Citation Nr: 9900337 Decision Date: 01/08/99 Archive Date: 01/19/99 DOCKET NO. 95-33 732 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Entitlement to service connection for hypertension. 2. Entitlement to service connection for a lumbar spine disability as secondary to a service connected cervical spine disability. 3. Whether new and material evidence has been submitted to reopen a claim for entitlement to service connection for a psychiatric disability as secondary to a service connected cervical spine disability and, if so, whether the evidence warrants a grant of service connection. 4. Entitlement to an increased rating for a cervical spine disability, currently evaluated as 30 percent disabling. 5. Entitlement to a total disability rating based on individual unemployability due to service connected disability. REPRESENTATION Appellant represented by: South Carolina Department of Veterans Affairs ATTORNEY FOR THE BOARD Debbie A. Riffe, Associate Counsel INTRODUCTION The veteran had active service from October 1, 1961 to August 11, 1962 and from July 1, 1976 to September 17, 1977. He had additional Reserve service with the United States Army Reserves from 1955 to 1963, with the United States Air Force Reserves from 1963 to 1966 and 1970 to 1972, and with the United States Naval Reserves from 1966 to 1970 and 1972 to 1977 to include a period of inactive duty training on September 27, 1975. In a June 1978 rating decision, the Columbia, South Carolina Regional Office (RO) granted service connection for a cervical spine disability and assigned a 10 percent rating. Thereafter, the Board of Veterans’ Appeals (Board) granted a 20 percent rating in a September 1980 decision, and the RO assigned a 30 percent rating in a December 1994 rating decision. This appeal arises from a June 1995 rating decision of the RO, which denied the veteran’s claims for service connection for hypertension and for a lumbar spine disability as secondary to a cervical spine disability, for an increased rating for a cervical spine disability, and for a total disability rating based on individual unemployability due to service connected disability. In a June 1986 decision, the Board denied the veteran’s claim for entitlement to service connection for a psychiatric disability as secondary to a service connected cervical spine disability. In July 1995, the veteran requested that his claim for entitlement to secondary service connection for a psychiatric disability be reopened, and additional evidence was received in support thereof. In a July 1995 rating action the RO, without considering the prior Board denial or establishing new and material evidence had been submitted to reopen the claim for service connection for a psychiatric disability as secondary to the service connected cervical spine disability, denied service connection for a psychiatric disability as secondary to the service connected cervical spine disorder on the merits. The veteran appealed the July 1995 rating action. The Board notes that in a statement received in October 1997 the veteran withdrew his appeal with regard to the issue of service connection for diplopia. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that service connection for hypertension is warranted based on military records indicating borderline hypertension at various times during periods of active duty training in the middle to late 1970s. He also contends that service connection for a lumbar spine disability as secondary to his cervical spine disability is warranted because the traumatic arthritis in his cervical spine “migrated” to his lumbar spine. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1998), has reviewed and considered all of the evidence and material of record in the veteran's claims files. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the veteran’s claims for entitlement to service connection for hypertension and for a lumbar disability as secondary to a cervical spine disability are not well grounded and must be denied. FINDINGS OF FACT 1. The veteran’s claim that his hypertension was incurred in service was not accompanied by any medical evidence to support that allegation. 2. The claim for service connection for hypertension is not plausible. 3. The veteran’s claim that his lumbar spine disability was caused or aggravated by his service connected cervical spine disability was not accompanied by any medical evidence to support that allegation. 