Citation Nr: 0026340 Decision Date: 09/29/00 Archive Date: 10/04/00 DOCKET NO. 94-06 676 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder (PTSD). 2. Entitlement to service connection for a skin rash, lung disability, nervous disability, loss of upper teeth and headaches secondary to exposure to Agent Orange. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD T. Stephen Eckerman, Associate Counsel INTRODUCTION The veteran had active military service from April 1966 to October 1968. This matter arises from rating decisions rendered by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. In April 1993, the RO denied a claim of entitlement to service connection for PTSD. In August 1994, the RO denied claims of entitlement to service connection for a skin rash, lung disability, nervous disability, loss of upper teeth and headaches secondary to exposure to Agent Orange. The veteran appeal all denials. In April 1996, the Board remanded all of the claims for additional development. The claim for a skin condition secondary to exposure to Agent Orange is the subject of the REMAND portion of this opinion. FINDINGS OF FACT 1. In an unappealed decision, dated in May 1988, the RO denied a claim by the appellant for entitlement to service connection for PTSD. 2. The evidence received since the RO's May 1988 decision is evidence that was not previously of record, bears directly and substantially upon the specific matter under consideration, is not cumulative of other evidence of record, and is so significant that it must be considered in order to fairly decide the merits of the claim. 3. The veteran did not engage in combat. 4. The appellant does not have PTSD attributable to military service or to any incident of active duty. 5. Competent medical evidence of chronic headaches, and an etiological relationship or nexus between a lung disability, a nervous disability, and loss of upper teeth, and exposure to Agent Orange, has not been presented. CONCLUSIONS OF LAW 1. The RO's May 1988 decision, denying a claim of entitlement to service connection for PTSD, became final. 38 U.S.C.A. § 7105(b) (West 1991). 2. New and material evidence has been received since the RO's May 1988 decision denying the appellant's claim PTSD, and the claim for PTSD is reopened. 38 U.S.C.A. § 5108 (West 1999); 38 C.F.R. § 3.156 (1999). 3. PTSD was not incurred or aggravated by the appellant's service. 38 U.S.C.A. §§ 1110, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.102, 3.303, 3.304(f) (1999). 4. The appellant's claims of entitlement to service connection for a lung disability, a nervous disability, loss of upper teeth and headaches, secondary to exposure to Agent Orange, or some other chemical agent, during service, are not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. PTSD In an unappealed decision, dated in May 1988, the RO denied a claim of entitlement to service connection for PTSD. In 1993 the veteran sought to reopen his claim. In June 1993 the RO reopened the claim and denied it on the merits. The veteran appealed, and in April 1996, the Board remanded the claim for additional development. Despite the RO's denial of this claim on the merits, the Board must consider the threshold question of whether new and material evidence has been submitted to reopen the claim. See Barnett v. Brown , 83 F.3d 1380 (Fed. Cir. 1996). After reviewing the record from a longitudinal perspective, the Board finds that new and material evidence has been received to reopen the veteran's claim for service connection for PTSD. When a claimant seeks to reopen a claim based upon additional evidence, VA must perform a three-step analysis. See Elkins v. West, 12 Vet. App. 209, 218-19 (1999). First, VA must determine whether the evidence is new and material under 38 C.F.R. § 3.156(a). Under 38 C.F.R. § 3.156(a) (1999), new and material evidence means evidence not previously submitted to agency decision makers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. See also Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). Further, when determining whether the claim should be reopened, the credibility of the newly submitted evidence is to be presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). If new and material evidence is presented or secured with respect to a claim which has been disallowed, the second step of the Elkins analysis requires VA to reopen the claim and determine whether the claim is well grounded pursuant to 38 U.S.C.A. § 5107( a) (West 1991). Finally, the third step of the Elkins analysis requires VA to evaluate the claim on the merits after ensuring that VA has fulfilled its duty to assist under 38 U.S.C.A. § 5107(b) (West 1991). The United States Court of Appeals for Veterans Claims (Court) has indicated that in order to reopen a claim, there must be new and material evidence presented or secured since the last determination denying the benefit sought. See Elkins v. West, 12 Vet. App. at 213-214. Accordingly, the Board must consider whether new and material evidence has