Citation Nr: 0217071 Decision Date: 11/25/02 Archive Date: 12/04/02 DOCKET NO. 99-06 668A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston- Salem, North Carolina THE ISSUE Whether new and material evidence has been submitted to reopen the claim for service connection for post-traumatic stress disorder. (The issue of whether the grant of service connection is warranted for PTSD will be the subject of a later decision.) REPRESENTATION Appellant represented by: Richard F. Curley, Attorney WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD Frank L. Christian, Counsel INTRODUCTION The veteran served on active duty from December 1969 to October 1971, including service in the Republic of Vietnam from August 31, 1970, to August 29, 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of July 1998 from the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. That decision denied entitlement to service connection for post-traumatic stress disorder (PTSD) on the merits. The claimant has appeared and offered testimony in support of his claim at a personal hearing held in November 1998 before an RO Hearing Officer, and at a hearing held in February 2001 before the undersigned Member of the Board sitting at Washington, DC. The record shows that previous rating decisions of June 1996 and October 1996 denied service connection for PTSD, and that the claimant was notified of those adverse determinations and of his right to appeal. The veteran failed to initiate an appeal, and those decisions became final. In August 1997, the veteran undertook to reopen his claim for service connection for PTSD by submitting additional evidence. Under Barnett v. Brown, 83 F.3d. 1380 (Fed.Cir.1996), any statutory tribunal must ensure that it has jurisdiction over each case before adjudicating the merits, a potential jurisdictional defect may be raised by the court or tribunal sua sponte or by any party and at any stage in the proceedings and, once apparent, must be adjudicated. Title 38 U.S.C.A. § 7104(b) does not vary the Board's jurisdiction according to how the RO ruled. Accordingly, the Board must independently address the issue of whether new and material evidence has been submitted to reopen the veteran's claim of entitlement to service connection for PTSD. The Board is undertaking additional development on the issue of entitlement to service connection for PTSD, pursuant to authority granted by 67 Fed. Reg. 3,099, 3,104 (Jan. 23, 2002) (to be codified at 38 C.F.R. § 19.9(a)(2). When it is completed, the Board will provide notice of the development as required by Rule of Practice 903. After giving notice and reviewing the appellant's response to the notice, the Board will prepare a separate decision addressing that issue. In this decision, the Board limits its consideration to the issue of whether new and material evidence has been submitted to reopen the claim for service connection for PTSD. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the instant appeal to reopen the claim for service connection for PTSD has been obtained by the RO, and VA's duty of notification to the claimant of required information and evidence and of its duty to assist him in obtaining all evidence necessary to substantiate his application to reopen that claim have been fully met. 2. The veteran served on active duty from December 1969 to October 1971, including service in the Republic Of Vietnam from August 31, 1970, to August 29, 1971. 3. Rating decisions of June 1996 and October 1996 denied service connection for PTSD, and the veteran was notified of those adverse determinations and of his right to appeal, but did not appeal those decisions. 4. In August 1997, the veteran undertook to reopen his claim for service connection for PTSD by submitting additional evidence. 5. The additional evidence submitted since the unappealed rating decision of October 1996 denying service connection for PTSD includes evidence not previously submitted to agency decisionmakers 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. CONCLUSION OF LAW New and material evidence having been submitted, the claim for service connection for PTSD is reopened. 38 U.S.C.A. § 5108 (West 1991 & Supp. 2002); 38 C.F.R. § 3.156(a)(2002). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. The Evidence The veteran served on active duty in the United States Army from December 1969 to October 1971, including service in the Republic Of Vietnam from August 31, 1970 to August 29, 1971. The claimant's DD Form 214 shows that his military occupational specialty (mos) was Clerk (70A). The veteran was separated from service for failure to demonstrate adequate potential for promotion or advancement, and was not recommended for reenlistment. He was awarded the National Defense Service Medal (NDSM), the Vietnam Service Medal (VSM), and the Vietnam Campaign Medal (VCM), none of which evidence participation in combat. His service administrative and personnel records show no awards or decorations for valor, and he did not receive the Purple Heart Medal. The veteran's service medical records show that a Report of Medical History prepared by the claimant in connection with his service entrance examination denied any pertinent abnormalities. His service entrance examination disclosed no defects, no scars or abnormalities of the skin, and his psychiatric evaluation was normal. The service medical records show that in March 1970, the veteran was found to have two sebaceous cysts of the right side of his face; that in May 1970, he requested facial surgery for sebaceous cysts of the face; and that in November 1970 and January 1971, he was shown to have folliculitis barbae, and was given a shaving profile. In May 1971, the veteran was twice seen for complaints of a boil on his back, and in June 1-16, 1971, the boil was incised, drained, and packed with iodoform. On June 16 and 18, 1971, the boil on his back looked fine, but a swelling was noted in the right axilla, and it was believed that the veteran was not taking his penicillin as directed. On June 21, 1971, swelling and induration was noted in the right axilla (under his right arm). He was treated for that condition, and it was noted that the veteran had just had a similar episode of induration on his back which was successfully treated with heat and antibiotics. The lump in the right axilla was felt to be cellulitis, and not responsive to heat and antibiotics, and the veteran was referred to the 85th Evacuation Hospital on June 21, 1971, where his abscess under the right arm was incised, drained, and packed with iodoform. The diagnosis was abscess, right axilla. During the period from June 21 through July 8, 1971, the veteran was treated regularly for an abscess of the right axilla. On July 8, 1971, his surgical incision was found to be closed, and he was returned to full duty. The service medical records further show that on September 14, 1971, after leaving the Republic of Vietnam, the veteran was seen for a draining abscess on the left side of his back, diagnosed as an abscess of the back, and it was noted that hot soaks had provided improvement. No complaint, treatment, findings or diagnosis of a shrapnel or gunshot wound was shown during the cited periods of treatment or at any time during the veteran's period of active service. At the time of service separation, the veteran denied any history of illness or injury, denied treatment for anything other than minor illnesses within the past five years, and denied frequent trouble sleeping, depression or excessive worry, loss of memory, or nervous trouble of any sort. His service separation examination disclosed no pertinent abnormalities, and his psychiatric condition was normal. The claimant's original application for VA disability compensation benefits (VA Form 21-526), received at the RO in February 1972, claimed service connection for a sebaceous cyst of the face, treated at St. Albans's Naval Hospital in July 1970, and for claimed shrapnel in his back, treated at the 85th Evacuation Hospital in July 1971. He also cited removal of a sebaceous cyst at the VAMC, New York in February 1972, but reported no other treatment. No mention was made of a nervous condition or psychiatric disorder. A report of VA general medical examination, conducted in April 1972, showed that the veteran claimed that he received a shrapnel wound in combat in the Republic of Vietnam; that he was treated at the 85th Evacuation Hospital; and that he also had a growth removed from his right axilla area. Examination revealed a 1.5 cm. by 5 cm. scar of the right side of the face, a 3 cm. by 3 cm. linear scar of the right axilla, residual to excision of lymph node, and multiple scars of the back, varying in size from 3 cm. to 5 cm. to pinhead in size, while X-rays of the chest, and the thoracic and lumbar spines revealed no bone pathology, misalignment, or retained metallic or foreign bodies. The diagnosis was surgical scars, right cheek and lip; surgical scar, right axilla, residual of excision of back; and scars of back residuals of shrapnel wound. No complaint, treatment, findings or diagnosis of a nervous condition or psychiatric disorder was shown. A rating decision of May 1972 granted service connection for impaired hearing, for the veteran's scars of the right cheek and lip, residual to sebaceous cyst excisions; granted service connection for a scar of the right axilla, residual to excision, and deferred a determination as to the veteran's claimed shrapnel wound pending receipt of additional evidence. His scars of the right cheek and upper lip were considered moderately disfiguring, and rated as 10 percent disabling, while his scar of the right axilla and hearing impairment were