Godfrey v. Brown

Godfrey v. Brown, 7 Vet. App. 398, decided 1995-03-06.

STEINBERG, Judge: The appellant, Vietnam-era veteran Willis W. Godfrey, appeals from a January 9, 1992, decision of the Board of Veterans’ Appeals (BVA or Board) denying reopening of claims for, inter alia, a back disorder and arthritis, and referring the claim of service connection for residuals of right-ankle fracture to the agency of original jurisdiction (AOJ) for further consideration. The appellant has filed a brief requesting that the Court vacate the Board’s decision denying his claims for back condition and arthritis, reverse the Board’s finding that the evidence submitted to support his claim was not new and material, and reverse the Board’s decision that the issue of the residuals of the right-ankle fracture was not properly before the Board for review. The appellant also requests that the Court remand the case to the Board to consider the issue of residuals of right-ankle and wrist and hand injuries. The Secretary has filed a brief urging summary affirmance as to the back-disorder and arthritis claims and remand as to the hand and wrist claims. He also argues that the referral to the AOJ on the right-ankle claim was proper. For the reasons that follow, the Court will affirm in part and vacate in part the BVA decision and remand two matters to the Board.

I. Background

The veteran served on active duty in the U.S. Air Force from November 1953 to October 1957 and from December 1957 to January 1974. Record (R.) at 11-12, 272. His November 1953 entrance medical examination reported no abnormalities. R. at 13-14. An October 1954 Service Medical Record (SMR) noted that he had noticed “a steady, dull localized [backache] in the lumbo-sacral region since last June ... accompanied by a burning sensation on urination.” R. at 27, 32, 53, 59. The clinical record reported that the “pains had radiated to both hips and become worse when he bends back his body”. R. at 32. Physical examination revealed “slight pain, tender and spasm”. R. at 33. The examination and notations were made in connection with a U.S. Army hospital admission and later diagnosis of urethritis. R. at 27. A November 1954 SMR stated that the veteran “ha[d] lumbo-sacral pain on exertion” and that he had “hurt his back while driving about 4 months ago”. R. at 70. A September 1955 SMR reported that he had claimed to have “[fallen] or slipped down metal stairs” and that an accident report had been submitted. R. at 87. That record did not contain any reference to the veteran’s back. A November 1955 SMR indicated that he had complained of a backache. Ibid.

A June 1956 SMR report stated the following: “Past mo[nth] mild discomfort over L2 [and] 3 on left side. Since 1954 driving [accident], snapped back [and] has hurt off [and] on. Constant soreness, mostly on extending back or bending over. More pain in the morning right after getting out of bed.” R. at 99. The report stated that an x-ray had shown “a [s]pina [b]ifida L5”. Ibid. (Spi-*401na bifida is “a congenital cleft of the vertebral column with hernial protrusion of the meninges”; meninges are more than one of the three membranes that envelop the brain and spinal cord, Webster’s Medical Desk Dictionary 667, 422 (1986) [hereinafter Webster’s].) However, an x-ray report of the same date stated “essentially normal”. R. at 102. The impression was “myositis”. R. at 99. (Myositis is muscular discomfort or pain from infection or an unknown cause, Webster’s at 461.) The recommendation was “Xylocaine [i]nj[eetion] locally” and “Tol-snol”. R. at 99.

A September 1957 examination for discharge from his first period of service included a history in which the veteran reported that he had never had arthritis but that he did have “bone, joint, or other deformity”. R. at 105. The examining physician’s summary stated that other than mumps in childhood and an injury to his right leg, the veteran had “[d]enie[d] all other pertinent medical or surgical history.” R. at 106, 108. The discharge clinical evaluation showed no abnormalities. R. at 107.

A December 1957 examination for reenlistment reported no abnormalities. R. at 111— 12. A March 1961 SMR stated: “Back — no CVA [costovertebral angle, SHEILA B. SLOANE, MEDICAL ABBREVIATIONS AND EPONYMS 46 (1985)] tenderness.” R. at 128. A July 1962 examination reported no abnormalities in the clinical evaluation (R. at 145, 150), and stated that other than mumps in childhood, the veteran “[d]enie[d] all else” (R. at 153). At that time, his history stated no arthritis and no “bone, joint, or other deformity”. R. at 151.

A February 1963 SMR reported no abnormalities on examination. R. at 171. An August 1963 SMR stated that the veteran had reported having been in a car accident. R. at 120. There is no reference to any back pain but an x-ray of his left ankle was taken which was “negative”. Ibid. Another August 1963 SMR stated that the veteran had “sustained ‘fall off scooter’ ”, R. at 166, 170. Pain and swelling of his right ankle was reported and diagnosed as a strain; an ace bandage was applied. R. at 166, 170. A December 1964 SMR reported, on examination, a history of no arthritis and no “bone, joint, or other deformity”. R. at 109. A December 1966 SMR noted that he had experienced right shoulder and “some back pain”, with full range of motion and no tenderness. R. at 202. A January 1967 SMR stated that the veteran had fallen about a month before and experienced pain in the right ankle, scapular shoulder, and upper arm. R. at 203. An x-ray of his cervical spine was negative. The impression was “post[-]traumatic muscu-loskeletal pain”. Ibid. There was no reference to back pain.

A September 1967 SMR noted that the “Middle part of [the veteran’s] back aches”. R. at 211. A February 1968 SMR stated that he had complaints of “head and back pain lasting for short periods of time to 12 or 14 [hours]”, that the “back pain [was] continuous with or without head pain”, and that he had injured his back in December 1966 from a fall. R. at 211-12. The backache was described as being a “dull ache between shoulder blade[s]”. R. at 212. An examination of the back revealed “[n]o palpable tenderness” and full range of motion. The impression was myositis. Ibid.

A February 1970 SMR reported that the veteran had complained of “pains in back [and] chest due to being ‘beat-up’ by Tacoma police”. R. at 217. The impression was “multiple blunt traumatic injuries”. Ibid. A June 1970 SMR stated that he had complained of “[b]ack pain since swimming — 1 w[ee]k ago.” R. at 218. July 1972 and April 1973 SMRs showed that the veteran had pain and was treated for his right ankle, and that x-rays had revealed that the ankle had been fractured in July 1972. R. at 187, 188, 194, 222, 226, 229. A February 1972 SMR noted that he “twisted ankle while playing ball”. R. at 222, 226. The impression was “contusion” (R. at 222) and “sprained r[ight] ankle” (R. at 226). In April 1973, ankle pain was noted. R. at 229.

The veteran’s SMRs also included reports of right-hand pain and a fracture. R. at 87, 115, 116, 193, 200, 206, 213, 215. First were entries for right-hand pain in July and September 1955. R. at 87. A September 1958 SMR stated that the veteran had injured his right hand when he “slammed car door” on *402it, and that he had received a laceration. R. at 114-15. An x-ray revealed no evidence of fracture. R. at 116. A May 1966 SMR reported that the veteran had pain in his wrist for five months. R. at 200. An April 1967 SMR noted that a hand x-ray showed a “possible] fracture”. R. at 206. An April 1968 SMR reported that the veteran had injured his right hand “when he fell while drinking”, and noted that an x-ray showed a fracture. R. at 213, 215. A February 1972 x-ray report of the right hand “show[ed] a deformity ... indicative of a healed old fracture”. No new fractures were noted. R. at 193.

An Air Force retirement examination SMR from August 1973 reported no abnormalities (including as to his “spine [and] other muscu-loskeletal” parts) as part of a clinical evaluation. R. at 236. An examining physician’s notes referred to a fractured right foot and stated that the veteran had “denie[d] family history of diabetes or psychosis ... and all other significant medical or surgical history”. R. at 237, 239. At that time, the veteran reported that he felt that he was “in excellent health,” and indicated that he never had, and did not then have, arthritis, “bone, joint or other deformity”, or “recurrent back pain”. R. at 238.

A December 1978 medical record from a private physician, David Shaw, M.D., an orthopedic surgeon, in Salem, Oregon, reported that the veteran had been “having back problems in 1966 when he fell as he came down a maintenance stand, sliding backward down the steps” and that he “did not seek immediate medical attention”. R. at 287. The report noted that he was a car mechanic and that he found “that in certain positions, he ha[d] pain in his back and neck ... with occasional headaches”. Ibid. The report stated that he “obviously” had a “left dorso-lumbar scoliosis” which is “mild”, that he had “a full range of spinal movements” and that he had tenderness in the dorsolumbar region of his spine. R. at 287-88.

A December 1981 medical record from a private physician, Michael Weinstein, M.D., at Kaiser Permanente in Salem, Oregon (Kaiser), stated that the veteran was seen for back pain. The impression was “[m]uscle strain of the back”. R. at 319. A July 1982 Kaiser medical record noted that the veteran had injured his right shoulder playing football. R. at 320. A December 1982 Kaiser record stated that he was seen for severe back pain after “apparently [being] involved in an arrest by the police last night, [and having] severely wrenched his back”. R. at 321. The impression was “acute musculo-skeletal strain”. Ibid. A February 1983 Kaiser examination report noted that “palpation of the lower back revealfed] ... spasm on the right side of the spine” and tenderness. R. at 322.

A September 1984 letter from a private neurological surgeon stated that the veteran had been examined because of complaints of migraine headaches. R. at 332. Past history revealed that the veteran “suffers from a back injury”. Examination of the lumbar spine showed that “[m]otions [were] normal”. R. at 333. The letter noted that he “ha[d] a normal examination today”. Ibid. A January 1986 Kaiser record stated that the veteran was seen for back pain; it stated the following: “The [veteran] has had a long term back injury of the posterior thoracic area. It has been bothering him again recently. He thinks that this is in part related to difficulty with walking on the right foot and therefore he walks with an odd gait.” R. at 326. The veteran was found to have “definite muscle spasms” and tenderness.

A January 1987 Kaiser record entry reported that the veteran complained of pain in both feet and of occasional swelling. Ibid. It was “suspeet[ed]” to be an “orthopedic problem”. Ibid.

In January 1987, the veteran filed a claim with a Veterans’ Administration (now Department of Veterans Affairs) (VA) regional office (RO) seeking service connection for, inter alia, “back condition”, “arthritis”, “and any and all disabilities of record”. R. at 274-77. On the VA form, he stated that he had received treatment for his back in February 1967, and for his arthritis in 1966. R. at 275. A June 1987 medical record from a private physician who had seen the veteran for his complaints of headaches, noted that he had experienced “some problems with his back *403since a fall in 1966 when he was in Vietnam”. R. at 254.

