Citation Nr: 0510617 Decision Date: 04/13/05 Archive Date: 04/21/05 DOCKET NO. 02-07 423 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for coronary artery disease and hypertension as a result of exposure to herbicide agents. 2. Entitlement to service connection for left upper lobe granuloma as a result of exposure to asbestos or herbicide agents. 3. Entitlement to service connection for a laceration to the head and severe headaches. REPRESENTATION Appellant represented by: Texas Veterans Commission WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD Tanya A. Smith, Associate Counsel INTRODUCTION The veteran had active service from April 1965 to April 1969. This matter is before the Board of Veterans' Appeals (Board) following a Board Remand of August 2003. This matter was originally on appeal from a February 1998 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO) in Nashville, Tennessee that denied (1) service connection for coronary artery disease and hypertension as a result of exposure to herbicide agents, (2) service connection for left upper lobe granuloma as a result of asbestos exposure and as a result of exposure to herbicide agents, and (3) service connection for a laceration to the head and severe headaches. The Houston, Texas RO mailed notice of the decision. In VA Form 21-4138 (Statement in Support of Claim) dated in April 2004, in response to the March 2004 development letter from the Appeals Management Center (AMC) in Washington, D.C., the veteran noted that the AMC "did not mention [that he] was appealing tinnitus, peripheral neuropathy, and special monthly compensation" claims. The Board notes that these issues have not been developed for appellate consideration. Accordingly, this matter is referred to the RO for appropriate action. In the Statement of Accredited Representative in Appealed Case (in lieu of VA Form 646) dated in January 2005, the veteran's authorized representative noted that the veteran had not been afforded a medical opinion as to whether his diabetes had contributed to or aggravated his coronary artery disease and hypertension. The Board notes that the veteran did not perfect his appeal or file a Substantive Appeal on his claims for service connection of coronary artery disease and hypertension as secondary to diabetes associated with herbicide agent exposure, following the RO's issuance of a Statement of the Case in May 2002. 38 C.F.R. § 20.302(b) (2004). The issue of entitlement to service connection for a laceration to the head and severe headaches is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the AMC, in Washington, D.C. FINDINGS OF FACT 1. The veteran has been notified of the evidence necessary to substantiate his claims, and all relevant evidence necessary for an equitable disposition of this appeal has been obtained. 2. The veteran had service in the Republic of Vietnam as he served aboard the U.S.S. Boston during the time this vessel stopped at Da Nang in the Republic of Vietnam on April 30, 1967 and on approximately May 17, 1967. 3. Coronary artery disease, hypertension, and granuloma are not among the diseases associated with exposure to certain herbicide agents enumerated under VA regulation, 38 C.F.R. § 3.309(e). 4. The medical evidence shows that the veteran's coronary artery disease and hypertension were not present during service and did not manifest to a compensable degree during the one-year presumptive period following the veteran's discharge from service. 5. There is no competent medical evidence of record that shows that the veteran's coronary artery disease and hypertension have been determined to be etiologically related to the veteran's exposure to herbicide agents during service or otherwise related to any other incident of his service. 6. The medical evidence of record shows no radiographic evidence of parenchymal lung disease and shows that the veteran is not currently diagnosed with an asbestos-related disorder. 7. The medical evidence shows that the veteran's left upper lobe granuloma was not present during service; the medical evidence does not show that the left upper lobe granuloma is a chronic residual of a disease that manifested during service. 8. There is no competent medical evidence of record that shows that the veteran's left upper lobe granuloma has been determined to be etiologically related to the veteran's exposure to herbicide agents during service or otherwise related to any other incident of his service. CONCLUSIONS OF LAW 1. Coronary artery disease and hypertension were not incurred in or aggravated during active service and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1110, 1112, 1113, 1116, 5103, 5103A (West 2002); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2004). 2. Left upper lobe granuloma was not incurred in or aggravated during active service. 38 U.S.C.A. §§ 1110, 5103, 5103A (West 2002); 38 C.F.R. §§ 3.159, 3.303 (2004). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Board Remand of August 2003/Veterans Claims Assistance Act of 2000 The Veterans Claims Assistance Act of 2000, Pub. L. No. 106- 475, 114 Stat. 2096 (2000) (VCAA) redefines the obligations of VA with respect to the duty to assist and includes an enhanced duty to notify a claimant as to the information and evidence necessary to substantiate a claim for VA benefits. 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2004). VA is required to provide the claimant with notice of what information or evidence is to be provided by the Secretary and what information or evidence is to be provided by the claimant with respect to the information and evidence necessary to substantiate the claim for VA benefits. Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The Board notes that the RO provided the veteran with a copy of the February 1998 rating decision, March 1999 Statement of the Case (SOC), and December 2004 Supplemental Statement of the Case (SSOC), which together provided the veteran with notice as to the evidence needed to substantiate his claims and the reasons for the denials. The March 1999 SOC provided the veteran with notice of laws and regulations pertinent to his claims. In addition, the Board notes that pursuant to its August 2003 Remand, in correspondence dated in March 2004, the AMC advised the veteran of VA's duties under the VCAA and the delegation of responsibility between VA and the veteran in procuring the evidence relevant to his claims, including which portion of the information and evidence was to be provided by the veteran and which portion VA would attempt to obtain on behalf of the veteran. Quartuccio, 16 Vet. App. at 187. The AMC advised the veteran of the information and evidence necessary to establish entitlement to service- connected compensation benefits. The AMC explained that the evidence must show a current disability, in-service incurrence of an injury or a disease, and a relationship between the current disability and an injury, disease, or event in service. The AMC further explained that a relationship between the claimed current disability and service may be presumed for veterans who have certain chronic diseases that manifested within a specific period of time or veterans who have certain diseases and who served in Vietnam. Thus, the Board finds that the VCAA notice provided the veteran with adequate notice as to the information and evidence necessary to substantiate his claims. Similar notice was provided to the veteran again in correspondence dated in July 2004. During the course of this appeal, the United States Court of Appeals for Veterans Claims (Court) handed down Pelegrini v. Principi, 18 Vet. App. 112 (2004) (Pelegrini II). In Pelegrini II, the Court reaffirmed that the enhanced duty to notify provisions under the VCAA should be met prior to an initial unfavorable agency of original jurisdiction (AOJ) decision on the claim. In the instant appeal, the Board notes that the initial unfavorable rating decision was rendered prior to the enactment of the VCAA; therefore, it was impossible for VA to provide notice pursuant to the enhanced duty to notify provisions of the VCAA prior to the initial AOJ decision. Nevertheless, the case was reconsidered again in December 2004 and the SSOC was provided to the veteran. Also, the Board notes that the notice was provided by the AOJ prior to the transfer and certification of the veteran's case to the Board. The December 2004 SSOC does not cite the law and implementing regulations of the VCAA; however, the Board finds that the substance of the regulations was provided to the veteran in the March and July 2004 VCAA notices. The veteran has been provided with every opportunity to submit evidence and argument in support of his claims and to respond to VA notices. The Board further acknowledges that the March and July 2004 VCAA notices contained no specific request for the veteran to provide any evidence in the veteran's possession that pertained to the claims or something to the effect that the veteran give VA everything he had that pertained to his claims. 38 C.F.R. § 3.159(b)(1) (2004). Nevertheless, the RO asked the veteran for all the information and evidence necessary to substantiate the veteran's claims. A generalized request for any other evidence pertaining to the claim would have been superfluous and unlikely to lead to the submission of additional pertinent evidence. Indeed, in VA Form 21-4138 (Statement in Support of Claim) dated in April 2004, in response to the March 2004 VCAA notice, the veteran indicated that he had submitted all the information that he had pertaining to his claims. Therefore, it can be concluded, based on the particular facts and circumstances of the case, the omission of the request for "any evidence in the claimant's possession that pertains to the claim" in the notices appears not to have harmed the veteran, and it would be legally proper to render a decision in the case without further notice under the regulation. The Board also concludes that the requirements of the notice provisions of the VCAA have been met, and