensation benefits. See 38 C.F.R. §§ 3.303(c), 4.9 (1999). The Court has held that in a case where the law, as opposed to the facts, is dispositive of the claim, the claim should be denied or the appeal to the Board terminated because of the absence of legal merit or the lack of entitlement under the law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). The Board finds that the appellant's claim for service connection for presbyopia and refractive error lack legal merit. II. Right ankle disability After having reviewed the evidence of record, the Board finds that the claim for service connection for right ankle disability, to include arthritis of the right ankle, is not well grounded. See Caluza, supra. The appellant is competent to report that he injured his right ankle in service, which is substantiated by the service medical records. The appellant has brought forth competent evidence of a diagnosis of arthritis in the right ankle. However, the appellant has not brought forth competent medical evidence that arthritis in the right ankle is related to the injury sustained in service. See id. Additionally, the appellant has not brought forth competent evidence of a diagnosis of arthritis within one year following service. Thus, the appellant's claim for service connection for right ankle disability, to include arthritis, is not well grounded. The Board is aware that in the March 1995 examination report, the VA examiner entered a diagnosis of chronic ankle strain. Such statement does not provide a nexus to service, as it is clearly based upon history provided by the appellant. See LeShore v. Brown, 8 Vet. App. 406, 409 (1995) (evidence which is simply information recorded by a medical examiner, unenhanced by any additional medical comment by that examiner, does not constitute "competent medical evidence" satisfying the Grottveit requirement). Such statement is inconsistent with the record, as there are numerous medical records following the injury in service which revealed no findings as to the appellant's right ankle. He underwent a medical examination one month following the ankle sprain. There, the examiner noted that the appellant had sprained his right ankle but that it had had full recovery and no complications. Examinations conducted in March 1957, May 1962, January 1968, and September 1968, revealed normal clinical evaluations as to the lower extremities. Following service, the first complaint of right ankle pain of record is in May 1994, which over 20 years following service. The only nexus evidence between the diagnosis of arthritis of the right ankle and service are the appellant's statements and testimony. However, the appellant does not have the requisite knowledge of medical principles that would permit him to render an opinion regarding matters involving medical diagnoses or medical etiology. See Espiritu, 4 Vet. App. at 494; see also Edenfield, 8 Vet. App. at 388. The appellant's own, unsupported opinion, even when sworn, does not give rise to a well-grounded claim. III. Low back disability After having reviewed the evidence of record, the Board finds that the claim for service connection for low back disability, to include degenerative joint disease and degenerative disc disease, is not well grounded. See Caluza, supra. The appellant is competent to report that he had an injury in service to his back, and his service medical records document treatment for acute low back strain. He has brought forth competent evidence of diagnoses of degenerative joint disease and degenerative disc disease of the lumbar spine. However, the appellant has not brought forth competent evidence of a nexus between the diagnoses of degenerative disc disease and degenerative joint disease and service, and thus the claim is not well grounded. See id. Additionally, the appellant has not brought forth evidence of a diagnosis of arthritis within one year following service. The only nexus evidence between the diagnoses of degenerative joint disease and degenerative disc disease of the lumbar spine and service are the appellant's statements and testimony. However, the appellant does not have the requisite knowledge of medical principles that would permit him to render an opinion regarding matters involving medical diagnoses or medical etiology. See Espiritu, 4 Vet. App. at 494; see also Edenfield, 8 Vet. App. at 388. The appellant's own, unsupported opinion, even when sworn, does not give rise to a well-grounded claim. IV. Right arm disability After having reviewed the evidence of record, the Board finds that the claim for service connection for right arm disability is not well grounded. See Caluza, supra. The appellant is competent to report that he injured his arm in service. However, he has not brought forth competent evidence of a current diagnosis of a right arm disability. The appellant underwent a VA examination in March 1995. He reported that he had had a right arm injury in service. The VA examiner did not enter a diagnosis as to the appellant's right arm. The service medical records are similarly negative as to a diagnosis of chronic right arm disability. The Court has stated that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability," and held that "[i]n the absence of proof of a present disability[,] there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau, 2 Vet. App. at 143-44. Because the appellant has not submitted any evidence of a current right arm disability, the Board must deny it as not well grounded. Id.; see also Caluza, supra. Although the appellant has stated that he currently suffers from a right arm disability, it has not been shown that he possesses the requisite knowledge of medical principles that would permit him to render an opinion regarding matters involving medical diagnoses or medical etiology. See Espiritu, 4 Vet. App. at 494. Further, assuming that the appellant is claiming that there is a current right arm disability, he is a layman and his opinion is not competent. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). The appellant's own, unsupported opinion does not give rise to a well-grounded claim. Id. V. Headaches After having reviewed the evidence of record, the Board finds that the claim for service connection for headaches is not well grounded. See Caluza, supra. The appellant has stated that he had headaches in service, which is substantiated by the service medical records. The service medical records reveal that the appellant had headaches as a result of tension, flu, sinusitis, and allergic rhinitis. However, the headaches diagnosed since service have been not been related to service. Because there is no competent evidence that the headaches are related to service, the claim is not well grounded. See id. The only nexus evidence between the diagnosis of headaches and service are the appellant's statements and testimony. However, the appellant does not have the requisite knowledge of medical principles that would permit him to render an opinion regarding matters involving medical diagnoses or medical etiology. See Espiritu, 4 Vet. App. at 494; see also Edenfield, 8 Vet. App. at 388. The appellant's own, unsupported opinion, even when sworn, does not give rise to a well-grounded claim. VI. Leg cramps After having reviewed the evidence of record, the Board finds that the claim for service connection for leg cramps is not well grounded. See Caluza, supra. The appellant is competent to state that he had leg cramps while in service, which is substantiated by the service medical records. However, the appellant has not brought forth competent evidence of a disability manifested by leg cramps. In June 1993, the appellant reported leg pain. The examiner stated that the appellant had full range of motion of all joints and entered a diagnosis of leg pain, possibly secondary to gout. This diagnosis does not provide a nexus to service. Id. Additionally, in December 1994, a diagnosis of chronic leg pain was entered. However, the current diagnosis of leg pain does not establish that the appellant has a chronic disability causing leg pain that is due to disease or injury. Service connection is warranted for a "[d]isability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty . . . ." 38 U.S.C.A. §§ 1110, 1131. The current diagnosis of leg pain does not establish that there is a disability resulting from an injury or a disease. See id. Absent a disease or injury, service connection may not be granted and thus the claim for service connection for leg cramps is not well grounded and must be denied. Stated differently, VA does not grant service connection for symptoms such as leg pain or cramps pain in the absence of disease or injury. Although the appellant has claimed that he has leg cramps now which are related to service, he does not have the requisite knowledge of medical principles that would permit him to render an opinion regarding matters involving medical diagnoses or medical etiology. See Espiritu, 4 Vet. App. at 494; see also Edenfield, 8 Vet. App. at 388. The appellant's own, unsupported opinion, even when sworn, does not give rise to a well-grounded claim. VII. Left leg disability After having reviewed the evidence of record, the Board finds that the claim for service connection for left leg disability, to include arthritis of the left knee, is not well grounded. See Caluza, supra. The appellant is competent to state that he injured his left leg in service, which is substantiated by the service medical records. However, there has been no diagnosis of a left leg disability, apart from the diagnosis of arthritis of the left knee. The appellant has not brought forth competent evidence of arthritis within one year following service or of a nexus between arthritis of the left knee and service, and the claim is not well grounded. Id. The only nexus evidence between the diagnosis of arthritis of the left knee are the appellant's statements and testimony. However, the appellant does not have the requisite knowledge of medical principles that would permit him to render an opinion regarding matters involving medical diagnoses or medical etiology. See Espiritu, 4 Vet. App. at 494; see also Edenfield, 8 Vet. App. at 388. The appellant's own, unsupported opinion, even when sworn, does not give rise to a well-grounded claim. VIII. Tinea of the toenails After having reviewed the evidence of record, the Board finds that the claim for service connection for tinea of the toenails is not well grounded. See Caluza, supra. The appellant is competent to state that he had