been presented since the RO's May 1988 decision. In this case, a review of the RO's May 1988 decision shows that the RO determined that the record did not contain competent medical evidence showing that the veteran had PTSD. However, a review of the evidence received since the RO's May 1988 decision shows that it includes As this evidence was not of record at the time of the December 1994 decision and it is not cumulative or redundant of evidence that was of record in December 1994, the Board finds that this evidence is "new." The Board also finds it "material" in that it bears directly and substantially upon the specific matter under consideration and is so significant it must be considered in order to decide fairly the merits of the veteran's claim. This evidence is significant because it indicates that the veteran may have PTSD due to his service. In light of Board's finding that new and material evidence has been presented, the veteran's claim of entitlement to service connection for PTSD is reopened, and the Board will proceed to step two of the Elkins analysis by determining whether the veteran's claim is well grounded. B. Well-groundedness To establish a well-grounded claim for service connection for PTSD, the record must include a medical diagnosis of PTSD (showing a current disability), lay evidence of an in-service stressor (showing service incurrence), and medical evidence of a nexus between the PTSD and the stressor (linking the current disability to service). 38 C.F.R. § 3.304(f) (1999); Cohen v. Brown, 10 Vet. App. 128, 137 (1997). In this case, the record includes the veteran's contentions that he experienced stressors during his service sufficient to cause PTSD. As noted previously, the post-service medical evidence includes several VA outpatient treatment reports, dated between 1995 and 1996, which show that the veteran was assessed or diagnosed with PTSD (often "by history"). Of particular note, a February 1995 VA outpatient treatment report which shows that the examiner stated that the veteran should be service-connected for PTSD (this report is discussed in greater detail, infra). The criteria for a well-grounded service connection claim have therefore been met. Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995); King v. Brown, 5 Vet. App. 19, 21 (1993). The Board is also satisfied that all relevant facts have been properly developed. No further assistance to the veteran is required in order to comply with the duty to assist as mandated by 38 U.S.C.A. § 5107(a). Accordingly, the Board will now analyze the veteran's claim on the merits. C. Merits In this case, the veteran argues that he has PTSD as a result of participation in combat. Specifically, a review of the veteran's written statements, and the transcript from his hearing, held in February 1999, shows that the veteran asserts that he served as a guard with the 199th Light Infantry Brigade (LIB) for about the first four months of his tour in Vietnam. In addition, he argues that he was transferred from the 199th LIB to the 554th Maintenance Company (554th MC) for the remainder of his one year in Vietnam. During that time, he states that the 554th MC's base camp was often attacked, and that it was overrun twelve to thirteen times. He asserts that he received the Combat Infantryman Badge. A lay statement from C.H., received in April 1998, states that the veteran's symptoms include poor memory and flashbacks of Vietnam. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1999). Applicable regulations provide that service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125, a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f). The veteran's service medical records include a separation examination report, dated in September 1968, which shows that the veteran's psyche was clinically evaluated as normal. An accompanying report of medical history shows that he denied nervous trouble of any sort, depression or excessive worry, and frequent or terrifying nightmares. A report, dated in June 1967, (about twelve days after the veteran's arrival in Vietnam, and approximately one year and three months prior to separation from service) indicates that the veteran was serving with the 554th MC, and that he was diagnosed with acute situational reaction, moderate. The "stress" was listed as routine duty. He was treated for two days, at which time he was considered treated and improved, with no impairment. The remainder of the service medical records are silent as to complaints, treatment or a diagnosis involving an acquired psychiatric disorder. Despite the indications of PTSD, discussed below, which are sufficient to well ground the claim, the Board finds that the evidence does not show that the veteran has PTSD. In general, the Board notes that the post-service medical evidence includes VA psychiatric reports, dated in January 1988, July 1991 and October 1996, VA outpatient treatment reports, dated between 1974 and 1997, reports associated with a decision of the Social Security Administration (SSA), dated in 1990, and records from private health care providers. These records show that the veteran's diagnoses include PTSD, schizophrenia, an adjustment disorder and a personality disorder. Of particular note, in April 1996, the Board remanded the claim and requested the veteran be afforded a psychiatric examination by a board of two psychiatrists in order to determine whether or not the veteran has PTSD. A review of the report from that examination, dated in October 1996, shows that the examiners determined that the veteran's Axis I diagnosis was schizophrenia. An Axis II diagnosis of mixed personality disorder was also provided. The Board finds that the October 1996 VA examination report is highly probative evidence which shows that the veteran does not have PTSD. In particular, this report shows that the veteran was not oriented as to time and place, and that he was unable to add two plus two. He further stated that he was receiving messages from other planets, that he claimed to have regular auditory and visual hallucinations, and that he hears voices telling him to shoot his gun. The examiners noted that he tended to give positive answers to all questions, and that they had some question as to the validity of his responses. The examiners also noted that the veteran did not make systematic or logical references to his Vietnam experiences. The examiners concluded that he had schizophrenia. The Board further points out that the examiners' conclusions in the October 1996 VA examination report are consistent with the SSA's decision, dated in December 1990 (approximately), which shows that the SSA determined that the veteran was disabled due to schizophrenia, and that the date of onset was June 1989. In addition, the following medical reports show that the veteran has been diagnosed with schizophrenia: 1) a VA hospital report, dated in May 1988; 2) a report from Shael S. Bronson, M.D., dated in November 1990; 3) a VA psychiatric examination report, dated in July 1991; 4) a report from Robert Griffin, M.D., dated in April 1998; and 5) a VA psychiatric evaluation, dated in January 1988. The Board further points out that the diagnosis in the May 1988 VA hospital report was based on extensive observation (i.e., approximately three weeks). Finally, the Board notes that a February 1988 VA hospital report, and a September 1990 VA outpatient treatment report, contain diagnoses of acquired psychiatric disorders other than PTSD. Specifically, the veteran was diagnosed with an adjustment disorder with mixed emotional features, and a psychoses NOS (not otherwise specified), respectively. Based on the foregoing, the Board finds that the preponderance of the evidence shows that the veteran does not have PTSD. In reaching this decision, the Board has considered the notations of PTSD as found in several VA outpatient treatment reports, dated in 1996, as well as a VA outpatient treatment report containing concurrent diagnoses of PTSD and schizophrenia, dated in February 1993, and a diagnosis of "by history, PTSD" as found in a December 1996 report from the Forest Park Medical Center. However, many of these notations show that the veteran was primarily seeking treatment for physical conditions, and none of the PTSD notations are accompanied by indicia of reliability, such as a reference to combat or other stressors, psychological testing, additional medical comment, or citation to clinical findings. The probative value of many of these notations is minimal as they appear to be no more than a reiteration of lay history. See McQueen v. West, 13 Vet. App. 237 (1999). Of particular note, a February 1995 VA outpatient treatment report states that the veteran has PTSD, and that he "should be service connected as patient is currently being treated for this condition at the psychiatric division at JB (Jefferson Barracks)." However, this report indicates that the veteran was seeking treatment for sinus symptoms, and, as with the other notations of PTSD, this notation is unaccompanied by any other indicia of reliability. The Board therefore finds that the probative value of the evidence indicating that the veteran has PTSD is outweighed by the contrary evidence of record, which shows that the veteran does not have PTSD. This evidence shows that the veteran has consistently been diagnosed with schizophrenia since 1988. As the preponderance of the evidence is against the claim that the veteran has PTSD, the veteran's claim for service connection for PTSD fails on the basis that all elements required for such a showing have not been met. Accordingly, service connection for PTSD must be denied. While the Board has considered the written and oral testimony of the veteran, as well as C.H.'s April 1998 statement, the Board points out that although the arguments and reported symptoms have been noted, the issue in this case ultimately rests upon interpretations of medical evidence and conclusions as to the veteran's correct diagnosis. In such cases, lay persons untrained in the fields of medicine and psychiatry are not competent to offer such an opinion. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). The Board has determined that service connection for PTSD is not warranted. To that extent, the veteran's contentions are unsupported by persuasive evidence. II. Agent Orange The veteran argues that he has a lung disability, a nervous disability, headaches and loss of upper teeth secondary to exposure to Agent Orange (the claim for a skin condition is discussed in the REMAND portion of this decision). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1999). If a condition noted during service is not shown to be chronic, then generally a continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). The chronicity provision of 38 C.F.R. § 3.303(b) is applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service or during an applicable presumption period and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under the U.S. Court of Appeals for Veterans Claims (Court's) case law, lay observation is competent. If the chronicity provision is not applicable, a claim may still be well grounded or reopened on the basis of 38 C.F.R. § 3.303(b) if the condition is observed during service or any applicable presumption period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488 (1997). In addition, disease associated with exposure to certain herbicide agents, listed in 38 C.F.R. § 3.309, will be considered to have been incurred in service under the circumstances outlined in that section even though there is no evidence of such disease during the period of service. If a veteran was exposed to an herbicide agent during active military, naval, or air service, the following diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied: Chloracne or other acneform disease consistent with chloracne; Hodgkin's disease; non-Hodgkin's lymphoma; acute and subacute peripheral neuropathy; porphyria cutanea tarda; prostate cancer; multiple myeloma, respiratory cancers (cancers of the lung, bronchus, larynx, or trachea), and soft-tissue sarcoma. 38 C.F.R. § 3.309(e). The diseases listed at 38 C.F.R. § 3.309(e) must have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne, porphyria cutanea tarda, and acute and subacute peripheral neuropathy must have become manifest to a degree of 10 percent or more within a year, and respiratory cancers within 30 years, after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307(a)(6)(ii). Notwithstanding the foregoing, the United States Court of Appeals for the Federal Circuit has determined that the Veterans' Dioxin and Radiation Exposure Compensation Standards (Radiation Compensation) Act, Pub. L. No. 98-542, § 5, 98 Stat. 2725, 2727-29 (1984), does not preclude establishment of service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The initial question in this case is whether the veteran has presented well grounded claims for service connection. In this regard, the veteran has "the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded;" that is, the claims must be plausible and capable of substantiation. See 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). To establish that a claim for service connection is well grounded, a veteran must demonstrate a medical diagnosis of a current disability; medical, or in certain circumstances, lay evidence of inservice occurrence or aggravation of a disease or injury; and medical evidence of a nexus between an inservice disease or injury and the current disability. Where the determinative issue involves medical causation, competent medical evidence to the effect that the claim is plausible is required. See Epps v. Gober, 126 F.3d 1464 (1997). The Board initially notes that the veteran has filed a number of Agent Orange claims over the years. Specifically, in an unappealed decision, dated in June 1982, the RO denied a claim of entitlement to service connection for a skin condition. The RO's decision became final. 38 U.S.C.A. § 7105(c). In November 1989, the veteran filed a claim for a skin condition, a nervous condition, and loss of upper teeth secondary to exposure to Agent Orange. In September 1991, he filed a claim for a lung condition, and residuals of pneumonia, secondary to exposure to Agent Orange. Also in September 1991, the RO denied claims of entitlement to service connection for residuals of pneumonia (on a basis other than exposure to Agent Orange), and (otherwise unspecified) "residuals of exposure to Agent Orange." The veteran appealed only the issue of residuals of pneumonia (on a basis other than exposure to Agent Orange), and the RO's denial of the claim for "residuals of exposure to Agent Orange" became final. Id. In April 1992, the Board denied the claim for residuals of pneumonia (on a basis other than exposure to Agent Orange). The Board's decision was final. 