evaluated as noncompensably disabling. A June 1972 RO inquiry to the National Personnel Records Center (NPRC) as to whether the veteran was awarded the Purple Heart Medal received a response indicating that the veteran was not awarded the Purple Heart Medal. A rating decision of June 1972 denied service connection for claimed shrapnel wounds of the back, but granted service connection for multiple scars of the back. The veteran was informed of that action and of his right to appeal that decision by RO letter of June 29, 1972, but did not initiate an appeal and that decision became final. In a August 1972 letter, the veteran stated that he wanted to reopen his claim, seeking increased ratings for his service-connected disabilities, and related that he had his back and the right side of his face cut again at the VAMC, New York, in August 1972, and that he was entitled to increased evaluations for those conditions. A hospital summary from the VAMC, New York, dated in August 1972, shows that the veteran was admitted for a period of two days for excision of a recurrent epidermal cyst scars of the right face and for excision of scars claimed to be secondary to grenade fragment injuries. He underwent incision and drainage of three inclusion cysts of the right zygomatic area, and excision and revision of a scar of the right back. The diagnosis was inclusion cysts of left [sic] face times 3, and hypertrophic scar, right back. No complaint, treatment, findings or diagnosis of a nervous condition or psychiatric disorder was shown. A rating decision of September 1972 denied increased ratings for his service-connected scars of the right side of the face and for excision and revision of his service-connected back scar. The veteran was notified of that action and of his right to appeal by RO letter of September 25, 1972. He failed to initiate an appeal, and that decision became final after one year. In a Statement in Support of Claim (VA Form 21-4138) from the veteran, received in May 1975, he stated that the scar on his back resulted from an infection in Vietnam in 1971; that he was treated in his immediate company area and at the 85th Evacuation Hospital; and that the infection under his arm was surgically removed. He further related that in 1972, he had his back cut again at the VAMC; that he had also received surgery on the side of his face three times at the VAMC; and that he was entitled to increased ratings for those disabilities. No mention was made of any treatment for a nervous condition or psychiatric disorder. A report of VA orthopedic examination, conducted in June 1975, cited the veteran's complaints of muscle spasms of the back, and noted that the veteran's claims folder was not available. Examination revealed a firm, non-tender, non- keloidal operative scar of the right cheek, moderately disfiguring; and a firm, non-tender, non-keloidal operative scar of the right cheek, slightly disfiguring, residual to excision of sebaceous cysts. In addition, examination revealed a non-tender, slightly keloidal 3 cm. by 3 cm. operative scar of the right axilla, with no tissue loss, residual to excision of an infection according to the veteran; and a 6 cm. by 5 cm. scar of the right posterior chest wall, non-tender and non-keloidal, with no tissue loss, residual to a fragmentation wound according to the veteran. X-rays of the chest and lumbosacral spine disclosed normal vertebral alignment and curvature, with normal vertebral bodies, arches, pedicles and intervertebral disc spaces, with no evidence of fractures, bone destruction, or significant arthritic changes; and no retained metallic or foreign bodies. No complaint, treatment, findings or diagnosis of a nervous condition or psychiatric disorder was shown. A confirmed rating decision of August 1975 continued the prior ratings for the veteran's service connected scars of the right cheek and lip, residual to sebaceous cyst excisions; service-connected scar of the right axilla, residual to excision; and the service-connected scars of the right cheek, lip, and back. The veteran was notified of that action and of his right to appeal by RO letter of August 18, 1975. He failed to initiate an appeal, and that decision became final after one year. A report of VA orthopedic and audiology examination, conducted in April 1977, cited the veteran's assertion that he underwent excision of cysts of the face at St. Alban's Naval Hospital in 1970, and that a recurrence of that condition was excised at the VAMC, New York, in 1972, 1973 and 1974. In addition, he related that a cyst of the lip was excised at the VAMC, New York, in 1972 with recurrence and removal at the VAMC, New York, in 1974. The veteran further alleged that he sustained shell fragment wounds of the back in combat in Vietnam in 1971; that he underwent two surgical procedures for those injuries; and that he underwent excision of a cyst of the right axilla in 1971. The diagnoses were status post excision of cyst, right side of face and upper lip; status post excision of cyst, right axilla, and scar, right posterior chest wall, residual of shell fragment wound. Audiology examination disclosed that the veteran's hearing acuity was normal, bilaterally. No complaint, treatment, findings or diagnosis of a nervous condition or psychiatric disorder was shown. A confirmed rating decision of May 1977 continued the prior ratings for the veteran's service connected hearing impairment, scars of the right cheek and lip, residual to sebaceous cyst excisions; service-connected scar of the right axilla, residual to excision; and service-connected scars of the right cheek, lip, and back. The veteran was notified of that action and of his right to appeal by RO letter of May 27, 1977. He failed to initiate an appeal, and that decision became final after one year. In a Statement in Support of Claim (VA Form 21-4138) from the veteran, received in December 1977, the veteran requested a higher disability rating for his service- connected disabilities, asserting that he was admitted to the VAMC, New York, in September 1977. A hospital summary from the VAMC, New York, dated in September 1977, shows that the veteran was admitted for complaints of abdominal pain and a sebaceous cyst of the right cheek. The sebaceous cyst of the right cheek was excised without difficulty or complications. Abdominal examination was benign, and the veteran remained afebrile and without an elevated white count, while sigmoidoscopy, a combined blood count, intravenous pyelogram and upper gastrointestinal examination were all normal. The treating physician noted that the veteran seemed to enjoy his hospitalization, questioned the validity of his symptom complaints, and stated that no follow-up was required. No complaint, treatment, findings or diagnosis of a nervous condition or psychiatric disorder was shown. A confirmed rating decision of May 1978 denied the veteran's claim for increased evaluations for his service-connected disabilities and continued the prior ratings for those disabilities. The veteran was notified of that action and of his right to appeal by RO letter of May 30, 1978. He submitted a timely Notice of Disagreement, and further sought service connection for chronic cysts. He was issued a Statement of the Case in August 1978, and perfected his appeal by the timely filing of his Substantive Appeal (VA Form 9) in August 1978, in which he requested a hearing before an RO Hearing Officer. By RO letter of August 21, 1978, the veteran was informed that service connection was already in effect for his scar of the right axilla (under the right arm), and for his scars of the back, both evaluated as noncompensably disabling; and that he had been notified of those grants of service connection by RO letters of May 30, 1972 and June 29, 1972. He was further informed that additional evidence showing an increase in the severity of those disabilities was required in order to review the noncompensable rating evaluations. No additional evidence was submitted by the veteran. A report of VA orthopedic examination, conducted in January 1979, cited the veteran's assertion that he underwent excisions of sebaceous cysts of the right cheek at the VAMC, New York, in 1971, and excision of a cyst of the upper lip in 1972, with no residuals. Examination revealed a well- healed, 2 cm. scar of the right cheek, and a well-healed 1 cm. scar of the upper lip, with no keloid formation and no disfigurement. The diagnoses were status post sebaceous cysts of the cheek and lip. A Supplemental Statement of the Case was issued in February 1979. The veteran failed to appear for a scheduled personal hearing held in November 1978 before an RO Hearing Officer. A confirmed rating decision of February 1999 confirmed the prior ratings for his service-connected scars of the right cheek and the upper lip. No complaint, treatment, findings or diagnosis of a nervous condition or psychiatric disorder was shown. A Board decision of July 12, 1979, denied a rating in excess of 10 percent for scars of the right cheek and upper lip, residuals to sebaceous cyst excisions, and denied a temporary total rating under the provisions of 38 C.F.R. Part 4, § 4.29. In February 1994, the veteran notified the RO that he had relocated to a city in North Carolina, and requested that his claims folder be transferred to the VARO, Winston-Salem, North Carolina. In December 1995, the claimant submitted an application for VA disability compensation benefits (VA Form 21-526), seeking service connection for PTSD, claimed to have been incurred while serving in the Republic of Vietnam. He reported treatment for PTSD at the VAMC, Brooklyn, and the VAMC, Manhattan, but failed to provide the dates of