Citation Nr: 0811480 Decision Date: 04/08/08 Archive Date: 04/23/08 DOCKET NO. 03-29 155A ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, the Commonwealth of Puerto Rico THE ISSUES 1. Whether new and material evidence to reopen the veteran's claim for service connection for a back disability has been received. 2. Entitlement to service connection for a left knee disability. 3. Entitlement to a rating in excess of 50 percent for schizophrenia, undifferentiated type. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Timothy D. Rudy, Associate Counsel INTRODUCTION The veteran served on active duty from July 1977 to March 1979. Most recently, in September 1996, the RO denied the veteran's earlier attempt to reopen a claim for service connection for a back disability. Although the RO notified the veteran of the denial of his claim, the veteran did not initiate an appeal. The present matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2003 rating decision in which the RO, inter alia, declined to reopen the veteran's claim for service connection for a back disability on the basis that new and material evidence had not been received. The RO also denied the veteran's claim for service connection for a left knee disability and his claim for a higher rating for his service-connected schizophrenia, undifferentiated type. In March 2003, the veteran filed a notice of disagreement (NOD). A statement of the case (SOC) was issued in September 2003, and the veteran filed a substantive appeal (via a VA Form 9, Appeal to the Board of Veterans' Appeals) in October 2003. In a June 2006 supplemental SOC (SSOC), the RO continued the denial of the claims on appeal. In February 2008, the veteran testified during a hearing before the undersigned Veterans Law Judge at the RO; a transcript of that hearing is of record. During the hearing, the representative requested, and the undersigned granted, a 30-day abeyance period for the submission of additional evidence. The appellant has submitted additional evidence to the Board, waiving initial RO consideration of the evidence. The Board accepts the additionally-received evidence for inclusion in the record. See 38 C.F.R. § 20.800 (2007). The Board's decision on the petition to reopen the claim for service connection for a back disability and the claim for service connection for a left knee disability are set forth below. The claim for a higher rating for schizophrenia, undifferentiated type, is addressed in the remand following the order; that matter is being remanded to the RO via the Appeals Management Center (AMC), in Washington, D.C. VA will notify the appellant when further action, on his part, is required. FINDINGS OF FACT 1. All notification and development action needed to fairly adjudicate the claims herein decided has been accomplished. 2. In September 1996, the RO declined to reopen a claim for service connection for a back disability; although notified of the denial , the veteran did not initiate an appeal. 3. Although some of the additional evidence associated with the claims file since the RO's September 1996 denial was not previously before agency decision makers, none of the evidence is so significant that it must be considered in order to fairly decide the merits of the claim for service connection for a back disability. 4. While in- and post-service records reflect notations as to knee pain, competent evidence does not establish the veteran has, or ever has had, a left knee disability. CONCLUSIONS OF LAW 1. The September 1996 RO determination declining to reopen the petition to reopen the veteran's claim for service connection for a back disability is final. 38 U.S.C.A. § 7105(b) (West 2002); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2007). 2. As new and material evidence has not been received, the criteria for reopening the claim for service connection for a back disability are not met. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156(a) (as in effect prior to August 29, 2001)). 3. The criteria for service connection for a left knee disability are not met. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2007)) includes enhanced duties to notify and assist claimants for VA benefits. VA regulations implementing the VCAA have been codified, as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2007). Notice requirements under the VCAA essentially require VA to notify a claimant of any evidence that is necessary to substantiate the claims, as well as the evidence that VA will attempt to obtain and which evidence he or she is responsible for providing. See, e.g., Quartuccio v. Principi, 16 Vet. App. 183 (2002) (addressing the duties imposed by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)). As delineated in Pelegrini v. Principi, 18 Vet. App. 112 (2004), after a substantially complete application for benefits is received, proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claims; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claims, in accordance with 38 C.F.R. § 3.159(b)(1). VA's notice requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). With respect to a request to reopen a previously denied