A November 1987 entry in Dr. Shaw’s records noted that three or four weeks before, the veteran, after driving his van, had noticed “a sudden onset of neck and back pain” which had gradually worsened. R. at 289. An examination reportedly showed that “the thoracic spine has a mild lower thoracic and thoracolumbar kyphosis” with “moderate limitation of movement in the lumbar spine” and that his “spine is tender from the mid thoracic to the mid lumbar spinous processes”. Ibid. (Kyphosis is “abnormal backward curvature of the spine”, Webster’s at 369.) The report further stated that x-rays of his dorsal and lumbar spine from 1984 showed “extensive proliferative osteoarthropathy consistent with Forestier’s disease”. R. at 289. (Forestier’s disease is “hyperostosis of the anterolateral vertebral column, especially in the thoracic region”; hyperostosis is the enlargement or overgrowth of bone, Dor-land’s Illustrated Medical Dictionary 485, 796, 800 (1988).) Also noted was “some squaring of the vertebrae to suggest possible ankylosing spondylitis too”. (Osteoarthropa-thy is a disease of joints or bones; ankylos-ing spondylitis is rheumatoid arthritis of the spine, Webster’s at 501, 36.) The diagnosis was “[ojsteoarthritis of the thoracic spine with costovertebral arthritis”. R. at 290.

A subsequent November 1987 entry in Dr. Shaw’s records stated that the back symptoms had increased with physical therapy. Ibid. A December 1987 entry reported that a “bone scan was essentially negative but he does have some arthritis in the right mid clavicular joint”. Ibid. Back pain and tenderness were noted. A December 1987 x-ray report revealed the following: “Normal limited bone scan appearances, apart from right sternoclavicular joint arthritis. There is no ankylosing spondylitic nor other inflammatory nor neoplastic thoracic spine causes for the pain.” R. at 334. A February 1988 entry noted that an MRI did not show “any lesion to explain the severe thoracic pain he is having”. Ibid.

In March 1988, the VARO denied service connection for (1) back condition, (2) headaches, (3) hearing loss, (4) ringing in ears, (5) arthritis, (6) hypertension, and (7) “status post CVA [cerebrovascular accident]”. R. at 295-96. The RO noted that there “were no specific findings and no specific diagnosis of a chronic back disability”; that there were “no complaint[s] of back problems* in the last four years of service”; that the “discharge exam shows the spine and musculoskeletal system normal”; and that there was “no evidence of treatment for back problems until 1978, more than four years after service and the veteran had been working as a mechanic”. R. at 295. The RO also determined that “there is no evidence of ... arthritis within a year of discharge”. Ibid.

In September 1988, the veteran filed a Notice of Disagreement (NOD) as to, inter alia, his back strain and arthritis. R. at 297. That same month, a Statement of the Case (SOC) was sent to him by the RO. R. at 298-301. In October 1989, he filed a statement that he “wished to reopen [his] service-connectfion] claims for ... [, inter aha,] back conditions ... [and] arthritis”. R. at 343-44.

In June 1989, the Social Security Administration (SSA) awarded the veteran disability insurance benefits. In its decision, the SSA stated that he “has been under a disability within the meaning of the Social Security Act continuously from his June 5, 1987, stroke through the date of this decision-” R. at 311, 313. In November 1987, the veteran had applied for disability insurance benefits from the SSA, and asserted an inability to work since June 1987 “due-to complications ' of a stroke and a heart condition”. R. at 307, 313.

In January 1990, the RO denied reopening of those claims, concluding that “[t]he evidence is new and material but does not establish a new factual basis for a grant of S[erviee] Connection]”. R. at 345. In April 1990, the veteran submitted additional records, including records from the Naval Hospital in Lemoore, California. A June 1974 entry in those records reported the following: “C[omplained] o[f] mid[-]baek pain, bilateral shoulder pain, ... numbness down right arm, [illegible] fingers, with heavy use [illegible] farm equipment operator, and truck driver.... Has had problem for 9 years, states he injured back in Vietnam.” R. at 348. An *404examination report revealed “tender para-spinally” T10-L1, some limitation of extension, mild scoliosis to left, full range of motion in shoulders. R. at 349, 380. He also submitted a May 1976 x-ray report from that Naval Hospital which showed “some joint space narrowing with mild hypertrophic changes” and contained an impression of “[degenerative changes involving the right foot” (R. at 358); a November 1977 VA x-ray report revealing the following impression as to his spine: “Demineralization, degenerative joint disease and slight to moderate rotosco-liosis of the lower dorsal and lumbar spine” (R. at 359); and reports, described above, which were already in the record.

In November 1990, the RO confirmed the prior January 1990 RO decision. R. at 378. This document is essentially illegible in other respects. A January 1991 VA letter informed the veteran that his claims had been denied because “the evidence is new and material but does not provide a new factual basis for service connection for back condition, [and] arthritis”. R. at 380. In February 1991, the veteran filed an NOD. R. at 382. Later that month he was sent an SOC. R. at 384-89.

In May 1991, he filed a VA Form 1-9, Appeal to the BVA (1-9 Appeal), as to, inter alia, his claims of service connection for his back condition and arthritis. R. at 390. He also asserted the following with respect to his wrists:

In 1966 I went to the hospital at Travis AFB because of severe pain in my wrist, elbows and shoulders. I started having the pains first in my wrist. They would ache and burn terribly. This went on for a few months; then it would transfer to an elbow or shoulder; maybe all of them.

R. at 391. He further stated the following with respect to his ankle: “The ankle is still giving me problems today. It stiffens up, locks up, swells, and prevents me from too much walking.” R. at 392. He also explained: “In 1970 I was assigned to the aircraft maintenance school as an aircraft maintenance instructor. The duty was classroom instruction. Therefore, I did very little physical activities on the job.” Ibid.

In the January 9, 1992, BVA decision here on appeal, the Board found that, as to the claim of entitlement to service connection for the veteran’s right ankle, the matter was not properly before it for appellate review, and “referred [that matter] to the attention of the [RO] for further consideration”. R. at 4. As to the back and arthritis service-connection claims, the Board found that no new and. material evidence to reopen those claims had been presented or secured since the time of the March 1988 final RO decision and did not reopen the claims. R. at 5-6, 8.

II. Analysis

Service connection for purposes of VA disability compensation will be awarded for any disease or injury that was incurred during or aggravated by the veteran’s active service or, inter alia, for a chronic disease that was initially manifested to a degree of 10% or more within an applicable presumption period. See 38 U.S.C. §§ 1110, 1112(a); 38 C.F.R. §§ 3.303(a), (b), 3.307(a) (1994). Evidence of continuity of symptomatology from the time of service until the present is required where the chronieity of a condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b). Section 3.303(b) expressly provides:

With chronic disease shown as such in service (or within the presumption] period under § 3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intereurrent causes.... For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established ..., there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumption] period) is not, in fact, shown to be chronic or where the diagnosis of chronieity may *405be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim.

Pursuant to 38 U.S.C. § 5108, the Secretary must reopen a previously and finally disallowed claim when “new and material evidence” is presented or secured with respect to that claim. See 38 U.S.C. §§ 7104(b), 7105(c); Suttmann v. Brown, 5 Vet.App. 127, 135 (1993). On claims to reopen previously and finally disallowed claims, the BVA must conduct a “two-step” analysis. Manio v. Derwinski, 1 Vet.App. 140, 145 (1991). The Board must first determine whether the evidence presented or secured since the prior final disallowance of the claim is- “new and material” when viewed in the context of all the evidence. See Colvin v. Derwinski, 1 Vet.App. 171, 174 (1991). If it is, the Board must then review the new evidence “in the context of’ the old to determine whether the prior disposition of the claim should be altered. See Jones (McArthur) v. Derwinski, 1 Vet.App. 210, 215 (1991).

A Board determination as to whether evidence is “new and material” is a question of law subject to de novo review in this Court under 38 U.S.C. § 7261(a)(1). See Masors v. Derwinski, 2 Vet.App. 181, 185 (1992); Jones, 1 Vet.App. at 213; Colvin, supra.

The Court has synthesized the applicable law as follows:

“New” evidence is that which is not merely cumulative of other evidence of record. “Material” evidence is that which is relevant to and probative of the issue at hand and which, as this Court stated in Colvin, supra, ... must be of sufficient weight or significance (assuming its credibility) that there is a reasonable possibility that the new evidence, when viewed in the context of all the evidence, both new and old, would change the outcome.

Cox (Billy) v. Brown, 5 Vet.App. 95, 98 (1993); see also Justus v. Principi, 3 Vet.App. 510, 513 (1992) (in determining whether evidence is new and material, “the credibility of the evidence is to be presumed”). Lay assertions of medical causation cannot suffice to reopen a claim under 38 U.S.C. § 5108. See Moray v. Brown, 5 Vet.App. 211, 214 (1993). Where the determinative issue involves either medical etiology or a medical diagnosis, competent medical evidence is required to fulfill the well-grounded-claim requirement of section 5107(a); where the determinative issue does not require medical expertise, lay testimony may suffice by itself. See Lathan v. Brown, 7 Vet.App. 359, 365 (1995) (citing Grottveit v. Brown, 5 Vet.App. 91, 93 (1993)); Magana v. Brown, 7 Vet.App. 224, 227 (1994); see also Moray, supra (applying this rule of law to claims to reopen).

A. Service Connection for Back Condition and Arthritis

The Court holds that new and material evidence has not been presented or secured so as to justify reopening the veteran’s claims, previously and finally denied by the RO in March 1988, for service connection for a back disorder and arthritis. Pertinent evidence received since March 1988 consists of the following: (1) VA medical records from the Naval Hospital in Lemoore, California, including a June 1974 entry reporting that the veteran had complained of mid-back pain, bilateral shoulder pain, and numbness down right arm, and noting that he was a farm-equipment operator and truck driver and that he “[h]as had [a] problem for 9 years[;] states he injured back in Vietnam”; and an examination revealing “tender paraspinally” T10-L1, some limitation of extension, mild scoliosis to left, full range of motion in shoulders (R. at 348^49, 380); (2) a November 1977 x-ray report from the Naval Hospital which revealed the following impression as to the spine: “Demineralization, degenerative joint disease and slight to moderate rotosco-liosis of the lower dorsal and lumbar spine” (R. at 359); (3) December 1978, November 1987, December 1987, and February 1988 private medical records from Dr. Shaw (R. at 354, 365-67, 369); (4) the veteran’s 1-9 Appeal statement that in 1970 he had been “assigned to the aircraft maintenance school as an aircraft maintenance instructor”, an assignment which consisted of classroom in*406struction, and that he, therefore, “did very-little physical activities on the job” (R. at 392); and (5) the June 1989 SSA decision awarding the veteran disability insurance benefits.

The appellant argues that the “new evidence is material and not cumulative because the evidence shows symptomatology to establish service connection for [his] back problem and arthritis and would have affected the outcome.” Br. at 16. However, the veteran’s back condition is not a chronic disease subject to presumptive service connection. See 38 U.S.C. §§ 1101(3), 1112; 38 C.F.R. §§ 3.307, 3.308(a), 3.309(a) (1994). To establish service connection for this kind of condition, a showing of continuity of symptomatology after discharge is required, see 38 C.F.R. § 3.303(b); Sanchez v. Derwinski, 2 Vet.App. 330, 333 (1992); Ivey v. Derwinski, 2 Vet.App. 320, 323 (1992); Wilson v. Derwinski, 2 Vet.App. 16, 19 (1991), unless there is medical evidence that the inservice condition, although not diagnosed as such in service, was “chronic”, see 38 C.F.R. § 3.303(b), or there is evidence that connects the current condition to the inservice condition, see 38 C.F.R. § 3.303(d) (1994).