that treatment. He further indicated that he had been hospitalized or furnished domiciliary care at the VAMC, Durham. The RO requested the veteran's treatment records from the VAMC, Brooklyn, the VAMC, Queens, and the VAMC, Manhattan, from 1971 to the present. No additional medical records of the veteran were received from those VA medical facilities. The RO also requested the veteran's complete medical records from the VAMC, Durham. By RO letter of January 8, 1996, the veteran was notified of the requirements for establishing service connection for PTSD, was asked to provide the names, addresses and dates of treatment for all physicians who had treated him for the claimed disorder, was asked to provide his work history since service separation, and was asked to describe the events which he regarded as stressful, as well as the symptoms he now experienced, and statements from people who know of his condition. He was informed that when the requested evidence was received, the RO would request a search of unit records. The veteran failed to respond to that letter, or to provide the requested information. In June 1996, the veteran's complete service administrative and service personnel records (DA-20 and 201 file) were obtained by the RO. Those records disclosed that the claimant served on active duty from December 1969 to October 1971, including service in the Republic Of Vietnam from August 31, 1970, to August 29, 1971; that he underwent basic training at Fort Jackson, South Carolina; that he attended Clerk school for four weeks at Fort Polk, Louisiana; that his military occupational specialty (mos) was Clerk (70A); that he received no awards or decorations for valor; and that he did not receive the Purple Heart Medal. Those records further show that the veteran arrived in Vietnam on August 31, 1970, and was assigned to Troop C, 2nd Battalion, 17th Cavalry, 101st Airborne Division (Airmobile), as a troop clerk (71H) until September 14, 1970, when he was assigned as a Supply Clerk (76A) with Troop C, 2nd Squadron, 17th Cavalry, 101st Airborne Division (Airmobile), until June 6, 1971, when he was assigned as a Supply Clerk (76A) with Troop D, 2nd Squadron, 17th Cavalry, 101st Airborne Division (Airmobile), until August 29, 1971, when he departed Vietnam. The veteran's service administrative and service personnel records show that he did not serve in any other units or in any other capacity during his Vietnam service, and he did not receive the Combat Infantryman's Badge, any awards or decorations for valor, or the Purple Heart Medal. His sole military occupational specialty (mos) while in active duty in the Republic of Vietnam is as set forth above, and there is no evidence that the veteran served as an infantryman or in any other combat mos at any time during his period of Vietnam service. His April 22, 1971, his records show that on April 22, 1971, he was shown to be not recommended for further service/promotion and not recommended for reenlistment. A rating decision of June 1996 denied service connection for PTSD, finding that the veteran did not have a diagnosis of PTSD, and that the evidence did not establish that a stressor sufficient to cause PTSD had actually occurred. The veteran was notified of that decision and of his right to appeal by RO letter of June 15, 1996, but did not appeal that decision. In a Statement in Support of Claim (VA Form 21-4138) from the veteran, received at the RO in June 1996, the veteran requested that he be granted a 100 percent rating for PTSD, noting that a VA clinician had recommended that he make that request. He stated that he had just completed the PCT Clinic at the VAMC, Durham, and asked that the RO obtain those medical records. In a Statement in Support of Claim (VA Form 21-4138) from the veteran, received at the RO in July 1996, the veteran requested that his claim for service connection for PTSD be reconsidered in light of the enclosed VA psychologist's report. He submitted a VA psychologist's report, dated in June 1996, showing that the veteran was interviewed using the Clinician Administered PTSD Scale (CAPS), which measures the frequency and intensity of PTSD symptoms. The veteran related that he served in Vietnam with the 17th Cavalry, 101st Airborne Division, from 1970 to 1971; that he was currently service connected for "a facial injury"; that he recalled several events in Vietnam which continued to cause him distress, including a mortar round landing near his bunker. He further related that he experienced intrusive recollections of this and other events from Vietnam, as well as distress on exposure to reminders of Vietnam, and that he makes efforts to avoid thinking about his experiences and things that remind him, including conversations, war movies, and newscasts about Vietnam. He made no mention of sustaining fragment wounds in Vietnam. He related that he had previously used alcohol and marijuana, but related that he had discontinued use of alcohol, although he continued to use marijuana. He further endorsed symptoms consistent with PTSD, including anhedonia, feelings of detachment from others, hyperarousal, difficulty sleeping, daily irritability, and excessive hypervigilence. The veteran further recounted childhood trauma, and a head injury in 1980, but the examiner asserted that his reexperiencing involved only his military traumas. The examining clinician did not indicate that she had reviewed the veteran's claims folder or other factual evidence pertaining to the veteran's period of active service. That report further showed that the veteran underwent psychological testing with the PTSD-Keane (PK) scale of the MMPI-2, the Positive and Negative Affect Exposure Scale (PANAS), the Mississippi Scale for Combat-Related PTSD, and the Combat Exposure Scale. The veteran reported a high level of negative affect on the PANAS scale, consistent with an anxiety disorder, and reported a significant level of PTSD symptoms on the PK scale of the MMPI-2, and the Mississippi Scale for Combat-Related PTSD. The veteran further related a moderate level of combat exposure while serving in Vietnam, and the reporting clinician concluded that the veteran's assertions and the results of psychological testing were consistent with a diagnosis of combat-related PTSD. It was further asserted that the veteran was also interviewed using the Major Depression module of the Structured Clinical Interview for DSM-IIIR, and was reported to meet the criteria for Major Depressive Disorder, recurrent. The reporting clinician also reported that the veteran had been totally incapacitated by his psychiatric symptoms in terms of his interpersonal functioning, noting that he had been twice married, divorced once, and was widowed from his second marriage, which had lasted nine years. The veteran related that his first marriage was "rotten"; that his second marriage was "terrible", with frequent arguments with both wives; that he had few friends, and that those relationships were not close; and that he feels detached from almost everyone most of the time. The reporting clinician also reported that the veteran had been totally incapacitated by his psychiatric symptoms in terms of his occupational functioning; that his longest job had been with the U.S. Postal Service for approximately six years; that he asserted that had frequent difficulty in keeping jobs due to feelings of hostility and frequent arguments with supervisors. He related that he left the Post Office in 1986; that he had a series of jobs between 1986 and 1993; that he was unable to maintain employment at any of these jobs; and that he had not worked since 1993. The diagnoses were Axis I: PTSD; major depressive disorder, recurrent; cannabis abuse, by history; and alcohol abuse, by history; no Axis II diagnosis was shown; the Axis IV psychosocial stressors were identified as status post head injury, 1980; poverty, inadequate social support, chronic unemployment, homelessness, and exposure to war; while the Global Assessment of Functioning (GAF) Score was 35, indicative of some impairment of reality testing or communication, or major impairment in several areas, such as work or school, family relations, judgment, thinking or mood. By RO letter of August 26, 1996, the veteran was notified of the requirements for establishing service connection for PTSD, and was asked to provide the following information and evidence: the names, addresses and dates of treatment for all physicians who had treated him for the claimed disorder, his work history since service separation, the events which he regarded as stressful, as well as a description of the symptoms he now experienced, and statements from people who know of his condition. The veteran failed to respond to that letter, or to provide the requested information or evidence. A rating decision of October 1996 denied service connection for PTSD on the grounds that the evidence did not disclose verified stressors or awards of decorations which would serve as automatic evidence of stressors. He was notified of that decision and of his right to appeal by RO letter of November 8, 1996, but did not initiate an appeal of that decision. In a Statement in Support of Claim (VA Form 21-4138) from the veteran, received at the RO in February 1997, the veteran asserted that he had failed to respond to the RO's August 26, 1996 PTSD development because he did not have the documents requested by the RO, but had since obtained those documents. He asked that his claim for service connection for PTSD be reconsidered based upon the enclosed documents. With that letter, the veteran enclosed a letter in which he asserted that he was unable to work because of symptoms of PTSD, which he