4. The claim for service connection for a lumbar spine disability as secondary to a service connected cervical spine disability is not plausible. CONCLUSIONS OF LAW 1. The veteran’s claim for entitlement to service connection for hypertension is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The veteran’s claim for entitlement to service connection for a lumbar spine disability as secondary to a service connected cervical spine disability is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection for Hypertension Service medical records show that on a September 1961 examination, the veteran’s blood pressure was 138/88 (sitting). On a separation physical examination in August 1962, the veteran’s blood pressure was 140/80 (sitting). On a reenlistment examination in November 1972, his blood pressure was 120/80 (sitting), 118/80 (recumbent), and 120/82 (standing). On an annual examination in December 1973, his blood pressure was 116/78 (recumbent) and 114/82 (standing). On an annual examination in March 1975, his blood pressure was 138/70 (recumbent) and 136/80 (standing). On a June 1976 physical examination, his blood pressure was 136/80 (sitting). On a May 1977 physical examination, his blood pressure was 132/82 (sitting). The records show no clinical findings or diagnosis of hypertension. On VA examination in November 1962, the veteran’s blood pressure was 146/88 (sitting). On examination, the heart sounds were regular and clear, and peripheral vessels were not thickened. The diagnosis did not include hypertension. On VA examination in November 1977, the veteran’s blood pressure was 140/80. The diagnosis did not include hypertension. In May 1983, medical records from Aiken Community Hospital dated in November 1978, and VA outpatient records dated from March to August 1979 and January 1982, were received. The records indicate that the veteran’s blood pressure was 130/80 in November 1978, 160/90 and 160/84 in March 1979, 134/72 in August 1979, and 136/70 in January 1982. The records show no diagnosis of hypertension. In March 1985, medical records from Aiken Community Hospital were received, indicating blood pressure readings of 124/80 in March 1981, 136/92 in October 1981, 140/98 and 112/84 in December 1981, 160/90 in February 1982, and 120/80 in January 1983. On VA examination in March 1994, it was noted that the veteran had a history of hypertension. A March 1994 medical record from the Eisenhower Army Medical Center (EAMC) indicates that the veteran was taking medication for hypertension. In May 1994, a VA outpatient record dated in January 1994 was received, indicating that the veteran’s blood pressure was 126/80. Medical records dated in August 1994 show that the veteran’s blood pressure was 159/89 on a VA outpatient record and 130/82 on an EAMC record. In September 1994, a consultation report dated in June 1994 from John Handy, M.D., was received, indicating that the veteran’s blood pressure was 140/80. A December 1994 medical record from St. Joseph Hospital indicates a history of hypertension. In March 1995, a letter dated in February 1995 from Combined Insurance Company of America was received, indicating that the veteran’s application for life insurance coverage was denied on the basis of his admitted history of high blood pressure. On a June 1995 VA outpatient record, the veteran was diagnosed with hypertension. Medical records dated in July and August 1995 indicate blood pressure readings of 141/79 and 116/80. In April 1996, a letter dated in September 1995 from the Medical Information Bureau (MIB) was received. The MIB informed the veteran that in its data files there were three reports from insurance companies, which indicated that the veteran was currently under treatment for his blood pressure, that the average of his current readings were systolic of 141-160 and diastolic of 90 or less, that the highest known readings in the past were systolic of 161-180 and diastolic of 91 through 100, and that the information was obtained from medical personnel and facilities. In April 1996, medical records, dated from September 1995 to February 1996, from the VA and the EAMC were received. The records indicate that the veteran had a history of hypertension and that his current blood pressure readings were 146/81, 136/81, 121/74, and 133/71. In May 1996, medical records dated in October 1995 and clinical records of a treadmill test were received. The medical records show an assessment of fatigue associated with chest discomfort. The veteran’s blood pressure was 138/79. The impression of the treadmill test revealed good blood pressure response although the veteran did not achieve the target heart rate. Medical records dated from May to June 1996 show that the veteran had blood pressure readings of 142/76 and 158/79. In June 1996, the impression included hypertension in fair control. A January 1997 medical record from the EAMC indicates a medical history of hypertension. In April 1998, additional medical records dated from December 1997 to March 1998 were received, indicating a history of hypertension. In December 1997, the veteran’s blood pressure was 133/115. In January 1998, his blood pressure was 155/92. A March 1998 record shows a blood pressure reading of 153/83. Other March 1998 records show that the veteran’s blood pressure was 154/78 and 172/80 and that he was receiving treatment for proteinuria as secondary to his hypertension. Under applicable criteria, service connection will be granted for disability resulting from personal injury suffered or disease incurred in or