The Court holds that the records in item (3) above are not new because they are duplicate copies of records that were previously before the RO in 1988. See Smith (Albert) v. Derwinski, 3 Vet.App. 205, 207 (1992). The Court holds that items (1) and (2) are new because they show treatment of back pain within a year after discharge and were not merely cumulative of other evidence in the record. Item (4) is also new because that proffered explanation was not previously of record. Although the Board incorrectly found the above items to be not new, this error was not prejudicial to the veteran because this Court holds that they were not material. See 38 U.S.C. § 7261(b) (Court shall take due account of rule of prejudicial error); Yabut v. Brown, 6 Vet.App. 79, 83 (1993); Godwin v. Derwinski, 1 Vet.App. 419, 425 (1991). Items (1) and (2), while new, are not material evidence because they are not relevant to and probative of the issue at hand — whether there was continuity of symptomatology during and after service, up to the time when the claim was filed. Although item (4) is new, it also is not material evidence because it does not show continuity of symptomatology. See Cornele v. Brown, 6 Vet.App. 59, 62 (1993) (finding no continuity of symptomatology where the evidence, consisting of physician’s report, although new, was not material because it was not probative of the issue whether veteran’s head and neck injuries were related to accident which occurred during service, and no other report showed head or neck injuries during thirty-year period after accident); Colvin, supra.

As to item (5) above, the appellant argues that the Board failed to consider the findings of the SSA. In its decision, the SSA concluded that the veteran “has been under a disability within the meaning of the Social Security Act continuously from his June 5, 1987[,] stroke through the date of this decision_” R. at 311. The SSA found that the “medical evidence establishes that the claimant has severe degenerative joint disease and status post cerebrovascular with dizziness, fatigue, memory loss, and difficulty concentrating_” R. at 312. The Court holds that the June 1989 SSA decision, although new, is not material because it is based primarily upon disabilities other than the veteran’s back condition and arthritis and because the findings of the SSA do not support a showing of continuity of symptomatol-ogy. The Court finds that the SSA’s notation that the “medical evidence shows that the claimant has a twenty-year history of back problems with x-rays showing scoliosis and degenerative joint disease” (R. at 310) fails to identify what evidence shows such “a twenty-year history”. The notation is followed by a discussion of the evidence SSA relied upon in reaching its decision to award benefits. It referred to (1) the records of Dr. Shaw who treated the veteran since 1978; (2) the records of Dr. Richard Schwartz who treated the veteran after his stroke in 1987, and showed that the veteran had experienced left-sided weakness, lethargy, headaches, dizziness, fatigue, depression, and difficulty in maintaining balance; (3) the records of Dr. Alan Brooks who evaluated the veteran in August 1988, and opined that the veteran’s history was compatible with a history of a *407brain-stem ischemic event and that the symptoms were not uncommon after a stroke; (4) the records of Dr. Ronald Glaus whose evaluation in September 1988 showed impairment of brain functions and included a diagnosis of multi-infarct dementia with depression; and (5) the records of Dr. Walter Whitman who had continuously treated the veteran since 1985. The latter records included an October 1987 summary that the veteran “was in relatively good health until his 1987 stroke” and a final January 1989 report stating that the veteran would continue to be unable to work because of his dizziness, balance disturbance, memory loss, and inability to concentrate.

As noted in part I, above, the Court has held that when the question before the Board is one of medical etiology or causation, medical evidence is required to make a claim well grounded. See Lathan, Magana, Grottveit, all supra. Here, the question of continuity of symptomatology is not a matter of medical etiology or causation, but rather whether the veteran manifested symptoms during and after service, up to the time when his claim was filed in January 1987. Under Justus and Cox, both supra, the credibility of the evidence is to be presumed for purposes of the decision whether or not to reopen. However, where the SSA states that its finding (of a “twenty-year history of back problems”) is based on “medical evidence” and the medical evidence shows no such history, the SSA statement cannot be presumed to be credible when on its face it conflicts with the lack of substantiation for it in the very medical evidence on which it is expressly premised. Cf. Duran v. Brown, 7 Vet.App. 216, 220 (1994) (Justus credibility rule does not apply to newly submitted evidence which is inherently false or untrue; “Justis does not require the Secretary to consider the patently incredible to be credible”); Kightly v. Brown, 6 Vet.App. 200, 205-06 (1994) (finding that presumption of credibility of evidence did not arise as to medical opinion that veteran’s disability was incurred in service because it was based on an inaccurate history, one which failed to acknowledge an injury well-documented in record, and hence holding such evidence not “material”); Reonal v. Brown, 5 Vet.App. 458, 460-61 (1993) (finding that presumption of credibility did not arise because physician’s opinion was based upon “an inaccurate factual premise” and thus had “no probative value” since it relied upon veteran’s “account of his medical history and service background, recitations which had already been rejected ” by RO, and hence holding opinion not to be “material” evidence); Robinette v. Brown, — Vet.App. -, -, No. 93-985, slip op. at 12, 1994 WL 495078 (Sept. 12, 1994), mot. for recons, granted on other grounds (Oct. 21, 1994) (holding that “the connection between the layman’s account, filtered as it was through a layman’s sensibilities, of what a doctor purportedly said is simply too attenuated and inherently unreliable to constitute ‘medical’ evidence”). Accordingly, the Court holds that the medical records which supported the SSA’s determination that the veteran was under a disability under the Social Security Act continuously since his June 1987 stroke do not support a finding of continuity of symptomatology for a back condition over “a twenty-year history”, and that the SSA statement thus does not constitute “material” evidence because there is no reasonable possibility that, “when viewed in the context of all the evidence, both new and old, [it] would change the outcome”. Cox, 5 Vet.App. at 98.

As to the medical evidence (which the Board did not discuss) underlying the SSA’s determination, the Court holds that it either constituted duplicate copies of records previously before the RO in 1988 (the November 1987 records of Dr. Shaw) and thus was not new or, although new, did not show continuity of symptomatology for the veteran’s back condition (the December 1988 physical capabilities assessment form of Dr. Shaw) or was irrelevant because the evidence related to treatment and examination of the veteran with respect to his stroke (the June 1987, January 1988, and March 1988 records of Dr. Richard Schwartz; the August 1988 record of Dr. Alan Brooks; the September 1988 record of Dr. Ronald Glaus; and the October 1987, July 1988, and January 1989 records of Dr. Walter Whitman). R. at 310-11, 319-42. Accordingly, any error made by the Board in failing to consider the SSA June 1989 determination and underlying evidence *408was not prejudicial to the veteran. See 38 U.S.C. § 7261(b); Yabut and Godwin, both supra.

In its decision, the Board found that the “additional evidence shows nothing more than that he was treated for back ... complaints several months after service discharge”, and that “such symptoms were attributable to the strenuous employment he held at the time”. R. at 8. The Board is required to provide a written statement of the reasons or bases for its findings and conclusions on all material issues of fact and law presented on the record. See 38 U.S.C. § 7104(d)(1). The Board must support its medical conclusions on the basis of independent medical evidence in the record or through adequate quotation from recognized treatises; it may not rely on its own unsubstantiated medical judgment. See Thurber v. Brown, 5 Vet.App. 119, 122 (1993); Hatlestad v. Derwinski, 3 Vet.App. 213, 217 (1992); Colvin, 1 Vet.App. at 175. The Court holds that any error made by the Board in providing its own medical conclusion that the veteran’s “symptoms were attributable to the strenuous employment he held at the time”, was not prejudicial to the veteran in light of the Court’s holding, upon de novo review of all the evidence, that the veteran had not submitted new and material evidence to warrant the reopening of his claim. See 38 U.S.C. § 7261(b); Yabut and Godwin, both supra. Furthermore, any error made by the Board in failing to take into account that “the credibility of the evidence is to be presumed” for purposes of reopening, see Justus, supra, was also not prejudicial to the veteran in light of the Court’s holding on its de novo review.

As to arthritis, the November 1977 report (item (2)) is not material because it does not address the question whether the veteran’s current arthritis had its inception during service. It does not link the current arthritis to the inservice symptoms and fall. Therefore, it is not sufficient to reopen his arthritis claim.

B. Service Connection for Right-Ankle Claim

The Board determined that “the issue of service connection for residuals of right-ankle fracture has been raised by the veteran”, and that the matter was not properly before it for appellate review. R. at 4. The Board stated that the matter “is referred to the attention of the [AOJ] for further consideration.” Ibid. The appellant contends that, because he raised the issue in his 1-9 Appeal and the SMRs reasonably show service connection, the Board erred in “referring” the issue to the RO. He contends that the Board should have “remanded” the claim, giving specific and formal direction to the RO. Brief (Br.) at 21-22; Reply Br. at 4-5. He also argues that the Board was required to remand the matter pursuant to 38 C.F.R. § 19.182 (1991) and to direct that it be given expedited treatment by the RO. Reply Br. at 5 (“convey to the AOJ [a] sense of ... urgency in ‘considering’ the claim” so as to avoid “unwarranted and unnecessary delay in the adjudication of the claim”). (The appellant states that § 19.182 is currently “new [sjection 19.38”. Although § -19.182(c), with revisions not relevant here, does now form part of 38 C.F.R. § 19.38 (1994), § 19.182(b) now forms part of 38 C.F.R. § 19.31 (1994), and § 19.182(a) was superseded by 57 Fed.Reg. 4105 (1992) and is currently codified at 38 C.F.R. § 19.9 (1994).)

When the Board referred this issue to the RO in January 1992, § 19.182 was in effect. Section 19.182(a) provides:

When, during the course of review, it is determined that further evidence or clarification of the evidence or correction of a procedural defect is essential for a proper appellate decision, the section of the Board shall remand the case to the agency of original jurisdiction, specifying the further development to be undertaken.

38 C.F.R. § 19.182(a) (emphasis added). This regulatory provision is invoked when the record is inadequate and the BVA remands the case to the RO to obtain more complete information (e.g., medical) and to develop the record further, or for consideration of later-developed evidence. See Littke v. Derwinski, 1 Vet.App. 90, 92 (1990). This provision requires that when the BVA reviews the evidence and makes a determina*409tion as to the adequacy of the record, remand is mandatory if the BVA finds that the record before it is inadequate. Littke, 1 Vet.App. at 93; see Austin v. Brown, 6 Vet.App. 547, 558 (1994) (recognizing that 38 C.F.R. § 19.9 remands to the RO are “mandatory when the BVA determines that further development of the record is essential”).