treated with Travalone, a prescription medication. He further enclosed duplicate copies of his DD Form 214; duplicate copies of his service administrative and personnel records; a duplicate copy of a RO award letter, dated July 12, 1987, showing that he was in receipt of benefits for a service-connected disability; an undated letter from an individual at a private security company, who stated that the veteran had applied for employment at that company, but appeared to have a nervous condition; that the veteran was nevertheless employed in March 1993, but missed work for several days which he attributed to his nervous condition; and that the veteran was terminated in September 1993. In addition, the veteran enclosed a May 1990 letter from a State of New York Veterans' Counselor asserting that the veteran was in receipt of VA compensation benefits, and that his service-connected disability was the result of his service in Vietnam, for which he received a Purple Heart. The writer provided no information or evidence concerning the basis for that belief. In an RO development letter of February 13, 1997, the RO acknowledged receipt of the veteran's February 1997 Statement in Support of Claim and enclosures. That RO letter further notified the veteran that further information and evidence was needed in order to meet the requirements for establishing service connection for PTSD, and asked that he provide the following information and evidence: the names, addresses and dates of treatment for all physicians who had treated him for the claimed disorder, his work history since service separation, the events which he regarded as stressful, including the dates, units, places, and names of comrades killed or wounded, as well as the symptoms he now experienced, and statements from people who know of his condition. The veteran failed to respond to that letter, or to provide the requested information or evidence. In an RO development letter to the veteran, dated April 17, 1997, the RO noted that in its February 13, 1997, letter to the veteran, it had asked that he submit information about the inservice events which he regarded as stressful, including the dates, units, places, and names of comrades killed or wounded, and that he provide the names, addresses and dates of treatment for all physicians who had treated him for the claimed disorder. He was further informed that the duplicate copies of his DD Form 214, and the duplicate copies of his service administrative and personnel records did not identify any stressors that he had endured, or show that he was awarded the Purple Heart Medal. Rather, the record showed that he was awarded service connection for scars resulting from the excisions of cysts and for impaired hearing. The RO again requested that the veteran submit the information and evidence requested in its prior February 13, 1997, development letter to the veteran. In July 1997, the veteran submitted a Net Worth and Employment Statement (VA Form 21-527), seeking VA nonservice-connected pension benefits due to PTSD. In a Statement in Support of Claim (VA Form 21-4138) from the veteran, received at the RO in August 27, 1997, the veteran submitted a duplicate copy of the VA psychologist's report, dated in June 1996. He failed to provide any of the information or evidence requested in the RO's prior development letter of February 13, 1997. In an RO development letter of September 24, 1997, the RO notified the veteran that further information and evidence was needed in order to meet the requirements for establishing service connection for PTSD, and asked that he provide the following information and evidence: evidence of combat stressors, the names, addresses and dates of treatment for all physicians who had treated him for the claimed disorder, his work history since service separation, the events which he regarded as stressful, including the dates, units, places, and names of comrades killed or wounded, as well as the symptoms he now experienced, and statements from people who know of his condition. A PTSD Questionnaire was provided for the veteran's use. In August 1997, the veteran submitted a VA outpatient progress note, dated in July 1997, showing that he was initially evaluated in June 1996, and essentially repeating the matters set forth in the prior VA psychologist's report, dated in June 1996. The newly submitted report showed that the veteran reported that he had stopped drinking 18 months previously, and that he reported that he had discontinued the use of marijuana. The Axis I diagnoses were changed to: PTSD; major depressive episode; cannabis abuse, by history; and alcohol abuse, by history. The Axis IV psychosocial stressors were identified as status post head injury, 1980; poverty, inadequate social support, chronic unemployment, homelessness, and exposure to war; while the Axis V GAF Score was 30, indicative of behavior considerably influenced by delusion or hallucinations or serious impairment in communication or judgment or inability to function in almost all areas. Together with a Statement in Support of Claim (VA Form 21- 4138) from the veteran, received at the RO in November 18, 1997, he enclosed copies of outpatient treatment records from the VAMC, Durham, dated from June 1994 to July 1996; and a hospital summary from the VAMC, Durham, dated in November 1995. That evidence showed that the veteran was seen by a VA social worker in June 1994; that he related that he served in the Army from September 1969 to October 1971, with service in Vietnam from August 1970 to September 1971; that he served in Vietnam with the 25th Infantry, 39th DLAT, Americal Division, at Chu Lai; that he declined to discuss specific traumatic stressors; and that he was currently employed as a security guard, but was unwilling to provide an employment history. That report cited the veteran's claim of PTSD-like symptoms, that he lives alone with no close friends, but has several acquaintances and gets along with his neighbors; that he drinks one can of beer every two weeks and smokes marijuana weekly; that he wants to go to school, but has no transportation; and that he had no history of psychiatric treatment and was in good health. That report further cited the veteran's statement that he was in much combat as a rifleman from 1970 to 1971 with Force Recon and the Americal Division, but he declined to identify any stressors, stating that it was "too painful to talk about." The reporting social worker noted that the veteran was an active substance abuser, citing alcohol and marijuana use. The diagnoses were polysubstance abuse, ethanol and marijuana; rule out PTSD, and the veteran's psychosocial problems identified were "handicapped" and emotional/ behavioral. The veteran was seen in the PCT Clinic in June and July 1994, but discontinued attendance until March 1996, when he returned for follow-up of PTSD. It was noted that his PTSD symptoms had improved; that he was ineligible for further mental health clinic follow-up; and that he might follow-up at the VAMC, Raleigh, or at the VetCenter in Raleigh. A VA hospital summary from the VAMC, Durham, dated in November 1995, shows that the veteran demanded to be admitted so that he might be reevaluated for PTSD and detoxified for alcohol and marijuana, and was admitted for neuropsychiatric testing and evaluation. It was noted that the veteran was petitioning for admission to "obtain disability." On admission, he complained of inability to extend his left arm due to a gunshot wound when his father shot him during an argument, and a head injury with loss of consciousness in 1980, while his physical examination was otherwise non-contributory. He related that he lived with his sister-in-law and her children, and stated that he kept close contact with his mother and brother, but indicated that he was a loner. He reported skin pathology while in Vietnam which was removed by surgery, but denied any past psychiatric history, and denied any dreams, flashbacks, or disturbances related to the Vietnam war. He related that he enjoys movies about Vietnam, and "wouldn't mind going back to Vietnam as a tourist." He related drinking a six-pack of beer daily for the past several years, and of smoking a $5.00 bag of marijuana 2 to 5 times a week. Mental status examination revealed poor eye contact, a depressed mood, and a somewhat flat and irritable affect with restricted expression and no emotional signs. His cognition was intact, and his speech was normal in volume, rate, and structure and was without flight of ideas or looseness of association, and he denied suicidal or homicidal ideation, or auditory or visual hallucinations. His judgment and insight were limited, but he was 30/30 on a Mini-Mental Status examination. During hospitalization, the veteran was calm and cooperative, showed no aggressive or violent behavior, and manifested no obvious signs of intrusive thoughts, nightmares or autonomic hyperarousal consistent with a person suffering PTSD, but continually asked the examiner what the results of the evaluation would be and how to pursue obtaining records for further service connection secondary to PTSD, including a summary of the current hospitalization. During his November 1995 hospitalization, the veteran underwent psychological testing for PTSD by the Neuropsychology Service, and his MMPI results were characterized by 8 of 10 clinical scales greater than or equal to three standard deviations above the mean, suggestive of endorsement of pansymptomatology, indicative of substantial mental distress, notable dependence on others, and strong feelings of alienation, all suggestive of depression and hostile dependency in a individual with substance