claim, a claimant must be notified of both what is needed to reopen the claim and what is needed to establish the underlying claim for service connection. See Kent v. Nicholson, 20 Vet. App. 1 (2006). VCAA-compliant notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO). Id; Pelegrini, 18 Vet. App. at 112. See also Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). However, the VCAA notice requirements may, nonetheless, be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Id. In this appeal, an April 2002 pre-rating letter provided notice to the appellant regarding what information and evidence was needed to substantiate the petition to reopen his claim for service connection for a back disability and his claim for service connection for a left knee disability, as well as what information and evidence must be submitted by the appellant and what information and evidence would be obtained by VA. The April 2002 letter-which meets the first three of Pelegrini's content of notice requirements-also meets the VCAA's timing of notice requirement. While the veteran has not explicitly been advised to provide any evidence in his possession that pertains to his claims, the April 2002 letter informed the appellant that he could obtain medical records on his own "and send them to us." Given these instructions, the Board finds that the veteran has, effectively, been put on notice to provide any evidence in his possession that pertains to these claims. Accordingly, on these facts, the RO's omission is harmless. See Mayfield v. Nicholson, 20 Vet. App. 537, 543 (2006) (rejecting the argument that the Board lacks authority to consider harmless error). Further, while the April 2002 letter did not inform the appellant of the bases for the prior, final denial of his petition to reopen a claim for service connection for a back disability or the correct date of that prior final denial, consistent with Kent, the letter provided the appellant with the correct definition of what constitutes new and material evidence in this appeal. To the extent the April 2002 letter was deficient, such deficiency was "cured by actual knowledge on the part of the claimant." See Sanders v. Nicholson, 487 F.3d 881, 889 (Fed. Cir. 2007) .Both the January 2003 rating decision and the September 2003 SOC explained to the appellant the bases of the original denial of his service connection claim and how newly submitted evidence he had submitted was not material to whether the veteran had a back disability related to service. Thereafter, during the 2008 Board hearing, the veteran and his representative indicated their knowledge that to reopen the claim for service connection for a back disability, new and material evidence that the veteran has a back disability and that his back disability is related to service must be presented. The Board also notes that a March 2006 post-rating letter informed the appellant how disability ratings and effective dates are assigned, as well as the type of evidence that impacts those determinations. However, the timing of this notice is not shown to prejudice the veteran. After issuance of the notice, and opportunity for the appellant to respond, the June 2006 SSOC reflects readjudication of the claims. Hence, the appellant is not shown to be prejudiced by the timing of such notice. See Mayfield, 20 Vet. App. at 543; see also, Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as in a SOC or SSOC, is sufficient to cure a timing defect). The record also reflects that VA has made reasonable efforts to obtain or to assist in obtaining all relevant records pertinent to the matters on appeal. Pertinent medical evidence associated with the claims file consists of the veteran's service medical records, as well as outpatient treatment records from the VA Medical Center (VAMC) in San Juan, Puerto Rico, and from a VA outpatient clinic in Arecibo, Puerto Rico. Also of record and considered in connection with these claims is the transcript of the veteran's February 2008 Board hearing, as well as various written statements provided by the veteran and his representative, on his behalf. In summary, as regards the claims herein decided, the duties imposed by the VCAA have been considered and satisfied. Through various notices of the RO, the appellant has been notified and made aware of the evidence needed to substantiate these claims, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. There is no additional notice that should be provided, nor is there any indication that there is additional existing evidence to obtain or development required to create any additional evidence to be considered in connection with either claim. Consequently, any error in the sequence of events or content of the notice is not shown to prejudice the appellant or to have any effect on the appeal. Any such error is deemed harmless and does not preclude appellate consideration of the matters on appeal, at this juncture. See Mayfield, 20 Vet. App. at 543 (rejecting the argument that the Board lacks authority to consider harmless error). See also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. Service Connection Under the applicable criteria, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Such a determination requires a finding of a current disability that is related to an injury or disease incurred in service. Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). A. Petition to Reopen The veteran's entitlement to service connection for a back disability has previously been considered and denied, most recently in September 1996. In the September 1996 decision letter, the RO notified the veteran that he had failed to provide new and material evidence with which to reopen a service connection claim for a back disability. The evidence then of record included service medical records (which show a complaint of lower back pain in May 1978, and reports of May 1978 and November 1978 pre-discharge examinations which show no abnormalities of the spine or musculoskeletal system), the report of a May 1979 VA examination (which reflects no back complaints or findings), and evidence related to the veteran's psychiatric complaints. As the veteran did not appeal the RO's September 1996 determination, it is final as to the evidence then of record, and is not subject to revision on the same factual basis. See 38 U.S.C.A. § 7105(b); 38 C.F.R. §§ 3.104, 20.302, 20.1103. However, VA may reopen and review a claim that has been previously denied if new and material evidence is submitted by or on behalf of a veteran. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a). See also Hodge v. West, 155 F. 3d 1356 (Fed. Cir. 1998). The veteran's application to reopen his claim for service connection for a back disability was received on August 28, 2001. As regards petitions to reopen filed prior to August 29, 2001, 38 C.F.R. § 3.156(a) provides that new and material evidence is evidence not previously submitted that bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. In determining whether new and material evidence has been received, VA must initially decide whether evidence received since the prior final denial is, in fact, new. This analysis is undertaken by comparing newly received evidence with the evidence previously of record. After evidence is determined to be new, the next question is whether it is material. The provisions of 38 U.S.C.A. § 5108 require a review of all evidence received by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. See Evans v. Brown, 9 Vet. App. 273, 282- 83 (1996). Furthermore, for purposes of the new and material analysis, the credibility of the evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 512-13 (1992). The evidence associated with the claims file since the RO's September 1996 denial consists of VA medical records, the transcript of the veteran's Board hearing, and various statements provided by the veteran and by his representative, on his behalf. The treatment records are new, in the sense that they were not previously before agency decision makers, and are not cumulative or duplicative of evidence previously of record. However, none of these records include any medical comment or opinion indicating that the veteran has a current back disability (underlying the complaints of back pain noted in the records, see Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999) (holding that pain, alone, without evidence of underlying pathology, does not constitute a disability for VA purposes)) or that there exists a medical nexus between current back disability and service. As regards the written statements and hearing testimony, the Board notes, in particular, that, during the February 2008 Board hearing, the veteran asserted that, during service, he requested pain medication for his back. He testified that his lower back problems, including fused discs, arose from a sadistic jump master who made paratrooper trainees jump outside the specific terrain for which the rope and rail training mechanism was designed. He also said that during service he once was jumped by a group of individuals at 4 a.m. outside a doughnut store near the base at Fort Bragg. He said that he was attacked because he was speaking Spanish, that he was grabbed by the neck, and ever since had neck pain. He also testified that he has many spurs along his spinal cord. He indicated that he is treated at VA facilities for these back and neck problems because he cannot afford a private physician. He said that recent magnetic resonance imaging (MRI) and CT scans taken at VA show his back spurs. See Transcript, pp. 12-15. While the veteran's testimony is presumed to be credible for purposes of reopening, he (like his representative) is layperson not shown to have the appropriate medical training and expertise to competently provide a probative (i.e., persuasive) opinion on a medical matter-such as the diagnosis or etiology of particular disability. See, e.g., Bostain v. West, 11 Vet. App. 124, 127 (1998). Accordingly, where, as here, the resolution of the claim turns on a medical matter, unsupported lay statements, even if new, cannot serve as a predicate to reopen a previously disallowed claim. See Hickson v. West, 11 Vet. App. 374 (1998); Moray v. Brown, 5 Vet. App. 211, 214 (1993) In view of the above, the Board concludes that none