The Court holds that the Board did not err in referring the right-ankle claim to the RO without additional specific instructions because at the time the Board referred that issue § 19.182(a) was not applicable to it since that issue was not in appellate status. See Hamilton v. Brown, 39 F.3d 1574, 1585 (Fed.Cir.1994), aff'g 4 Vet.App. 528 (1993) (construing § 19.182 to apply to the appellate-review function of the Board and concluding that the references to AOJ in § 19.182 “signify that a remanded case is returned, to the unit that made the initial determination in connection with the claim” and “do not signify that the unit, in disposing of a claim on remand, is functioning as an AOJ” (emphasis added)); cf. 38 C.F.R. § 20.714(a)(2) (1994) (requiring transcripts to be prepared from audiotapes of BVA hearings when testimony and/or argument pertains to “an issue which is not in appellate status [and] which is to be referred to the [AOJ] for consideration” or pertains to “an issue which is to be remanded to the [AOJ] for further development” (emphasis added)). A claim for service connection for a right-ankle condition had not yet been filed with, nor initially examined or adjudicated by, the RO. The first time it was raised was on appeal to the Board, in the 1-9 Appeal. The Board complied with the requirements of EF v. Derwinski, 1 Vet.App. 324, 326 (1991), when it liberally construed the 1-9 Appeal as including a claim for service connection for the veteran’s right ankle, which he had fractured in service, and recognized that the issue had been reasonably raised and needed to be adjudicated.

In Bernard v. Brown, 4 Vet.App. 384, 391 (1993), the Court held that “the Board’s jurisdiction is limited to deciding questions in ‘appeals’ of ‘a matter which under section [511(a) ] of this title is subject to decision by the Secretary and which has been the subject of a decision by an AOJ.” Id. at 391; see 38 U.S.C. §§ 501, 7104(d). In so holding, the Court noted that section 7105 of title 38, U.S.Code, establishes “very specific, sequential, procedural steps that must be carried out by a claimant and the RO or other [AOJ (such as a VA health-care facility) ] ... before a claimant may secure ‘appellate review' by the BVA”. Bernard, 4 Vet.App. at 390; 38 C.F.R. §§ 20.200, 20.202 (1994).

In Bernard, the Court concluded as follows:

[T]he question whether the Board in this case lacked jurisdiction to adjudicate the merits of the veteran’s claim for service-connected disability compensation turns upon whether that determination itself involves a “matter”, as that term is used in section 7104(a), separate from the determination of whether new and material evidence to reopen had been submitted, or, alternatively, whether those two determinations were merely “questions” in a single “matter”. If the two are separate “matters”, then the Board would lack jurisdiction to address the merits of the veteran’s benefits claim because the RO had not rendered a decision on that matter that could have been appealed to the Board. However, if they are merely different questions within a single “matter”, then the Board would have jurisdiction to adjudicate the merits of the claim because the veteran had properly appealed to the Board from an RO decision on that “matter”.

Bernard, 4 Vet.App. at 391 (second emphasis added). The Court there determined that “the question whether a claimant has submitted new and material evidence to reopen a claim and the question whether, upon such reopening, a claimant is entitled to VA benefits, are questions relating to a single ‘matter’ for purposes of the Board’s jurisdiction under 38 U.S.C.[] § 7104(a)”, ibid., and that the two questions are “components of a single claim for benefits” and “relate to a single ‘decision by the Secretary under a law that affects the provision of benefits by the Secretary', as referred to in section 511(a)”, id. at 392. The Court held that the Board had “appellate jurisdiction to review the veteran’s *410claim of entitlement to benefits under section 1110” and had authority “to decide all questions presented on the record before it that were necessary to its decision on that matter”. Id. at 392.

Unlike the two questions involved in a single “matter” in Bernard, in the case at bar the right-ankle claim was not a component of the back-condition and arthritis claims, and those claims were thus not components of a single claim for benefits under 38 U.S.C. § 1110. Rather, each was a separate “matter”. Furthermore, the right-ankle claim had not been the subject of a decision by an AOJ (that could have been appealed to the Board). The Board’s referral of the claim to the RO in the present case enables the RO, as an AOJ and not as part of the appellate process, to make the “initial review or determination” referred to in 38 U.S.C. § 7105(b)(1), as to that issue. See Hamilton, supra. The appellant has made no showing that would cause the Court to agree with his contention that the Board was in some way obligated to direct that the RO expedite its adjudication of his “referred” right-ankle claim, which had not been adjudicated by the RO and which was raised for the first time on appeal to the Board. Cf. Veterans’ Benefits Improvements Act of 1994 (VBIA), Pub.L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994) (as to “expeditious treatment” for claims “remanded” by BVA or the Court). Accordingly, the Court holds that the Board did not err in referring the matter to the RO because the Board did not have appellate jurisdiction to review the veteran’s claim of entitlement to benefits under section 1110 for the right-ankle claim and lacked jurisdiction to adjudicate the merits of that claim.

C. Service Connection for Wrist(s) and Hand

Both parties agree that the appellant’s claims of service connection for disability of his wrist or wrists and hand should be remanded to the Board. Appellant’s Br. at 21-22; Secretary’s Br. at 10-11. The Secretary concedes that “the issue of service connection for disability of wrists and hand was raised in [the veteran’s 1-9 Appeal] ... sufficiently that the Board should have inferred [the existence of] the issue and taken some kind of action on it”. Secretary’s Br. at 10.

The appellant’s May 1991 1-9 Appeal stated the following with respect to his wrist(s):

In 1966 I went to the hospital at Travis AFB because of severe' pain in my wrist, elbows and shoulders. I started having the pains first in my wrist. They would ache and burn terribly. This went on for a few months; then it would transfer to an elbow or shoulder; maybe all of them.

R. at 391. In its January 1992 decision, the BVA denied service connection for, inter alia, back condition and arthritis, but did not address, or mention, the issue of service connection for disability of his wrist(s) and hand. (The Court notes that it is difficult to determine, from the appellant’s contentions, for which hand and wrist(s) he wishes to seek service connection. In his brief, the appellant contends that residuals of both wrists should be considered; however, he refers to SMRs that show injury to his right hand and wrist (R. at 83, 87, 114, 188, 189, 200, 359), and in his 1-9 Appeal he' refers only to “wrist” without identifying which one.) Upon receipt of a 1-9 Appeal, the BVA is required to address all issues which are reasonably raised from a liberal reading of an appellant’s substantive appeal. See Chisem v. Brown, 4 Vet.App. 169, 176 (1993); Myers v. Derwinski, 1 Vet.App. 127, 129 (1991). The Court holds that the language used in the veteran’s 1-9 Appeal reasonably raised claims of service connection for these disabilities and that the Board was required to address them. These claims will thus be remanded to the Board.

The Court notes that the wrist(s) and hand claims, raised for the first time in the 1-9 Appeal, as with the right-ankle claim, have not yet been adjudicated by the RO and must, for the reasons stated in part II.B., above, be referred to the RO for initial review and adjudication there. However, unlike the situation as to the right-ankle claim, as to which the Board made no error, the Board did err in not referring the wrist(s) and hand claims to the RO.

*411III. Conclusion

Upon consideration of the record and the pleadings of the parties, the Court affirms in part the January 9, 1992, BVA decision and in part vacates that decision, to the extent that it did not address the issues of service connection for disabilities of the veteran’s wi'ist(s) and hand, and remands these matters for expeditious treatment (including referral to the RO) in accordance with this opinion and VBIA § 302. As to the Board’s denial of the claims for service connection for a back condition and arthritis and as to the Board’s referral of the right-ankle claim to the RO, the Court holds that the appellant has not demonstrated that the BVA committed error — in its findings of fact, conclusions of law, or articulation of reasons or bases— that would warrant remand or reversal under 38 U.S.C. §§ 5108, 7105(c), 7104(d)(1), 7252, and 7261 and the analysis in Gilbert v. Derwinski, 1 Vet.App. 49 (1990). On remand, “the appellant will be free to submit additional evidence and argument” on the remanded claims. Quarles v. Derwinski, 3 Vet.App. 129, 141 (1992). A final decision by the Board following the remand herein ordered will constitute a new decision which, if adverse, may be appealed to this Court only upon the filing of a new Notice of Appeal with the Court not later than 120 days after the date on which notice of the new Board final decision is mailed to the appellant.

AFFIRMED IN PART; VACATED AND REMANDED IN PART.

Godfrey v. Brown, 8 Vet. App. 113, decided 1995-08-09.

STEINBERG, Judge, dissenting.

I am unable to join in the opinion of the majority affirming the Board of Veterans’ Appeals (BVA or Board) decision. My basic disagreement is with the portion of the Board decision rejecting the appellant’s Theory # 2 for service connection of his hearing loss. The appellant’s Theory # 2 is that his hearing was damaged during service in such a way that only a sophisticated test would have detected the damage at that time; that hearing loss was not noticeable to him at separation from service; and that it took the passage of many years before his service-incurred hearing damage manifested as noticeable hearing loss.1 The majority opinion is based on an unwarranted and unstated extension of the Court’s holdings in Owens v. Brown, 1 Vet.App. 429 (1995), and Elkins v. Brown, 5 Vet.App. 474 (1993), and other Court jurisprudence.

I also have reservations about the majority’s affirmance of the BVA decision in regard to the appellant’s Theory # 1 (that in some cases, progressive hearing loss may occur after cessation of exposure to noise), given the BVA’s mischaracterization of the treatise evidence it cited.2 I would thus remand that question as well since I believe remand is required as to Theory # 2. However, if, as I believe should be done (see part II.A. infra), the Court were to reverse the Board on Theory # 2 and direct the award of service connection, then the Court would not be called upon to address Theory # 1.

I. Majority Opinion

A. Medical history. The majority states that in the instant case the Board determined that the two experts who had reviewed the veteran’s records, Drs. Hoover and Ator, “relied on a medical history as related by the appellant”, and then states: “The Board is not required to accept doctors’ opinions that are based upon the appellant’s recitation of medical history.” Ante at 121. Our cases have never before explicitly held that the Board may reject physicians’ opinions merely because they “are based upon the appellant’s recitation of medical history”.

The majority cites several cases, including Owens and Elkins, both supra, as support for such a proposition, but none of those cases actually held that the BVA is free to disregard a physician’s statement that is based on an appellant’s history. Owens does state:

The BVA was not bound to accept the appellant’s uncorroborated testimony that teeth numbered 3, 4, 15, and 18 were removed in service, nor was it bound to accept the opinions of Drs. Ward and Cherry that were based on the appellant’s recitation of his dental history. See Wood v. Derwinski, 1 Vet.App. 190, 192 (1991); *125Wilson v. Derwinski, 2 Vet.App. [614], 618 (1992).

Owens, 7 Vet.App. at 433. However, the Owens opinion notes in the very next sentence that “the appellant’s S[erviee] M[edical] R[ecord]s [SMRs] do not show that teeth numbered 3, 4, 15, and 18 were removed in service”, and then concludes: “Because the appellant’s testimony conflicts with his SMRs, the Board’s rejection of the doctors’ opinions, which were based on dental history related by the appellant, is justified.” Ibid. (emphasis added). Thus, read fairly, Owens does not stand for the proposition that in a case such as this one where the veteran’s testimony was not contradicted by SMRs (indeed, where the veteran’s SMRs were lost in a fire) the Board may reject physicians’ retrospective opinions on the sole ground that they are based on the appellant’s recitation of medical history.3

Neither do the two cases cited in the majority’s quotation from Owens (Wood and Wilson, both supra), nor an additional case cited by the majority (Swann v. Brown, 5 Vet.App. 229 (1993), ante at 121), stand for that proposition. In Wood, Wilson, and Swann, the appellants were seeking service connection for post-traumatic stress disorder (PTSD). Entitlement to compensation for disability relating to PTSD is a special matter because the veteran must prove the occurrence of a stressor — a legal, not medical, requirement. When a physician relies on a veteran’s account of a legally insufficient stressor in making a diagnosis of PTSD, that diagnosis can be rejected by the BVA on that ground rather than on the ground that the patient supplied the history. In Wood, Wilson, and Swann, the Court cited evidence indicating that the required PTSD stressor had not occurred.