dependence. Interpersonally, he was likely to appear passive-aggressive, or aggressive, but no evidence of PTSD was found. The examining psychiatrist noted that neuropsychiatric testing revealed that the veteran had personality traits most consistent with a dependent personality in addition to some antisocial features. While the veteran might suffer some depressive symptomatology, it was not felt that he was experiencing any significant exacerbation in a symptoms complex consistent with PTSD exacerbation. He required no symptom management of his claimed PTSD condition and, as no symptoms were in evidence, no pharmacological management was initiated. The Axis I diagnoses were marijuana abuse, alcohol abuse, rule out PTSD; the Axis II diagnosis was mixed personality disorder with antisocial and schizoid features; the Axis III diagnoses were gunshot wound of the left elbow and headaches secondary to a head injury; the Axis IV psychosocial stressors were severe (death of wife, financial hardship); and the Axis V GAF Score was 55, indicative of moderate symptoms or moderate difficulty in social, occupational or school functioning. Outpatient treatment records from the VAMC, Durham, show that the veteran returned for follow-up of PTSD in March 1996 and in June and July 1996, and that in June 1996, he underwent psychological testing, the report of which is set out above. In a PTSD Questionnaire submitted by the veteran in November 1997, he reported the units in which he served while in the Republic of Vietnam as Troop C and D, 2nd Battalion, 17th Cavalry, 101st Airborne Division; identified three individuals in his unit who were killed in action in November 1970, December 1970, and August 1971; and asserted that he assisted in putting one of those individuals in a body bag. He further asserted that he was in Khe Sahn when it was struck by rocket and mortar fire; that in August 1970, near Quang Tri, an individual next to him dropped a hand grenade, and the next thing he remembered body parts were scattered all over; that his first combat assault after arriving in Vietnam was a helicopter insertion between Phu Bai and Quang Tri, with small firefights that had him crying and scared; and that in November 1970, he was flying up to Khe Sahn with a warrant officer buddy of his when they started taking ground fire, causing him to become nervous and scared. The veteran's responses to the PTSD Questionnaire made no mention of serving with any units other than Troops C and D, 2nd Battalion, 17th Cavalry, 101st Airborne Division, while in Vietnam, and made no mention of any claimed shrapnel wounds. By RO letter of December 17, 1997, the RO asked the United States Armed Services Center for Research of Unit Records (USASCRUR) to verify the stressors claimed by the veteran. That request identified two of the individuals identified by the veteran as reportedly killed in action, the third name not being shown on the list of servicemen on the Vietnam Memorial. In a January 1998 letter from the USASCRUR, providing an Interim Response, it was indicated that the function of that office was to provide documented information to support veterans' involvement in stressful incidents while serving in the military, but that it was unable to provide stressors because it was impossible to determine what the veteran knew or what he personally witnessed. In February 1998, the veteran submitted a duplicate copy of the VA progress notes, dated in July 1997, previously described above. In an undated letter to the President, the veteran complained that he had been denied Social Security Administration disability benefits and that VA had denied service connection for PTSD, and asked that the President take action to compel those agencies to grant the requested benefits. By RO letter of May 13, 1998, the RO informed the veteran of the status of his claim for service connection for PTSD. A May 1998 reply from the USASCRUR stated that it was unable to verify the deaths of the individuals identified by the veteran, according to the names and time frame provided by the veteran. That reply enclosed a copy of a 1970 Unit History of the 2nd Squadron, 17th Cavalry; Operational Reports-Lessons Learned from the 2nd Squadron, 17th Cavalry, for the period from January through May 1971; Combat After Action Feeder reports from Troop C, 2nd Squadron, 17th Cavalry, for the period ending May 31, 1971, involving aerial reconnaissance, convoy escort, and screening, including activity at the A Shau valley airstrip which involved small arms and 51 caliber fire, airstrikes, and heavy artillery; and copies of Combat After Action Feeder reports from Troop D, 2nd Squadron, 17th Cavalry, for the period from June 1 to August 31, 1971. The Board notes that the veteran's service administrative and personnel records show that he arrived in Vietnam on August 31, 1970, and was assigned to Troop C, 2nd Battalion, 17th Cavalry, 101st Airborne Division (Airmobile), as a troop clerk (71H) until September 14, 1970, when he was assigned as a Supply Clerk (76A) with Troop C, 2nd Squadron, 17th Cavalry, 101st Airborne Division (Airmobile), until June 6, 1971, when he was assigned the veteran was assigned as a Supply Clerk (76A) with Troop D, 2nd Squadron, 17th Cavalry, 101st Airborne Division (Airmobile), until August 29, 1971, when he departed Vietnam. In June 1998, duplicate copies of VA outpatient treatment records from the VAMC, Durham, dated from June 1994 through June 1996, were received from the office of the veteran's Congressman. A rating action of July 1998 denied service connection for PTSD, and granted a permanent and total disability rating for pension purposes. The veteran was notified of that action and of his right to appeal by RO letter of August 25, 1998. In a Statement in Support of Claim (VA Form 21-4138) from the veteran, received at the RO in September 1998, the veteran requested a hearing before an RO Hearing Officer. A hearing was held in November 1998 before an RO Hearing Officer. The veteran testified as to the dates of his active service, and his service in the Republic of Vietnam. He further testified that he served with the 101st [Airborne Division], with the 25th Infantry, and with the 2nd and 5th Infantry while in the Republic of Vietnam; that his military occupational specialty was 11B (Light Weapons Infantryman); that he took infantry training at Fort Polk before going to Vietnam; that while in Vietnam, he served in a variety of forward and rear units; and that on a typical day, he would muster and be sent on search and destroy missions which were miserable, frightening, and typical of combat situations. He further testified as to his current medication, and his symptoms of PTSD, and related that prior to his treatment at the VAMC, Durham, he was going in and out of VA hospitals in New York (Brooklyn and Manhattan) for psychiatric treatment for his PTSD trauma and for surgery for lesions on his back. He asserted that he received psychiatric treatment at the VAMC, Brooklyn, from 1971 to 1986 or 1987. The veteran testified that while his unit was going into the City of Hue in October 1970, he saw a friend (unidentified) get his leg blown off; that in December 1970, he went into Khe Sahn and remained there until March 1971; that he saw two friends of his get shot (naming the individuals whose deaths he had previously reported); that he was sure of the identity and rank of those individuals; and that there was no one he knew that could verify his combat experiences or stressors. In response to an inquiry as to the discrepancy between his testimony that he was a Light Weapons Infantryman (11B) in Vietnam, while his service administrative and personnel records showed that he was a clerk, the veteran stated that he did serve as a clerk in Vietnam, but also served as a Light Weapons Infantryman and was involved in combat for 3 months because of the need for replacements. He further testified that he served both in the 101st Airborne Division and in the 1st Cavalry Division while in Vietnam. A transcript of the testimony is of record. In January 1999, the veteran submitted a VA Form 21-22, appointing Disabled American Veterans (DAV) as his accredited service organization representative The veteran's testimony at his personal hearing was accepted as a Notice of Disagreement, and a Statement of the Case was issued in March 1999. That document informed the veteran of the issue addressed, the evidence considered, the adjudicative actions taken, the pertinent law and regulations governing service connection, the decision reached, and the reasons and bases for that decision. That document further informed the veteran of VA's duty to assist him by obtaining all evidence in the custody of military authorities or maintained by any other federal, State or local government agency, as well as any medical, employment, or other non-government records which are pertinent or specific to his claim; and which the claimant identified and provided a record release authorization permitting VA to obtain those records. In addition, he was informed that should efforts to obtain records identified by the claimant prove unsuccessful for any reason which the claimant could remedy, the VA would notify the claimant and advise him that the ultimate responsibility for furnishing such evidence lay with the claimant. In April 1999, the veteran appointed a private attorney as his representative, thereby revoking the prior appointment of the DAV as such representative. A letter from that representative, with an enclosed Substantive Appeal (VA Form 9), was received in November 1999. In that document, the veteran's attorney requested Remand of the veteran's appeal to the RO to obtain