there is no outstanding duty to inform the veteran that any additional information or evidence is needed. Quartuccio, 16 Vet. App. at 187. For the reasons discussed above, the Board also finds that the AMC complied with the Board's August 2003 Remand. Stegall v. West, 11 Vet. App. 268 (1998). In regard to VA's duty to assist, the Board notes that efforts to associate a copy of the veteran's service medical records with the claims file have been unsuccessful. Responses (VA Form 3101) from the National Personnel Records Center (NPRC) provided in April 1997 and August 1998 indicated that all available medical records were furnished to the Houston, Texas RO in January 1990. In correspondence dated in July 2001, the RO continued to advise the veteran that his service medical records could not be obtained. Thus, the Board assumes that the RO cannot find the service medical records at its facility. Consequently, no additional development is warranted as it appears that any further efforts to obtain the service medical records would be futile. 38 U.S.C.A. § 5103A(b)(3) (West 2002); 38 C.F.R. § 3.159(c)(2) (2004). The Board acknowledges that in cases such as these, VA has a heightened duty to explain its findings and conclusions and to consider carefully the benefit-of-the doubt rule. Pruitt v. Derwinski, 2 Vet. App. 83, 85 (1992); O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). In further regard to VA's duty to assist, the Board notes that the RO obtained VA treatment records identified by the veteran. Private treatment records have been associated with the claims file. Adequate evidence for verification of whether the veteran had the requisite type of service in the Republic of Vietnam is of record. The RO scheduled the veteran for the travel board hearing that was held before the undersigned Veterans Law Judge in February 2003. Lastly, the Board notes that the RO did not develop the asbestos claim as to the question of whether the veteran was in fact exposed to asbestos during service. [In the March 1999 SOC, it appears the RO may have conceded exposure but the RO inexplicably noted this in the analysis portion of the head injury claim.] The Board, however, finds that a remand of the asbestos claim to the RO for additional development is unnecessary because there is no reasonable possibility that the veteran can prevail on the claim as the medical evidence shows that the veteran is not currently diagnosed with an asbestos-related disorder. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994); Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991). The veteran has not made VA aware of any other evidence relevant to his appeal that needs to be obtained. Based on the foregoing, the Board finds that all relevant facts have been properly and sufficiently developed in this appeal and no further development is required to comply with the duty to assist the veteran in developing the facts pertinent to his claims. Accordingly, the Board will proceed with appellate review. II. Coronary Artery Disease and Hypertension Due to Exposure to Herbicide Agents The veteran contends that his coronary artery disease and hypertension were caused by exposure to herbicide agents during service. In order to establish presumptive service connection for a disease associated with exposure to certain herbicide agents, the veteran must show the following: (1) that he served in the Republic of Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975; (2) that he currently suffers from a disease associated with exposure to certain herbicide agents enumerated under § 3.309(e); and (3) that the current disease process manifested to a degree of 10 percent or more within the specified time period prescribed in § 3.307(a)(6)(ii). 38 U.S.C.A. § 1116 (West 2002); 38 C.F.R. §§ 3.307(a)(6), 3.309(e) (2004). In the August 4, 2003 decision that considered the veteran's claim of entitlement to service connection for diabetes mellitus as a result of exposure to herbicide agents, the Board found that the veteran had service in the Republic of Vietnam as defined by § 3.307(a)(6)(iii) based on service aboard the U.S.S. Boston during the time this vessel stopped at Da Nang in the Republic of Vietnam on April 30, 1967 and on approximately May 17, 1967. Accordingly, in the instant claim, the Board finds that the veteran has the requisite type of service in the Republic of Vietnam for the same reasons the Board provided in its prior decision. 