Citation Nr: 0119681 Decision Date: 07/31/01 Archive Date: 08/07/01 DOCKET NO. 94-41 385 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Portland, Oregon THE ISSUES 1. Whether new and material evidence has been obtained that is sufficient to reopen a claim of entitlement to service connection for a vision disability. 2. Whether new and material evidence has been obtained that is sufficient to reopen a claim of entitlement to service connection for a lung disability. 3. Entitlement to service connection for a psychiatric disability. REPRESENTATION Appellant represented by: AMVETS WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Vito A. Clementi, Counsel INTRODUCTION The appellant had active duty from June 1965 to June 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decision of the Portland, Oregon, Department of Veterans Affairs (VA) Regional Office (RO). The record reflects that at a May 2001 Travel Board hearing, the appellant withdrew a pending claim of entitlement to an increased disability rating for a right finger disability. That claim is no longer before the Board for appellate review. The record also reflects that the appellant is in receipt of non-service-connected pension benefits, which were granted by rating decision dated in June 1995. During the pendency of this matter, the Veterans Claims Assistance Act of 2000 ("VCAA") was made law, and provides that VA shall make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the claimant's claim for a benefit under a law administered by the Secretary, unless no reasonable possibility exists that such assistance would aid in substantiating the claim. In part, the VCAA specifically provides that VA is required to make reasonable efforts to obtain relevant governmental and private records that the claimant adequately identifies to VA and authorizes VA to obtain. The VCAA further provides that the assistance provided by the Secretary shall include providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary, as further defined by statute, to make a decision on the claim. VCAA, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, __ (2000) (to be codified at 38 U.S.C.A. § 5103A). Of relevance to this inquiry, the VCAA specifically provides that there is nothing in its provisions as to the duty to assist to require VA to reopen a claim that has been disallowed, except when new and material evidence has been presented or secured. VCAA, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2097-98 (2000) [to be codified at 38 U.S.C. § 5103A(f))]. Having reviewed the record in light of the VCAA as well as other applicable law, the Board is of the opinion that the appellant's attempt to reopen claims of entitlement to service connection for a vision disability and for a lung disorder are ready for appellate review. The appellant's reopened claim for a lung disorder, and his initial claim to establish service connection for a psychiatric disorder, will be remanded for further development. FINDINGS OF FACT 1. Service connection for a vision disorder was denied by rating decision dated in December 1981 and not appealed. 2. Since the December 1981 decision denying service connection for a vision disorder, evidence has not been obtained or reported to exist that bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 3. Service connection for a lung disorder was denied by rating decision dated in December 1981 and not appealed. 4. Since the December 1981 decision denying service connection for a lung disorder, evidence has been obtained or reported to exist that bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. CONCLUSIONS OF LAW 1. New and material evidence has not been submitted to reopen the claim of entitlement to service connection for a vision disorder. 38 U.S.C.A. §§ 5108, 7105(c) (West 1991); 38 C.F.R. § 3.156 (2000). 2. New and material evidence has been submitted to reopen the claim of entitlement to service connection for a pulmonary disorder. 38 U.S.C.A. §§ 5108, 7105(c) (West 1991); 38 C.F.R. § 3.156 (2000). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Preface As to the appellant's attempt to reopen his claims, applicable law provides that RO decisions which are unappealed become final. 38 U.S.C.A. 7105; 38 C.F.R. 20.1103. Once a decision becomes final, new and material evidence is required to reopen the claim which was denied. 38 U.S.C.A. 5108 provides that "[I]f new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim." In determining whether to reopen previously and finally denied claims, the Board must apply a sequential analysis. See Elkins v. West, 12 Vet. App. 209 (1999). First, VA must determine whether the claimant has presented new and material evidence under 38 C.F.R. 3.156(a) in order to have a finally denied claim reopened under 38 U.S.C.A. 5108. By "new and material evidence" is meant "evidence not previously submitted to agency decisionmakers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim." In Hodge v. West, 155 F. 3d 1356 (Fed. Cir. 1998), it was noted that such evidence could be construed as that which would contribute to a more complete picture of the circumstances surrounding the origin of a veteran's injury or disability, even where it would not be enough to convince the Board to grant the claim. If new and material evidence has been presented, the claim must be reopened, and the Board must determine whether, based upon all the evidence of record in support of the claim, VA has complied with its statutory duty to assist. See 38 U.S.C. 5103(b). Following this determination, the Board may then proceed to evaluate the merits of the claim. See also Winters v. West, 12 Vet. App. 203 (1999). It has been held that VA is required to review for newness and materiality only the evidence submitted by a claimant since the last final disallowance of a claim on any basis in order to determine whether a claim should be reopened and readjudicated on the merits. Evans v. Brown, 9 Vet. App. 273, 283 (1996). The newly presented evidence need not be probative of all the elements required to award the claim, but need be probative only as to each element that was a specified basis for the last disallowance. Id. at 284. The law provides that evidence proffered by the appellant to reopen his claim is presumed credible for the limited purpose of ascertaining its materiality, but it must be of such significant import that it must be considered in order to fairly decide the merits of the appellant's claim. See Spalding v. Brown, 10 Vet. App. 6, 10 (1997); Justus v. Principi, 3 Vet. App. 510, 512 (1992). The submission of "new and material" evidence is a jurisdictional prerequisite to the Board's review of such an attempt to reopen a claim. Absent the submission of evidence that is sufficient to reopen the claim, the Board's analysis must cease. See Barnett v. Brown, 83 F.3d 1380, 1383 (Fed.Cir. 1996); Butler v. Brown, 9 Vet. App. 167, 171 (1996); McGinnis v. Brown, 4 Vet. App. 239, 244 (1993). The Board may not then proceed to review whether the duty to assist has been fulfilled. Reopening of the claim of entitlement to service connection for a vision disability Factual Background During the course of his pre-enlistment physical examination in April 1964, the appellant reported that he had worn prescription eyewear for correction of astigmatism two years previously, but that he was not then wearing eyeglasses. The appellant underwent service department physical examinations in June 1965 and in June 1967, both reflecting normal vision. In his initial application for service-connected disability compensation received in October 1978, the appellant alleged that he had a vision disability due to being exposed to sonar and radar scopes while serving on active duty. He underwent a vision examination conducted by G.H.H., M.D., in January 1980. The appellant was diagnosed to have a moderate myopic, non-progressive astigmatism. By rating decision dated in December 1981, service connection was denied for a vision disorder. The RO noted that the appellant's sole vision abnormality was myopic astigmatism with a corrected vision of 20/20. The appellant sought to reopen his claim by application received in June 1993. He underwent a VA vision examination in September 1993, and reported that he was having increasing difficulty with near vision. He was diagnosed to have mild hyperopic astigmatism. In May 2001, the appellant testified before the undersigned at a Travel Board hearing, and reiterated prior contentions. The appellant further stated that since he left service, he had developed headaches, which he attributed to his blurred vision. Analysis The evidence of record at the time of the unappealed December 1981 rating decision may be characterized as indicating: 1. During his active naval service, there were no abnormalities of the appellant's vision noted, and; 2. In October 1978, the appellant was diagnosed to have a moderate myopic, non-progressive astigmatism. In order to reopen his claim, the appellant argued that his vision disorder was caused by his exposure to radar and sonar scopes while serving on active naval duty. The appellant has not submitted new and material evidence that is sufficient to reopen his claim. As is noted above, it is well-settled in the law that the competent subjective reports of claimants are presumed to be credible in the first stage of determining whether new and material evidence has been presented. Justus, supra. However, the appellant's theory as to the cause of his stigmatism is plainly not competent. There is no evidence to suggest that the appellant, as a layperson, is competent to render such an opinion, and as such it is entitled to no weight. Cromley v. Brown, 7 Vet. App. 376, 379 (1995); Boeck v. Brown, 6 Vet. App. 14, 16 (1993); Grivois v. Brown, 6 Vet. App. 136, 140 (1994); Fluker v. Brown, 5 Vet. App. 296, 299 (1993); Moray v. Brown, 5 Vet. App. 211, 214 (1993); Cox v. Brown, 5 Vet. App. 93, 95 (1993); Clarkson v. Brown, 4 Vet. App. 565, 567 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). The appellant has also not alleged that any competent physician has reported