aggravated in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). The term “active military, naval, or air service” includes active duty, any period of active duty for training during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C.A. § 101(24) (West 1991). Where a veteran served 90 days or more during a period of war or peacetime after December 31, 1946 and hypertension becomes manifest to a degree of 10 percent within 1 year from date of termination of active duty, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991 & Supp. 1998); 38 C.F.R. §§ 3.307, 3.309 (1998). Furthermore, the law provides that a claimant for benefits under a law administered by the Secretary of the United States Department of Veteran Affairs (VA) shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. The Secretary has the duty to assist a claimant in developing facts pertinent to the claim if the claim is determined to be well grounded. 38 U.S.C.A. § 5107(a). Thus, the threshold question to be answered is whether the veteran has presented a well grounded claim; that is, a claim 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 as any such additional development would be futile. Murphy v. Derwinski, 1 Vet. App. 78 (1990). As explained below, the Board finds that the veteran’s claim is not well grounded. To sustain a well grounded claim, the claimant must provide evidence demonstrating that the claim is plausible; mere allegation is insufficient. Tirpak v. Derwinski, 2 Vet. App. 609 (1992). The determination of whether a claim is well grounded is legal in nature. King v. Brown, 5 Vet. App. 19 (1993). A well grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of 38 U.S.C.A. § 5107(a). Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). To be well grounded, a claim must be accompanied by supportive evidence, and such evidence must justify a belief by a fair and impartial individual that the claim is plausible. 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 38 U.S.C.A. § 5107(a ). Lathan v. Brown, 7 Vet. App. 359 (1995). In order for a claim for service connection to be well grounded, there must be competent evidence of a current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the inservice injury or disease and the current disability (medical evidence.) The nexus requirement may be satisfied by a presumption that certain diseases manifesting themselves within certain prescribed periods are related to service. Caluza v. Brown, 7 Vet. App. 498 (1995). In this case, the veteran contends that his military records reflect that he had borderline hypertension at various times during periods of active duty training in the middle to late 1970s. However, the entire service medical record is silent as to complaints, treatment, or diagnosis of hypertension. Moreover, there are no medical records of a diagnosis or treatment of hypertension in the year following his September 1977 discharge from the last period of active duty. The service medical records fail to show--and the veteran has not submitted evidence of--high blood pressure or hypertension in the middle to late 1970s, as alleged. While the veteran believes his hypertension was incurred in service, as a layman, he may not offer evidence that requires medical knowledge. Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). See also, Hyder v. Derwinski, 1 Vet. App. 221 (1991)(lay hypothesizing as to the etiology of a current disability is not credible, particularly if it is not supported by medical authority). What is lacking in establishing a well grounded claim is competent medical evidence of hypertension in service, within one year of separation from service, or a nexus between currently demonstrated hypertension and service. Consequently, the veteran has not met the initial burden under 38 U.S.C.A. § 5107(a) as the evidence submitted does not cross the threshold of mere allegation. Thus, the claim for hypertension is not well grounded as it lacks plausibility. II. Secondary Service Connection for a Lumbar Spine Disability Service medical records do not show any complaints, clinical findings, or diagnosis of a lumbar spine disability. On VA examination in November 1962, the veteran complained of pain in the lower back. There were no clinical findings or diagnosis referable to the lumbar spine. In February 1984, medical records from a private hospital dated in March 1963 were received, indicating an impression of leg length inequality and low back pain. In March 1985, medical records from Aiken Community Hospital were received. A March 1963 clinical record notes that the veteran’s right leg was 7 millimeters shorter than his left leg. A December 1981 record indicates a complaint of low back pain over the lumbosacral joint and a diagnosis of lumbosacral spine pain. In November 1994, VA outpatient records were received, indicating that in October 1994 the veteran complained of low back pain and in November 1994 he underwent a magnetic resonance imaging (MRI). The MRI revealed a combination