38 C.F.R. § 3.307(a)(6)(iii) (2004). Therefore, the veteran is presumed to have been exposed to an herbicide agent during such service in the absence of affirmative evidence to the contrary. Id. The disease processes for which the veteran seeks service connection, however, are not enumerated in 38 C.F.R. § 3.309(e) (2004). Coronary artery disease and hypertension are not listed diseases. Accordingly, since the disease processes for which the veteran seeks service connection are not enumerated in 38 C.F.R. § 3.309(e) (2004), the presumption of service connection for a disease associated with exposure to certain herbicide agents under 38 C.F.R. § 3.307(a)(6) (2004) is not for application. The Board recognizes the veteran's sincere belief that his coronary artery disease and hypertension were caused by exposure to herbicide agents, but under the authority granted by the Agent Orange Act of 1991, VA has determined that presumption of service connection based on exposure to herbicides used in Vietnam is not warranted for any disorders other than those for which VA has found a positive association between the disorder and such exposure. VA has not determined that a positive association exists between exposure to herbicide agents and the subsequent development of coronary artery disease and hypertension. That the veteran is not entitled to presumptive service connection under 38 C.F.R. § 3.307(a)(6) (2004) does not preclude an evaluation as to whether the veteran is otherwise entitled to service connection on a direct basis under 38 C.F.R. § 3.303 (2004) or on a presumptive basis for a chronic disease under 38 C.F.R. §§ 3.307(a)(3), 3.309(a) (2004). Notwithstanding the fact that the veteran's service medical records are missing, the private medical records and VA treatment records as well as the medical history provided by the veteran and noted in the aforesaid medical records, all indicate that the onset of the veteran's coronary artery disease and hypertension occurred in the 1980s with progression into the 1990s, and not within the year following the veteran's discharge from service in April 1969. Thus, the medical evidence does not show that the veteran's coronary artery disease or hypertension was present during service or manifested to a compensable degree during the one- year presumptive period following the veteran's discharge from service. The record also does not contain any competent medical evidence that otherwise relates the veteran's coronary artery disease and hypertension to his herbicide agent exposure in service. See 38 C.F.R. § 3.303(d) (2004); Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994) (providing that a claimant is not precluded under the Radiation Compensation Act from otherwise establishing service connection with proof of direct causation); McCartt v. West, 12 Vet. App. 164, 167 (1999) (acknowledging that the principles set forth in Combee with regard to proof of direct causation are applicable in cases involving Agent Orange exposure). There is similarly no competent medical evidence that links the veteran's coronary artery disease and hypertension to any other incident of his military service. As for the veteran's opinion on the cause of these diseases, the Board notes that where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence is required. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). Because the veteran is not a medical expert, his assertions of a relationship between his coronary artery disease and hypertension and exposure to herbicide agents during service cannot constitute competent evidence of such a relationship. Accordingly, service connection for coronary artery disease and hypertension may not be established on the basis of herbicide agent exposure on a presumptive basis under 38 C.F.R. §§ 3.307(a)(6), 3.309(e) (2004), or on a direct basis under 38 C.F.R. § 3.303 (2004), or on a presumptive basis for a chronic disease under 38 C.F.R. §§ 3.307(a)(3), 3.309(a) (2004). III. Left Upper Lobe Granuloma Due to Exposure to Asbestos or Herbicide Agents The Board observes that there is no specific statutory guidance with regard to asbestos-related claims, nor has the Secretary promulgated any regulations. VA, however, has issued a circular on asbestos-related diseases which provides some guidelines for considering compensation claims based on exposure to asbestos. Department of Veterans Benefits, Veterans' Administration, DVB Circular 21-88-8, Asbestos- Related Diseases (May 11, 1988) (DVB Circular). The information and instructions from the DVB Circular are incorporated in the VA Adjudication Procedure Manual, M21-1 (M21-1), Part VI, 7.21. The provisions of M21-1, Part VI, par. 7.21(a), (b), & (c) are not substantive in nature, but relevant factors discussed by them must be considered by the Board in all decisions in order to fulfill the Board's obligation under 38 U.S.C.A. § 7104(d)(1) to provide an adequate statement of the reasons and bases for a decision. See VAOPGCPREC 4-00; Ennis v. Brown, 4 Vet. App. 438, vacated at 4 Vet. App. 523, new decision issued at 4 Vet. App. 523 (1993); McGinty v. Brown, 4 Vet. App. 428 (1993). The first three sentences of M21-1, Part VI, par. 7.21(d)(1) are substantive in nature and must have been followed by the agency of original jurisdiction or the appeal must be remanded for this development. See VAOPGCPREC 4-00. Additionally, while not discussed in VAOPGCPREC 4-00, it is likely that factors enumerated at M21- 1, Part III, par. 5.13(b) should be considered by the Board. The guidelines further provide that the latent period varies from 