38 U.S.C.A. § 7104(a). In August 1994, the RO denied claims of entitlement to service connection for a skin rash, a nervous condition, a lung condition, headaches, and loss of upper teeth, with all claims secondary to exposure to Agent Orange. The veteran appealed all of the RO's August 1994 denials. Notwithstanding the aforementioned final decisions pertaining to the veteran's Agent Orange claims, the Board has determined that the claims for a skin rash, a nervous condition, a lung condition, headaches, and loss of upper teeth, with all claims secondary to exposure to Agent Orange, are sufficiently distinct from the final decisions such that they may be adjudicated without a new and material analysis. See 38 C.F.R. § 3.156. In McCartt v. West, 12 Vet. App. 164 (1999), the Court held that in the absence of the presence of a disease listed in 38 C.F.R. § 3.309(e), a veteran is not entitled to a presumption of Agent Orange exposure. In this case, the veteran is not shown to have a disease listed in 38 C.F.R. § 3.309(e), and his exposure to Agent Orange has not been verified. However, for the purposes of this opinion, the Board has noted the veteran's service in Vietnam, and will assume arguendo that the veteran was exposed to Agent Orange or some other herbicide during his service. Under 38 U.S.C.A. § 1110, the veteran must submit proof of a presently existing disability resulting from service in order to merit an award of compensation. See Gilpin v. West, 155 F.3d 1353 (Fed.Cir. 1998); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). The Board finds that as no competent medical evidence has been submitted showing that the veteran has chronic headaches, the claim must be denied as not well grounded on any basis, to include a secondary to exposure to Agent Orange. The claims that the veteran has a lung disability and a nervous disability, and upper tooth loss, secondary to exposure to Agent Orange or some other herbicide during his service are not well grounded. The Board first notes that it does not appear that the veteran is claiming any disease which is recognized as attributable to Agent Orange under the applicable regulations. See 38 C.F.R. §§ 3.307, 3.309(e). In this regard, the Board further notes that the record does not contain a diagnosis of any such "presumptive" disease. See id. Furthermore, the Secretary of Veterans Affairs, based on research from the National Academy of Sciences, has recently determined that a presumption of service connection based on herbicides used in the Republic of Vietnam during the Vietnam era is not warranted for any condition which the Secretary has not specifically determined that a presumption of service connection is warranted. 62 Fed. Reg. 59232-59243 (Nov. 11, 1999). Given the foregoing, as a matter of law, the veteran cannot receive the benefit of a rebuttable presumption that he has a lung disability, a nervous disability, or loss of upper teeth, which is attributable to Agent Orange under the applicable regulations. Id. To the extent the law is dispositive of an issue on appeal, the claims lack legal merit. See Sabonis v. Brown, 6 Vet. App. 427, 430 (1994). Second, with regard to the claims for lung and nervous disabilities, the medical evidence includes VA examination, hospital and outpatient treatment reports, as well as non-VA reports, collectively dated between 1974 and 1998. With regard to the claim for a lung disability, these records show that the veteran has been diagnosed with conditions that include chronic obstructive pulmonary disease (COPD), rhinitis, sinusitis, bronchitis and a "minimal restrictive ventilatory defect." The medical records are also remarkable for notations showing a long history of smoking. See e.g., VA outpatient treatment report, dated in March 1996 (noting a smoking history of one pack-per-day for 30 years). With regard to the claim for a nervous condition, these records show that the veteran has been diagnosed with various psychiatric disorders (the veteran's psychiatric diagnoses are discussed in detail in part I, supra). Furthermore, a lay statement from C.H., received in April 1998, states that the veteran's symptoms include poor memory and flashbacks of Vietnam. However, as none of the medical evidence in the record shows that the veteran currently has a lung disability, or a nervous disability, that is related to his service, it is axiomatic that entitlement to service connection cannot be established under Combee, supra. Accordingly, the veteran's claims for a lung disability, and a nervous disability, secondary to exposure to Agent Orange, or some other herbicide, during service must be denied as not well grounded. With regard to the claim for upper tooth loss, the Board notes during the pendency of this appeal, VA regulations regarding service connection for dental disorders were revised, effective June 8, 1999. 64 Fed.Reg. 30392 (June 8, 1999). The United States Court of Appeals for Veterans Claims has held that where a law or regulation changes after a claim has been filed or reopened but before the administrative or judicial appeal process has been concluded, the version more favorable to the veteran will apply. Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). Previously, VA regulation provided that treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, periodontal disease (pyorrhea), and Vincent's stomatitis were not disabling conditions, and could be considered service-connected solely for the purpose of determining entitlement to dental examination or outpatient dental treatment. 38 C.F.R. § 4.149 (effective prior to June 8, 1999). Under amended VA regulations, treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease will be considered service- connected solely for the purpose of establishing eligibility for outpatient dental treatment, and rating action should consider each defective or missing tooth and each disease of the teeth and periodontal tissues separately to determine whether the condition was incurred or aggravated in line of duty during active service and, when applicable, to determine whether the condition is due to combat or other in-service trauma, or whether the veteran was interned as a prisoner of war. See 38 U.S.C.A. § 1712 (West 1991 & Supp. 1999); 38 C.F.R. § 3.381 (effective after June 8, 1999). Teeth noted as normal at entry will be service-connected if they were filled or extracted after 180 days or more of active service. Id. Although the RO did not consider the amended regulation, since this case was certified for appeal prior to the effective date of the amended regulation, the Board concludes that there is no prejudice to the veteran in proceeding with his appeal since the regulatory change does not have any substantive effect regarding the veteran's entitlement to the claimed benefits. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993) (the Board must consider whether the claimant is prejudiced when the Board addresses a question that has not been addressed by the RO; and the Board must set forth an adequate statement of reasons and bases for its decision). Therefore, the Board finds that it is not necessary to remand the matter for the issuance of a supplemental statement of the case concerning the regulatory change. Id. In the present case, the veteran's service medical records include a dental examination report performed at the time of entry into service, dated in April 1966, which indicates that teeth #12, 14, 19 and 30 were missing, and that teeth #2, 3, 4, 5, 15, 18 and 31 were abnormal. In addition, tooth #4 was apparently extracted during service. The "dental" portion of the veteran's separation examination report, dated in September 1968, is unmarked. An accompanying report of medical history, dated in September 1968, shows that the veteran denied ever having severe tooth or gum trouble. A dental examination, apparently performed in September 1968, indicates that tooth #4 was extracted during service, and that teeth #13 and 31 were abnormal. The service medical records are negative for any evidence of service trauma leading to a dental condition. In summary, as noted above, the veteran's service medical records appear to reflect that tooth #4 was extracted during military service, and that teeth #13 and 31 may have became carious (or otherwise became abnormal) during service. In addition, a VA hospital report, dated in April 1988, indicates that the veteran's upper teeth were missing. However, as explained below, in the absence of evidence of service trauma associated with any tooth extraction, the mere fact that teeth may have been carious or extracted in service is not determinative to a claim for VA dental treatment. The Board emphasizes that both the old and new regulations clearly provide that replaceable missing teeth and treatable carious teeth are not disabling conditions subject to compensation under VA laws, and may be considered service- connected solely for the purpose of determining entitlement to dental examinations or outpatient dental treatment. See 38 C.F.R. § 3.381(a) (1999) and 38 C.F.R. § 4.149 (in effect prior to June 8, 1999). The Court has held that in order to be entitled to outpatient dental treatment, a veteran must first meet the criteria specified in one of the clauses of 38 U.S.C.A. § 1712(b)(1)(A)-(H). See 38 C.F.R. § 17.161; Woodson v. Brown, 8 Vet. App. 352 (1995), aff'd 87 F.3d 1304 (Fed.Cir. 1996). Furthermore, the Court has indicated that if the evidence is insufficient to establish that the veteran is a member of one of the "classes" of eligibility for dental treatment, then the veteran has not submitted a well-grounded or "plausible" claim for entitlement to outpatient dental services, and the appeal must be denied. Woodson, 8 Vet. App. at 355; see 38 U.S.C.A. § 1712(b)(1)(A)-(H); 38 C.F.R. § 17.161. The classes of eligibility for dental treatment are set forth in 38 C.F.R. § 17.161. See 38 U.S.C.A. § 1712. Only three of those Classes are potentially applicable in this case, which are analyzed below. According to Class I, those having a service-connected compensable dental disability or condition may be authorized dental treatment as necessary to maintain oral health and masticatory function. However, loss of teeth can