something wrong with his toenails in service; however, he is not competent to state that he had tinea in service. The service medical records are silent as to a diagnosis of tinea of the toenails. The appellant underwent a VA examination in March 1995, and the VA examiner entered a diagnosis of tinea of the toenails. The VA examiner did not enter a medical opinion as to the nexus of the tinea. Thus, the appellant has not brought forth competent evidence of a nexus between the diagnosis of tinea of the toenails and service, and therefore, the claim is not well grounded. Id. The only nexus evidence between the diagnosis of tinea of the toenails and service are the appellant's statements and testimony. However, the appellant does not have the requisite knowledge of medical principles that would permit him to render an opinion regarding matters involving medical diagnoses or medical etiology. See Espiritu, 4 Vet. App. at 494; see also Edenfield, 8 Vet. App. at 388. The appellant's own, unsupported opinion, even when sworn, does not give rise to a well-grounded claim. IX. General duty Although the VA does not have a statutory duty to assist a claimant in developing facts pertinent to the claim when it is determined to be not well grounded, it may be obligated under 38 U.S.C.A. § 5103(a) (West 1991) 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. Robinette v. Brown, 8 Vet. App. 69 (1995). Here, VA fulfilled its obligation under section 5103(a) by issuing a statement of the case in November 1995 and subsequent supplemental statements of the case. The Board must point out that in its May 1998 and November 1998 remands, it informed the appellant of the duty to submit evidence of a well-grounded claim for service connection. It informed the appellant that he should submit a medical opinion that establishes that there is a current disability due to disease or injury and a medical opinion which links the disability to a disease or injury in service. In this respect, the Board is satisfied that the obligation imposed by section 5103(a) has been satisfied. See Franzen v. Brown, 9 Vet. App. 235 (1996) (VA's obligation under sec. 5103(a) to assist claimant in filing his claim pertains to relevant evidence which may exist or could be obtained). See also Epps v. Brown, 9 Vet. App. 341 (1996) (sec. 5103(a) duty attaches only where there is an incomplete application which references other known and existing evidence that pertains to the claim under consideration); Wood v. Derwinski, 1 Vet. App. 190 (1991) (VA's duty is just what it states, a duty to assist, not a duty to prove a claim). ORDER Service connection for (1) residuals of chemical injury to eyes, to include blepharitis, macular degeneration, nuclear sclerotic cataract change, left hypertropia, retinal pigment epithelial changes, choroidal nevus in the left eye, exotropia, hyperphoria, refractive error, presbyopia (2) right ankle disability, to include arthritis, (3) low back disability, to include degenerative joint disease and degenerative disc disease, (4) right arm disability, (5) headaches, (6) leg cramps, (7) left leg disability, to include arthritis, and (8) tinea of the toenails is denied. REMAND The Board notes that the appellant has filed a claim for service connection for psychiatric disorder. While the claim was on appeal, the appellant filed a claim for post-traumatic stress disorder. He underwent a VA psychiatric evaluation in April 1997. The VA examiner stated that the appellant fulfilled the minimal requirements for a diagnosis of post- traumatic stress disorder. The appellant submitted a statement as to the stressor in service, which he claims caused post-traumatic stress disorder. The Board finds his statement is not sufficiently detailed to permit verification of the stressor. He needs to submit a more detailed statement concerning the incident in which he killed a Korean man in 1947. The date, place and the names of any individuals involved should be as specific as possible, as should all facts surrounding this incident. Accordingly, the case is hereby REMANDED to the RO for the following action: 1. The RO should ask the appellant to submit a more detailed statement of the alleged stressor. He should specify, to the best of his recollection, the date, place, circumstances and names of any other individuals who had knowledge of the incident. He should also be asked whether there was any official response by military authorities. 2. Following the appellant's submission of the stressor in service, the RO is to submit the appellant's stressor and all associated documents, including a copy of the appellant's personnel records, to United States Armed Services Center for Research of Unit Records (USASCRUR), 7798 Cissna Road, Springfield, Virginia, 22150. The RO should ask USASCRUR to attempt to verify such stressor and provide any information which might corroborate the appellant's alleged stressor. 3. The appellant is placed on notice that if he has any evidence which corroborates his stressor in service, he must submit such evidence. The case should be returned to the Board after compliance with all requisite appellate procedures. 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. NANCY I. PHILLIPS Member, Board of Veterans' Appeals