10-45 years or more between first exposure and development of disease. M21-1, part VI, para. 7.21(b)(1) and (2). It is noted that an asbestos-related disease can develop from brief exposure to asbestos or as a bystander. The guidelines identify the nature of some asbestos-related diseases. The most common disease is interstitial pulmonary fibrosis (asbestosis). Asbestos fibers may also produce pleural effusions and fibrosis, pleural plaques, mesotheliomas of the pleura and peritoneum, lung cancer, and cancers of the gastrointestinal tract. See M21-1, part VI, para. 7.21(a)(1). Finally, the guidelines provide that the clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal lung disease. The medical evidence shows that a pulmonary consultation report dated in December 1986 explained that the veteran was admitted to a Texas hospital for a laminectomy during which time x-rays revealed a granuloma of the left upper lobe, confirmed by a tomogram, so a pulmonary consultation was called. Consulting physician Dr. H.I.S. noted that the veteran was totally asymptomatic. Dr. H.I.S. indicated that the veteran did not recall having a respiratory illness in his life, except for minor colds. Dr. H.I.S. related that the veteran reported that he had no history of tuberculosis or histoplasmosis; however, the veteran indicated that he did have a known positive "PPD" [purified protein derivative of tuberculin] at least since 1965 when he was discharged from the Navy. Dr. H.I.S. noted that the veteran reported that he had no known exposure to toxins or fibers such as asbestos, silica, etc. Dr. H.I.S. indicated that the chest examination revealed a normal-appearing chest without gynecomastia and that the chest x-ray revealed the left upper lobe granuloma but was otherwise negative. Dr. H.I.S. noted an impression of old granuloma with known positive PPD, which he added was most likely a benign calcified granuloma, such as old tuberculosis, histoplasma, or other fungal infections. Dr. H.I.S. maintained that there was no evidence of acute disease. Dr. H.I.S. indicated that it was unlikely that the lesion could represent hamartoma or similar problem or cancer. Dr. H.I.S. recommended that other than observation with a possible chest x-ray at one year, no further investigations were indicated at that time. VA treatment records included an April 1994 radiology report that noted that x-rays of the chest were normal except for a minimal density of the right suprahilar region for which the interpreter recommended a follow-up in two to three weeks. An April 1994 radiology report noted that repeat x-rays of the chest for slight oblique-density right suprahilar region revealed no evidence of an abnormality of the chest, particularly in the hilar areas. An April 1995 radiology report noted that x-rays of the chest revealed clear lungs with no mediastinal or hilar abnormality. The radiologist noted an impression of normal chest. A February 1996 radiology report of x-rays of the chest noted an impression of no lung infiltrates or pneumothorax. The foregoing medical evidence shows no radiographic evidence of parenchymal lung disease. Also, the medical evidence shows that the veteran is not currently diagnosed with an asbestos-related disorder. Dr. H.I.S. attributed the left upper lobe granuloma as due to factors other than asbestos exposure. This matter is further complicated by the fact that the more current VA radiology reports dated in 1994, 1995, and 1996, noted normal chest examinations with no mention of a continuing presence of a left upper lobe granuloma. Even assuming without deciding that the veteran has a current disability manifested by a left upper lobe granuloma, the medical evidence shows that the granuloma did not result from asbestos exposure. Therefore, service connection for a left upper lobe granuloma on the basis of asbestos exposure is not warranted. Service connection for left upper lobe granuloma as a result of exposure to herbicide agents is also not warranted. As previously discussed, the veteran is presumed to have been exposed to an herbicide agent during service in the absence of affirmative evidence to the contrary. Id. Granuloma, however, is not among the diseases associated with exposure to certain herbicide agents enumerated under 38 C.F.R. § 3.309(e) (2004). Therefore, the presumption of service connection for a disease associated with exposure to certain herbicide agents under 38 C.F.R. § 3.307(a)(6) (2004) is not for application. Service connection for left upper lobe granuloma is also not warranted on a direct basis. The medical evidence shows that the left upper lobe granuloma was discovered in December 1986. As such, there is no evidence that the left upper lobe granuloma was present during service. The veteran reportedly had a positive PPD test at his service separation examination. Dr. H.I.S. contended that the old granuloma was most likely a benign calcified granuloma, such as old tuberculosis, histoplasma, or other fungal infections. According to the history