only be compensably service connected if such loss is "due to loss of substance of body of maxilla or mandible without loss of continuity." See 38 C.F.R. § 4.150, Diagnostic Code (DC) 9913 (1999); Woodson, 8 Vet. App. at 354. In the present case, the veteran has not presented a well-grounded claim for Class I eligibility because he may not establish compensable service connection for missing teeth, and he has neither claimed nor submitted evidence that he had teeth removed in service due to jaw damage. According to Class II criteria, a veteran who has a service- connected, noncompensable dental condition or disability may, under certain specified conditions, utilize outpatient dental services and treatment. However, restrictions include one- time treatment and timely application after service, usually within 90 to 180 days. Those circumstances are not shown in this case. Finally, under Class II(a) criteria, dental treatment is provided for a service-connected noncompensable dental condition that resulted from combat wounds or other service trauma. The veteran is not eligible under this category since he does not contend, nor does the evidence reflect, that he had teeth extracted in service due to service trauma. See VAOPGCPREC 5-97, 62 Fed. Reg. 15,566 (1997) ("service trauma" does not include the intended effects of treatment provided during the veteran's military service). In short, the veteran does not meet any of the criteria for outpatient dental treatment, and as such, the veteran's claim must fail as not well-grounded. See Woodson, supra. In addition, to the extent that the veteran is claiming that he has loss of teeth secondary to Agent Orange, none of the medical evidence in the record shows that the veteran has upper tooth loss that is related to his service, to include exposure to Agent Orange, it is axiomatic that entitlement to service connection cannot be established under Combee, supra. Accordingly, the veteran's claim for loss of upper teeth secondary to exposure to Agent Orange, or some other herbicide, during service must be denied as not well grounded Finally, although the Board has considered C.H.'s statement, and although the veteran's statements represent evidence of continuity of symptomatology, such lay statements are not competent evidence showing that the veteran currently has chronic headaches, or that he has a lung disability, a nervous disability, or loss of upper teeth that is related to his service, to include as secondary to exposure to Agent Orange. Under such circumstances, the claims are not well grounded. See Savage v. Gober, 10 Vet. App. 488 (1997). Furthermore, lay persons untrained in the field of medicine are not competent to offer an opinion as to medical diagnosis or causation. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Hence, these arguments do not provide a factual predicate upon which service connection may be granted. Since the record does not contain competent medical evidence that establishes that the veteran currently has chronic headaches, or that he has a lung disability, a nervous disability, or loss of upper teeth that are related to his service, to include as a result of exposure to Agent Orange, the Board finds that the veteran has not met his "burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claims are well grounded." 38 U.S.C.A. § 5107(a). Accordingly, entitlement to service connection for a lung disability, a nervous disability, loss of upper teeth and headaches is denied. Although the Board considered and denied this appeal on a ground different from that of the RO, the appellant has not been prejudiced by the decision. This is because in assuming that the claims were well grounded, the RO accorded the claimant greater consideration than his claims in fact warranted under the circumstances. See Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993). To remand these claims to the RO for consideration of the issue of whether the appellant's claims are well grounded would be pointless and, in light of the law cited above, would not result in determinations favorable to him. VAOPGCPREC 16-92; 57 Fed.Reg. 49,747 (1992). Further, the Court has held that "when an RO does not specifically address the question whether a claim is well grounded but rather, as here, proceeds to adjudication on the merits, there is no prejudice to the veteran solely from the omission of the well-grounded analysis." Meyer v. Brown, 9 Vet. App. 425, 432 (1996). The Board views its discussion above, together with the statement of the case and other information provided by the RO, sufficient to inform the veteran of the elements necessary to complete his application, pursuant to 38 U.S.C.A. § 5103(a). See Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995). ORDER Service connection for PTSD is denied. Service connection for a lung disability, a nervous disability, loss of upper teeth and headaches is denied. REMAND The veteran argues that he has a skin disability secondary to exposure to Agent Orange. As a preliminary