Citation Nr: 0117420 Decision Date: 06/29/01 Archive Date: 07/03/01 DOCKET NO. 98-08 519 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for a heart disorder as a result of exposure to herbicides and/or nerve gas. 2. Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Kenneth M. Carpenter, Attorney WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Douglas E. Massey, Associate Counsel INTRODUCTION The veteran served on active duty from February 1970 to April 1972. His claims come before the Board of Veterans' Appeals (Board) on appeal from a January 1998 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri, which denied the benefits sought on appeal. In this decision, the Board will adjudicate the issue of entitlement to service connection for a heart condition as a result of exposure to herbicides and/or nerve gas. The issue of entitlement to service connection for PTSD will be discussed in the remand portion of this decision. In a January 2001 brief, the veteran's representative appears to have raised issues concerning service connection for an anxiety disorder and schizophrenia. As these matters have not been procedurally developed for appellate review, the Board refers them back to the RO for appropriate action. FINDINGS OF FACT 1. All evidence necessary for an equitable resolution of the issue involving service connection for a heart condition has been obtained, and no further development is necessary to comply with the Veterans Claims Assistance Act of 2000. 2. No medical evidence establishes that the veteran suffers from an organic heart disorder related to his military service. CONCLUSION OF LAW A heart disorder was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107 (West 1991 & Supp. 2000); 38 C.F.R. §§ 3.102, 3.303 (2000). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran maintains that he currently suffers from a heart disorder as a result of having been exposed to herbicides and/or nerve gas while serving in Vietnam. In particular, he claims that he has an abnormal electrocardiogram (EKG) which is evidence of a heart disorder. For the reasons that follow, the Board disagrees and finds that the preponderance of the evidence is against the veteran's claim. I. Duty to Assist On November 9, 2000, the President signed the "Veterans Claims Assistance Act of 2000," Pub. L. No. 106-475 (2000) (to be codified at 38 U.S.C. §§ 5100-5103A, 5106-7, 5126) (VCAA), which modified the circumstances under which VA's duty to assist claimants applies, and how that duty is to be discharged. The law affects this claim as it was pending on the date of enactment of the new law. This law eliminates the concept of a well-grounded claim, redefines the obligations of VA with respect to the duty to assist, and supersedes the decision of the United States Court of Appeals for Veterans Claims (Court) in Morton v. West, 12 Vet. App. 477 (1999), withdrawn sub nom. Morton v. Gober, No. 96-1517 (U.S. Vet. App. Nov. 6, 2000) (per curiam order) (holding that VA cannot assist in the development of a claim that is not well grounded). The new law also includes an enhanced duty to notify a claimant as to the information and evidence necessary to substantiate a claim for VA benefits. First, VA has a duty under the VCAA to notify the veteran and his representative of any information and evidence needed to substantiate and complete a claim. Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2096-97 (2000) (to be codified as amended at 38 U.S.C. §§ 5102 and 5103). The Board finds that the statement of the case and supplemental statements of the case, provided to both the veteran and his representative, specifically satisfy the requirement of 38 U.S.C.A. § 5103 of the new statute in that they clearly notify the veteran and his representative of the evidence necessary to substantiate his claim; specifically, these documents notify the veteran of the need for competent medical evidence showing that he currently has a heart disorder related to an incident, injury or disease during active service. The RO also notified the veteran of the presumptive provisions pertaining to exposure to herbicides. Under these circumstances, the Board finds that the notification requirement has been satisfied even though the RO did not have an opportunity to apply the specific provisions of the VCAA. Secondly, VA has a duty to assist the veteran in obtaining evidence necessary to substantiate his claim. Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2097-98 (2000) (to be codified at 38 U.S.C. § 5103A). The veteran has been afforded recent VA examinations in connection with his claim for service connection for a heart disorder, and was afforded a hearing before the undersigned member of the Board in May 2001. The veteran has not referenced any unobtained evidence that might aid his claim or that might be pertinent to the bases of the denial of his claim. The veteran testified that service medical records documented that he had a heart condition in service but that a commanding officer destroyed these records because he held a personal grudge against the veteran. As a result, the Board finds that any attempt to obtain any such records would be futile. See Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2097-98 (2000) (stating that the efforts to obtain outstanding relevant records shall continue until the records are obtained unless it is reasonably certain that such records do not exist or that further efforts to obtain those records would be futile.) The Board also points out that the veteran submitted a written statement which was received by the Board in June 2001. The veteran, in essence, stated that he collapsed and suffered a mild heart attack in service, and that VA falsified his records. As this is merely another lay statement by the veteran in support of his claim, the Board finds that RO consideration of this evidence in not necessary. 38 C.F.R. § 19.37(b) (2000). The Board thus finds that VA has done everything reasonably possible to assist the veteran and that no further action is necessary to meet the requirements of the VCAA. Accordingly, under the circumstances of this case, a remand would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements in the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of he result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). II. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). In addition, certain chronic diseases, such as cardiovascular disease and hypertension, may be presumed to have been incurred in service if manifest to a compensable degree (10 percent) within one year of discharge from service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137 (West 1991 & Supp. 2000); 38 C.F.R. §§ 3.307, 3.309 (2000). "Generally, to prove service connection, a claimant must submit (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus between the current disability and the in-service disease or injury." Pond v. West, 12 Vet. App. 341, 346 (1999). Service connection may also 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. 38 C.F.R. § 3.303(d). Where the determinative issue involves a medical diagnosis, competent medical evidence is required. This burden typically cannot be met by lay testimony because lay persons are not competent to offer medical opinions. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). In addition to these regulations, a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era, and has a disease listed in 38 C.F.R. § 3.309(e), shall be presumed to have been exposed during such service to an herbicide agent, such as Agent Orange, unless there is affirmative evidence to establish that he or she was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iii). If a veteran was exposed to Agent Orange during active military, naval, or air service, the following diseases shall be service-connected, if the requirements of 38 C.F.R. § 3.307(a) are met, even if there is no record of such disease during service: chloracne or other acneform diseases 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 lungs, bronchus, larynx, or trachea), and soft-tissue sarcomas. 38 C.F.R. § 3.309(e). Thus, service connection may be presumed for residuals of Agent Orange exposure by showing two elements. First, a veteran must show that he served in the Republic of Vietnam during the Vietnam War era. 38 U.S.C.A. § 1116 (West 1991); 38 C.F.R. § 3.307(a)(6). Second, the veteran must be diagnosed with one of the specific diseases listed in 38 C.F.R. § 3.309(e). Brock v. Brown, 10 Vet. App. 155, 162 (1997). If a disorder is not listed in 38 C.F.R. § 3.309(e), the presumption of service connection related to Agent Orange is not available, and the presumption of exposure to herbicides is also precluded. McCartt v. West, 12 Vet. App. 164 (1999). However, even if an appellant is found not entitled to a regulatory presumption of service connection, the claim must still be reviewed to determine if service connection can be established on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed Cir. 1994) (holding that the Veterans' Dioxin and Radiation Exposure Compensation Standards (Radiation Compensation) Act, Pub. L. No. 98-542, § 5, 98 Stat. 2724, 2727- 29 (1984), does not preclude a veteran from establishing service connection with proof of actual direct causation). Finally, to the extent that the veteran's claims of exposure to "nerve" gas constitute a claim that he was exposed to a specified vesicant agent in service, the Board notes that service connection may be established on a presumptive basis for certain conditions (including chronic conjunctivitis, keratitis, corneal opacities, scar formation, nasopharyngeal cancer, laryngeal cancer, lung cancer (except mesothelioma), squamous cell carcinoma, or a chronic form of laryngitis, bronchitis, emphysema, asthma or chronic obstructive pulmonary disease or acute nonlymphocytic leukemia) if, during active military service, the veteran had full-body exposure to nitrogen or sulfur mustard or Lewisite and subsequently develops the condition. 