of posterior osteophyte and disc herniation at L1-2, L2-3, and L3-4, and spondylosis deformans of the upper lumbar spine. In February 1995, private and VA medical records were received. An October 1994 record from Cardiology Associates notes a diagnosis of acute lumbar strain. A November 1994 prescription form from Summerville Neurosurgery indicates that physiotherapy was ordered for the veteran’s lumbar and cervical spondylosis. A December 1994 record from St. Joseph Hospital notes a complaint of severe low back pain and moderately severe cervical pain. The veteran underwent therapy to decrease his lumbar pain. A January 1995 VA prescription form indicates that range of motion and strengthening exercises were ordered for the veteran’s cervical and lumbosacral spine. In March 1995, an EAMC record dated in February 1995 was received, indicating that a preliminary scout film on a upper gastrointestinal and barium swallow test demonstrated degenerative changes in the lumbar spine. In July 1995, VA and private medical records were received. Records dated from March to May 1995 from Walton Rehabilitation Care Center indicate that the veteran was evaluated and received physical therapy for his diagnosed neck and lower back pain. An April 1995 VA outpatient record indicates that the veteran had mild lumbar stenosis and foraminal impingement of L1-2 and L2-3. There was a complaint of cervical and lower back pain. On a June 1995 VA outpatient record, the veteran was diagnosed with cervical and lumbar spondylosis. Another June 1995 record indicates a diagnosis of mild lumbar stenosis with foramen impingement at L1-2 and L2-3. In September 1995, medical records dated in July and August 1995 were received, indicating treatment for lumbar spondylosis. In April 1996, medical records dated from September 1995 to February 1996 from the VA and the EAMC were received, indicating complaints and treatment of low back pain with lower extremity symptomatology. The diagnoses included chronic low back pain, multi-level lumbar spine degenerative disc and joint disease, herniated nucleus pulposus, and sciatica. In May 1996, a medical record dated in March 1996 from the EAMC, reflecting severe degenerative joint disease of the lumbar spine, and copies from medical texts and extracts concerning degenerative joint disease of the spine were received. On VA examination in June 1996, the veteran complained of low back pain over the previous two to three years. On examination, the range of motion of the lumbar spine was flexion to 75 degrees, extension to 10 degrees, rotation to 30 degrees, and lateral bending to 10 degrees. The motor examination of the lower extremities was 5/5, and sensation was intact. The deep tendon reflexes were +2 and symmetric, and Babinski’s tests were downgoing. The assessment was spondylosis. The examiner opined that there was no relation of the lumbar spine problems to the cervical problems and that the problems were “completely unrelated” although probably related to the same underlying degenerative process involving the veteran’s disks. The examiner also stated that the problems were not trauma-related, service-related in any way, or connected in any way to the veteran’s cervical spine. In October 1996, a medical record dated in May 1996 from the EAMC was received, indicating that the veteran’s low back pain was better. A January 1997 medical record from the EAMC indicates a medical history of degenerative joint disease with disk disease at L2-3. A November 1997 medical record indicates occasional low back pain radiating into the left lower extremity. As noted above in Part I in the reasons and bases for findings and conclusions with respect to the issue of service connection for hypertension, the applicable regulations are contained in 38 U.S.C.A. §§ 5107(a), 1110, 1131, 101(24). The Court’s holdings in Murphy, Tirpak, King, Lathan, and Caluza with respect to establishing a well grounded claim are also for application. Additionally, 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, see 38 C.F.R. § 3.303(d) (1998); and for a disability which is proximately due to or the result of a service connected injury, see 38 C.F.R. § 3.310 (1998). In this case, the veteran contends that the traumatic arthritis in his service connected cervical spine “migrated” to his lumbar spine and that he should therefore be service connected on a secondary basis. The service medical records do not show any complaints, treatment, or diagnosis of a lumbar spine disability. The VA and private medical evidence of record reveals that the veteran complained of lumbar and lumbosacral spine pain in 1962 and 1963, which is prior to his cervical spine injury in a 1975 motor vehicle accident. Following service, the medical evidence shows that the veteran’s initial complaint regarding the low back was in a December 1981 Aiken Community Hospital record. The next low back complaints in the medical record appeared in 1994 when the veteran was diagnosed with osteophyte and disc herniation at L1-2, L2-3, and L3-4 and with spondylosis deformans of the lumbar spine. Thereafter, the veteran was treated continuously for his lumbar spine problems; however, the medical records do not indicate a relationship between the lumbar spine disability and his cervical spine disability. In fact, the VA examiner in June 1996 specifically addressed the question of a nexus between the cervical and lumbar problems and opined that such problems were “completely unrelated” and that the lumbar problems were not connected in any way to the veteran’s cervical spine. In sum, the medical evidence of record does not show a connection between the veteran’s service connected cervical spine disability and his diagnosed osteophyte and disc herniation at L1-2, L2-3, and L3-4 and spondylosis deformans of the lumbar spine. In short, what is lacking in establishing a well grounded claim is evidence that the veteran’s service connected cervical spine disability caused or aggravated his lumbar spine disability. Without this medical evidence, the veteran has not met the initial burden under 38 U.S.C.A. § 5107(a) as the evidence submitted does not cross the threshold of mere allegation. Thus, the claim for service connection for a lumbar spine disability as secondary to a service connected cervical spine disability is not well grounded as it lacks plausibility and must therefore be denied. ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for a lumbar spine disability as secondary to a service connected cervical spine disability is denied. REMAND The Board notes that in a June 1986 decision it denied entitlement to service connection for a psychiatric disability as secondary to the service connected cervical spine disorder. The RO in July 1995, without considering the prior Board decision or whether new and material evidence had been submitted to reopen the claim, considered the issue on the merits. On an application to reopen a previously and finally disallowed claim, the RO must conduct a two-part analysis. See Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). First, it must be determined whether the evidence presented or secured since the prior final disallowance of the claim is new and material. See Colvin v. Derwinski, 1 Vet. App. 171, 174 (1991). New evidence is evidence that is not merely cumulative of other evidence in the record. Ibid. Evidence is material where it is relevant to and probative of the issue at hand and where it is of sufficient weight or significance (assuming its credibility, see generally, Justus v. Principi, 3 Vet. App. 510, 513 (1992)) 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. Sklar v. Brown, 5 Vet. App. 140, 145 (1993); Cox v. Brown, 5 Vet. App. 95, 98 (1993); Colvin, 1 Vet. App. at 174. However, in a recent case the United States Court of Appeals for the Federal Circuit determined that in imposing the requirement that there be a reasonable possibility of a changed outcome, the United States Court of Veterans Appeals in the Colvin case impermissibly ignored the definition of material evidence adopted by VA. Thus, that part of the Colvin test was overruled. Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). Second, if it is determined that the evidence is new and material, the Board must reopen the claim and evaluate the merits of the veteran's claim in light of all the evidence, both old and new. Masors v. Derwinski, 2 Vet. App. 181, 185 (1992 Once it has been determined that new and material evidence has been submitted to reopen the veteran’s psychiatric disability claim, the RO must now determine whether the evidence of record, both old and new, supports his claim for entitlement to service connection for a psychiatric disability as secondary to a service connected cervical spine disability. In view of the foregoing the RO must consider whether new and material evidence has been submitted to reopen the claim and, if so, whether all the evidence warrants a grant of service connection. With regard to the increased rating claim, the veteran contends that a rating in excess of 30 percent for his service connected cervical spine disability is warranted. He is currently service connected for limitation of motion of the cervical spine with traumatic arthritis and spinal stenosis at CC3-4, 4-5, and 6-7 and the disability is evaluated as 30 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5290, the maximum permitted under this code. However, in light of medical records that show there is a neuropathy associated with the veteran’s cervical spine, the RO must also consider the potential applicability of 38 C.F.R. § 4.71a, Diagnostic Code 5293, which permits a maximum rating of 60 percent. The medical evidence of record shows that from 1995 the veteran variously complained of numbing of his arms, radiating pain to the shoulders, and decreased grip strength on the right. On VA examination in June 1996 his cervical spine x-rays revealed degenerative changes involving facet joints from C3 below