his vision disability to have been caused by his naval service. In this respect, the record does not indicate the existence of any evidence "not previously submitted to agency decisionmakers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim." 38 C.F.R. § 3.156(a); Hodge, supra. As noted, there is nothing in the VCAA that requires VA to reopen a claim in the absence of new and material evidence or the report of its existence. Because such has not been reported or obtained, reopening of the claim is denied. Reopening of the claim of entitlement to service connection for a lung disability Factual Background The appellant's service medical records are devoid of any mention of complaint, symptom, or diagnosis of any pulmonary disorder. The appellant's service personnel records reflect that as a member of the U.S. Naval Reserve, he entered active duty in June 1965 for a period of 24 months, and was continually assigned to the U.S.S. O'Brien (DD 725). In October 1978, the appellant was hospitalized at a VA facility and underwent right and left thoracotomies with pleurodeses. It was noted that the appellant had been admitted after sustaining a right-sided spontaneous pneumothorax. It was noted that the appellant was then smoking between two to three packs of cigarettes per day. He was advised to stop smoking, although the physician noted that the appellant was continuing to smoke when discharged from the hospital. In a statement received in December 1979, the appellant alleged that his lung condition was caused by in-service exposure to asbestos. He stated that his symptoms of coughing began during such service. The appellant underwent a VA physical examination in February 1980. He reported that he began smoking from one to one and one-half packs of cigarettes per day beginning in 1964, and that he had a chronic cough since 1965. He reported that he was still smoking about one half of a pack of cigarettes per day. He reiterated that he was exposed to asbestos in service. He was diagnosed to have chronic obstructive pulmonary disease and bilateral emphysematous blebs. In a March 1980 statement, E.L.M., M.D., a VA physician, reported that the appellant's recent pulmonary function tests demonstrated moderately severe obstructive emphysema, and that radiographic examination detected residuals of old fibrosis or pleural reaction in both of the upper thoraces. In September 1981, the appellant submitted a VA Herbicide Exposure questionnaire. In part, he reported that while he was serving off of the coast of Vietnam, he was exposed to the herbicide "Agent Orange" during "Operation Ranch Hand." During a further VA medical examination in November 1981, the appellant reiterated that he had been exposed to asbestos and herbicides while serving on active naval duty. As to the former, he reported that asbestos powder could be seen coming from the ship's insulation when guns were fired, and that the vessel's steam pipes were all insulated with the material. He also claimed that his vessel came close to the shoreline where herbicides were being used between 1965 to 1967, and that dispersing aircraft flew overhead frequently. It was noted that the appellant was still smoking about a quarter of a pack of cigarettes per day. In its December 1981 rating decision, the RO denied service connection for a pulmonary disorder on the bases that there was no evidence the appellant was exposed to herbicides while on active duty. It also noted that the appellant had been denied service connection for a lung disorder in April 1980 on the basis that there was no evidence that the appellant had been exposed to asbestos in service, as he claimed. The appellant sought to reopen his claim by application received in June 1993. He underwent a VA pulmonary examination in September 1993, and reiterated a history of asbestos and herbicide exposure. It was noted that the appellant was then smoking a half of a pack of cigarettes per day. The appellant was diagnosed to have emphysema. Although the appellant reported being exposed to "Agent Orange," it was noted that he then showed no evidence of chloracne or neoplasms. In a statement received in February 1994, the appellant claimed that when on active naval service, he was told by a ship's physician that he had been exposed to "Agent Orange." He added that he had stood on the decks of the vessel U.S.S. O'Brien as helicopters flew over the ship to spray the waters with the substance in an effort to kill fish and diminish the enemy's food supply. In his substantive appeal, the appellant claimed that at the time of his October 1978 thoracotomies, he was informed by two physicians that he had "Agent Orange in [his] system." The appellant underwent a VA physical examination in November 1994. The appellant reported that he was continuing to smoke from one-quarter to one-half of a pack of cigarettes per day, and a history of smoking at least 40 packs per year. The appellant reported that he had been exposed to asbestos while in service. In part, the appellant was diagnosed to have chronic obstructive pulmonary disease, with evidence of a severe small airways disease. In a statement received in October 1996, the appellant stated that one of the VA physicians who informed him in October 1978 that he had "Agent Orange" in his system was E.M., who had performed his surgery. The appellant underwent a VA respiratory examination in March 1998. The examiner reported that the appellant's VA claims folder had been reviewed. However, he further observed that the appellant had: ". . . a history of spontaneous pneumothoraxes bilaterally in 1978. He had bilateral chest tubes, and in fact it sounds like he had a thoracotomy. Medical records from that period of time are not available, so I cannot elaborate further on the procedures that were done at that time." The examiner observed that the appellant had reported a history of asbestos exposure while in service, and that subsequent to service, the appellant worked as an automotive mechanic, a construction worker, and in shipyards. The examiner also noted that the appellant had a history of smoking from 50-60 packs of cigarettes per year and that he was then smoking approximately one pack of cigarettes per day. The appellant was diagnosed to have chronic obstructive pulmonary disease. Radiographic findings indicated hyperation and probable pulmonary fibrosis, which were noted to be compatible with a history of asbestos exposure and consistent with asbestosis, and bilateral pleural plaques compatible with asbestos-related disease. Subsequently received by the RO was a copy of the appellant's Social Security Administration disability file. In part, the file contains an October 1978 surgical report authored by T.A.P., M.D., reflecting that the appellant had reported to the emergency room at a private hospital with an acute episode of shortness of breath. It was noted that the appellant's past medical history was "essentially unremarkable," and that he had been involved in 3 automobile accidents - the last occurring about eight years previously and causing the appellant to have multiple contusions of the right ribs. In March 1999, the appellant testified at a personal hearing conducted at the RO. In substance, he reiterated his prior accounts of having been exposed to herbicides and asbestos during active naval service. In January 2000, a statement was received from a Navy Liaison office. The agency reported that it was unable to determine to what extent the appellant was exposed to asbestos during his service. It added that while general specifications for ships required that heated surfaces be covered with insulation at the time of the appellant's service, and it was "highly probable" that asbestos products were used, the probability to the appellant being exposed to asbestos as a seaman was minimal. In May 2001, the appellant testified before the undersigned at a Travel Board hearing, and reiterated prior contentions. Analysis The record at the time of the December 1981 denial of service connection for a lung disorder may be summarized as indicating: 1. The appellant served for two years of active duty aboard the U.S.S. O'Brien, a destroyer; 2. The appellant underwent bilateral thoracotomies in October 1978 after sustaining a right-sided spontaneous pneumothorax, without attribution as to its etiology; 3. In October 1978, the appellant had been smoking from two to three packs of cigarettes per day, and the appellant alleged that his lung condition may have been caused by in-service exposure to asbestos and herbicides, and; 4. In February 1980, the appellant was diagnosed to have chronic obstructive pulmonary disease and bilateral emphysematous blebs, and in March 1980 was found by radiographic examination to have residuals of old fibrosis or pleural reaction in both of the upper thoraces. Since the December 1981 denial of his claim, the appellant has continuously reiterated that he was exposed to asbestos and to herbicides during his active service. His account is not new, as it has been previously asserted. However, plainly "new" is the report received in January 2000 from an official of the Navy Liaison office, observing that it was "highly probable" that the appellant's vessel contained asbestos. Although the official commented that the probability to the appellant being exposed to such substance was minimal, this information provides the first confirmation of record to any degree that the appellant may have been so exposed. When this opinion is coupled with the March 1998 VA examination report, also "new" within the meaning of law, indicating that radiographic findings were compatible with a history of asbestos exposure and consistent with asbestosis and asbestos-related disease, the evidence in its whole is plainly material and must be considered within the context of all evidence of record. In sum, new and material evidence has been obtained with regard to the appellant's lung disorder, and the claim is reopened. ORDER New and material evidence not having been obtained, the claim of entitlement to service connection for a vision disorder is not reopened. New and material evidence having been obtained, the claim of entitlement to service connection for a lung disorder is reopened. REMAND Service Connection for a Lung Disorder Reasons for Remand Having found that new and material evidence has been submitted to reopen the claim in this matter does not terminate the Board's inquiry. Such a finding in the reopened claim places upon VA the duty to assist the appellant in the development of the claim by obtaining relevant records which could possibly substantiate the claim and conducting appropriate medical inquiry. See Peters v. Brown, 6 Vet. App. 540, 542 (1994); see 38 U.S.C.A. § 5107(a). Upon completion of this effort, the Board is required to assess the credibility, and therefore the probative value of proffered evidence of record in its whole. Owens v. Brown, 7 Vet. App. 429, 433 (1995); see Madden v. Gober, 125 F. 3d 1477, 1481 (Fed. Cir. 1997); Guimond v. Brown, 6 Vet. App. 69, 72 (1993); Hensley v. Brown, 5 Vet. App. 155, 161 (1993). As noted, one of the two pieces of critical evidence that served to reopen the claim was the March 1998 VA examination report indicating that as of that time, (i.e., 30 years after service), radiographic findings were consistent with a history of asbestos exposure. However, although the examiner reported that the appellant's VA claims folder had been reviewed, he further indicated that "medical records from that period of time are not available." The appellant's Social Security Administration file was subsequently received and included more comprehensive records of the development of the appellant's disorder, in particular the October 1987 spontaneous pneumothorax. It is now well-settled that the duty to assist includes the affording to the VA claimant a thorough and contemporaneous medical examination, accounting for all evidence of record. See Shipwash v. Brown, 8 Vet. App. 218, 222 (1995); Flash v. Brown, 8 Vet. App. 332, 339-340 (1995); Floyd v. Brown, 9 Vet. App. 88, 93 (1996). Moreover, in light of the fact that the appellant's spontaneous pneumothorax occurred approximately 10 years after he was discharged from active naval service, further medical inquiry is necessary to determine the merits of the claim. Allday v. Brown, 7 Vet. App. 517 (1995); Godfrey v. Brown, 7 Vet. App. 398 (1995); Traut v. Brown, 6 Vet. App. 495 (1994); Colvin v. Derwinski, 1 Vet. App. 171 (1991). Accordingly, the claim will be remanded as is set forth below. Service connection for a psychiatric disability Factual Background The appellant's service medical records are devoid of any mention of psychiatric complaints, symptoms or diagnoses. In February 1982, the appellant was hospitalized at a VA facility and diagnosed to have a personality disorder. The appellant underwent a VA psychiatric examination in August 1993. It was noted that the appellant worked as a truck driver, and that he worked in automobile repair from 1984 to 1986. The appellant reported that he had to leave the latter job because he was advised by physicians that he should not be exposed to automobile fumes. The appellant reported that he then owned and operated a tavern for two years. He reported that he then sold the business, and worked thereafter as a sandblaster and painter at a shipyard. In part, the appellant reported that he felt rejected because his working hours at his job were cut; that he felt betrayed by his family. The appellant was diagnosed to have a personality disorder, not otherwise specified, with borderline and paranoid tendencies. In a statement received in February 1994, the appellant related that while on active naval service aboard the vessel U.S.S. O'Brien, his "best friend" was killed and four others wounded. He stated that he participated in a rescue mission, where 15 Nationalist Chinese sailors were recovered from the South China Sea. He reported that the bodies of nine dead sailors were also recovered. [The Board observes that on December 23, 1966, the vessel U.S.S. O'Brien was engaged in an incident similar to that described by the appellant. See Dictionary of American Fighting Ships, Volume V, pp. 132-133 (1970).] During the March 1999 personal hearing and the May 2001 Travel Board hearings, the appellant reiterated prior accounts of his active naval service. During the former, the appellant related that he was having "flashbacks" and nightmares of his naval service, and that his friend A.P. was killed in December 1966. Reasons for Remand As noted above, under the VCAA, VA must afford the claimant a medical examination when it is "necessary to make a decision on the claim." VCAA, Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, ___ (2000) (to be codified as amended at 38 U.S.C. § 5103A(d)). The VA's duty to assist requires that the veteran be afforded a VA examination with respect to his disability, which should take into account the records of the veteran's prior medical history, and includes an opinion as to the etiology of his disability before a decision concerning his appeal can be made. See Pond v. West, 12 Vet. App. 341, 346 (1999); Moore v. Derwinski, 1 Vet. App. 401, 405 (1991). Service connection for PTSD requires medical evidence establishing a diagnosis of the condition, credible supporting evidence that the claimed in-service stressors actually occurred, and a link, established by medical evidence, between the current symptomatology and the claimed in-service stressors. 38 C.F.R. § 3.304(f). In order to ascertain whether the appellant has the disorder as claimed, a medical examination will be conducted upon remand. See also 38 U.S.C.A. § 1154(b) (West 1991); 38 C.F.R. § 3.304(d) (1999); see also Gregory v. Brown, 8 Vet. App. 563 (1996); Collette v. Brown, 82 F.3d 389 (Fed.Cir. 1996). Accordingly, these matters are REMANDED for the following development: 1. The RO should contact the appellant and his representative and ascertain if the appellant has received any VA, non- VA, or other medical treatment for the disorders at issue that is not evidenced by the current record. The appellant should be provided with the necessary authorizations for the release of any treatment records not currently on file. The RO should then obtain these records and associate them with the claims folder. At the same time as its effort in paragraph 1, above, the RO should request from the appellant: a. any further information as to dates, times, places, witnesses, or other data that would assist in corroborating his account of being exposed to asbestos or herbicides, and b. any further information as to dates, times, places, witnesses, or other data that would assist in corroborating his account of his claimed in-service stressors. The RO should conduct any necessary further investigation after receipt of the appellant's account. 2. After receipt of the information requested above, the RO should afford the appellant a pulmonary examination, to be conducted by an appropriately qualified physician, to ascertain whether the appellant's lung disorder was caused by in-service exposure to asbestos or herbicides. The appellant's claims folder, and a copy of this remand, must be reviewed by the physician conducting the examination, and such receipt and review must be acknowledged in any report generated. A copy of the letter or notice advising the appellant of the date, time, and place of the scheduled examination must be included in the claims folder. 3. Also after receipt of the information requested in paragraph 1 above, the RO should have the appellant scheduled for a psychiatric examination, to be conducted by an appropriately qualified physician, to ascertain whether the appellant has PTSD or other mental disorder caused or aggravated by active military service. The appellant's claims folder, and a copy of this remand, must be reviewed by the physician conducting the examination, and such receipt and review must be acknowledged in any report generated. A copy of the letter or notice advising the appellant of the date, time, and place of the scheduled examination must be included in the claims folder. The RO must specify the claimed stressors that have been verified by credible supporting evidence. The examining physician must review the accounts of the verified service stressors and state a medical opinion as to whether the appellant has PTSD as a result of the verified service stressors. 4. After completion of all requested development, the RO should review the appellant's claims. The RO should also ensure compliance with the VCAA, where applicable, in the adjudication of the veteran's appeal. If the actions taken remain adverse to the appellant, he and his representative should be furnished with a supplemental statement of the case. They should then be afforded a reasonable opportunity to respond. The RO and the appellant are advised that the Board is obligated by law to ensure that the RO complies with its directives, as well as those of the appellate courts. It has been held that compliance by the Board or the RO is neither optional nor discretionary. Where the remand orders of the Board or the Courts are not complied with, the Board errs as a matter of law when it fails to ensure compliance. Stegall v. West, 11 Vet. App. 268, 271 (1998). No action is required of the appellant until further notice is obtained. However, the Board takes this opportunity to advise the appellant that the conduct of the efforts as directed in this remand, as well as any other development directed by the RO, is necessary for a comprehensive and correct adjudication of his claims. 38 C.F.R. § 3.655(b). The appellant's cooperation in the RO's efforts is both critical and appreciated. However, the appellant is further advised that his failure to report for any scheduled examinations without good cause may result in the claim being considered on the evidence now of record or denied. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). 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 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. 2000) (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. G. H. SHUFELT Member, Board of Veterans' Appeals