Moreover, the majority has decided, without discussion or analysis, that the phrase “based on” in Owens, supra, means “based in part on”. This appears to be the first time the Court has taken it upon itself to decide that a physician’s consideration of patient history invalidates a diagnosis, notwithstanding the fact that there is evidence of several factors other than patient history considered by the veteran’s physician.4 It is trenching on the area of the expertise of a physician for the Court to state that a physician cannot use history recounted by the patient in reaching a conclusion about the nature or etiology of an illness. A patient’s “case history” is generally an integral part of a diagnosis, and physicians are trained to evaluate the credibility of a patient’s medical history.5

The majority also mischaracterizes the holding of Elkins, supra, by taking a quotation out of context. Although Elkins does hold that a physician’s statement was “not material”, it did not do so, as the majority suggests, merely because the physician relied on a history related by the veteran. Rather, as Elkins expressly stated, it was because the physician’s statement was based on the *126“appellant’s own account of his medical history and service background, recitations which have already been rejected by the RO and BVA.” Elkins, 5 Vet.App. at 478 (citing Reonal v. Brown, 5 Vet.App. 458, 460 (1993) (emphasis added)).6

B. Treatise evidence. One other mistake made by the majority in rejecting Theory # 2 is its reliance on the Board’s quotation of a passage from Dr. Alberti’s article in Diseases of the Nose, ThRoat, EaR, Head, and Neck 1059 (J.J. Ballenger, 14th ed., 1991) [hereinafter “Ballenger”], which states that “hearing loss that progresses after removal from noise exposure is from some other cause”. Although this passage might apply to the appellant’s Theory #1, it is irrelevant to Theory #2. Under Theory # 2, the appellant admits that the postservice proyression in his hearing loss is due to age-related changes in his hearing, not noise exposure. However, he contends that that progression has made the occult noise-induced damage to his hearing that he asserts he suffered during service become overtly symptomatic. Thus, the excerpt from the Ballenger treatise cited by the majority as rebutting Theory # 2 does not, in fact, contradict that theory in any way.

II. Board Errors

I believe that this case should be (1) reversed, with the Board directed to award service connection, or (2) at the least, remanded, because the BVA’s statement of the reasons or bases for its decision was inadequate.7

A. Reversal. In support of his Theory # 2, the veteran presented reports from two physicians, specialists in otolaryngology, indicating that his audiograms showed a pattern typical of noise-induced hearing loss (NIHL) and that his hearing loss resulted from noise trauma while serving as a weapons instructor in the Army. R. at 106, 283. One of these specialists opined that the “whisper test” he received in his separation medical examination could not have detected his type of hearing loss. R. at 109.8 Furthermore, the appellant presented a letter from Dr. Alberti, also an otolaryngologist and the very expert whose article in the Ballenger treatise was quoted extensively and relied upon by the BVA. Dr. Alberti’s letter stated that, although damage from noise trauma is not “progressive” after exposure to noise ceases, the damage may not become manifest as noticeable hearing impairment until a person has lost additional “hair cells” during the aging process. R. at 271-72.

In other words, Dr. Alberti’s letter clearly supports the appellant’s assertion that his hearing was damaged but that he was not aware of it at the time, and that he suffers from age-related hearing loss earlier and more severely than if he had not been exposed to noise trauma. Dr. Alberti characterizes early, severe onset of age-related hearing loss following noise trauma as a “frequent” occurrence. R. at 271. The only evidence apparently cited by the Board in *127opposition to the appellant’s Theory # 2 was the article by Dr. Alberti in the Ballenger treatise.9 See R. at 14-15. The Alberti article does not, however, support the Board’s position as to Theory # 2.

The Board highlights a sentence in the Alberti article which states that it is error to assume that noise exposure and hearing loss are “necessarily causally related”. R. at 13. Both by its plain meaning and in context, that sentence, which follows a discussion of diagnostic criteria for NIHL, is clearly a merely cautionary statement that hearing loss does not invariably result when a person has been exposed to noise. The sentence preceding the Board’s highlighted quoted sentence states that when noise exposure has been adequate and other causes of hearing loss have been excluded, it is “customary” to attribute the hearing loss to noise exposure. The Board inexplicably transmutes Dr. Al-berti’s purely cautionary statement into support for the Board’s own conclusion that “the evidence of record does not support the veteran’s assertion that hearing loss, like cancer, can first appear many years after exposure to the offending agent has ceased.” R. at 15. In fact, that is exactly what the veteran’s two medical specialists’ reports state, and exactly what Dr. Alberti stated in his explanatory letter.

Indeed, the Board admits that Dr. Alber-ti’s letter points out that “an individual could sustain some degree of hearing loss in service, which would result in later developing hearing loss being noticed earlier” but, incredibly, states that this is an “additive” rather than a “causative” effect, and thus not a ground for service connection. R. at 15-16. If a veteran suffers from a disability earlier than he otherwise would have, due to a service-incurred injury, how can the service-incurred injury be other than “causative”?

The Court has held that it will not reverse the Board on a question of fact unless there is no plausible basis for the Board’s finding. See Gilbert v. Derwinski, 1 Vet.App. 49, 53 (1990). In this case, the BVA did not cite a plausible basis for rejecting the evidence in support of Theory #2, and there is none.

B. Remand. Alternatively, I would vacate the decision of the Board and remand the matter for readjudication and a new decision accompanied by an adequate statement of reasons or bases, because the Board did not state a valid reason under our caselaw for rejecting the statements of Drs. Hoover and Ator, and because the Board did not explain why the Alberti article in the Ballen-ger treatise remained persuasive as to the veteran’s Theory #2 in light of the more detailed explanatory letter by the treatise’s author on the point at issue. Before the BVA discounts a physician’s opinion (let alone the opinions of specialists in the relevant field) on the grounds that the physician is just parroting what the patient said, it should be required to attempt to clarify with the physician the basis of the physician’s opinion.

Dr. Ator stated: “The lack of any subsequent occupational noise exposure precludes damage being done subsequent to his military career.” R. at 283. However, the BVA opined that the physician-appellant might have had occupational noise exposure because “[mjedieal equipment ... can produce intense sounds”. R. at 16. Given that this is the BVA’s supposition, it violates Colvin v. Derwinski, 1 Vet.App. 171,175 (1991) (Board may not rely on its own unsubstantiated medical conclusions to reject expert medical evidence in the record). The Board did not explain why Dr. Ator, as a physician himself, is not presumed to be aware of the occupational noise levels to which physicians are generally exposed.

III. Conclusion

The logical result of the BVA’s decision and the majority’s holding in this case as to Theory #2 would be to give the Board license to find a physician’s opinion not credible whenever that physician did not examine the patient during service or a presumption period, or did not examine SMRs. This would mean that conditions incurred during service, but not diagnosed until after service, *128could never be service connected when SMRs were missing. Another way of looking at this is that, notwithstanding applicable law and regulation allowing a veteran to use current medical evidence to show a “nexus” between a current condition and service,10 the Board has extended the Court’s holdings in such a way as to make it impossible for medical evidence to show such a nexus credibly unless the physician’s finding of a nexus is based on the physician’s direct observation of the condition during service or review of SMRs (which, in this case, were destroyed). That is not the law at present, and it should not become the law.

For the above reasons, I respectfully dissent.

. The majority attempts to draw a distinction between hearing damage noticeable during service but not at separation and hearing damage not noticeable either during service or at separation. Ante at 123. This is a distinction without a difference, because the veteran’s Theory # 2 could encompass cither scenario. The important point about Theory # 2 is the contention that hearing damage existed at separation but was not detectable at that time either by the veteran or by the crude audiometric test used in the veteran’s separation examination.

. The BVA cites Environmental and Occupational Medicine (W.N.Rom, 2d ed., 1992) [hereinafter "Rom”] for the proposition that "most of the damage" to hearing tends to occur "within the first 10 years”. R. at 14. However, the BVA takes that statement out of context. The Rom quote refers to the first ten years of exposure to noise, not the first ten years after noise exposure ceases. See R. at 308.

The BVA also quotes the Rom treatise to the effect that age-related hearing loss begins in the mid — 40s or thereafter, and notes that the veteran "was over 50 when hearing loss was first diagnosed”. R. at 14. The graphs from the Rom treatise, R. at 369-70, show that age-related hearing loss in men progresses vety slowly from the ages of 20 to approximately age 55-60, and begins to decline at a faster rate only after age 55-60 for all cycles except 4000 Hz, where the decline occurs more evenly. The appellant’s contention that he experienced early onset of age-related hearing loss (that is, earlier than he, as an individual, would have experienced if he had not suffered noise trauma in service) is thus not rebutted by evidence that a small percentage of men suffer from age-related hearing loss before age 55-60.

Finally, the Board states that the appellant is an "insulin-dependent" diabetic and cites the Rom treatise for the proposition that diabetics are at greater risk of developing hearing loss. R. at 14. However, the appellant asserts that he has the milder, adult-onset type of diabetes, not insulin-dependent diabetes. Reply Brief at 4.

. The majority opinion makes much of the fact that the veteran's separation examination did not mention complaints of hearing loss or noise trauma during service. Ante at 122. However, the Court’s reliance in Owens v. Brown, 7 Vet.App. 429, 433 (1995), upon contradiction of the physician's opinion by evidence in SMRs involved actual contradiction, not mere silence in the SMRs. Even more importantly, in Owens all of the veteran's SMRs were apparently available, not just a lone separation examination as in the instant case. Silence is inescapable when records do not exist. In this case, placing any weight on SMR silence is unwarranted.

. The majority's assertion that the physicians' reports were "based upon" the history given by the veteran is not supported by the reports themselves, which do not have a section marked "history”, and do not have any statement such as "based on what the veteran told me about his history”. Dr. Ator opined that the veteran clearly had noise-induced hearing loss (NIHL) and that he had had no occupational exposure subsequent to service to account for the degree of hearing loss. Dr. Hoover's opinion is apparently based in part on the veteran's description of his symptoms over time, including his military service, but Dr. Hoover does not merely accept the veteran's history as true; he clearly states that the history is consistent with the current clinical picture and cites to other factors. As an example of how the veteran's history is related to clinical findings, both Drs. Hoover and Ator cite undisputed evidence in the record that the veteran has the "notch” audiogram pattern more typical of NIHL than age-related hearing loss. R. at 106, 109, 279, 283, 290. '

. See VA Physician’s Guide for Disability Evaluation Examinations § 14.10 (1985), quoted in Elkins v. Brown, 5 Vet.App. 474, 483 (1993) (Steinberg, J., dissenting).

. Reonal made the same holding, noting that the veteran’s "recitations ... had already been rejected by the [RO]” in a previous final decision and stating: "An opinion based upon an inaccurate factual premise has no probative value”.

. The Board is required to provide a written statement of the reasons or bases for its findings and conclusions on all material issues of fact and law presented on the record; the statement must be adequate to enable an appellant to understand the precise basis for the Board’s decision, as well as to facilitate review in this Court. See 38 U.S.C. § 7104(d)(1); Gilbert v. Derwinski, 1 Vet.App. 49, 57 (1990). To comply with this requirement, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the veteran. See Gabrielson v. Brown, 7 Vet.App. 36, 39-40 (1994).

.More accurate hearing-test methods have largely replaced the "whisper” test. VA’s own regulations seem to contemplate that scientific advances in examination of hearing disorders require evaluation using the controlled speech discrimination test together with the puretone audiometry test. 38 C.F.R. § 4.85(a) (1994). VA has also recognized that there may be situations where the only available evidence predates the availability of controlled speech discrimination and puretone audiometry testing. 38 C.F.R. § 4.86a (1994) (citing 38 C.F.R. §§ 4.85-4.87 (1987)). This difference between testing methods certainly suggests an imprecision in the testing method used on the appellant's separation examination and warrants further discussion and analysis by the Board.

. I say “apparently” because the Board did not, in its statement of the reasons or bases for its decision, clearly differentiate between the appellant's theories, and correspondingly did not specify what, exactly, the evidence it cited was supposed to rebut.

. When a disease is first diagnosed after service, service connection may nevertheless be established by evidence demonstrating that the disease was in fact "incurred" during the veteran’s service, or by evidence that a presumption period applied. See 38 C.F.R. § 3.303(d) ("Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.”); Com-bee v. Brown, 34 F.3d 1039, 1042 (Fed.Cir.1994) ("[pjroof of direct service connection ... entails proof that exposure during service caused the malady that appears many years later”); Cosman v. Principi, 3 Vet.App. 503, 505 (1992) ("even though a veteran may not have had a particular condition diagnosed in service, or for many years afterwards, service connection can still be established”); see also Grottveit v. Brown, 5 Vet.App. 91, 93 (1993).

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MANKIN, Judge, filed the opinion of the Court, in which IVERS, Judge, joined. STEINBERG, Judge, filed a dissenting opinion.

MANKIN, Judge: On September 10, 1990, the Board of Veterans’ Appeals (BVA or Board) denied Robert G. Godfrey (appellant) service connection for bilateral hearing loss. The appellant sought reversal of this decision with this Court and on April 15, 1992, we vacated and remanded the matter for further consideration. Godfrey v. Derwinski, 2 Vet.App. 352 (1992) (hereinafter Godfrey I). On remand, the BVA, in a January 28, 1994, decision denied the appellant’s claim for entitlement to service connection for defective hearing and tinnitus. Record (R.) at 8. The appellant filed a timely appeal to this Court on February 28, 1994. For the reasons set forth below, the Court will affirm the Board’s January 28, 1994, decision.

I. BACKGROUND

We will first summarize the facts previously before the Court and the Court’s conclusions in Godfrey I, and will then address the Board’s treatment of those conclusions in the decision that is now before us.

A. Godfrey I

The appellant appealed the BVA’s September 10, 1990, denial of his claim for service connection for bilateral hearing loss. Robert G. Godfrey, BVA 90-25963 (September 10, 1990). He claimed that the hearing loss resulted from his work in the United States Army as a weapons and explosives instructor during his first period of enlistment from September 13, 1945, until his discharge for purposes of immediate reenlistment on April 19, 1946. R. at 9. The appellant contended that during his first enlistment, he worked without hearing protection in a basic training unit where he was repeatedly exposed to acoustic trauma from firearms and explosives over a period of several months. R. at 2, 9. The record on appeal neither confirms nor denies the appellant’s assertion that he participated in weapons systems instruction for seven months after basic training — his military occupational specialty during this period was listed as “[bjasic.” R. at 12, 23. The appellant contended that in this capacity, he suffered hearing loss, pain, and tinnitus on numerous occasions, which improved only after a few weeks away from the range. R. at 7. The appellant stated that he sought treatment for his condition but was told his only resort was to avoid noise exposure. R. at 7.

The appellant was discharged, and he reenlisted as a surgical technician where he served from April 19, 1946j to May 22, 1947. R. at 9. With the exception of the appellant’s separation examination, his service medical records (SMRs) were unavailable because they were destroyed in the 1973 fire at the National Personnel Records Center (NPRC) in St. Louis. Godfrey I, at 356. The Board concluded that there was no evidence that the appellant experienced hearing loss during service. Id.

On appeal, this Court found that the BVA’s decision was defective because it: (1) misstated the legal standard used to determine service connection; and (2) disregarded the arguably doubtful credibility of the appellant’s separation physical. Id. at 356-57. As to the Court’s first finding, the Court held that the BVA misinterpreted the law when it' treated the lack of evidence that the appellant experienced hearing loss during service as dispositive of his claim. Id. at 356. The Court held that in order to establish service connection, the appellant did not have to *116show hearing loss was present during service, but instead, was only required to show that hearing loss resulted from personal injury in service. Id. With respect to the Court’s second finding, the Court found that the Board erred by not discussing the appellant’s attack on the credibility of his separation physical. Id. at 356-57. As a consequence, the Court remanded the case to the BVA for further adjudication. Id. at 357.

B. Post-Remand Proceedings

In response to the Court’s opinion in God-frey I, on September 9, 1992, the Board remanded the case to the regional office (RO) for further development. R. at 209. On remand, the appellant argued that: (1) in some cases, progressive hearing loss may occur after cessation of exposure to noise; and (2) hearing loss is not noticeable after apparent recovery from the more severe temporary damage resulting from initial noise trauma. R. at 11, 243. In support of these theories, the appellant submitted a March 13, 1991, letter (R. at 106) and an April 29, 1991, (R. at 109) letter from a Dr. Larry A. Hoover who treated the appellant for a sensorineural hearing loss. R. at 283.

In his March 13, 1991, letter, Dr. Hoover mentioned the appellant’s noise injury that occurred when he served as a weapons instructor on active duty. R. at 106. Dr. Hoover opined that there was significant inner ear damage from the explosions the appellant was exposed to during service because of the

persistent tinnitus since [service]_ Additional evidence of [noise exposure] is the fact that [the appellant] had multiple episodes of transient threshold shifts with ear fullness, decreased hearing, and associated severe tinnitus [since the appellant’s departure from the service]_ [T]he particular configuration of [the appellant’s] hearing loss, that is, with it being relatively normal at the lower frequencies with a severe loss from 2000 hertz on up, is also very consistent with noise exposure.

R. at 106.

The RO denied the appellant’s claim because Dr. Hoover relied on the appellant’s history of what occurred. R. at 244. The RO further related that while the appellant’s statements regarding occurrences of acute hearing problems while in the military were accepted as factual, service connection was not warranted because of the lack of complaints regarding a hearing disorder on the separation examination combined with the lack of post-service medical evidence until 1980 (which failed to find tinnitus). R. at 238-39. The appellant disagreed with this decision and appealed to the BVA. R. at 229, 254.

In accordance with this Court’s holding in Thurber v. Brown, 5 Vet.App. 119, 126 (1993) (before BVA can rely on any evidence developed after the issuance of the most recent statement of the case, the Board must give the veteran notice of the evidence and of the reliance proposed to be placed on it, and a reasonable opportunity to respond thereto), the BVA notified the appellant on July 15, 1993, of the additional evidence it would consider in rendering a decision. R. at 259-67. The Board’s evidence, a text on occupational hearing loss, reflected that the appellant’s first theory, regarding progressive hearing loss after the cessation of noise, was under attack in the medical community (R. at 11, 265, 286); P.W. Alberti, “Occupational Hearing Loss,” in Diseases of the Nose, ThROAt, EaR, Head and Neck 1059 (J.J. Ballenger, ed., 14th ed. 1991) [hereinafter “Ballenger”].

In response, the appellant submitted a letter from Dr. Alberti wherein the doctor stated that noise-induced hearing loss (NIHL) and tinnitus “may be caused by a short term exposure to noise.... [S]ome people[,] after only one or two episodes of shooting[,] develop a permanent [NIHL] notch and certainly tinnitus, which may be temporary or permanent. It is not only possible, but I believe frequent[,] that someone with an early [NIHL] has no symptoms related to the hearing loss. The only way to tell an early loss is by Audiometry.” R. at 271. However, Dr. Alberti also stated that he did not believe in the appellant’s first theory — that damage from noise is progressive after the noise exposure finishes. R. at 272. Rather, Dr. Alberti stated that the relationship between early NIHL and later symptoms can *117be explained by the following “additive theory”:

The additional hair cells lost from aging experienced in the 40’[s], 50’s and upwards when added to pre existing [sic] hearing loss from noise produces symptoms which are much greater than if there had been no hearing loss (even an asymptomatic one, from the noise). In other words, the effect of noise and aging is generally considered to be additive except with very severe loss [sic] hearing losses. Put yet another way, the hearing loss from aging occurs on a different baseline in a noise damaged ear than in a normal ear and handicapping levels of hearing loss are experienced sooner than had there been no noise exposure.

R. at 271. Dr. Alberti added that he was unable to comment further on the appellant’s case without further clinical details. R. at 272.

In further support of his claim, the appellant submitted a letter from Gregory A. Ator, M.D. R. at 282-83. Like Dr. Hoover, Dr. Ator focussed on the configuration of the appellant’s audiograms when he concluded that “it is clear that [the appellant] has had a significant noise exposure as the audiometric profile is very consistent with this process.” R. at 283. Dr. Ator also commented that the lack of evidence of “subsequent occupational noise exposure precludes damage being done subsequent to [the appellant’s] military career.” R. at 283. Regarding the second theory advanced by the appellant, Dr. Ator stated: “I think the whole issue of whether or not a sensorineural hearing loss produced from noise injury has to manifest itself at the time of the injury is far from clear. The magnitude of the loss produced in the short term, if any, would unlikely have been of sufficient magnitude [sic] to be picked up by the cursory discharge audiometric test that the patient had.” R. at 283.

The appellant presented additional evidence in the form of a hearing profile characterized by a “V notch” that is indicative of acoustic trauma, in contrast to a declining straight line profile which is characteristic of hearing loss attributable to old age. R. at 291. In further support of his claim, the appellant submitted numerous medical treatises (R. at 148-72; 296-431) relating to acoustic trauma and hearing loss, including NIHL, to support his assertion that noise exposure (to include percussion from small arms fire) causes hearing loss, and that prolonged exposure can cause irreversible damage. R. at 11.