with mild to moderate disc disease at the levels of C4-5 and C6-7. A September 1997 VA record indicated that the veteran had a central herniated disc at the levels of C3-4 and C4-5 with cervical spinal cord compression at these levels. A March 1998 medical record showed that the veteran was diagnosed with degenerative disc disease. While this evidence reflects that the veteran has intervertebral disc disease, it is not clear from the record whether his neuropathy was either caused by or related in any way to his service connected cervical spine disability. Although a VA examiner opined in June 1996 that the veteran’s cervical problems were probably related to an underlying degenerative process involving the disks which was not trauma-related, the record is still ambiguous with regard to this question. Under the circumstances, a VA examination is in order to resolve the issue of whether the veteran has an intervertebral disc syndrome and if so, whether it is attributable or related to the veteran’s service connected cervical spine disability. Moreover, in light of the Court’s holding in Francisco v. Brown, 7 Vet. App. 55, 58 (1994), that the present level of disability is of primary concern in a claim for an increased rating, the Board requests evidentiary development to ensure that all pertinent up-to-date clinical evidence is obtained regarding the veteran’s claim for an increased rating for his cervical spine disability. Under the circumstances of this case, the Board finds that further assistance is required. Accordingly, the case is REMANDED to the RO for the following actions: 1. The RO should obtain all VA treatment records of the veteran which are not currently in the claims file and associate them with the claims file. 2. The RO should consider whether new and material evidence has been submitted to reopen the claim for service connection for psychiatric disorder as secondary to the service connected cervical spine disorder and, if so, whether all the evidence warrants service connection for a psychiatric disorder as secondary to the service connected cervical spine disorder. 3. Thereafter, the veteran should be afforded a VA examination in orthopedics and neurology to determine the current nature and severity of his service connected cervical spine disability. The claims folder must be made available to the examiner(s) prior to the examinations so that the pertinent aspects of the veteran’s military and medical history may be reviewed. Such tests as the examiner(s) deem necessary should be performed, to include range of motion studies. The RO should provide the examiner(s) with the criteria of Diagnostic Code 5290 and 5293. The examiner(s) should first set forth the limitation of motion of the cervical spine in relationship to Diagnostic Code 5290. Then the examiner(s) should state whether the veteran has intervertebral disc syndrome of the cervical spine and, if so, whether it is as likely as not due to the service connected cervical spine disorder. If the veteran has intervertebral disc syndrome of the cervical spine the examiner(s) should put forth the findings in relationship to that code. The examiner(s) should render an opinion whether the cervical spine disorder alone precludes employment. 4. If the veteran has intervertebral disc syndrome of the cervical spine and the RO determines that it is not service connected, the veteran should be informed of the decision and furnished appellate rights. 5. The RO should readjudicate the veteran’s claims and provide the veteran and his representative with a supplemental statement of the case. They should be afforded the applicable time to respond if the decision remains adverse to the veteran. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration, if appropriate. The veteran need take no action until otherwise notified, but he may furnish additional evidence and argument while the case is in remand status. Quarles v. Derwinski, 3 Vet. App. 129, 141 (1992); Booth v. Brown, 8 Vet. App. 109 (1995). The purpose of this REMAND is to obtain additional information and to ensure due process of law. No inference should be drawn regarding the final disposition of the claims as a result of this action. 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 Veterans Appeals 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. E. M. KRENZER Member, Board of Veterans' Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1998), a decision of the Board of Veterans’ Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans’ Judicial Review Act, Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The date that appears on the face of this decision constitutes the date of mailing and the copy of this decision that you have received is your notice of the action taken on your appeal by the Board of Veterans’ Appeals. Appellate rights do not attach to those issues addressed in the remand portion of the Board’s decision, because a remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1998). - 2 -