Citation Nr: 9907308 Decision Date: 03/18/99 Archive Date: 03/24/99 DOCKET NO. 98-01 792A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Entitlement to an increased evaluation for gunshot wound residuals involving Muscle Group XI, with a fracture of the right tibia and loss of tissue substance, currently evaluated as 30 percent disabling. 2. Entitlement to an increased evaluation for an unstable right knee, currently evaluated as 30 percent disabling. 3. Entitlement to an increased evaluation for osteomyelitis, currently evaluated as 20 percent disabling. 4. Entitlement to an increased evaluation for a left knee disorder, currently evaluated as 10 percent disabling. 5. Entitlement to an increased evaluation for a low back strain, currently evaluated as 10 percent disabling. 6. Entitlement to service connection for prostatitis due to bladder obstruction secondary to exposure to Agent Orange. 7. Entitlement to service connection for a stomach disorder as secondary to medications for service-connected disorders. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. ATTORNEY FOR THE BOARD L. M. Barnard, Counsel INTRODUCTION The veteran served on active duty from September 1966 to November 1968. This appeal arose from an October 1997 rating decision of the Jackson, Mississippi, Department of Veterans Affairs (VA), Regional Office (RO), which denied entitlement to the requested benefits. It has been held that the Board is precluded by regulation from assigning an extraschedular rating under 38 C.F.R. § 3.321(b)(1) in the first instance; however, the Board is not precluded from considering whether referral to the appropriate first-line official is required. The Board is still obligated to seek out all issues that are reasonably raised from a liberal reading of documents or testimony of record and to identify all potential theories of entitlement to a benefit under the law and regulations. Floyd v. Brown, 9 Vet. App. 88 (1996). Moreover, the Court has also held that the Board must address referral under 38 C.F.R. § 3.321(b)(1) only when circumstances are presented which the Director of VA's Compensation and Pension Service might consider exceptional or unusual. Shipwash v. Brown, 8 Vet. App. 218,227 (1995). Having reviewed the record with these holdings in mind, the Board finds no basis for action on the question of the assignment of an extraschedular rating. The issues of entitlement to increased evaluations for the service-connected unstable right knee, left knee disorder, low back disability, and osteomyelitis will be subject to the attached remand. FINDINGS OF FACT 1. The veteran's service-connected right tibia gunshot residuals are manifested by severe residuals, including genus recurvatum with poor balance, right forefoot abduction and a protruding tibia. 2. The veteran has not been shown by competent medical evidence to suffer from the residuals of Agent Orange, to include prostatitis due to bladder outlet obstruction. 3. The veteran has not been shown by competent medical evidence to suffer from a stomach disorder related to the medications that he takes for service-connected disorders. CONCLUSIONS OF LAW 1. The evidence does not support a finding of an evaluation in excess of 30 percent for the service-connected gunshot wound residuals involving Muscle Group XI, with a fracture of the right tibia and loss of tissue substance. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38 C.F.R. § 3.350, Part 4, including §§ 4.1, 4.2, 4.7, 4.10, 4.40, 4.56(c) & (d)(4), Code 5311 (1998). 2. The veteran has not presented evidence of a well grounded claim for service connection for the residuals of exposure to Agent Orange, to include prostatitis due to bladder outlet obstruction. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. §§ 3.307(a)(6), 3.309(e) (1998). 3. The veteran has not presented evidence of a well grounded claim for service connection for a stomach disorder secondary to medications taken for service-connected disorders. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.310(b) (1998). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Entitlement to an evaluation in excess of 30 percent for the service- connected gunshot wound residuals involving Muscle Group XI (with a fracture of the right tibia and loss of tissue substance) The veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is plausible. It is also found that all relevant facts have been properly developed. The record is devoid of any indication that there are other records available which should be obtained. Therefore, no further development is required in order to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). Under the applicable criteria, disability evaluations are determined by the application of a schedule of ratings which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1998). When a question arises as to which of two evaluations shall be assigned, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1998). In determining the disability evaluation, the VA has a duty to acknowledge and consider all regulations which are potentially applicable based upon the assertions and issues raised in the record and to explain the reasons used to support the conclusion. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). These regulations include, but are not limited to, 38 C.F.R. § 4.1, that requires that each disability be viewed in relation to its history and that there be an emphasis placed upon the limitation of activity imposed by the disabling condition, and 38 C.F.R. § 4.2 which requires that medical reports be interpreted in light of the whole recorded history, and that each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.10 states that, in cases of functional impairment, evaluations are to based upon lack of usefulness, and medical examiners must furnish, in addition to etiological, anatomical, pathological, laboratory and prognostic data required for ordinary medical classification, full description of the effects of the disability upon a person's ordinary activity. This evaluation includes functional disability due to pain under the provisions of 38 C.F.R. § 4.40. These requirements for the evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decision based upon a single, incomplete or inaccurate report and to enable VA to make a more precise evaluation of the disability level and any changes in the condition. The Board notes that while the regulations require review of the recorded history of a disability by the adjudicator to ensure an accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where an increase in the disability rating is at issue, the present level of the veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue- pain, impairment of coordination and uncertainty of movement. 38 C.F.R. § 4.56(c) (1998). According to 38 C.F.R. Part, Code 5311 (1998) (the muscles that affect propulsion of the foot), a 30 percent evaluation is warranted for muscle injury residuals which are severe in nature. A severe injury results from a through and through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding or scarring. The objective findings include the following: ragged, depressed and adherent scars indicting wide damage to muscle groups in the missile track; palpation revealing loss of deep fascia or muscle substance, or soft flabby muscles in the wound area; muscles that swell and harden abnormally in contraction. Tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. If present, the following are also signs of severe muscle disability: x-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile; adhesion of the scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where the bone is usually protected by muscle; diminished muscle excitability to pulsed electrical current in electrodiagnostic tests; visible or measurable atrophy; adaptive contraction of an opposing group of muscles; atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle; and induration or atrophy of an entire muscle following simple piercing by a projectile. 38 C.F.R. § 4.56(d)(4) (1998). According to 38 C.F.R. § 3.350(a) (1998), special monthly compensation is payable for loss of use of one foot. Loss of use of the foot will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below the knee with the use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function; for example, whether the acts of balance or propulsion could be accomplished equally well by an amputation stump with prosthesis. Extremely unfavorable complete ankylosis of the knee, or complete ankylosis of two major joints of an extremity, or shortening of the lower extremity of 3 and1/2 inches or more, will constitute loss of use of the foot involved. 38 C.F.R. § 3.350(2)(a) (1998). The service medical records indicated that the veteran suffered a shrapnel fragment wound to the right anterior tibia, with a severe comminuted fracture of the right tibia in July 1967. The veteran was examined by VA in July 1997. The objective examination noted a huge irregular scar and discoloration of the right leg below the knee with some soft tissue defect. There was some genu recurvatum with poor balance while standing on the floor and right forefoot abduction. The right tibia appeared to be protruding outward to the lateral aspect, just below the knee joint. There was some tenderness over the scar tissue and the over the protruded tibia. While he was standing, there appeared to be some leg length discrepancy and he was standing with the right knee hyperextended. The absolute leg length (from the anterior superior iliac spine to the medial malleolus) was 86 cm (about 33.86 inches) on the left and 83 cm (about 32.68 inches) on the right. From the umbilicus to the medial malleolus on the left, the leg measured 96 cm (about 37.80 inches) and 93 cm (about 36.61 inches) on the right. An x- ray revealed a deformity of the proximal tibial shaft, which appeared to be relatively stable. The diagnosis was compound fracture of the right tibia and soft tissue injury. After a careful review of the evidence of record, it is found that an evaluation in excess of the 30 percent disability evaluation currently assigned to the shrapnel fragment wound residuals to Muscle Group XI is not warranted. Initially, it is noted that the veteran is already receiving the maximum amount of disability compensation allowable under the applicable schedular criteria for his injury residuals. He has been awarded a 30 percent disability evaluation, which compensates him for his severe residuals. Given the extent of his injury, the Board will consider whether he is entitled to special monthly compensation for the loss of use of one foot. While the evidence indicates that he has balance problems, it does not suggest that he would be equally well served by an amputation stump with prosthesis. The objective evidence indicates that he is able to ambulate, albeit with a right-sided limp. A leg length discrepancy has been noted, but it is not to the degree that would justify a finding of loss of use of the foot. Finally, while he holds his right knee in hyperextension, there is no indication that extremely complete unfavorable ankylosis is present. Thus, the evidence does not support a finding of entitlement to special monthly compensation for loss of use of the right foot. Under the circumstances, it is found that the preponderance of the evidence is against the veteran's claim for an evaluation in excess of 30 percent for the service-connected gunshot wound residuals involving Muscle Group XI, with a fracture and loss of tissue substance. II. Service connection for prostatitis due to bladder outlet obstruction secondary to exposure to Agent Orange The threshold question to be answered in this case is whether the appellant has presented evidence of a well grounded claim; that is, one which is plausible. If he has not presented a well grounded claim, his appeal must fail and there is no duty to assist him further in the development of his claim because such additional development would be futile. 