Citation Nr: 0409436 Decision Date: 04/12/04 Archive Date: 04/16/04 DOCKET NO. 98-06 290 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder (PTSD) as a result of sexual assault and sexual harassment. 2. Entitlement to service connection for a gynecological disability manifested by severe bleeding. 3. Whether new and material evidence has been presented to reopen the previously denied claim of entitlement to service connection for dental trauma, for dental treatment purposes. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. Pitts, Counsel INTRODUCTION The veteran served on active duty from May 1974 to May 1976. It appears that she also had service in the reserves, but the dates and character of this service are not verified in the record of the case. This matter comes before the Board of Veterans' Appeals (Board) on appeal of two decisions by the Department of Veterans Affairs (VA) Regional Office (RO) a Houston, Texas. In an August 1997 rating decision, the RO denied entitlement to service connection for PTSD and for excessive gynecological bleeding. The veteran filed a notice of disagreement in October 1997 disputing, and initiating appeal of, the RO's decision of these issues. A statement of the case addressing those issues was provided in March 1998, and the veteran perfected the appeal by filing a substantive appeal document later in that month. In the August 1997 rating decision the RO also denied entitlement to service connection for dental trauma, for dental treatment purposes. However, the veteran did not file a notice of disagreement contesting the RO's decision of that issue. In an April 2001 rating decision, the RO again denied entitlement to service connection for dental trauma, for dental treatment purposes. In May 2001, the veteran filed a notice of disagreement disputing, and initiating appeal of, the RO's decision of that issue. It is noted that the RO denied entitlement to service connection for a nervous condition in a November 1998 rating decision, but the veteran did not file a timely notice of disagreement with that decision. A personal hearing before the undersigned Veterans Law Judge was conducted by videoconference in November 2003. A hearing transcript is of record This appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify you if further action is required on your part. REMAND This claim must be afforded expeditious treatment by the Veterans Benefits Administration (VBA ) AMC. The law requires that all claims that are remanded by the Board or by the United States Court of Appeals for Veterans Claims (CAVC) for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans Benefits Act of 2003, Pub. L. No. 108-183, § 707(a), (b), 117 Stat. 2651 (2003) (to be codified at 38 U.S.C. §§ 5109B, 7112). Statement of the Case after Notice of Disagreement In the August 1997 rating decision, the RO denied entitlement to service connection for dental trauma, for dental treatment purposes. However, the veteran did not file a notice of disagreement contesting the RO's decision of that issue. Therefore, the decision became final. 38 U.S.C.A. § 7105(c) (West 2002). In an April 2001 rating decision, the RO again denied entitlement to service connection for dental trauma, for dental treatment purposes. In May 2001, the veteran filed a notice of disagreement disputing, and initiating appeal of, the RO's decision of that issue. A notice of disagreement must be followed by a statement of the case. 38 U.S.C.A. § 7105; 38 C.F.R. §§ 19.26, 19.29 (2003). The RO did not issue a statement of the case after the veteran submitted the notice of disagreement in May 2001. Where a claimant files a notice of disagreement but the RO has not issued a statement of the case, the claim must be remanded to the RO for issuance of such adjudicative document. Godfrey v. Brown, 7 Vet. App. 439 (1995), Manlincon v. West, 12 Vet. App. 238 (1999). Therefore, the claim will be remanded. Id.; see also 38 C.F.R. § 19.9(a) (2003). On remand, the RO must provide the veteran and any representative she may have at that time with a statement of the case. The statement of the case should address the issue whether new and material evidence was submitted to reopen the previously denied claim of entitlement to service connection for dental trauma, for dental treatment purposes. The statement of the case should advise the veteran of the time period in which a substantive appeal must be filed in order to obtain appellate review of the issue. Thereafter, the veteran must submit a timely substantive appeal in order for the Board to have jurisdiction over the claim. 38 U.S.C.A. § 7105; 38 C.F.R. §§ 20.202, 20.300-20.306 (2003). Notice and Development The claims of entitlement to service connection for PTSD as the result of sexual assault and sexual harassment and for a gynecological disorder manifested by severe bleeding are remanded so that additional efforts may be undertaken to develop evidence that could help to substantiate the claims and so that the veteran may be notified about evidence that is needed to substantiate the claims. The veteran alleges that she began to have severe gynecological bleeding while on active duty with her USARIEM (United States Army Research Institute of Environmental Medicine) unit in Natick, Massachusetts. She alleges that she was the victim of sexual and other personal assault (including battery) while on active duty with her unit at the United States Army Forces Command at Fort Devens, Massachusetts. Service personnel records show that she was transferred from the former to the latter duty in July 1975. In addition, the veteran alleges that she endured head trauma, apparently as part of a personal assault, at Fort Jackson, South Carolina, although she has not clarified the circumstances and date of this supposed incident. This appeal is governed by the Veterans Claims Assistance Act of 2000 (VCAA) and its implementing regulations. See 38 U.S.C.A. §§ 5100, 5102-5103A, 5106, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2003). Signed into law on November 9, 2000, the VCAA eliminated 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 CAVC in Morton v. West, 12 Vet. App. 477 (1999), withdrawn 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. This change in the law is applicable to all claims filed on or after November 9, 2000 or filed before the date of enactment and not yet final as of that date. VCAA, Pub. L. No. 106-475, §7(b), 114 Stat. 2096, 2099-2100 (2000), 38 U.S.C.A. § 5107 note (Effective and Applicability Provisions). Because the claims presented on appeal for service connection for PTSD and a gynecological disability manifested by excessive bleeding were pending before VA on the November 9, 2000 date of enactment of the VCAA, they are subject to the terms of that statute. The regulations implementing the VCAA that have been promulgated are effective from the date of the statute's enactment, except for certain provisions concerning the reopening of claims with new and material evidence. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2003); 66 Fed. Reg. 45,620-32 (Aug. 29, 2001). Without providing for any rights over and above those established in the VCAA, they define the requirements of the statute with additional specificity. See 66 Fed. Reg. 45,629. The VCAA requires VA to provide claimants with certain notice concerning the evidence that is needed to substantiate their claims. The notice furnished by VA must inform the claimant, and the claimant's representative, if any, of any information and of any medical and lay evidence that VA determines is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183, 186-87 (2002). The notice must be furnished upon receipt of a complete or substantially complete application. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1). The notice must explain which evidence the claimant is finally responsible for obtaining and which evidence VA will attempt to obtain on the claimant's behalf. Quartuccio, 16 Vet. App. at 186. The statute provides that the claimant has one year from the date the notice is sent in which to submit information or evidence that VA has identified. 38 U.S.C.A. § 5103(b). The implementing regulation states that if a claimant has not responded to a notice requesting information or evidence within 30 days of the date of the notice, VA may decide the claim prior to the expiration of the one-year period on the basis of the evidence of record but must readjudicate the claim if the claimant later provides the information or evidence within the one-year period. 38 C.F.R. § 3.159(b)(1). A recent amendment of section 5103 provides that VA may make a decision on the claim before the one-year period has expired without vitiating the notice. 38 U.S.C.A. § 5103(b), as amended by Veterans Benefits Act of 2003, P.L. 108-183, Section 701(b), 117 Stat. 2651, ___ (Dec. 16, 2003) (to be codified at 38 U.S.C. § 5103). This amendment is by its terms retroactive to the November 9, 2000 date of enactment of the VCAA. 38 U.S.C.A. § 5103(b), as amended by Veterans Benefits Act of 2003, P.L. 108-183, Section 701(c), 117 Stat. 2651, ___ (Dec. 16, 2003) (to be codified at 38 U.S.C. § 5103). Moreover, the VCAA requires VA to assist a claimant with obtaining medical records and other documentary evidence. 38 U.S.C.A. § 5103(A)(b), (c); 38 C.F.R. § 3.159(c)(1)-(3). VA must make reasonable efforts to obtain outstanding records pertinent to the claim. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c)(1)-(3). When such records are in the custody of a federal department or agency, VA must continue to try to obtain them until it has been successful unless it is reasonably certain that they do not exist or that further efforts to obtain them would be futile. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c)(2). VA must give appropriate notice to the claimant if it is unable to obtain needed records. 38 C.F.R. § 3.159(e). Under the VCAA, the duty to obtain records applies when the claimant, after being requested to do so by VA, "adequately identifies [such records] to the Secretary and authorizes the Secretary to obtain" them. 38 U.S.C.A. § 5103A(b). While it has advised her from time to time about the kind of evidence that is needed to support her claims for benefits for PTSD and a gynecological disability manifested by excessive bleeding, the RO has not provided the veteran with the notice that is required by the VCAA. On remand, the RO must provide such notice to the veteran and any representative that she may have at that time. The notice must apprise the veteran of alternate sources of evidence, for two reasons. First, it is evident that the RO has been able to obtain only a scant, partial set of the veteran's service medical records and has not succeeded in securing the particular service medical records that the veteran has alleged would substantiate her claims. The National Personnel Records Center (NPRC), the claims file shows, confirmed in April 2001 that no additional service medical records were available for the period extending from May 1974 to May 1976 during which the veteran served on active duty. The notice issued by the RO on remand under section 5103 of the VCAA should describe sources of alternate evidence that may be needed when service medical records cannot be found. The Department of Veterans Affairs Adjudication Procedure Manual provides that alternate sources of evidence should be resorted to in fire-related cases. See BVA Adjudication Procedure Manual, M21-1, Part III, Paragraphs 4.23, 4.25, 4.29 (Change 88, February 27, 2002). A "partial list" of "alternate documents that might substitute for service medical records" is set forth in M21-1: VA military files; statements from service medical personnel; "buddy" certificates of affidavits; state or local accident and police reports; employment physical examinations; medical evidence from hospitals, clinics, and private physicians by which or by whom a veteran may have been treated, especially soon after separation; letters written during service; photographs taken during service; pharmacy prescription records; and insurance examinations. Adjudication Procedure Manual, M21-1, Part III, Paragraph 4.25. NA Form 13055, Request for Information Needed to Reconstruct Medical Data (Form 13055) should be given to the claimant for completion and return to the RO. Adjudication Procedure Manual, M21-1, Part III, Paragraph 4.23. Second, this is a case in which the veteran has alleged that she was a victim of sexual and other personal assault (as well as verbal sexual harassment) during her active duty service, and in such cases, VA recognizes that such events are often not reported by victims and therefore, although alleged as part of a service connection claim, may not be confirmed in the claimant's service medical records or service personnel records. The NPRC informed the RO in June 1997 that it had found no information in the veteran's service records concerning sexual harassment or sexual assault. However, for a claim of entitlement to service connection for PTSD to be granted, there must be credible evidence that the traumatic event(s) (stressor(s)) upon which a medical diagnosis of PTSD could be based actually occurred. 38 C.F.R. § 3.304(f) (2003). Unless - - what is not the case here - - an alleged stressor concerns combat in which the veteran is shown to have participated, the veteran's allegations must be corroborated by independent evidence. Id. Accordingly, VA adjudication policy and regulations provide that when a claimant's allegations of sexual or other personal assault are not documented in service medical or personnel records, alternate evidence may be needed. Alternate sources of evidence to support a claim concerning sexual or other personal assault are described in the BVA Adjudication Procedure Manual. See Adjudication Procedure Manual, M21-1, Part III, Paragraph 5.14c(5). Such evidence also is described in 38 C.F.R. § 3.304(f), as amended in March 2002: If a post-traumatic stress disorder claim is based on in-service personal assault, evidence from sources other than the veteran's service records may corroborate the veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. 67 Fed. Reg. 10,330, 10,332 (Mar. 7, 2002) (now codified at 38 C.F.R. § 3.304(f)(3) (2003)). It is observed in the regulation: "VA will not deny a post- traumatic stress disorder claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than the veteran's service records or evidence of behavior changes may constitute credible supporting evidence of the stressor and allowing him or her the opportunity to furnish this type of evidence or advise VA of potential sources of such evidence." 38 C.F.R. § 3.304 (f)(3). Therefore, the notice issued by the RO on remand under section 5103 of the VCAA should refer to such alternate evidence. At the same time, the Board notes that the record as it stands currently contains a number of items of evidence of a kind described by the regulation and that this evidence tends to corroborate the contention of the veteran that she was assaulted, including sexually, and sexually harassed on various occasions during active duty service between May 1974 and May 1976. The service personnel records that have been obtained show that between October 1975, when she was recommended for promotion in laudatory terms, and April 1981, when she was released from the reserves for "unsatisfactory participation" after a series of unexcused absences from duty, the veteran's performance deteriorated. A service dental record dated in July 1980 reflects that the veteran was found to have a fractured root and was advised to see an oral surgeon. The veteran has alleged that she was hit in the jaw by other soldiers. On remand, the RO must make efforts to obtain certain medical records that could help to substantiate the claims. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c)(1)-(3). As noted above, complete sets of the veteran's service medical records and service personnel records have not been obtained, and the NPRC has apprised the RO that no additional such records are available. Additional service medical records would be particularly helpful to each of the claims. It appears to the Board that the RO's efforts to obtain the needed service medical records have been thorough and another effort would be futile. See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c)(2). Therefore, the Board is requesting in this Remand that the RO try to obtain as a substitute for the service medical records documentation from Office of the Army Surgeon General (SGO). At the same time, the RO should make efforts on remand to obtain certain records of medical treatment by private providers that the veteran has said she received during service and is relevant the current claims. In addition, the RO should assure that it has obtained all post-service medical records that have to do with a gynecological disability manifested by severe bleeding. Private medical records dated in 1989 confirm that at that time, the veteran had such a condition. VA outpatient treatment records contained in the claims file that are dated in 1997 show a diagnosis of "hemophilus vaginalis." Medical records that are dated closer to the time of the veteran's years in service than those now on file could have a bearing on the question as to whether the veteran currently has a gynecological disorder manifested by severe bleeding that is service related. Under the VCAA, VA has a duty to secure a medical examination or opinion if such is necessary to decide a claim for benefits. 38 U.S.C.A. § 5103(A)(d)(1); 38 C.F.R. § 3.159(c)(4). Under the VCAA, a need for a medical examination or opinion in the decision of the claim is considered to exist if the record, including all information and lay or medical evidence (including statements of the claimant), presents competent evidence that the veteran has a current disability, or persistent or recurring symptoms thereof, and indicates that the current condition may be associated with his or her service. 38 U.S.C.A. § 5103A(d)(2); see also 38 C.F.R. § 3.159(c)(4)(i). The Board finds that competent medical evidence is needed to aid VA adjudicators in determining whether the veteran currently has a gynecological disorder manifested by severe bleeding that is related to her active duty service. The Board also has concluded that a VA medical examination should be performed in conjunction with the claim of entitlement to service connection for PTSD. The Board notes that a diagnosis of PTSD standard, even when based on one or more stressors alleged by a veteran, does not enable VA adjudicators to grant a claim for service connection for PTSD unless VA has determined that the stressor or stressors on which the diagnosis is based have been verified. Verification of the occurrence of a stressor is part of the proof required to establish service connection for PTSD. 38 C.F.R. § 3.304(f). Whether a stressor alleged by a claimant actually occurred is a question of fact that is resolved not by medical experts but by VA adjudicators alone. Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Wood v. Derwinski, 1 Vet. App. 190 (1991). The determination is to be made with reference to the "places, types and circumstances" of a veteran's service. 38 C.F.R. § 3.303(a). At the same time, when a claim of entitlement to service connection for PTSD is based on allegations of personal, including sexual, assault, VA may submit any evidence it receives to an appropriate medical or mental health professional for an opinion as to whether a personal assault occurred. 38 C.F.R. § 3.304(f) (3). A VA mental disorders examination performed in October 1998 in conjunction with the claim resulted in a multiaxial assessment that included an Axis I diagnosis of "[d]elusional disorder" and an Axis IV diagnosis that included "questionable history of sexual assault in the service." A diagnosis of PTSD is not stated in the examination report. At the same time, the examination report indicates, the examiner stated that "[i]f information should become available that the veteran's story of harassment by the alleged perpetrator is correct, then the diagnosis of delusional disorder is quite questionable and, in fact, would need to be changed." The Board finds that the veteran should be seen in another VA examination in which the examiner considers, and has an opportunity to ask the veteran about, evidence already on file that could indicate that she experienced the traumatic events that she has alleged and any additional evidence that is acquired on remand. Both of the examinations requested here should be performed only after the RO has made all appropriate efforts to associate with the claims file all outstanding medical records and other evidence pertinent to the service connection claim. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991). The Board observes that additional due process requirements may be applied as a result of the enactment of the VCAA and its implementing regulations. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A and 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2003). Accordingly, this case is REMANDED for the following actions: 1. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the VBA AMC. Kutscherousky v. West, 12 Vet. App. 369 (1999). 2. The VBA AMC should provide the veteran and her representative, if any, with a statement of the case concerning the issue of whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for dental trauma, for dental treatment purposes. The statement of the case should be accompanied by an explanation of the time period in which a substantive appeal must be filed in order to obtain appellate review. 3. The VBA AMC must review the claims file and ensure that all VCAA notice obligations have been satisfied in accordance with 38 U.S.C.A. §§ 5102, 5103, and 5103A (West 2002), Veterans Benefits Act of 2003, Pub. L. 108-183 ,§ 701, 117 Stat. 2651, ___ (Dec. 16, 2003) (to be codified at 38 U.S.C.A. § 5103), and any other applicable legal precedent. In particular, the VBA AMC must provide the veteran with notice specifically describing the type of evidence and information that could help to substantiate her claims of entitlement to service connection for PTSD as the result of sexual assault and sexual harassment and for a gynecological disability manifested by excessive bleeding. By way of explaining what evidence or information is needed when, as in this case, service medical records are unavailable, this notice should apprise the veteran of alternate sources of evidence to show that she was treated during service for sexual assault and sexual harassment, or symptoms thereof, and for excessive gynecological bleeding, in accordance with the procedures set forth in VBA's Adjudication Procedure Manual, M21-1. By way of explaining what evidence or information is needed to support her contention that she was sexually assaulted and sexually harassed during service, this notice should apprise the veteran that when service medical or personnel records do not note, or suggest, that sexual assault or sexual harassment alleged by a claimant actually occurred, evidence from sources other than a veteran's service records may be presented to corroborate the claimant's account, and the notice should describe such alternate sources of evidence. In so doing, the notice should refer to the alternate sources of evidence to support allegations of sexual and other personal assault that are described in VBA's Adjudication Procedure Manual, M21-1 and in 38 C.F.R. § 3.304(f), as amended in March 2002. In the notice, the VBA AMC should ask the veteran to identify all treatment for a gynecological disorder manifested by bleeding that she received from the time she was separated from service until 1989. 4. The VBA AMC should then conduct any necessary development brought about by the veteran's response. In addition, and regardless of what the veteran's response, if any, is, the VBA AMC should do the following: (i) Contact the NPRC and request that it obtain all Office of the Army Surgeon General (SGO) reports concerning the veteran dated during the specific period extending from May 1974 to May 1976 that comprised her active duty service and through April 1981, when, it is shown in the claims file, her service in the reserves ended. Make specific reference in the request to records, including records of psychiatric treatment, generated at the military medical facility at Fort Campbell, Kentucky. All information that could aid in the effort to retrieve any such reports, including the three different surnames that, it is shown in the claims file, the veteran used at different times during service and her different units of assignment during her active duty service, should be provided with the request to the NPRC. (ii) The VBA AMC should send another letter to Leonard Morse Hospital in Natick, Massachusetts containing a request for all medical records concerning the veteran that are dated during the specific period extending from May 1974 to May 1976 that comprised her active duty service and through April 1981, when, it is shown in the claims file, her service in the reserves ended. The VBA AMC should cite in the letter the three different surnames that, it is shown in the claims file, the veteran used at different times during service. (iii) The VBA AMC should send separate letters to Burbank Hospital and Dr. S in Fitchburg, Massachusetts, referred to in, respectively, the VA Form 21-4142 that the veteran submitted in November 2000 and the statement that she submitted in September 2002, containing a request for all medical records for the veteran that are dated during the specific period extending from May 1974 to May 1976 that comprised her active duty service and through April 1981, when, it is shown in the claims file, her service in the reserves ended. Cite in the letter the three different surnames that, it is shown in the claims file, the veteran used at different times during service. All records and information obtained which are not duplicative of evidence already received should be associated with the claims file. 5. If the VBA AMC is unable to obtain any of the relevant records sought, it shall notify the veteran and her representative, if any, that it has been unable to obtain such records by identifying the specific records not obtained, explaining the efforts used to obtain those records, and describing any further action to be taken with respect to the claim. 38 U.S.C. § 5103A(b)(2)). 6. The VBA AMC should arrange for a VA special gynecological examination of the veteran for the purpose of ascertaining the nature, extent of severity, and etiology of any gynecological disability manifested by bleeding which may be present. The claims file and a separate copy of this Remand must be made available to and reviewed by the examiner prior and pursuant to conduction and completion of the examination(s). The examiner must annotate the examination report(s) that the claims file was in fact made available for review in conjunction with the examination(s). Any further indicated special studies must be conducted. The medical specialist should provide in the examination report(s) the diagnosis or diagnoses of any gynecological disorder or disorders found during the examination. Then, as to each disorder diagnosed, the medical specialist must express an opinion in the examination report(s) as to whether it is at least as likely as not that the disorder is related to service (injury or disease therein, to include surgery performed during service), or if pre-existing service, was/were aggravated thereby. The opinions expressed by the examiner must be accompanied by a complete rationale. 7. The VBA AMC should arrange for a VA special PTSD examination for the purpose of ascertaining whether the veteran now has PTSD as the result of having experienced one or more personal, including sexual, assaults during service. The examination should be performed by the same VA physician who conducted the VA mental disorders examination in October 1998. If that physician is not available, the examination should be performed by a VA psychiatrist. The claims file and a separate copy of this Remand must be made available to and reviewed by the examiner prior and pursuant to conduction and completion of the examination(s). The examiner must annotate the examination report(s) that the claims file was in fact made available for review in conjunction with the examination(s). Any further indicated special studies must be conducted. The examiner must be requested to address the following medical issues: Is it at least as likely as not, taking into account all of the evidence on file and her own statements, that the veteran was personally, including sexually, assaulted during service one or more times? Is it at least as likely as not that the veteran now has PTSD and developed that disorder as the result of one or more personal, including sexual, assaults that she suffered during service? Any opinions expressed by the examiner must be accompanied by a complete rationale. 8. Thereafter, the VBA AMC should review the claims file to ensure that all of the foregoing requested development has been completed. In particular, the VBA AMC should review the requested examination reports and required medical opinions to ensure that they are responsive to and in complete compliance with the directives of this remand and if they are not, the VBA AMC should implement corrective procedures. The Board errs as a matter of law when it fails to ensure compliance, and further remand will be mandated. Stegall v. West, 11 Vet. App. 268 (1998). In addition, the VBA AMC must review the claims file to ensure that any other notification and development action required by the VCAA completed. In particular, the VBA AMC should ensure that the new notification requirements and development procedures contained in sections 3 and 4 of the Act (38 U.S.C. §§ 5102, 5103, 5103A and 5107) are fully complied with and satisfied. 9. After undertaking any development deemed essential in addition to that specified above, the VBA AMC should readjudicate the claims of entitlement to service connection for PTSD and for a gynecological disorder manifested by severe bleeding. If the benefits requested on appeal are not granted to the veteran's satisfaction, the VBA AMC should issue a supplemental statement of the case (SSOC). The SSOC must contain notice of all relevant actions taken on the claims for benefits, to include a summary of the evidence and applicable law and regulations pertinent to the claims currently on appeal. A reasonable period of time for a response should be afforded. Thereafter, the case should be returned to the Board for final appellate review, if in order. By this remand, the Board intimates no opinion as to any final outcome warranted. No action is required of the veteran until she is notified by the VBA AMC; however, the veteran is hereby notified that failure to report for any scheduled VA examination(s) without good cause shown may adversely affect the outcome of her claims for service connection, and may result in their denial. 38 C.F.R. § 3.655 (2003). _________________________________________________ RONALD R. BOSCH Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board is appealable to the CAVC. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2003).