38 C.F.R. § 3.316 (2000). III. Discussion In the present case, the veteran's military records reflect that he served in the Republic of Vietnam during the Vietnam era. However, his service medical records make no reference to any cardiovascular problems. Of particular relevance, his separation examination performed in April 1972 reflects that his blood pressure was 108/70, with a pulse of 72 beats per minute. No cardiovascular abnormalities were identified. Post-service medical records also fail to show that the veteran suffers from a heart disability related to his military service. A November 1997 Holter monitor report from the Ozarks Medical Center shows a normal sinus rhythm with rare atrial premature depolarizations and ventricular premature depolarizations. The veteran also underwent a VA examination in November 1997, at which time he claimed that he had been diagnosed with an abnormal EKG. He reported infrequent dizziness when standing, but denied chest pain, shortness of breath, angina, abnormal sweating, nausea, and syncope. Physical examination showed a blood pressure reading of 122/80 while sitting and 124/80 while lying down. An EKG showed a normal sinus rhythm with a non-specific and T-wave abnormality. The examiner discussed these findings with the chief of medicine who also reviewed the EKG report. Although the chief of medicine could not explain the non- specific ST-T wave, she said it was not uncommon and was an otherwise normal sinus rhythm. Under the diagnosis section, the examiner noted "electrocardiogram normal sinus rhythm, nonspecific ST-T wave abnormality." The veteran was afforded a VA cardiovascular examination in January 1998. The veteran reported a history of collapsing in 1971, 1993 and 1995. However, the examiner found no significant cardiac history. A multigated angiogram (MUGA) scan was performed which showed a normal left ventricular ejection fraction (LVEF) of 55% without focal wall motion abnormality. The examiner concluded that there was no rheumatic heart disease, no arteriosclerotic heart disease, no hypertension, and no heart disability present. At a May 2001 hearing before the undersigned member of the Board, the veteran expressed his belief that he currently suffered from a heart condition as a result of having been exposed to herbicides and nerve gas while serving in Vietnam. He related an incident in which he was standing near an unidentified canister when it was opened. He said he was able to smell what be believed to be gas. He said he began to walk away but collapsed after walking only twelve feet. He alleged that another soldier who was also standing nearby had died a week later. After this incident, he said the gas in the container was sprayed in a room and that he and other soldiers were ordered to enter the room and inhale the fumes, which had a sweet scent. In addition, the veteran said he was exposed to Agent Orange while in Vietnam, which he described as a large white cloud. He stated that heart problems were identified on several occasions in service, including a medical examination performed in 1972 in Brooklyn, New York, but that all pertinent records were destroyed by a superior who resented the veteran because of a period in which he was absent without leave (AWOL). In correspondence received at the Board in June 2001, the veteran stated that he collapsed and suffered a mild heart attack in service. He then accused VA of falsifying his records, but did not elaborate. He also reported a family history of heart disease, stating that his biological father received a medical discharge from the military for a bad heart. After reviewing the merits of the case, the Board finds that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for a heart disorder as a result of exposure to herbicides and/or nerve gas. The veteran's service in the Republic of Vietnam during the Vietnam War era is not in dispute. However, the veteran has not presented medical evidence establishing that he currently has an organic heart disability related to his military service. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (in the absence of proof of the presently claimed disability, there can be no valid claim). The only objective finding includes a findings of a non-specific and T-wave abnormality on EKG examination, which, by itself, does not constitute a disability as the January 1998 cardiologist found no rheumatic heart disease, no arteriosclerotic heart disease, no hypertension and, fact, no heart disability at all. The Board notes that a VA physician said the EKG finding was not uncommon and was an otherwise normal sinus rhythm. Despite the veteran's assertions that he currently suffers from a heart condition, as a layperson without medical expertise or training, his statements alone are insufficient to establish the presence of this claimed disability. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993) (lay assertions of medical etiology cannot constitute evidence to render a claim well grounded under section 5107(a)); Espiritu, 2 Vet. App. at 494-495 (laypersons are not competent to render medical opinions). Thus, the veteran's statements concerning the presence of a current heart disability related to service are of limited probative value, particularly in light of the medical evidence showing no such disorder. In conclusion, the Board finds that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for a heart disability. Accordingly, there is not an approximate balance of positive and negative evidence to which the benefit-of-the-doubt standard applies. VCAA, Pub. L. No. 106-475, § 4, 114 Stat. 2096, 2098-99 (2000). Thus, the appeal is denied. ORDER Entitlement to service connection for a heart disorder as a result of exposure to herbicides and/or nerve gas is denied. REMAND The veteran claims that he currently suffers from PTSD as a result of having been assaulted on two occasions while serving in Vietnam. He related that the first incident occurred while playing soccer with some kids in Saigon, at which time two Vietnamese civilians approached him and knocked him down. He said he received no medical attention but reported the incident to a Lieutenant Commander Whitman. He said the second incident occurred while walking down a street in Saigon after a night of drinking. He reported that a scuffle broke out after he felt someone place a knife to his back. He stated that the man hit him in the eye with a rock and tore his tear duct. He said he received medical attention in Saigon and was later transferred to Fitzsimmons after stopping in Japan. He said he later went AWOL. In correspondence received in June 2001, the veteran stated that "I had to go off base to capture a V.C. who took shots at us was scared at first and that still bothers me and not the part of getting him except the worry (stress) of others and him getting the drop on me. They told me they shot him." This appears to be the first time the veteran raised this stressor. Service connection for PTSD requires the following three elements: [1] medical evidence establishing a diagnosis of the disorder; [2] credible supporting evidence that the claimed in-service stressor actually occurred; and [3] a link, established by the medical evidence, between current symptomatology and the claimed in-service stressor. See 38 C.F.R. § 3.304(f) (2000); Cohen v. Brown, 10 Vet. App. 128, 137 (1997). The evidence necessary to establish the occurrence of a stressor during service to support a claim for PTSD will vary depending on whether the veteran was "engaged in combat with the enemy." Hayes v. Brown, 5 Vet. App. 60, 66 (1993). If it is determined through military citations or other supportive evidence that a veteran engaged in combat with the enemy, and the claimed stressors are related to combat, the veteran's lay testimony regarding the reported stressors must be accepted as conclusive evidence as to their actual occurrence and no further development or corroborative evidence will be necessary, provided that the veteran's testimony is found to be satisfactory, e.g., credible, and "consistent with the circumstances, conditions, or hardships of such service." 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d), (f). However, if it is determined that a veteran did not engage in combat with the enemy, or the claimed stressor is not related to combat, the veteran's lay testimony alone will not be enough to establish the occurrence of the alleged stressor. In such cases, the record must contain some corroborative evidence which substantiates or verifies the veteran's testimony or statements as to the occurrence of the claimed stressors. Such corroborative evidence cannot consist solely of after- the-fact medical nexus evidence. Moreau v. Brown, 9 Vet. App. 389 (1996). In reviewing the veteran's PTSD claim, the Board notes that since the veteran's principal claimed stressors, two in- service assaults, are not combat-related stressors, the record must contain evidence which corroborates the veteran's claim as to the occurrence of these claimed stressors. The Board notes that the veteran's service medical records do indicate that the veteran was struck in the eye in August 1971 by a rock thrown by a Vietnamese civilian. However, the other stressors related by the veteran have yet to be verified. The Board observes that, during the pendency of the veteran's appeal, the Court issued a decision in Patton v. West, 12 Vet. App. 272, 277 (1999), in which it noted that in the particular case of claims of PTSD due to a personal assault, VA has established special procedures for evidentiary development. These procedures, which became effective in February 1996, take into account the fact that since personal assault is an extremely sensitive issue, many incidents of personal assault are not officially reported, and victims of this type of in-service trauma may find it difficult to produce evidence to support the occurrence of the stressor. These procedures thus acknowledge the difficulty veterans