On remand, the BVA, in a January 28, 1994, decision, continued its denial of the appellant’s claim after determining that his separation physical was credible. R. at 8, 12-13. Robert G. Godfrey, BVA 94-00882 (Jan. 28,1994). While the BVA accepted the appellant’s contention “[t]hat he was a weapons instructor for at least part of his initial 7-month tour of duty”, it found less credible his contentions “that he had numerous temporary threshold shifts with accompanying pain or fullness and severe tinnitus in service, followed by persistent tinnitus continuing after service.” R. at 17. The Board also noted that the appellant’s bilateral hearing loss was not diagnosed until he underwent an audiological examination in 1980 — thirty-three years after his separation from military service in 1947. R. at 9, 13. The appellant waited until 1989, when he was again diagnosed with hearing loss in both ears and given hearing aids, to file a claim for service connection. R. at 8, 10, 35. Neither the 1980 or the 1989 examination reported a finding of the tinnitus the appellant stated he suffered from continuously for thirty years. R. at 9,10, 32, 35. Because of the absence of hearing disorder complaints on the appellant’s separation examination and for many years after service, the Board concluded that there was not an approximate balance of the evidence (Gilbert v. Derwinski, 1 Vet.App. 49, 53 (1990)), and that the preponderance of the evidence was against finding that hearing loss and tinnitus were due to service. R. at 17-18. The Board further found that private physician statements had diminished probative value because their diagnoses relied on a medical history as related by the appellant as well as on recent audiograms which reflected “a configuration ... merely consistent with, not diagnostic of, NIHL.” (Emphasis added.) R. at 16. A timely appeal to this Court followed.

*118II. ANALYSIS

Section 3.385 in 38 C.F.R. (1994) sets forth the specific requirements regarding hearing disorders. At the time of the BVA decision in January 1994, 38 C.F.R. § 3.385 (effective April 3, 1990) stated that hearing loss does not constitute a disability for the purposes of service connection by the VA when the threshold levels at 500, 1000, 2000, 3000, and 4000 Hertz are all less than 40 decibels. See 38 C.F.R. § 3.385 (1993). At the appellant’s separation examination in April 1947, the appellant’s hearing was 15/15 bilateral, using the whispered voice test, with no ear abnormalities noted. R. at 29. However, VA regulations do not address hearing loss as determined by a whispered voice test, but instead as measured by audiograms, which were not available at the time of the appellant’s discharge from service. R. at 289.

In Hensley v. Brown, 5 Vet.App. 155, 159 (1993), the Court held that section 3.385 does not preclude service connection for a current hearing disability where the appellant submits “evidence that the current disability is causally related to service.” Hensley, 5 Vet. App. at 160. See also, Cuevas v. Principi, 3 Vet.App. 542, 548 (1992) (in order for the appellant to establish service connection for hearing loss of his left ear, there must be not only a current disability, but also a determination of a relationship between that disability and an injury or disease incurred in service or some other manifestation of the disability during service).

As Congress indicated in 1941, the question of service connection is a question of fact to be determined “upon the evidence in each individual case.” H.R.Rep. No. 1157, 77th Cong., 1st Sess. (1941), reprinted in 1941 U.S.C.C.A.N. 1035. This Court will not overturn the BVA’s factual findings unless they are “clearly erroneous.” 38 U.S.C. § 7261(a)(4); Gilbert, 1 Vet.App. at 52-53; Francisco v. Brown, 7 Vet.App. 55, 57 (1994). Under this standard of review, “if there is a ‘plausible’ basis in the record for the factual determinations of the BVA, even if this Court might not have reached the same factual determinations, [the Court] cannot overturn them.” Gilbert, 1 Vet.App. at 53. The Board is required to provide a written statement of the reasons or bases for its findings and conclusions on all material issues of fact and law presented on the record; the statement must be adequate to enable an appellant to understand the precise basis for the Board’s decision, as well as to facilitate review in this Court. See 38 U.S.C. § 7104(d)(1); Simon v. Derwinski, 2 Vet.App. 621, 622 (1992); Masors v. Derwinski, 2 Vet.App. 181,188 (1992); Gilbert, 1 Vet.App. at 57. To comply with this requirement, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the veteran. See Gabrielson v. Brown, 7 Vet.App. 36, 39-40 (1994); Abernathy v. Principi, 3 Vet.App. 461, 465 (1992); Simon, supra; Peyton v. Derwinski, 1 Vet.App. 282, 285 (1991); Hatlestad v. Derwinski, 1 Vet.App. 164, 169 (1991); Gilbert, supra. When SMRs have been destroyed, the Board has a heightened obligation to provide an explanation of reasons or bases for its findings and to consider the benefit-of-the-doubt rule under 38 U.S.C. § 5107(b). O’Hare v. Derwinski, 1 Vet.App. 365, 367 (1991). For the reasons set forth below, the Court holds that the Board’s findings of fact in this case have a plausible basis in the record and are not subject to reversal as being clearly erroneous.

A. Separation Examination

As noted earlier, with the exception of his separation physical, the remainder of the appellant’s records were destroyed in the 1973 NPRC fire. Godfrey I, at 356. The appellant has repeatedly challenged both the existence and accuracy of his separation examination. R. at 12. On remand, this Court ordered the Board to make express findings as to the probative value of the separation physical report and to ensure that its conclusions were supported by an adequate statement of reasons or bases. Id. at 357.

The Board found the appellant’s separation examination to be credible — a factual finding that this Court must accept unless it finds it to be clearly erroneous. R. at 12-13. See Burger v. Brown, 5 Vet.App. 340, 342-43 *119(1993). While the appellant did not recall receiving a separation examination, he did recall that a clerk asked him a few questions and told him that if he were to mention any disabilities upon outproeessing, he would be placed in a hospital for observation and his separation would be delayed. R. at 7, 12. The Board noted that while it was credible that the appellant was exposed to noise in service, it was not credible that he would not have mentioned it at his separation exam, especially given the fact that the medical history portion of the separation examination related that the appellant: suffered a fractured right radius in 1937; underwent a tonsillectomy in 1940; and fractured a toe in 1942. R. at 12.

The record of the separation physical showed that the appellant’s hearing was normal upon examination using the whispered voice test. R. at 29. The examination also documented 20/20 uncorrected visual acuity in each eye with no eye abnormalities. R. at 29. However, there is uncontroverted evidence that the appellant

suffered from a lifelong vision impairment. [The appellant] contended that such evidence would show that, notwithstanding the notation of 20/20 uneorrected vision in the 1947 record of his separation physical, an accurate examination could not have found him to have normal vision at the time of his discharge; therefore, the entire report, including the ‘whisper test’ results indicative of normal hearing, was highly suspect.

Godfrey I, at 354. The appellant contended that the fact that his separation eye examination results were incorrect supports his contention that no separation examination took place and that it consequently follows that the reported hearing test results are suspect. R. at 242. The appellant therefore believes that the examination report has no value and that it should be purged from the record on appeal. R. at 7.

The appellant further contended that even if the separation examination did take place, it would not have been able to detect high frequency hearing loss without an audiologie examination that included an audiogram. R. at 99. Regarding the reliability of a hearing examination by whisper test at fifteen feet, the appellant submitted evidence from Dr. Hoover wherein he opined that it

is obviously a very unreliable way to test hearing, especially in patients whose hearing loss is not symmetrical, i.e. where there is more loss in one region than another, as is the ease in your particular situation. It is my professional opinion, as an otolaryngologist practicing now for fifteen years, that such testing would provide no reliable information regarding the presence or absence of severe noise-induced, primarily upper frequency hearing loss.

R. at 109. Dr. Ator commented in his September 9, 1993, dictation regarding this case, that

[t]he status of [the appellant’s] hearing at the conclusion of his military career is far from clear given the cursory discharge au-diometric examination that he had.... The magnitude of the loss produced in the short term, if any, would unlikely have been of sufficient magnitude to be picked up by the cursory discharge audiometric test that the patient had.

R. at 283.

This Court may not overturn the Board’s findings regarding the credibility or probative value accorded the separation examination absent clear error. See Lizaso v. Brown, 5 Vet.App. 380, 386 (1993) (it is the Board’s function, and not that of the Court, to determine the credibility and authenticity of documents in question); Ohland v. Derwinski, 1 Vet.App. 147, 149-50 (1991) (remanded in part for failure of the BVA to analyze the credibility or probative value of the evidence). The Court finds the Board’s determination that the separation examination took place and was credible to be plausible. While the Board agreed that the appellant’s visual acuity was misstated, it cited numerous reasons why the separation examination report was still credible and should be regarded as more than just cursory: (1) it accurately reflected the appellant’s childhood medical history; (2) it contained pertinent personal data regarding the appellant’s weight, height, and blood pressure which the appellant admits was correct (Appellant’s Brief (Br.) at 3); and (3) it indicates that an *120x-ray of the appellant's chest was taken. R. at 29.

The Board conceded that the whispered voice test "cannot detect hearing loss with anywhere near the precision of an but stated that what was of particular importance was that the separation examination did not mention hearing loss or tinnitus despite the fact that just one year prior, these problems prompted the appellant to seek reassignment into a different career field. R. at 12-13, 29. The Court finds that the fact that the separation examination report is silent as to any complaints of a hearing disorder enhances the Board's finding that the report is indeed credible.

B. Appellant~s Theories of Service Connectiom

On remand, the appellant argued that: (1) in some cases, progressive hearing loss may occur after cessation of exposure to noise; and (2) hearing loss is not noticeable after apparent recovery from the more severe temporary damage resulting from initial noise trauma. R. at 11, 243.

1. Theory #1

The Court finds that the appellant's first theory of causation is not supported by the evidence. Dr. Alberti's letter noted that "damage from noise exposure is not progressive after the exposure ceases." R. at 271-72. Dr. Alberti's letter also stated that hearing loss appeared to be cumulative with other factors such as advancing age. R. at 271-72. The Board specifically relied on Dr. Alberti's statement that "one should avoid the statistical epidemiologic error of believing that noise exposure and hearing loss are necessarily causally related. To believe this is to believe that working in noise protects one from all other forms of ear disease." Ballenger at 1060. R. at 13-14, 266. While Dr. Alberti stated that the relationship between early NIHL and later symptoms can be explained by an "additive theory," he failed to make any explicit conclusions regarding the appellant's case. R. at 271.

2. Theory #2

The appellant's second theory concerning his hearing loss is that NIHL was not noticeable for many years after exposure to acoustic trauma. Appellant's Br. at 13. The appellant stated that while he had severe hearing loss at the higher frequencies ever since noise exposure in service, he and his family and friends have only become aware of it recently because of the additive effects of aging. R. at 287. He further stated that any hearing recovery that he experienced was "more apparent than real." II. at 287. The appellant submitted a television news documentary on hearing disorders that indicated that many years can go by before noise-inflicted damage becomes obvious. H. at 113-15. The appellant also submitted a letter from Dr. Alberti wherein he stated that it is not only possible, but frequent, that someone with early NIHL has no symptoms related to the hearing loss. R. at 271. Dr. Ator also opined:

I think the whole issue of whether or not sensorial hearing loss produced from noise injury has to manifest at the time of injury is far from clear. The magnitude of the loss produced in the short term, if any, would unlikely have been of sufficient magnitude [sic] to be picked up by the cursory discharge audiometric test that the patient had.