additional medical evidence from the VAMC, Brooklyn, showing treatment for a "nervous condition from Vietnam" in 1971. That individual also speculated as to what the veteran might have seen in Vietnam, and that previous VA medical reports not showing evidence of PTSD reflected incompetence or prejudice on the part of the reporting physician. By RO letter of March 2000, the veteran and his attorney were notified that his case was being transferred to the Board; and that he had the right to submit additional evidence or to request a hearing before the Board, and the time limit for doing so. In June 2000, the veteran submitted a marriage certificate showing that he had remarried on June 7, 2000. A hearing before the Board was scheduled for October 23, 2000. The veteran's attorney subsequently filed a motion to have the hearing rescheduled because of health problems, and the hearing was rescheduled for February 7, 2001, before a Member of the Board. A hearing was held on February 7, 2001, before the undersigned Member of the Board sitting at Washington, DC. The veteran's representative took notice of the provisions of the VCAA, and acknowledged that there were missing elements as to the veteran actually being in I Corps hot spots, and whether he served as a clerk or as a Light Weapons Infantryman while in the Republic of Vietnam. The veteran testified as to the dates of his active service, and the dates of his service in the Republic of Vietnam, stating that when he first arrived in Vietnam, he was stationed in Cu Chi for one month, then was assigned to Phu Bai, where he remained for seven months before being stationed at Khe Sahn from December 1970 to March 1971. He further testified as to the units in which he served while in the Republic of Vietnam; that his military occupational specialty was Clerk, but he also served as a Light Weapons Infantryman (11B) at Cu Chi; that he served at Phu Bai for 7 months; and that he served at Khe Sahn from December 1970 to March 1971. He further testified that he was under constant rocket, mortar and artillery attacks while at Cu Chi; that he was under constant rocket, mortar and artillery attacks while at Phu Bai; and that he was under constant rocket, mortar and artillery attacks while at Khe Sahn. He further testified that a mortar round narrowly missed his bunker while at Khe Sahn, and that a rocket came through the mess hall at Phu Bai; that no one was killed, but 2 or 3 guys were wounded. He testified that when he returned from Vietnam in October 1971, he went to the VAMC in Manhattan, New York, and filed a claim for a nervous condition from Vietnam; that he was examined and diagnosed with a nervous condition at that facility; and that he had been going back and forth to all three VA medical facilities up there for the last 20-25 years. He indicated that he had worked in construction from 1972 to 1974, but had to quit because of his nervous condition and a back problem from the minor surgery he had for cysts or boils pathology he had at Phu Bai while in Vietnam, and subsequently at the VAMC, Manhattan. He stated that while he was a bunker guard at Phu Bai, there were a lot of mortar attacks; while he was in Quang Tri, a rocket came through the mess hall and blew it up, with no deaths but 2 or 3 injuries. He further indicated that he had memory problems associated with a head injury sustained while employed with the U.S. Postal Service in July 1980; that he had to leave that job because of stress; and that he had done little odd jobs, but had not worked since leaving the U.S. Postal Service in 1986. The veteran related that that he was hospitalized for 19 days at the VAMC, Durham, in November 1995 for a psychiatric evaluation; that in November 1995, a physician from Duke University stated that he did not have PTSD; that he had been diagnosed with PTSD by a VA psychologist in June 1996; and that he had given the same information to both health care providers. He described his current symptomatology, and the medications prescribed; stated that he had not worked since being a security guard in 1993 or 1994, when he stopped working because his wife died (in 1994); that he had an accident with his car; and that his neighbors and employers were harassing him. He further asserted that he had trouble getting along with his employers while a security guard and while working at the U.S. Postal Service. He described difficulties in his marriage to his second wife; that he lived in a shelter for about a year after his wife's death, but had no problems with anyone at the shelter; and that he was currently married and had no current problems with his wife or the neighbors. He further related that he was shot in the elbow after a heated argument with his father in February 1979; that he had no problems with alcohol; that he had never been in alcohol rehabilitation; and that he currently had liver fibrosis due to stress. The veteran also testified that the November 1995 diagnosis of alcohol abuse was a misdiagnosis or a mistake; that he moved to North Carolina in 1991; that he was never awarded a Purple Heart; that his skin pathology was a result of shrapnel wounds of the back; and that he had made separate applications for service connection for his back injury and sebaceous cyst of the face, and for service connection for his nervous condition. He related that he sustained shrapnel wounds of the back while on bunker guard at Phu Bai; that he was posted to Phu Bai from approximately September 1970 to January 1971; that he also sustained grenade fragment wounds of the back while at Khe Sahn between December 1970 and March 1971, when the NVA overran the perimeter and overran the compound; that he was treated for both fragment wounds at the 85th Hospital at Phu Bai; and that the fragment wound at Phu Bai is just to the left on the midline of his spine, while the fragment wound from Khe Sahn is on his right side just above his right hip. He then testified that the surgery he had while in Vietnam was for skin pathology, and not for a shrapnel wound; that while undergoing refresher training at Phu Bai in late August 1970, another serviceman panicked and dropped a grenade, and was blown to bits; and that he does not know the identity of that individual. He further asserted that the primary mission of the 2nd Squadron, 17th Cavalry, was reconnaissance. The veteran further testified that he had informed both the treating psychiatrist in November 1995 and the VA psychologist who evaluated him in June 1996 of the events at Cu Chi and Phu Bai; that he had received no further treatment from the VA psychologist since that time; and that he had gone to her office and gotten an updated report in 1997. The veteran further testified that upon arriving in Vietnam, he was posted to the 25th Infantry Division in Cu Chi for one month; that he left Cu Chi in September 1970, and went to Phu Bai; that he sustained the first fragment wound at Phu Bai in late November or early December 1970, when snipers overran the wire, and had the shrapnel removed at the 85th Evacuation Hospital in Phu Bai; that he sustained the second fragment wound at Khe Sahn, when the NVA overran the wire; and that wound was also treated at the 85th Hospital in Phu Bai in January 1971. The veteran further stated that he had obtained a psychiatric evaluation from a private physician in Philadelphia the previous year, and that the report of that private psychiatric evaluation is not associated with his claims file. A transcript of the testimony is of record. In a July 20, 2001, order, the Board remanded the case to the RO for additional development of the evidence, to include obtaining all current or relevant records of treatment of the veteran for PTSD, obtaining any morning or sick reports of the veteran from Troop C, 2nd Battalion, 17th Cavalry, 101st Airborne Division, for the month of November and December 1970, and January 1971. If the veteran's claimed shrapnel wounds were verified, the RO was to schedule a VA PTSD examination and specific medical opinions as to whether the claimant has PTSD and whether it is at least as likely as not that PTSD is the result of shrapnel wounds or any other verified stressor incurred while in service. In addition, the RO was instructed to ensure that the provisions of the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2097-98 (2000) [codified as amended at 38 U.S.C.A. §§ 5102, 5103, 5103A, and 5107 (West Supp. 2002)] were fully complied with and satisfied. As noted, the requested development was not satisfactorily completed at the time the case was returned to the Board. A Report of Contact (VA Form 119), dated in January 2001, shows that the veteran stated that the doctor in Philadelphia lost his examination report, but provided a medical record release authorization (VA Form 21-4142) for that physician. He also expressed eagerness to drive to the VAMC, Durham, for examination. A report of evaluation of the veteran in the PTSD program at the VAMC, Durham, dated in January 2002, stated that the veteran underwent reevaluation at his own request to up-date the previous clinical evaluation in June 1996; that such reevaluation included an abbreviated clinical interview, and testing with the Davidson Trauma Scale (DTS) and the Beck Depression Inventory (BDI); and that the clinical interview and DTS Score supported a continued diagnosis of PTSD. The reporting psychologist cited the veteran's reports of near misses during mortar attacks and a friend being blown up when he panicked and dropped a grenade he was holding, and stated that the clinical interview and BDI supported a continued diagnosis of Major Depressive Disorder, with the veteran endorsing suicidal