face in establishing the occurrence of the stressor through standard evidence, and the need for development of alternate sources of evidence. See VA Adjudication Procedure Manual M21-1 (hereinafter Manual M21- 1), Part III, paragraph 5.14c (Feb. 20, 1996) (substantially enlarging on the former Manual M21-1, Part III, paragraph 7.47c(2) (Oct. 11, 1995)). Alternate sources that may provide credible evidence of an in-service personal assault include medical or counseling treatment records following the incident, military or civilian police reports, reports from crisis intervention or other emergency centers, statements from confidants or family, copies of diaries or journals, or behavior changes documented or observed at the time of the incident, such as obsessive behavior at the time of the incident, termination of primary relationships, or alcohol and drug abuse. Evidence that documents any such behavioral changes may require interpretation by a VA neuropsychiatric physician to determine whether such evidence bears a relationship to the medical diagnoses. See M21-1, Part III, para. 5.14(c)(9). Furthermore, these provisions recognize that the standard PTSD stressor letter may be inappropriate for this type of PTSD claim, and thus state that if the claimed stressful incident is a personal assault, a stressor development letter specifically tailored for personal assault cases should be sent to such veterans. See M21-1, Part III, para. 5.14(c)(6). In addition, the Court in Patton noted that in two places the MANUAL M21-1, Part III, 5.14(c)(3) and (9), appears improperly to require that the existence of an in- service stressor be shown by "the preponderance of the evidence" and holds that any such requirement, however, would be inconsistent with the benefit of the doubt, or equipoise, doctrine contained in 38 U.S.C. § 5107(b). Therefore the evidence need only be in relative equipoise to prevail on the question of the existence of the stressor. The Court has held that the provisions in M21-1, Part III, 5.14(c), which address PTSD claims based on personal assault are substantive rules which are the equivalent of VA regulations, and are binding on VA. Cohen, 10 Vet. App. at 137; YR v. West, 11 Vet. App. 393, 398-99 (1998); Patton, 12 Vet. App. at 272. Under these circumstances, the Board finds that additional development in needed before it can adjudicate the veteran's claim for service connection for PTSD. The Board also points out that it is unclear from the record whether the veteran actually suffers from PTSD. At an October 1997 VA psychiatric examination, the examiner recorded the veteran's history concerning the two alleged assaults in Vietnam before conducting a mental status examination. The examiner determined that the veteran had an anxiety disorder and a history of alcohol abuse in full remission. It was noted that the veteran exhibited some symptoms of PTSD but did not meet the full criteria for such a diagnosis based on DSM-IV. At a VA psychiatric examination in September 1998, the veteran reported the incident in Vietnam in which "someone threw rocks at him." Following a mental status examination, the examiner concluded that the veteran's symptoms were not consistent with PTSD, given that he was able to sleep well and did not experience intrusive memories regarding Vietnam. Furthermore, the record shows that the veteran underwent psychiatric treatment at the Ozarks Medical Center from November 1997 to March 1998. Records from that facility reflect, in essence, that the veteran's symptoms were attributed to a diagnosis of paranoid schizophrenia. None of these reports mentions PTSD. On the other hand, however, several reports have recently been submitted which indicate that the veteran may suffer from PTSD. In February 1998, the veteran was evaluated by a VA psychologist who recorded the two incidents in which he was allegedly assaulted. The diagnostic impression was PTSD (provisional). In an August 1998 counseling report from AVA, a psychiatrist stated that the veteran had some symptoms of PTSD related to his tour of duty in Vietnam. The symptoms identified were nightmares, flashbacks, anxiety, and paranoia. A November 1998 progress note from Heart of the Ozarks Counseling Services also listed diagnoses of schizophrenia, paranoid type, and PTSD. It is therefore unclear whether the veteran suffers from PTSD. Accordingly, in light of the evidence of record and the recent amendment concerning the duty to assist, the Board finds that the veteran should be afforded a VA psychiatric examination to determine whether he suffers from PTSD, and, if so, whether it is related to any verified in-service stressors. See VCAA. Accordingly, the case is REMANDED for the following action: 1. The RO should contact the veteran and request that he identify any and all health care providers who have rendered treatment for his psychiatric disorder since the time of the last request for such information. The RO should also request from the veteran information regarding his claim for disability benefits with the Social Security Administration (SSA). After obtaining any necessary authorization, any identified treatment records not presently associated with the claims file should be secured and associated with the claims file. As well, any available SSA records, including related medical records, relevant to the veteran's disability claim with that agency should be requested and associated with the claims folder. If no additional records have been identified or are otherwise unavailable, the RO should so indicate. 2. The RO should provide the veteran with a personal assault letter and questionnaire to be filled out and returned, in accordance with M21-1, Part III, § 5.14(c), in order to obtain as much information as possible about the personal assault incidents in service, to include a detailed description of the pertinent incidents, with all pertinent dates and locations, as well as the complete names and unit designations of others who have knowledge of the incidents. 3. The RO should afford the veteran the opportunity to submit any additional evidence in support of his claim for service connection for PTSD, to include statements from relatives. He should be asked to provide any additional information possible regarding the stressful events claimed to have caused PTSD and to identify potential alternative sources for supporting evidence regarding the stressors he alleges occurred in service. In particular, the veteran should provide as much detailed information as possible including the dates, places, names of people present, and detailed descriptions of events. The veteran is advised that this information is necessary to obtain supportive evidence of the stressful events and that he must be as specific as possible because without such details an adequate search for verifying information can not be conducted. The RO should then request any supporting evidence from alternative sources identified by the veteran and any additional alternative sources deemed appropriate, including military police records, if the veteran has provided sufficiently detailed information to make such request feasible. 4. The RO should then review the file and make a specific written determination, in accordance with the provisions of 38 C.F.R. § 3.304(f) and M21-1, Part III, 5.14(c), with respect to whether the veteran was exposed to a stressor in service, and, if so, the nature of the specific stressor(s) established by the record. In reaching this determination, the RO should address any credibility questions raised by the record. 5. Thereafter, the veteran should be afforded a VA psychiatric examination. The claims file, a separate copy of this remand, and a list of the stressor(s) found by the RO to be corroborated by the evidence must be provided to the examiner for review, the receipt of which should be acknowledged in the examination report. The examiner must determine whether the veteran has PTSD and, if so, whether the in-service stressor(s) found to be established by the RO is sufficient to produce PTSD. The examiner should be instructed that only the verified events listed by the RO may be considered as stressors. The examiner should utilize the DSM-IV in arriving at diagnoses and identify all existing psychiatric diagnoses. If PTSD is diagnosed, the examiner must explain whether and how each of the diagnostic criteria is or is not satisfied, and identify the stressor(s) supporting the diagnosis. A complete rationale must be given for any opinion expressed and the foundation for all conclusions should be clearly set forth. The report of the psychiatric examination should be associated with the veteran's claims folder. 6. The RO must then review the examination report to ensure that it is in complete compliance with the directives of this REMAND, and, if not, the RO should implement corrective procedures. The RO must also review the claims file and ensure that all notification and development action required by the Veterans Claims Assistance Act of 2000, Pub. L. No. 106- 475, 114 Stat. 2096 (2000) is completed. 7. When the development requested has been completed, the RO should readjudicate the veteran's claim of entitlement to service connection for PTSD with consideration of all pertinent law, regulations, and M21-1, Part III, 5.14(c). Any additional action required to comply with the notice and development requirements of the Veterans Claims Assistance Act of 2000 should also be undertaken. If the benefit sought is not granted, the veteran and his attorney should be furnished a supplemental statement of the case, and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. The purpose of this REMAND is to obtain additional development and adjudication, and the Board does not intimate any opinion as to the merits of the case, either favorable or unfavorable, at this time. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). No action is required of the veteran until he is notified. S. L. KENNEDY Member, Board of Veterans' Appeals