38 U.S.C.A. § 5107(a) (West 1991); Murphy v. Derwinski, 1 Vet. App. 78 (1990). As will be explained below, it is found that his claim is not well grounded. According to 38 C.F.R. § 3.307(a)(6) (1998), the term herbicide agent means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the Vietnam era. The diseases listed at 38 C.F.R. § 3.309(e) (1998) shall be service-connected if they manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne and porphyria cutanea tarda shall have become manifest to a degree of 10 percent or more within one year after the last date on which the veteran was exposed to an herbicide agent during active military, naval or air service. If a veteran was exposed to an herbicide agent during active military, naval, or air service, the following disease shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met even though there is no record of such disease: chloracne or other acneform disease consistent with chloracne; Hodgkin's disease; multiple myeloma; Non-Hodgkin's lymphoma; acute and subacute peripheral neuropathy; porphyria cutanea tarda; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx or trachea); soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). The term soft-tissue sarcoma includes the following: adult fibrosarcoma; dermatofibrosarcoma protuberans; malignant fibrous histiocytoma; liposarcoma; leiomyosarcoma; epithelioid leiomyosarcoma (malignant leiomyoblastoma); rhabdomyosarcoma; ectomesenchymoma; angiosarcoma (hemangiosarcoma and lymphangiosarcoma); proliferating (systemic) angioendotheliomatosis; malignant glomus tumor; malignant hemangiopericytoma; synovial sarcoma (malignant synovioma); malignant giant cell tumor of the tendon sheath; malignant schwannoma, including malignant schwannoma with rhabdomyoblastic differentiation (malignant Triton tumor), glandular and epitheloid malignant schwannomas; malignant mesenchymoma; malignant granular cell tumor; alveolar soft part sarcoma; epithelioid sarcoma; clear cell sarcoma of the tendons and aponeuroses; extraskeletal Ewing's sarcoma; congenital and infantile fibrosarcoma; and malignant ganglioneuroma. 38 C.F.R. § 3.309(e) (1998). The new regulations pertaining to Agent Orange exposure, expanded to include all herbicides used in Vietnam, now provide for a presumption of exposure to herbicide agents for veterans who served on active duty in Vietnam during the Vietnam era. 38 C.F.R. § 3.307(a)(6) (1998). The veteran's active duty included service in Vietnam during the Vietnam era. Consequently, it is presumed that he was exposed to Agent Orange or other herbicide agents while in Vietnam. The veteran's service medical records revealed that he was treated for one episode of prostatitis in service. However, there was no evidence of this condition during the February 1970 VA examination. The veteran was examined by VA in October 1988. This noted a question of prostatitis by history. There was no evidence of current disease. VA outpatient treatment records developed between August 1995 and June 1997 reflected the veteran's treatment for increased PSA in August 1995. His prostate was about 30 gms in size, symmetric and displayed no induration. A prostate biopsy in September 1995 revealed benign adenomatous hyperplasia. The veteran was hospitalized by VA in June 1996. He was noted to have bladder outlet obstruction with a UAA score of 21. He was complaining of significant lower tract obstruction symptoms. The prostatic biopsy showed benign prostatic hypertrophy. He was admitted for a simple vestibule prostatectomy. VA examined the veteran in July 1997. He stated that he had had occasional bouts of urgency since service, although he denied any difficulties with voiding. He stated that these complaints had progressed and that for the past year he had experienced marked increase in nocturia and a decrease in force and size of stream, which eventually ended in urinary retention. In July 1996, he underwent a suprapubic prostatectomy, following which he had done well, with no difficulties holding his urine, with still some sense of urgency. The examination of the prostate revealed a surgical capsule with a normal open prostatectomy. The examiner noted no known relationship between the veteran's condition and any medications that he was taking. Initially, in order to establish service connection, the following three elements must be satisfied: 1) the existence of a current disability; 2) the existence of a disease or injury in service, and 3) a relationship or nexus between the current disability and a disease contracted or an injury sustained in service. Caluza v. Brown, 7 Vet. App. 498 (1995); Grivois v. Brown, 6 Vet. App. 136 (1994); Grottveit v. Brown, 5 Vet. App. 91 (1993); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). In the instant case, the veteran has alleged that he suffers from prostatitis due to bladder outlet obstruction as a result of exposure to Agent Orange in Vietnam. In cases where a veteran is claiming entitlement to service connection for disabilities due to Agent Orange exposure or other herbicides, the United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999)(hereinafter "the Court"), has held