matter, the Board notes that a May 1996 VA outpatient treatment report shows that the assessment was possible chloracne secondary to Agent Orange. Accordingly, the Board finds that the veteran's claim of entitlement to service connection for a skin condition is plausible and capable of substantiation and is thus well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1999). See Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The veteran's service medical records include his personnel record (DA Form 20), which indicates that he served in Vietnam from June 4, 1967 to June 5, 1968, and that while in Vietnam he served as a cook with the 554th Maintenance Company (the DA Form 20 gives somewhat different dates for the veteran's Vietnam service, specifically, it indicates that he served in Vietnam from June 9, 1967 to May 28, 1968). The veteran's service medical records include a separation examination report, dated in September 1968, which shows that the veteran's skin was clinically evaluated as normal. In the accompanying report of medical history, the veteran denied having skin diseases. The remainder of the veteran's service medical records are negative for any complaints, treatment or diagnosis of a skin condition. Post-service medical records include a VA examination report, dated in July 1991, which contains diagnoses that include chronic skin condition, and which notes "consult dermatology VA St. Louis for definitive diagnosis" (it does not appear that such a consultation was ever performed). In addition, a May 1996 VA outpatient treatment report contains an assessment of possible chloracne secondary to Agent Orange. The Board is of the opinion that given the aforementioned diagnosis in the July 1991 VA examination report, which indicates that the veteran has a chronic skin condition, and the May 1996 VA outpatient treatment report, which indicates that there is a link between the veteran's exposure to Agent Orange and a skin condition, an examination is required in which the doctor reviews all records and addresses the question of whether the veteran currently has chloracne, and whether the veteran currently has any other chronic skin condition that is etiologically related to exposure to Agent Orange, or some other herbicide, during service. See 38 C.F.R. § 4.2 (1999); Green v. Derwinski, 1 Vet. App. 121 (1991). In addition, the Board notes that in the event that the veteran is found to have a chronic skin disease other than those discussed in 38 C.F.R. §§ 3.307, 3.309(e), the RO may find it necessary to verify of the veteran's claims of exposure to herbicides. See McCartt v. West, 12 Vet. App. 164 (1999). Therefore, this case is REMANDED for the following action: 1. The veteran should be afforded a comprehensive VA dermatological examination to determine the nature, extent, and etiology of any current skin condition, including chloracne (or any other acneform disease consistent with chloracne). If a chronic skin condition is found other than chloracne (or any other acneform disease consistent with chloracne), an opinion should be obtained as to whether it is at least as likely as not that such skin condition is related to the veteran's military service, including, but not limited to, exposure to the herbicide dioxin. All indicated studies should be conducted, and the examination report should include a detailed account of all pathology found to be present. The claims folder and a copy of this REMAND must be provided to and reviewed by the examiner in conjunction with any examination. All clinical findings and opinions, and the bases therefor, should be set forth. 2. If the physician determines that the veteran has a skin condition other than chloracne (or any other acneform disease consistent with chloracne) which is related to exposure to herbicides, the RO should contact the U.S. Armed Service Center for Research of Unit Records (USASCRUR), 7798 Cissna Road, Springfield, Virginia 22150-3197, and request that they attempt to verify that the veteran was exposed to Agent Orange, or some other herbicide, during service. The RO's request should be accompanied by copies of his discharge (DD Form 214) and personnel record (DA 20) and a summary of the veteran's relevant contentions as to his exposure. When the requested development has been completed, the case should again be reviewed by the RO on the basis of the additional evidence. If the benefits sought are not granted, the veteran and his representative should be furnished a supplemental statement of the case, and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. The purpose of this REMAND is to obtain additional development, and the Board does not intimate any opinion as to the merits of the case, either favorable or unfavorable, at this time. The veteran is free to submit any additional evidence he desires to have considered in connection with his current appeal. No action is required of the veteran until he is notified. BRUCE KANNEE Veterans Law Judge Board of Veterans' Appeals - 22 - - 1 -