ideation without intent or plan, and denying homicidal ideation. In addition, the reporting psychologist cited the veteran's assertions that he continued to experience severe PTSD symptoms causing him to be totally socially and occupationally disabled. She further noted his assertions that he was unable to concentrate; that intrusive thoughts of his traumas had interfered with his ability to work; that he experienced increased irritability coinciding with increasing effects of poverty and decreased physical health; that he avoids loud noises which resulted in exaggerated startle responses; that he avoids relationships with others in general to prevent situations in which his anger or irritability may escalate; that he often responds to his spouse with irritability and that the quality of the relationship is poor; and that the veteran averred that he has not used alcohol or other substances (e.g. cannabis) for six years. The Axis I diagnoses were: PTSD; Major Depressive Disorder, Recurrent; the Axis II diagnoses were deferred; Axis IV diagnoses were unemployment, inadequate social support, and exposure to war; and the Axis V GAF Score was 35, indicative of behavior considerably influenced by delusions or hallucinations or serious impairment in communication or judgment, or inability to function in almost all areas. By RO letter of February 11, 2002, the RO requested copies of the treatment records of the veteran from Dr. C.D.M., a private physician. The veteran and his representative were notified of that request by RO letter of February 11, 2002. A March 2002 report of evaluation of the veteran by Dr. C.D.M., a private physician, stated that he had been informed that the diagnosis of PTSD had already been accepted, and that he conducted a 2 1/2 hour neuropsychiatric evaluation of the veteran on that date to determine the extent of disability related to PTSD and its possible relatedness to events occurring during his military service. The reporting physician recounted the veteran's assertions that he served in the Republic of Vietnam for 13 months; that he had traumatic events from the very beginning while in Vietnam; that a friend in a booth next to him dropped a grenade, which exploded, distributing blood and body parts everywhere; that he was in the front lines and there was daily incoming fire; that a mortar round missed his bunker by approximately three feet and scared him; that bullets were always zinging by very close to him; that he saw a number of others killed; that no events subsequent to Vietnam were as terrifying as what occurred on a daily basis while there; and that his PTSD was incapacitating upon his return from Vietnam. He further asserted that he applied for service connection for a nervous disorder in 1971 because of his very high level of stress and anxiety, and that he had experienced depression for the last 30 years. The reporting physician expressed the opinion that depression was part of every severe PTSD, and that it was his opinion that the veteran's depression was a direct result of his PTSD. No diagnostic tests were conducted, but the reporting physician cited his review of the psychological tests performed by the VA psychologist at the VAMC, Durham in January 2003, and stated that he agreed with the findings of PTSD and Major Depression. The Axis I diagnoses were PTSD, severe, and Major Depression, Recurrent; the Axis IV psychosocial stressors were "nearly everything in his environment as a result of his severe PTSD, unemployment status, poverty, lack of social support, and relations with those close to him." The reporting physician cited the diagnostic criteria for PTSD, and indicated that the veteran's self-report of claimed symptoms met those criteria. He concluded that the veteran's stated symptoms of PTSD appeared to relate to his experiences in Vietnam, and stated that the veteran currently met the DSM- IV diagnostic criteria for a 100 percent rating for PTSD and Major Depression. No treatment records of the veteran were provided by Dr. C.D.M., and the veteran was notified of that fact by the Supplemental Statement of the Case issued in October 2002. A response from the National Personnel Records Center (NPRC), dated in March 2002, showed no morning or sick reports of the veteran in November or December 1970, or in January 1971. No additional service medical records were obtained from the NPRC other than those already included in his service medical records, an no service medical records were obtained reflecting treatment of the veteran for shrapnel or foreign bodies during active service and no history or findings of shrapnel wounds at the time of his service separation examination. A Supplemental Statement of the Case was provided the veteran and his representative in July 2002. In October 2002, the veteran and his representative were notified that his case was being transferred to the Board, and of his right to submit additional evidence, request a hearing before the Board, or appoint or change his representative, and the time limit for doing so. No additional communication from the veteran has been received. II. Analysis VCAA There has been a significant change in the law during the pendency of this appeal with the enactment of the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2097-98 (2000) [codified as amended at 38 U.S.C.A. §§ 5102, 5103, 5103A, and 5107 (West Supp. 2001)]. This law eliminates the concept of a well-grounded claim, redefines the obligations of VA with respect to the duty to assist, and supersedes the decision of the United States Court of Appeals for Veterans Claims (the Court) in Morton v. West, 12 Vet. App. 477 (1999), withdrawn sub nom. Morton v. Gober, No. 96-1517 (U.S. Vet. App. Nov. 6, 2000) (per curiam order) (holding that VA cannot assist in the development of a claim that is not well grounded). The VCAA is applicable to all claims filed on or after the date of enactment, November 9, 2000, or filed before the date of enactment and not yet final as of that date. See Karnas v. Derwinski, 1 Vet. App. 308, 312-13 (1991). The record shows that the claimant and his representative were notified of the provisions of the VCAA by the Board's Remand order of July 20, 2001; by the RO letter of November 16, 2001; and by the Supplemental Statement of the Case issued on July 24, 2002. The Board finds that the cited RO letter of November 16, 2001; and the Supplemental Statement of the Case issued on July 24, 2002, provided notifications to the claimant and his representative which fully complied with the requirements of the United States Court of Appeals for Veterans Claims (the Court), stated in Quartuccio v. Principi, 16 Vet. App. 183,187 (2002) (requiring VA to notify the veteran of what evidence he was required to provide and what evidence the VA would attempt to obtain). The record further shows that RO letters of January 8, 1996; August 26, 1996; February 13, 1996; April 17, 1997; and September 24, 1997 notified the veteran of the evidence needed to establish entitlement to service connection for PTSD, and asked that he provide the names, addresses, and dates of treatment for all physicians who had treated him for that disability; asked that he provide his work history since service separation; asked that he describe the events he regarded as stressful, as well as the symptoms he now experienced; and that he provide statements from people who know of his condition. He was informed that when the requested evidence was received, the RO would request a search of his unit records. He was provided a PTSD Questionnaire for completion and return. The RO letter of April 17, 1997, further informed the veteran that the duplicate copies of his DD Form 214 and of his service administrative and personnel records that he had submitted did not identify any stressors that he had experienced, or show that he had received the Purple Heart Medal. In addition, the Statement of the Case issued on March 29, 1999, informed the veteran and his representative of VA's duty to assist him by obtaining all evidence in the custody of military authorities or maintained by any other federal, State or local government agency, as well as any medical, employment, or other non-government records which are pertinent or specific to his claim; and which the claimant identified and provided a record release authorization permitting VA to obtain those records. In addition, he was informed that should efforts to obtain records identified by the claimant prove unsuccessful for any reason which the claimant could remedy, the VA would notify the claimant and advise him that the ultimate responsibility for furnishing such evidence lay with the claimant. Final regulations to effectuate the VCAA were published on August 29, 2001 with the same effective date of the VCAA, November 9, 2000. Except for the amendment to 38 CFR § 3.156(a)(relating to the definition of new and material evidence); the second sentence of 38 CFR § 3.159(c)(relating to VA assistance in the case of claims to reopen previously denied claims); and 38 CFR § 3.159(c)(4)(iii) (relating to providing medical examinations or obtaining medical opinions in claims to reopen a finally adjudicated claim), effective August 29, 2001, governing reopening of previously and finally denied claims, the provisions of this final rule apply to any claim to reopen a finally decided claim for benefits received by VA on or after August 29, 2001. As the instant appeal was received at VA prior to August 29, 2001, the revised regulations applicable to reopened claims are inapplicable to the instant appeal. New and Material Evidence Under Barnett v. Brown, 83 F.3d. 1380 (Fed.Cir.1996), any statutory tribunal must ensure that it has jurisdiction over each case before adjudicating the merits, a potential jurisdictional defect may be raised by the court or tribunal sua sponte or by any party and at any stage in the proceedings and, once apparent, must be adjudicated. Title 38 U.S.C.A. § 7104(b) does not vary the Board's jurisdiction according to how the RO ruled. Accordingly, the Board must independently address the issue of whether new and material evidence has been submitted to reopen the veteran's claim of entitlement to service connection for PTSD. In general, RO decisions which are unappealed become final. See 38 U.S.C.A. § 7105; 38 C.F.R. § 20.1103. The governing regulations provide that an appeal consists of a timely filed Notice of Disagreement in writing and, after a Statement of the Case has been furnished, a timely filed Substantive Appeal. 