that the list of presumptive and herbicide diseases is exclusive in nature. See Combee v. Principi, 4 Vet. App. 78 (1993), denying en banc review, sub.nom., Combee v. Brown, 5 Vet. App. 248 (1993) (Steinberg and Kramer, JJ., dissenting). In other words, the veteran must show that he developed a disease listed under the above regulations. Prostatitis is not included in the above-noted list of presumptive diseases (while prostate cancer is listed, there is no evidence to suggest that the veteran has ever been diagnosed with this disorder). Therefore, it is concluded that the veteran has not presented evidence of a well grounded claim for service connection for prostatitis due to bladder outlet obstruction as a result of exposure to Agent Orange. III. Service connection for a stomach condition secondary to medications taken for service-connected disorders The threshold question to be answered in this case is whether the appellant has presented evidence of a well grounded claim; that is, one which is plausible. If he has not presented a well grounded claim, his appeal must fail and there is no duty to assist him further in the development of his claim because such additional development would be futile. 38 U.S.C.A. § 5107(a) (West 1991); Murphy v. Derwinski, 1 Vet. App. 78 (1990). As will be explained below, it is found that his claim is not well grounded. Under the applicable criteria, service connection may be granted for disabilities which are proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (1998). The veteran has alleged that he has developed a chronic stomach condition as a result of the medications that he must take for his service-connected injury residuals. The veteran's VA outpatient treatment records developed between August 1995 and June 1997 contained no complaints of or treatment for stomach complaints. VA examined the veteran in July 1997. At that time the veteran reported no abdominal pain, nausea or vomiting. He denied any history of peptic ulcer disease, although he did admit to a little heartburn, which occasionally occurred after ingesting spicy or greasy foods. He gave no history of constipation or diarrhea. He then denied that any of his medications that he was taking for his service-connected disabilities were causing any problems with his stomach. The physical examination noted that he weighed 179 pounds (his maximum weight in the past year was 188 pounds). He appeared to be well-developed and well-nourished. His abdomen was slightly obese with no organomegaly or masses. He complained of some tenderness in the left lower quadrant, but there was no rebound tenderness. Bowel sounds were normoactive. An upper gastrointestinal series was normal. The diagnosis was no stomach disorder found. Initially, in order to establish service connection, the following three elements must be satisfied: 1) the existence of a current disability; 2) the existence of a disease or injury in service, and 3) a relationship or nexus between the current disability and a disease contracted or an injury sustained in service. Caluza v. Brown, 7 Vet. App. 498 (1995); Grivois v. Brown, 6 Vet. App. 136 (1994); Grottveit v. Brown, 5 Vet. App. 91 (1993); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). In the instant case, in order for the veteran's claim to be well grounded, he would have to submit competent medical evidence of the current existence of a stomach disorder which had been etiologically related to the medications that he takes for his service-connected disabilities. However, the objective evidence of record indicated that no current chronic stomach disorder has been diagnosed. The July 1997 VA examination specifically noted that no such disorder existed. Moreover, during this examination, the veteran denied that his medications were causing any problems with his stomach. Clearly, there is no objective of the existence of a current disability that could related to any of the veteran's service-connected disorders or the medications he takes for their treatment. Therefore, it is found that the veteran has failed to present sufficient evidence of a well grounded claim for service connection for a stomach disorder secondary to the medications he takes for his service-connected disorders. ORDER An increased evaluation for the service-connected gunshot wound residuals involving Muscle Group XI with a fracture and loss of tissue substance is denied. Service connection for prostatitis due to bladder outlet obstruction secondary to exposure to Agent Orange is denied. Service connection for a stomach condition secondary to medications for service-connected disorders is denied. REMAND The veteran has contended that his service-connected right knee, low back, and left knee disorders and osteomyelitis are more disabling than the current disability evaluations would suggest. He reports that his functional abilities are greatly decreased and that he suffers from constant pain. Therefore, he believes that increased evaluations are justified. VA has a duty to assist the veteran in the development of all facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1994). This includes the duty to obtain a VA examination which provides an adequate basis upon which to determine entitlement to the benefit sought. Littke v. Derwinski, 1 Vet. App. 90 (1991). Examinations by specialists are recommended in those cases which present a complicated disability picture. Hyder v. Derwinski, 1 Vet. App. 221 (1991). According to DeLuca v. Brown, 8 Vet. App. 202 (1995), the United States Court of Veterans Appeals (Court) held that in evaluating a service-connected disability involving a joint rated on limitation of motion, the Board erred in not adequately considering functional loss due to pain