R. at 283.

The BVA found that the appellant's second theory regarding hearing loss was not sustainable because: (1) there was insufficient evidence to rule out other causes for the appellant's current condition; (2) private medical statements submitted by the appellant had little probative value because they relied on medical history as relayed by the appellant; and (3) the private medical statements were undermined by medical literature. Secretary's Br. at 13.

a. Other Sources

Regarding the BVA's first point, the Court notes that the Board cited to other possible sources of the appellant's hearing loss such as presbycusis (a "lessening of hearing acuteness resulting from degenerative changes in the ear that occur esp[ecially] *121in old age.” WebsteR’s Medical Desk Dictionary 572 (1986)) and diabetes. R. at 14. The Board’s views are speculative and unsupported by any clinical evidence, thus, the Court is not placing its reliance on them. Black v. Brown, 5 Vet.App. 177, 180 (1993).

b. Testimony

Of record is medical evidence from two private physicians in 1991 (Dr. Hoover) and 1993 (Dr. Ator). The BVA must determine the value and credibility of this evidence. Smith v. Derwinski, 1 Vet.App. 235, 237 (1991) (determining the credibility of evidence is a function of the BVA); Ohland, 1 Vet.App. at 149. The Court notes that the BVA has not ignored these physicians’ opinions. The Board found that these private physician statements had diminished probative value because their diagnoses relied on a medical history as related by the appellant as well as on recent audiograms which reflected “a configuration ... merely consistent with, not diagnostic of, NIHL.” (Emphasis added.) R. at 16.

The Board is not required to accept doctors’ opinions that are based upon the appellant’s recitation of medical history. See e.g., Owens v. Brown, 7 Vet.App. 429 (1995) (Board not required to accept uncorroborated testimony of claimant as to dental treatment during service; Board not bound to accept physicians’ opinions based on claimant’s recitation of events). See also Elkins v. Brown, 5 Vet.App. 474, 478 (1993) (rejecting medical opinion as “immaterial” where there was no indication that the physician reviewed claimant’s SMRs or any other relevant documents which would have enabled him to form an opinion on service connection on an independent basis); Swann v. Brown, 5 Vet.App. 229 (1993) (holding that the BVA was not required to accept the medical opinions of two doctors who rendered diagnoses of post-traumatic stress disorder almost twenty years after claimant’s separation from service and who relied on history as related by the appellant as the basis for those diagnoses); Heuer v. Brown, 7 Vet.App. 379, 386-87 (1995) (to demonstrate entitlement to service connection for hearing loss, there must be medical evidence indicating a nexus to service, and where the condition was noted during service, continued symptomatology can aid in establishing service connection).

Both Dr. Hoover and Dr. Ator ascribed the appellant’s hearing loss to military noise exposure. R. at 106,109, 283. It appears that both doctors relied on the appellant’s recitation of medical history. (While the appellant is a medical doctor, there is no evidence that he is also a specialist in the relevant field.) Our dissenting colleague clearly does not agree with our position and his dissenting opinion speaks for itself. His response flies in the face of this Court’s existing jurisprudence.

Dr. Ator relied on the appellant’s uncorroborated statements when he concluded that the lack of evidence of “subsequent occupational noise exposure precludes damage being done subsequent to [the appellant’s] military career.” R. at 283. (The Court questions how Dr. Ator could have concluded that the appellant’s noise exposure was “fully documented during his military career” (R. at 283) when all of the appellant’s SMRs, with the exception of his separation examination, were unavailable for review.)

The Board must provide reasons or bases for not accepting testimony and must make medical conclusions based on independent medical evidence. Colvin v. Derwinski, 1 Vet.App. 171, 175 (1991). While Doctors Hoover and Ator corroborated the appellant’s history of noise exposure with audiogram records upon which they based their medical conclusions (R. at 106, 109, 283), and while the Board agreed that the 1980 and 1989 audiological examinations reflected a configuration consistent with NIHL, the Board noted:

[T]he diagnosis [of NIHL] is based on history, physical examination, and appropriate laboratory tests including full hearing tests. Although there are audiometric configurations suggestive of the diagnosis, it may have many variations, and no one configuration fits all cases or excludes a case. To compound matters, NIHL, like any other chronic disorder, may coexist with other lesions. The diagnosis, which is circumstantial, is largely based on a care*122ful history and is frequently made by exclusion, i.e., if other causes of hearing loss have been excluded, noise exposure has been adequate, and there is an appropriate hearing loss, it is customary to attribute the loss to that cause. The diagnosis must be made individually, and one should avoid the statistical epidemiologic error of believing that noise exposure and hearing loss are necessarily causally related. To believe this is to believe that working in noise protects one from all other forms of ear disease.

R. at 13-14, 266. Ballenger at 1060 (emphasis added). The Board thus had a plausible basis for finding the doctor’s statements unpersuasive. Although the Board conceded that the appellant’s separation examination was insufficient to detect the type of hearing loss the appellant alleged that he suffered during service, the separation examination was also silent as to any complaints of noise trauma suffered during service. Consequently, it is not only the appellant’s recitation of events but also the fact that the appellant cannot submit any contemporaneous evidence of noise trauma that undermines the physicians’ opinions. The dissent argues that we have extended the reach of Owens and Elkins so as to bar the introduction of medical opinions from physicians in cases where SMRs are missing unless the physicians involved have personally witnessed the occurrence of the alleged events during service or reviewed SMRs. That is not the case here. On the facts of this case, the Board examined the bases for the physicians’ opinions and rejected their probative value. That is a function for the Board, and we cannot substitute our own judgment for that of the Board on matters involving probative weight or credibility. See Lizaso, Oh-land, Smith, all supra [cases regarding the BVA’s function on credibility].

Dr. Ator also asserted that “[t]he lack of any subsequent occupational noise exposure precludes damage being done subsequent to [the appellant’s] military career.” (Emphasis added.) R. at 283. In making this statement, Dr. Ator again relied on the appellant’s version of his medical history. The Board, while not conclusively stating that the appellant was exposed to these other sources, cites to numerous non-occupational environmental types of noise exposure that can induce hearing loss such as “power mowers, chain saws, loud voices, sirens, thunderclaps, jet planes, trains, even air conditioner units, auto traffic, vacuum cleaners, and other household appliances .... Medical equipment such as suction units, respirators, and incubators can produce intense sounds.” R. at 16, 306. R.J. McCunney, “Occupational Exposure to Noise,” in Environmental and Occupational Medicine 1125 (W.N.Rom, 2d ed., 1992). Thus, not only does Dr. Ator rely on unsubstantiated testimony in making his statement, but he also fails to account for the fact that non-occupational noise exposure can cause hearing loss also.

c. Medical Evidence

Under the facts and circumstances of this case, the medical evidence relied upon by the Board rebuts the evidence set forth by the appellant. The Board explicitly found that “the authorities relied upon by the veteran do not stand for his assertion that noise exposure can result in temporary threshold shifts, which then disappear, and then result in a permanent threshold shift first noticeable many years after the noise exposure has ceased, with subsequent continued worsening.” R. at 14.

The Board’s medical research did not support the appellant’s proposition that a permanent threshold shift can first appear years after the noise exposure has ceased. In support of its findings, the Board cited to Ballen-ger:

It is frequently asked if hearing loss from noise exposure can progress after removal from noise. Although it is generally accepted that hearing loss improves rather than worsens after removal from chronic noise exposure, there is considerable controversy in the literature about the interaction between noise, presbycusis, and progress of hearing loss. The overwhelming body of opinion, however, strongly suggests that hearing loss that progresses after removal from noise exposure is from some other cause.

R. at 15, 265. Ballenger at 1059.

The Board’s findings rest upon medical literature that is scientific in nature and is *123therefore not an impermissible expression of the Board’s own medical conclusions. The medical literature does not support the appellant’s contention that part of his healing loss was attributable to in-service noise trauma. Rather, as this medical treatise explained, hearing loss generally improves after removal from chronic noise exposure and subsequent manifestations of hearing loss are wholly attributable to some other subsequent source. Indeed, the appellant stated that his hearing improved upon removal from noise exposure. R. at 48.

While the BYA accepted the appellant’s contention that he was a weapons instructor for at least part of his initial seven-month tour of duty, it is less clear that the appellant was treated for hearing loss during his tour of duty. The NPRC informed the RO in November 1989 that the appellant’s SMRs were destroyed in the 1973 fire and that daily sick reports for the training battalion that the appellant was assigned to were not available in 1946. R. at 69. However, the battalion’s morning reports for the period from April 1, 1946 through June 30, 1946, were located but contained no reference that the appellant was ever sick, injured, or hospitalized. R. at 69.

The appellant contended that while his hearing improved a great deal after his duties involving firearms ended, the tinnitus persisted, although it was less severe. R. at 48. After discharge, the appellant stated that the tinnitus became worse without further noise damage and his high frequency hearing became impaired in the 1970’s. R. at 48. However, there is no evidence of tinnitus either at separation from service or on the appellant’s audiological examinations in 1980 or 1989. This lack of complaints of tinnitus undermines the appellant’s contentions regarding the persistence of tinnitus. Interestingly, while the appellant stated that his hearing loss had improved considerably by the time he left the service, he also stated that his tinnitus worsened after separation from service even though he had not been exposed to noise trauma subsequent to his in-service occupation as a weapons instructor for seven months. R. at 9, 10, 32, 35.

The dissent overemphasizes the medical treatises standing for the proposition that in-service hearing loss would be magnified over time because of the effects of aging. As the dissent readily states, the medical treatises and statements would support the argument that in-service noise trauma created a hearing loss which was not noticeable at that time and that subsequent aging effects, when added to the in-service NIHL, caused an earlier and more pronounced manifestation of hearing loss. However, the dissent fails to recognize that the appellant is in fact arguing that he experienced a noticeable hearing loss during service, which eventually improved by separation. Thus, the appellant’s own statements serve to distinguish his claim from the type of hearing loss being described by the physicians and treatises.

Reviewing under the clearly erroneous standard, the Court does not find that the BVA decision is lacking a plausible basis in the record. See Gilbert, su-pra. The Court notes the absence of complaints regarding a hearing disorder at the time of the separation examination and the lack of evidence of post-service treatment until the first objective medical evidence of hearing loss is established thirty-three years later, combined with the medical treatises’ undermining of the appellant’s evidence and contentions that the Board relied upon under the circumstances of this case; these factors do provide a plausible basis for the BVA’s credibility findings regarding the history of hearing loss as related by the appellant and for the denial of entitlement to service connection for defective hearing and tinnitus.

III. CONCLUSION

Upon consideration of the record and the parties’ briefs, the Court holds that the appellant has not demonstrated that the BVA committed error — in its findings of fact, conclusions of law, procedural processes, articulation of reasons or bases, or application of the benefit-of-the-doubt rule — that would warrant remand or reversal under 38 U.S.C. §§ 7252, 5107(a), (b), 7104(d)(1), 7261, and the analysis in Gilbert, supra. The Court affirms the January 28, 1994, decision of the Board.