of the evidence associated with the claims file since the September 1996 determination, when viewed either alone or in light of the evidence previously of record, tends to indicate that the appellant has a back disability as the result of disease or injury incurred in or aggravated by the appellant's military service. As such, none of the evidence is new and material for the purpose of reopening the claim, and the September 1996 determination remains final. As the veteran has not fulfilled his threshold burden of presenting new and material evidence to reopen the finally disallowed claim, the benefit-of-the-doubt doctrine is not applicable. See Annoni v. Brown, 5 Vet. App. 463, 467 (1993). B. Service Connection for a Left Knee Disability Service medical records indicate the veteran was seen for his right knee while in service, but reflect no complaints, findings, or diagnosis pertaining to the left knee. His May 1978 and November 1978 pre-discharge examinations revealed no abnormalities of the lower extremities. The Board also notes that the post-service record contains no competent, persuasive evidence of a current left knee disability. VA outpatient treatment records from April 1983 to January 2004 reflect no treatment for the left knee. Although September 2003 and January 2004 records reflect a notation of arthralgia (joint pain) of the knee (identified as one of the veteran's medical problems), the specific knee is not identified. In any event, the Board reiterates that t pain, alone, without evidence of underlying pathology, does not constitute a disability for VA purposes. See Sanchez- Benitez, 13 Vet. App. at 285,. Thus, in this case, the competent medical evidence of record simply does not establish that the veteran has, or ever has had, a left knee disability, and neither the veteran nor his representative has presented, identified, or even alluded to the existence of any such evidence. As indicated above, Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C.A. §§ 1110, 1131. Hence, where as here, medical evidence does not establish the disability for which service connection is sought, there can be no valid claim for service connection. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In addition to the medical evidence, in adjudicating this claim, the Board has considered the veteran's and his representative's oral and written assertions However, the Board points out that questions of medical diagnosis and causation are within the province of medical professionals. Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). As laypersons without the appropriate medical training and expertise, neither the veteran nor his representative is not competent to render a probative (persuasive) opinion on a medical matter. See Bostain, 11 Vet. App. at 127, citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). Hence, the lay assertions in this regard have no probative value. Under these circumstances, the claim for service connection for a left knee disability must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as no competent, probative evidence supports the claim, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER As new and material evidence to reopen the claim for service connection for a back disability has not been received, the appeal as to this matter is denied. Service connection for a left knee disability is denied. REMAND The Board's review of the claims file reveals that further RO action on the claim for a rating in excess of 50 percent for schizophrenia, undifferentiated type, is warranted. The most recent VA psychiatric examination of the veteran was performed in November 2002. The examiner then diagnosed the veteran with schizophrenia, alcohol abuse, and a cluster B personality disorder and assigned a Global Assessment of Functioning (GAF) score of 65. The Board notes that, in his January 2008 brief, the veteran's representative argued, on the veteran's behalf, that the November 2002 VA examination is inadequate for rating purposes because it is now more than five years old. The Board also notes that the first November 2002 VA examiner requested another psychiatrist examine the veteran because she had previously examined him for a higher rating. The second November 2002 VA examiner did not have access to the claims file. The Board also notes that, during his February 2008 Board hearing the veteran testified that he was now divorced, was unstable with poor impulse control, had psychotic moods and paranoia, and heard voices. Subsequent to the hearing, his private psychiatrist, E.J.O., M.D., submitted to the Board a two-page report in February 2008 in which the psychiatrist opined that the veteran's condition had markedly limited his ability to undertake any type of substantial gainful activity on a regular and substantial basis. Dr. E.J.O. noted that the veteran recently had tried working for the U.S. Postal Service but only worked for two months. He also suggested that the veteran should continue psychiatric treatment indefinitely. Thus, collectively, the evidence described above reflects a worsening of the veteran's service-connected schizophrenia, undifferentiated