under 38 C.F.R. § 4.40 and functional loss due to weakness, fatigability, incoordination or pain on movement of a joint under 38 C.F.R. § 4.45. The Court in DeLuca held that Diagnostic Codes pertaining to range of motion do not subsume 38 C.F.R. §§ 4.40 and 4.45 (1997), and that the rule against pyramiding set forth in 38 C.F.R. § 4.14 (1997) does not forbid consideration of a higher rating based on a greater limitation of motion due to pain on use, including during flare-ups. The Court remanded the case to the Board to obtain a medical evaluation that addressed whether pain significantly limits functional ability during flare-ups or when the joint is used repeatedly over a period a time. The Court also held that the examiner should be asked to determine whether the joint exhibits weakened movement, excess fatigability or incoordination. If feasible, these determinations were to be expressed in terms of additional range of motion loss due to any pain, weakened movement, excess fatigability or incoordination. The veteran's right knee, low back and left knee disorders were last examined by VA in July 1997. This examination did not discuss any of the criteria noted in DeLuca, supra. Therefore, it is found that this examination does not provide an adequate picture of the veteran's current degree of impairment. In regard to the claim for an increased evaluation for the service-connected osteomyelitis, it is noted that the VA examination performed in July 1997 did not evaluate this condition. Therefore, the current nature and degree of severity of this condition is unclear. Moreover, the RO has not considered whether the veteran is entitled to a separate evaluation for the degenerative changes in the right knee. See VAOPGCPREC 9-98 (August 14, 1998); 38 C.F.R. §§ 4.40, 4.45, 4.59 (1998). In order to make this determination, there must be evidence concerning range of motion; there must also be a comment as to whether there is any pain on motion. Under the circumstances of this case, it is found that additional assistance would be helpful, and this case will be REMANDED to the RO for the following: 1. The veteran should be afforded a VA orthopedic examination by a qualified physician in order to fully assess the current nature and degree of severity of the veteran's service-connected right knee, low back and left knee disabilities. The claims folder must be made available to the examiner to review in conjunction with the examination, and the examiner is asked to indicate in the examination report that she/he has reviewed the claims folder. All indicated special tests are to be performed and must include range of motion testing. The examiner should note the range of motion of the right knee, low back and left knee. The examiner must obtain active and passive ranges of motion (in degrees), state if there is any limitation of function and describe it, and state the normal range of motion. Whether there is any pain, weakened movement, excess fatigability or incoordination on movement should be noted, and whether there is likely to be additional range of motion loss due to any of the following should be addressed: (1) pain on use, including during flare- ups; (2) weakened movement; (3) excess fatigability; or (4) incoordination. The examiner is asked to describe whether pain significantly limits functional ability during flare-ups or when the knee joints and the low back spinal segment are used repeatedly. Special attention should be given to the presence or absence of pain, stating at what point in the range of motion pain occurs and at what point pain prohibits further motion. The factors upon which the opinions are based must be set forth. The examiner should provide a complete rationale for all conclusions reached and explain any loss of mobility reported in the above examination. 2. The veteran's service-connected osteomyelitis should be examined by a qualified VA physician in order to determine its current nature and degree of severity. The examiner should comment on whether there is definite involucrum or sequestrum, with or without discharging sinus. All indicated special tests deemed necessary should be accomplished. The claims folder must be made available to the examiner to review prior to the examination so that the veteran's entire medical history can be taken into consideration, and the examiner is asked to indicate in the examination report that the folder has been reviewed. 3. After the above-requested development has been completed, the RO should determine whether the appellant is entitled to a separate evaluation for arthritis of the right knee in light of Diagnostic Code 5010 and 38 C.F.R. §§ 4.40, 4.45, 4.59 (1998); VAOPGCPREC 9- 98 (August 14, 1998). 4. Following completion of the foregoing, the RO must review the claims folder and ensure that all of the foregoing development actions have been conducted and completed in full. If any development is incomplete, including if the requested examinations do not include all tests reports, special studies or opinions requested, appropriate corrective action is to be implemented. In the event that the veteran's claims remain denied, in whole or in part, he and his representative should be provided with an appropriate supplemental statement of the case, and an opportunity to respond, and the case should be returned to the Board for further appellate consideration if otherwise in order. The appellant is free to furnish additional evidence while his case is in remand status. Quarles v. Derwinski, 3 Vet. App. 129, 141 (1992). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1998) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44- 8.45 and 38.02-38.03. C. P. RUSSELL Member, Board of Veterans' Appeals - 18 - - 1 -