provided by the veteran, however, at no time prior to the discovery of the granuloma had the veteran suffered from a respiratory illness, tuberculosis, or histoplasmosis. Thus, the veteran's service medical records, had they been found, would be significant for only a positive PPD test with no documented bouts of tuberculosis or histoplasma in service. Therefore, the Board cannot find, on the basis of the foregoing evidence, that the left upper lobe granuloma is a chronic residual of a disease (such as tuberculosis or histoplasma) that manifested during service. Moreover, it is doubtful that the veteran has a current disability manifested by a left upper lobe granuloma given the VA radiology reports. Lastly, the record does not contain any competent medical evidence that otherwise relates the veteran's left upper lobe granuloma to his herbicide agent exposure in service. 38 C.F.R. § 3.303(d) (2004); Combee, 34 F.3d at 1043; McCartt, 12 Vet. App. at 167. There is similarly no competent medical evidence that links the veteran's left upper lobe granuloma to any other incident of his military service. The veteran's assertions of a relationship between his left upper lobe granuloma and exposure to herbicide agents during service do not constitute competent evidence of such a relationship. Grottveit, 5 Vet. App. at 93; Espiritu v. Derwinski, 2 Vet. App. at 494-95. Accordingly, service connection for left upper lobe granuloma may not be established on the basis of herbicide agents exposure on a presumptive basis under 38 C.F.R. §§ 3.307(a)(6), 3.309(e) (2004), or on a direct basis under 38 C.F.R. § 3.303 (2004). As the preponderance of the evidence is against the veteran's claims, the "benefit of the doubt" doctrine is not applicable, and the claims must be denied. 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2004) Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Service connection for coronary artery disease and hypertension, including as a result of exposure to herbicide agents is denied. Service connection for left upper lobe granuloma, including as a result of exposure to asbestos or herbicide agents is denied. REMAND The veteran contends that he sustained a laceration to his head during service in 1967 and every since that time he has experienced severe chronic headaches. VA treatment records are significant for complaints of headaches in April and May 1996 and in October 1998. The veteran complained of headaches at the July 2001 VA examination conducted in connection with his diabetes claim. There, however, is no medical evidence of a diagnosed disability attributable to the reported in-service head injury. Given that the veteran's service medical records are missing and given the facts of this particular claim, the Board finds that VA has a duty to assist the veteran in substantiating his claim. 38 U.S.C.A. § 5103A(d) (West 2002); 38 C.F.R. § 3.159(c)(4) (2004). Consequently, the veteran should be afforded a VA examination and a nexus opinion should be obtained to determine whether any head disorder found on examination is consistent with a head injury the veteran reportedly sustained during service. Accordingly, this case is REMANDED for the following action: 1. The veteran should be afforded an appropriate medical examination to ascertain the identity and etiology of any head disorder, to include headache disorder, that may be present. All indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The examiner is requested to review all pertinent records associated with the claims file and offer an opinion as to whether any head disorder, to include headache disorder, found on examination is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent) consistent with a head injury, to include a head laceration, that reportedly occurred in 1967 during the veteran's service. Please send the claims folder to the examiner for review in conjunction with the examination. 2. Thereafter, the veteran's claim should be readjudicated. If any benefit sought on appeal remains denied, the veteran and his representative should be provided with a supplemental statement of the case that contains notice of all relevant actions taken, including a summary of the evidence and applicable law and regulations considered pertinent to the issue. An appropriate period of time should be allowed for response by the veteran and his representative. Thereafter, the case should be returned to the Board for further appellate consideration, if in order. The purpose of this REMAND is to obtain additional development. The Board does not intimate any opinion as to the merits of the case, either favorable or unfavorable, at this time. The veteran has the right to submit additional evidence and argument on the matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. 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 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). ______________________________________________ John E. Ormond, Jr. Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs