Citation Nr: 0200273 Decision Date: 01/09/02 Archive Date: 01/16/02 DOCKET NO. 95-18 908 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in White River Junction, Vermont THE ISSUES 1. Entitlement to service connection for rheumatoid arthritis as secondary to exposure to Agent Orange. 2. Entitlement to an effective date earlier than June 7, 1996, for special monthly pension based on the need for the aid and attendance of another person. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. Shawkey, Counsel INTRODUCTION The veteran served on active duty from June 1970 to February 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from April 1994 and October 1996 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in White River Junction, Vermont. In the April 1994 rating decision, the RO denied the veteran's claim for entitlement to service connection for rheumatoid arthritis as secondary to exposure to Agent Orange. In the October 1996 rating decision, the RO granted entitlement to special monthly pension based on the need for aid and attendance, effective June 7, 1996. This case was previously before the Board in April 1999 at which time it was remanded to the RO pursuant to the veteran's request for a Travel Board hearing. After several communications between the RO and the veteran regarding scheduling the veteran for a Travel Board Hearing, the veteran stated in November 2001 that he did not want a Travel Board Hearing at that time. In October 2000, the veteran filed an informal claim of service connection for loss of teeth secondary to exposure to Agent Orange. He withdrew this claim in writing in April 2001. In numerous statements as recent as November 2001, the veteran alleged that the RO committed clear and unmistakable error in the November 1989 assignment of a 60 percent rating for his nonservice-connected rheumatoid arthritis. Specifically, the veteran contends that the RO used the wrong diagnostic codes in rating his rheumatoid arthritis and that he should have been rated at 100 percent. As this matter has not been developed for appellate review, it is referred to the RO for appropriate action. The issue of entitlement to service connection for rheumatoid arthritis as secondary to exposure to Agent Orange is deferred pending the completion being sought in the remand below. FINDINGS OF FACT 1. In July 1987, the veteran filed a claim for nonservice- connected pension benefits which the RO granted, becoming effective in July 1987. 2. On June 7, 1996, the veteran filed a claim for special monthly pension based on the need for the aid and attendance of another person. 3. The first evidence showing a need for aid and attendance was the veteran's June 7, 1996, claim, as well as an Aid and Attendance questionnaire received on that date containing a physician's statement that the veteran had problems dressing and undressing on his own. 4. The evidence does not show that the veteran met the criteria for entitlement to an award of special monthly pension based on the need for aid and attendance prior to June 7, 1996. CONCLUSION OF LAW The criteria for an effective date earlier than June 7, 1996, for the grant of special monthly pension based on the need for aid and attendance have not been met. 38 U.S.C.A. §§ 1521(d), 5110(a) (West 1991); 38 C.F.R. §§ 3.155, 3.351(a)(1),(b),(c) 3.352(a), 3.400, 3.401 (2001). REASONS AND BASES FOR FINDINGS AND CONCLUSION In deciding the issue of an effective date earlier than June 7, 1996, for the award of special monthly pension based on the need for aid and attendance, the Board has considered the applicability of the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, 114 Stat. 2096, which became effective during the pendency of this appeal. Among other things, 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 in Morton v. West, 12 Vet. App. 477(1999), opinion withdrawn and appeal dismissed sub nom. Morton v. Gober, 14 Vet. App. 174 (2000) (per curiam order), which had held that VA cannot assist in the development of a claim that is not well grounded. It also includes an enhanced duty to notify a claimant as to the information and evidence necessary to substantiate a claim for VA benefits. This change in the law is applicable to all claims filed on or after the date of enactment of the Veterans Claims Assistance Act of 2000, or filed before the date of enactment and not yet final as of that date. Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, 114 Stat. 2096 (2000), and implementing regulations published at 66 Fed. Reg. 45,620 (Aug. 29, 2001) (to be codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a)). See VAOPGCPREC 11-00; Karnas v. Derwinski, 1 Vet. App. 308, 312- 13 (1991). Under the Act, VA has a duty to notify the appellant 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 (to be codified as amended at 38 U.S.C. §§ 5102 and 5103). The veteran in this case was notified in a Statement of the Case issued in April 1998 of the provisions of law relied on, the facts developed in the case, and the reasoning used in reaching a decision on the issue of an earlier effective date. Additionally, the veteran has been provided the opportunity to present evidence and argument in support of the claim. Indeed, multiple statements have been submitted by the veteran in support of an earlier effective date. In May 2001, the RO sent the veteran a letter informing him that pursuant to his request, the RO would obtain his records from the Canada Pension Plan, but since these records were not maintained by the U.S. Government, he would have to complete authorization forms for the release of information. The veteran responded in May 2001 by stating that his pension records were not necessary to establish an earlier effective date for special monthly pension since these records pertained only to his condition in 1985 when he began receiving pension benefits under the Canada Plan, and not to his condition in 1987 when he initially filed a claim for VA pension benefits. He said that the claims file already contained medical evidence from his doctor and the VA regarding his condition in 1987. The RO responded by informing the veteran in June 2001 that based on his response, his pension records would not be requested. However, in a November 2001 statement to the RO, the veteran gave his consent to obtain his pension records from the Canada Pension Plan regarding this claim. Keeping in mind that the issue to be resolved is that of an earlier effective date for special monthly pension, and the veteran's acknowledgment that he first filed a claim for VA pension benefits in 1987, it does not appear that there would be any benefit flowing to the veteran in obtaining records from the Canada Pension Plan that are dated in 1985. Consequently, the Board has fulfilled its duty to assist the veteran under the VCAA and had addressed this issue on the merits. See Sabonis v. Brown, 6 Vet. App. 426 (1994). Factual Background In July 1987 the veteran filed a Veteran's Application for Compensation or Pension due to rheumatoid arthritis and completed those portions of the application pertaining to a claim for pension benefits. At a VA examination in April 1988, the veteran was diagnosed as having rheumatoid arthritis. He reported that symptoms first became manifest in the latter part of 1970. In a January 1989 rating decision, the RO denied the veteran entitlement to nonservice-connected pension benefits. The veteran was notified of this decision in a letter dated in January 1989. In a February 1989 VA Income-Net Worth And Employment Statement, the veteran said that he had to quit his job as a construction worker and painter due to his rheumatoid arthritis and that this disability affected his hands, elbows, shoulders, knees and feet. He attached photographs of his hands and feet. At a VA examination in July 1989, the veteran said that he experienced pain and fatigue associated with rheumatoid arthritis and that this forced him to give up his occupation in construction in the early 1980s. The VA examiner who examined him found that he had severe rheumatoid arthritis in his upper extremities, knees, ankles and feet. In a November 1989 rating decision, the RO granted the veteran nonservice-connected pension benefits with payments beginning in August 1989. In a May 1990 statement, the veteran said that his first medical appointment for rheumatoid arthritis was around 1980 and that symptoms first became manifest a few years before that. On file is a letter dated in July 1991, and received in March 1996, from Arnold Schecter, MD, MPH, of the State University of New York Health Science Center, informing the veteran that based on a letter and photographs he had sent, it looked as though he had a severe arthritis of some sort. Also in March 1996, the RO received a letter from a private rheumatologist, T. McCarthy, M.D., dated in May 1995. Dr. McCarthy said that the veteran's rheumatoid arthritis had first been diagnosed in 1982 and that the veteran had not been able to work since 1982 due to the severity of the disability. He said that the veteran continued to complain of one hour of morning stiffness as well as multiple regions of joint pain and stiffness. He said there was a significant decrease in range of motion of both shoulders as well as both elbows and hands. Specific findings included a 10-degree flexion contracture at both elbows as well as multiple nodules. Findings also included not being able to make more than 50 percent fists bilaterally and multiple Swan-neck and Boutonniere's deformities. Dr. McCarthy added that the veteran had multiple "MTP" deformities. The RO received another letter in March 1996 from J.B. Frain, M.D., FRCPC, to the veteran informing him that the latest X- rays regarding his condition were taken in 1988 and showed evidence of subluxation at the MCP joints in his fingers and in his great, second and third toes. He said that erosions had been noted around the right ankle in 1985 as well as about the ulnar styloid process on the left wrist and erosive changes. He said that the positive rheumatoid factor was more confirmatory evidence that it was rheumatoid arthritis. He concluded by saying that "From the letter I take it that you are not having particular troubles which you wish to receive any help and I hope this is of help to you in answering your questions." On June 7, 1996, the RO received statements from the veteran requesting special monthly pension based on the need for aid and attendance. The RO also received an Aid and Attendance Questionnaire completed in May 1996 by a private physician, K. Murray, M.D., who said that the veteran had rheumatoid arthritis and had problems with buttons, zippers, socks and shoe laces. In August 1996, the veteran submitted a statement from D.J.F. in support of his claim for aid and attendance benefits. In the statement, D.J.F. said that she provided regular aid and attendance to the veteran because of his "severe functional difficulties in performing the usual activities of daily life, due to Rheumatoid arthritis." She said that she assisted the veteran in daily activities such as putting on and removing socks, buttoning and unbuttoning apparel, operating zippers, lacing shoes, removing pants, putting on and taking off jackets, and combing hair. She said that she also assisted the veteran in opening food packages and other containers during the day. In addition, she said that she was there to assist the veteran in the event of an emergency since his disability hindered his reaction in an emergency situation. In a September 1996 rating decision, the RO denied the veteran's claim for special monthly pension based on the need for the aid and attendance of another person. In September 1996, the RO received photographs of the veteran's hands and feet. In an October 1996 rating decision, the RO granted the veteran special monthly pension based on the need for regular aid and attendance and assigned an effective date of June 7, 1996. In October 1996, the RO received a statement from the veteran requesting an earlier effective date for special monthly pension based on equitable grounds. In March 1997, the veteran said that his March 1987 claim for pension should have also been construed as a claim for special monthly pension based on the need for aid and attendance. He requested entitlement to aid and attendance benefits on equitable relief grounds. Also in March 1997 the RO received a copy of a letter from the veteran dated "Wed, March 4" in which he said that he wanted to apply for VA pension benefits and was totally disabled due to rheumatoid arthritis. The RO received the original copy of this letter in June 1997. In his Notice of Disagreement in November 1997, the veteran said that he was entitled to an effective date of March 1987 for aid and attendance based on an informal claim that he filed on "March 4, 1987." In an administrative decision in March 1998, the RO determined that consideration for an effective date earlier than June 7, 1996, for special monthly pension on account of the need for regular aid and attendance retroactive to July 28, 1987, was not warranted on equitable relief grounds. In October 1998, the RO received a letter dated in June 1986 from K. A. Murray, M.D., F.R.C.S.(C), F.A.C.S., addressed to the Canada Pension Plan Disability Division. In this letter, Dr. Murray said that the veteran had initially been seen in 1982 because of deformity secondary to rheumatoid arthritis involving his hand. He said that the veteran had since been seen in January 1985 for this disability at which time the veteran had progressive rheumatoid deformities involving his right hand and thumb. He said that there was flexor synovitis that was very marked in the index and the middle and right fingers showing swan neck deformities with no PIP or DIP motion. The little finger showed swan neck deformity with DIP motion present. He went on to say that the left hand examination revealed boutonniere deformity of the left thumb with decreased motion at the IP joint and a volar nodule. The index finger revealed a PIP nodule and marked synovitis. The mid-ring and little finger revealed prominent synovium with a tendency to a swan neck deformity. Dr. Murray noted that surgery had been planned for that year but the veteran had canceled and had not been seen since. The veteran submitted a statement to the RO in March 2001 acknowledging that he did file a claim for special monthly pension based on the need for aid and attendance in 1996, but that "VA failed to procedurally comply with statutory mandated requirements during the adjudication of [his] 1987 pension and inferred [special monthly pension based on aid and attendance] claim." He attached computer-generated reports dated in November 1987 and March 1989 as evidence that he had been denied special monthly pension in those reports without ever receiving notice of this and that, consequently, his November 1987 claim for special monthly pension was still open. Legal Analysis Applicable regulations provide that pension benefits are payable at a special, higher rate (with a higher minimum income limit) to a veteran who needs regular aid and attendance. 38 U.S.C.A. §§ 1502(b), 1521(d) (West 1991); 38 C.F.R. §§ 3.351(a)(1), 3.352 (2001). The need for aid and attendance means helplessness or being so nearly helpless as to require the regular aid and attendance of another person. 38 C.F.R. § 3.351(b). The criteria for establishing the need for regular aid and attendance require that the veteran be blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to five degrees or less; or that he be a patient in a nursing home because of mental or physical incapacity; or that he establish a factual need for aid and attendance. 38 U.S.C.A. § 1502(b); 38 C.F.R. §§ 3.351, 3.352. Determinations as to the need for regular aid and attendance are based on the veteran's actual need of personal assistance. In making such determinations, consideration is given to various factors, such as the inability of the veteran to dress or undress, or to keep himself clean and presentable; the frequent need to adjust a prostheses or appliance, which, because of disability, he cannot do himself; the inability to feed himself due to loss of coordination of the upper extremities or weakness; the inability to attend to the wants of nature; or the incapacity, either mental or physical, of the veteran to protect himself from the dangers inherent in his daily environment. Being bedridden, that is, confined to the bed, is a basis for the granting of regular aid and attendance. However, not all the disabling conditions noted above need to be present. Rather, the particular functions that the veteran cannot perform should be considered in relation to his condition as a whole. It is only necessary to show that he is so helpless as to require regular aid and attendance, not that the need be constant. 38 C.F.R. § 3.352(a). Except as otherwise provided, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later (emphasis added). 38 U.S.C.A. § 5110(a) (West 1991); 38 C.F.R. § 3.400 (2001). The general rule for claims for increase is that the award is effective the date of receipt of claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(o)(l) (2001). A claim for aid and attendance benefits is a claim for additional benefits payable in a specific circumstances to an individual entitled to, in this case, non-service connected pension. In that sense, it is similar to a claim for increase. The Board has also considered the provisions of 38 C.F.R. § 3.401, which specifically addresses aid and attendance (and housebound) benefits as follows, "(1) Except as provided in Sec. 3.400(o)(2) [which applies only to compensation and is not applicable to this pension claim], the date of receipt of claim or date entitlement arose, whichever is later. However, when an award of pension or compensation based on an original or reopened claim is effective for a period prior to the date of receipt of the claim, any additional pension or compensation payable by reason of need for aid and attendance or housebound status shall also be awarded for any part of the award's retroactive period for which entitlement to the additional benefit is established. 38 C.F.R. § 3.401(a)(2001). Under this provision, there would have to be a retroactive award of the basic pension benefits and the higher amount for aid and attendance would also be payable. This is not the case here. This part of the regulation does not provide for an earlier effective date of additional aid and attendance benefits where pension benefits have already been awarded. The provisions of 5110 (West 1991) refer to the date an "application" is received. "'Application' is not defined in the statute. However, in regulations, claim' and 'application' are considered equivalent and are defined broadly to include 'a formal or informal communication in writing requesting a determination or entitlement, or evidencing a belief in entitlement, to a benefit.'" Servello v. Derwinski, 3 Vet. App. 196, 198 (1992) (citing 38 C.F.R. § 3.1(p) (1991)). Payment of monetary benefits based on original, reopened, or increased awards of compensation, pension or dependency and indemnity compensation may not be made for any period prior to the first day of the calendar month following the month in which the award became effective. 38 C.F.R. § 3.31 (2001). The veteran in this case disagrees with June 7, 1996, as the effective date for special monthly pension benefits and contends that the effective date should be the date he originally filed a claim for pension benefits, in "March" 1987. He asserts that his 1987 claim for pension benefits should have also been treated as an inferred claim for special monthly pension benefits based on the need of regular aid and attendance because of his assertion that he was totally disabled. In support of his contention, he submitted a copy of an informal claim in March 1997 in which he states that he was totally disabled. However, the question as to whether this communication is an adequate claim for special monthly pension need not be addressed since there is no evidence that this informal claim was ever received by the RO prior to March 1997. Although the veteran contends that he initially submitted this claim to the RO in March 1987, there is no such claim on file in 1987 or at any other time prior to the copy that the RO received in 1997. The earliest claim for VA benefits that is on file is a Veteran's Application for Compensation or Pension (VA Form 21-526) that the veteran signed, and the RO received, in July 1987. Although it is evident from this claim that the veteran was claiming pension benefits since he completed those portions of the claim pertaining only to pension benefits, it is not likewise evident that he was claiming increased pension benefits by reason of the need for aid and attendance. See 38 C.F.R. § 3.351(a)(1). There is simply no indication from this form that the veteran was requesting increased pension benefits based on a need for aid and attendance. The veteran also asserts that the RO denied him entitlement to special monthly pension based on the need for aid and attendance in November 1987 and March 1989 and that he was denied due process because he was never given notice of these decisions so they are still open (see March 2001 letter). In support of this assertion, the veteran submitted two computer-generated reports dated in November 1987 and March 1989 respectively, which note, among other things, "special monthly pension denied." Notwithstanding this notation, these reports appear to have been generated in regard to VA examinations requested in November 1987 and March 1989 and are not rating decisions. In short, the RO did not adjudicate the issue of special monthly pension based on the need for aid and attendance prior to the October 1996 rating decision. The veteran further asserts that he should be given an earlier effective date for aid and attendance benefits because at the time the RO assigned him a 60 percent rating for pension purposes in 1989, it failed to follow VA's manual provisions requiring consideration of aid and attendance (see March 1997 letter). The veteran is apparently referring to a provision of M21-1 regarding special monthly pension ratings which states that "If a current examination is of record and the disability evaluation is less than 100 percent after a current examination, but severe disability demonstrates a need for regular A&A (aid and attendance), submit the claim to Central Office (212C) for an advisory opinion." See M21- 1, Part VI, 8.01(b) (August 1996). It is clear from this provision that such a referral is contingent on evidence demonstrating a need for regular aid and attendance and, as previously stated, there was no evidence demonstrating such a need prior to June 7, 1996. In addition to the RO's receipt of a claim for aid and attendance benefits on June 7, 1996, the RO also received on this date an Aid and Attendance questionnaire signed by the veteran's treating physician. On this form, the veteran's physician noted that the veteran had rheumatoid arthritis that was permanent and that he had problems dressing and undressing himself. Specifically, he said that the veteran had problems with buttons, zippers, socks and shoelaces. Later, in August 1996, the RO received a statement from D.J.F. who said that she provided regular aid and attendance to the veteran because of his "severe functional difficulties in performing the usual activities of daily life, due to Rheumatoid arthritis." She said that she assisted the veteran by putting on and removing his socks, buttoning and unbuttoning his apparel, operating zippers, lacing shoes, removing clothes and combing the veteran's hair. She said that she was also there so that she could assist the veteran in the event of an emergency. Based on this evidence, there is no disputing the factual determination that the disability requirements for special monthly pension were met on June 7, 1996, but not before this date. 38 C.F.R. §§ 3.351, 3.352 (2001). Therefore, June 7, 1996, is the correct effective date for the veteran's special monthly pension on account of the need for the regular aid and attendance of another person. 38 U.S.C.A. § 5110(a) (West 1991); 38 C.F.R. § 3.400(o)(1)(2001). Since the preponderance of the evidence is against an effective date earlier than June 7, 1996, for special monthly pension based on the need for regular aid and attendance for the reasons stated above, the benefit-of-the-doubt rule does not apply and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Entitlement to an effective date earlier than June 7, 1996, for special monthly pension based on the need for aid and attendance is denied. REMAND Because of the change in the law brought about by the Veterans Claims Assistance Act outlined above, a remand is required for compliance with the notice and duty to assist provisions contained in the new law in regard to the issue of service connection for rheumatoid arthritis secondary to Agent Orange exposure. Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, 114 Stat. 2096 (2000), and implementing regulations published at 66 Fed. Reg. 45,620 (Aug. 29, 2001) (to be codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a)). Pursuant to the Agent Orange Act of 1991, VA was given the authority to grant service connection for any condition where VA determined that there was a possible association between exposure to herbicides and the subsequent development of certain disabilities. Those disabilities for which a positive association was found are listed in 38 C.F.R. § 3.309(e) (2001). In this case, the RO denied service connection for rheumatoid arthritis in April 1994 and informed the veteran that rheumatoid arthritis was not one of the presumptive disabilities listed under 3.309(e). Nonetheless, the veteran correctly points out that service connection would still be warranted for rheumatoid arthritis if it was shown by medical evidence to be secondary to his exposure to herbicides in service. Brock v. Brown, 10 Vet, App. 155 (1997); Combee v. Brown, 34 F.3d 1039, 1043-1945 (Fed.Cir.1994). The medical evidence in this case includes a letter from rheumatologist T. McCarthy, M.D., dated in May 1995, who said that "there are reports in the medical literature of arthritis being secondary to exposure to herbicides." He went on to opine that "[the veteran's] service...may very well have played a part in his continuing arthritis as well as resulting severe disability." The claims file also contains an October 1998 letter from Dr. P. J. Bouch, who, noting that the veteran had been exposed to Agents Orange, White and Blue in Vietnam, said "it is possible that [the veteran's] immune system was affected by the toxins and thus the subsequent development of [rheumatoid arthritis]." In June 2001, the RO informed the veteran that his case was going to be referred to a Medical Center Agent Orange coordinator for review and an opinion as to whether it was at least as likely as not that the veteran's rheumatoid arthritis was related to his service in Vietnam. There is no evidence in the record that this was ever done. In light of this, the veteran's request that he be afforded a VA examination (see November 2001 letter), and the medical evidence outlined above, it is necessary that the veteran undergo a VA medical examination before a fully informed decision can be made on this claim. 38 U.S.C.A. § 5103A(c). Specifically, the examiner should be asked to review the medical evidence in the claims file, including the medical articles and text that the veteran submitted in April 2001, and opine as to the etiology of the veteran's rheumatoid arthritis, to include whether it is at least as likely as not related to exposure to Agent Orange. Id. In rendering an opinion, the VA examiner should have all pertinent medical records that are available. In this regard, the record shows that the veteran has been in receipt of benefits from the Canada Pension Plan since 1985 for rheumatoid arthritis. Since these records appear to be pertinent to the veteran's service connection claim, they should be obtained. 38 U.S.C.A. § 5103A(b). Accordingly, the RO should again ask the veteran to complete authorization of release forms so that records from the Canada Pension Plan can be obtained. The RO should also request any additional medical records that are pertinent to this claim. 38 U.S.C.A. § 5103A(b). As far as actual exposure to herbicides, the RO conceded exposure in its April 1994 rating decision, but later informed the veteran in a June 2001 letter that the alleged exposure could not be presumed since rheumatoid arthritis was not one of the presumptive disabilities under 38 C.F.R. § 3.309(e). The RO went on to inform the veteran that it would ask a section of the U.S. Army to verify his exposure to herbicides. It does not appear that this was ever done. Regardless, it is pertinent to note that prior to its rescission effective April 5, 1999, and prior to the decision of the United States Court of Appeals for Veterans Claims (Court) in McCartt v. West, 12 Vet. App. 164 (1999), VA Adjudication Procedure Manual M21-1, Part VI, par. 7.20b, provided that service in Vietnam gave rise to a rebuttable presumption of exposure to herbicides. Where the law or regulation changes after a claim has been filed or reopened but before the administrative or judicial process has been concluded, the version most favorable to the appellant applies. Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). Accordingly, this case is remanded to the RO for the following action: 1. The veteran should be contacted and requested to identify the names, addresses, and approximate dates of treatment for all VA, and private health care providers, who may possess additional records pertaining to his claim for service connection for rheumatoid arthritis secondary to exposure to Agent Orange. Efforts to obtain pertinent records must be documented in the claims file and the veteran must be informed of the results of the requests for records in keeping with the VCAA. Any records received should be associated with the claims file. 2. The RO should obtain from the Canada Pension Program a copy of its decision regarding the veteran's pension claim along with the medical evidence on which the decision was based. These records should then be incorporated into the claims file. 3. The veteran should be scheduled for a VA examination to determine the nature and etiology of his rheumatoid arthritis. Following a review of the entire claims file and all associated medical evidence, the examiner should indicate, with specificity, whether it is at least as likely as not that the veteran's rheumatoid arthritis is proximately related to exposure to herbicides, namely Agent Orange. The examiner should state in the examination report that the veteran's claims file has been reviewed. 4. To help avoid future remand, the RO must ensure that all requested development has been completed (to the extent possible) in compliance with this REMAND. If any action is not undertaken, or is taken in a deficient manner, appropriate corrective action should be undertaken. The RO should also undertake any additional development deemed appropriate in this case, as is required by the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475 and implementing regulations. 5. The RO should readjudicate the claim for service connection for rheumatoid arthritis as secondary to exposure to Agent Orange. If any action taken remains adverse to the veteran, he should be furnished with a new Supplemental Statement of the Case and be given an opportunity to respond. The case should then be returned to the Board, if in order. The veteran need take no action unless otherwise notified. 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. 2001) (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. RENÉE M. PELLETIER Member, Board of Veterans' Appeals