38 C.F.R. 20.200 (2002). The veteran did not file a Notice of Disagreement with the rating decisions of June 1996 and October 1996 denying service connection for PTSD, and those decisions became final. Pursuant to 38 U.S.C.A. § 5108, the Secretary must reopen a finally disallowed claim when new and material evidence is presented or secured with respect to that claim. Knightly v. Brown, 6 Vet. App. 200 (1994). Only evidence presented since the last final denial on any basis (either upon the merits of the case, or upon a previous adjudication that no new and material evidence had been presented), will be evaluated in the context of the entire record. Evans v. Brown, 9 Vet. App. 273 (1996). New and material evidence is defined as evidence not previously submitted to agency decisionmakers 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(a). In Hodge v. West, 155 F.3d 1356, 1363 (Fed. Cir. 1998), the Federal Circuit noted that new evidence could be sufficient to reopen a claim if it could contribute to a more complete picture of the circumstances surrounding the origin of a veteran's injury or disability, even where it would not be enough to convince the Board to grant a claim. In Elkins v. West, 12 Vet. App. 209 (1999), the United States Court of Appeals for Veterans Claims (the Court) held the Board 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 denied claim reopened under 38 U.S.C.A. § 5108. Then, if new and material evidence has been submitted, the Board may proceed to evaluate the merits of the claim but only after ensuring the VA's duty to assist has been fulfilled. See Vargas- Gonzalez v. West, 12 Vet. App. 321, 328 (1999). New and material evidence received prior to the expiration of the appeal period, or prior to the appellate decision if a timely appeal has been filed (including evidence received prior to an appellate decision and referred to the agency of original jurisdiction by the Board of Veterans Appeals without consideration in that decision in accordance with the provisions of § 20.1304(b)(1) of this chapter), will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. 38 C.F.R. § 3.156(b) (2002). Where the new and material evidence consists of a supplemental report from the service department, received before or after the decision has become final, the former decision will be reconsidered by the adjudicating agency of original jurisdiction. This comprehends official service department records which presumably have been misplaced and have now been located and forwarded to the Department of Veterans Affairs. Also included are corrections by the service department of former errors of commission or omission in the preparation of the prior report or reports and identified as such. The retroactive evaluation of disability resulting from disease or injury subsequently service connected on the basis of the new evidence from the service department must be supported adequately by medical evidence. Where such records clearly support the assignment of a specific rating over a part or the entire period of time involved, a retroactive evaluation will be assigned accordingly except as it may be affected by the filing date of the original claim. 38 C.F.R. § 3.156(c) (2002) For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is to be presumed. Once the evidence is found to be new and material and the claim is reopened, the presumption that the evidence is credible no longer applies. In the following adjudication [i.e., de novo review], the RO must determine both the credibility and weight of the new evidence in the context of all the evidence, both old and new. Justus v. Principi, 3 Vet. App. 510, 513 (1992); Kates v. Brown, 5 Vet. App. 93, 95 (1993). The record shows that rating decisions of June 1996 and October 1996 denied service connection for PTSD on the merits; and that the veteran was notified of those adverse determinations and of his right to appeal. The veteran failed to initiate an appeal. In August 1997, the veteran undertook to reopen his claim for service connection for PTSD by submitting additional evidence. The RO evidently found that the additional evidence submitted was both new and material to the veteran's claim for service connection for PTSD and, in a July 1998 decision, denied that claim on the merits, giving rise to this appeal. The evidence of record at the time of the rating decision of June 1996 denying service connection for PTSD included the veteran's service medical, administrative and personnel records; his original application for VA disability compensation benefits, received in February 1972; reports of VA examinations in April 1972, June 1975, April 1977, and January 1979; and hospital summaries from the VAMC, Manhattan, in August 1972 and August 1977. None of that evidence shows any complaint, treatment, findings or diagnosis of a nervous or psychiatric condition during active service, on service separation examination, during the initial postservice year, or at any time prior to June 1994, and there was no medical diagnosis of PTSD. In addition, there was no service department evidence that the veteran served in combat or was exposed to combat stressors. As noted, the veteran was notified of that adverse determination and of his right to appeal, but failed to initiate an appeal. The evidence of record at the time of the October 1996 rating decision denying service connection for PTSD included the evidence cited above, as well as a June 1996 report of VA psychological evaluation showing a diagnosis of PTSD which was not based upon a verified stressor. The additional evidence added to the record since the last previous denial of the veteran's claim for service connection for PTSD in October 1996 includes the veteran's testimony at his November 1998 hearing before an RO Hearing Officer; the veteran's testimony at his February 2002 hearing before the undersigned Member of the Board; the VA outpatient follow-up reports, dated in July 1997 and January 2002, showing a diagnosis of PTSD; the summary of the veteran's hospitalization for observation and evaluation at the VAMC, Durham, dated in November 1995; the veteran's PTSD Questionnaire, received in November 1997, which reported no shrapnel wounds to the veteran; a private physician's report diagnosing PTSD in the veteran and relating that condition to alleged combat stressors during the veteran's service in the Republic of Vietnam; and information and evidence received from the USASCRUR in June 1998, and from the NPRC in March and May 2002. None of the additional documentary evidence cited included any complaint, treatment, findings or diagnoses of shrapnel wounds to the veteran, but in his testimony, he asserted, for the first time, that he served as a Light Weapons Infantryman (11B), and that he sustained two shrapnel injuries, while serving in the Republic of Vietnam. The Board finds that the additional evidence submitted since the last final rating decision of October 1996 denying service connection for PTSD includes evidence not previously submitted to agency decisionmakers 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. Such evidence includes additional service department records not previously of record, received from the USASCRUR in June 1998; additional private and medical diagnoses of PTSD which is attributed to his service in the Republic of Vietnam; the veteran's testimony at his November 1998 hearing before an RO Hearing Officer, and his testimony at his February 2002 hearing before the undersigned Member of the Board in which he advanced contentions not previously of record concerning his duties and units of assignment while serving in the Republic of Vietnam, as well as his sworn testimony that in October 1971, he filed an application for service connection for a nervous condition from Vietnam, and that he was treated for a psychiatric disorder at the VAMC, New York (Manhattan), Brooklyn, and Queens from October 1971 through 1986-1987. Accordingly, the Board finds that new and material evidence has been submitted to reopen the claim for service connection for PTSD; and that the unappealed rating decision of October 1996 is no longer final. 38 U.S.C.A. § 5108(a) (West 1991 & Supp. 2002); 38 C.F.R. § 3.156(a) (2002). The Board further finds that the Board remanded the case in July 2001 for additional development and to ensure that the VA's duty of notification and assistance to the veteran under the provisions of the VCAA had been fully met. See Elkins, 12 Vet. App. 209 (1999), Vargas-Gonzalez, 12 Vet. App. at 328. To the extent indicated, the appeal of the denial of the veteran's claim to reopen the issues of service connection for PTSD is granted. ORDER New and material evidence having been submitted, the claim for service connection for PTSD is reopened. G. H. Shufelt Member, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.