type,psychiatric disability. To ensure that the record accurately reflects the current severity of the disability, the Board finds that a more contemporaneous examination-with findings responsive to the applicable rating criteria-is needed to properly evaluate the veteran's disability. See 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2007). See also Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA has a duty to provide the veteran with a thorough and contemporaneous medical examination, one which takes into account the records of prior medical treatment, so that the evaluation of the claimed disability will be a fully informed one) and Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (an examination too remote for rating purposes cannot be considered contemporaneous). Accordingly, the RO should arrange for the veteran to undergo VA examination, by a psychiatrist, at an appropriate VA medical facility. The veteran is hereby notified that failure to report to the scheduled examination, without good cause, shall result in denial of the claim for increase. See 38 C.F.R. § 3.655(b) (2007). Examples of good cause include, but are not limited to, the illness or hospitalization of the veteran and death of an immediate family member. Id. If the veteran fails to report to the scheduled examination, the RO must obtain and associate with the claims file (a) copy(ies) of any notice(s) of the date and time of the examination sent to the veteran by the pertinent VA medical facility. Prior to arranging for the veteran to undergo further examination, the RO should obtain and associate with the claims file all outstanding records of treatment and/or evaluation of the veteran for schizophrenia. The record reflects that the veteran receives treatment from the VA hospital in San Juan and the VA clinic in Arecibo, Puerto Rico; however, the most recent outpatient treatment records from the San Juan VAMC are dated in April 2000 and the most recent outpatient treatment records from the VA clinic in Arecibo are dated in January 2004. The Board emphasizes that records generated by VA facilities that may have an impact on the adjudication of a claim are considered constructively in the possession of VA adjudicators during the consideration of a claim, regardless of whether those records are physically on file. See Dunn v. West, 11 Vet. App. 462, 466-67 (1998); Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). Hence, the RO must obtain all outstanding psychiatric records of the San Juan VAMC and the Arecibo VA clinic, following the current procedures prescribed in 38 C.F.R. § 3.159 (2007) as regards requests for records from Federal facilities. To ensure that all due process requirements are met, the RO should also give the veteran another opportunity to provide information and/or evidence pertinent to the claim on appeal, explaining that he has a full one-year period for response. See 38 U.S.C.A. § 5103 (b)(1)(West 2002); but see also 38 U.S.C.A. § 5103(b)(3) (West Supp. 2007) (amending the relevant statute to clarify that VA may make a decision on a claim before the expiration of the one-year notice period). The RO should also invite the appellant to submit all pertinent evidence in his possession, and ensure that its notice to the appellant meets the requirements of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006)- particularly, as regards assignment of disability ratings and effective dates-as well as Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008) (as regards the minimum notice requirements for increased rating claims). In Vazquez-Flores, the Court held that, in rating cases, VA must notify the claimant that, to substantiate a claim for an increased rating: (1) the claimant must provide, or ask VA to obtain, medical or lay evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on the claimant's employment and daily life; (2) if the diagnostic code under which the claimant is rated contains criteria necessary for entitlement to a higher disability rating that would not be satisfied by the claimant demonstrating a noticeable worsening or increase in severity of the disability and the effect of that worsening on the claimant's employment and daily life (such as a specific measurement or test result), the Secretary must provide at least general notice of that requirement to the claimant; (3) the claimant must be notified that, should an increase in disability be found, a disability rating will be determined by applying relevant diagnostic codes; and (4) the notice must also provide examples of the types of medical and lay evidence that the claimant may submit (or ask VA to obtain) that are relevant to establishing entitlement to increased compensation. The Board also notes that the veteran testified that he had been treated for five years by Dr. E.J.O, a psychiatrist. Because the claims file includes no treatment records from Dr. E.J.O., in its letter, the RO should specifically request that the veteran provide any necessary authorization to enable the RO to obtain all outstanding records of treatment by Dr. E.J.O. After providing the required notice, the RO should attempt to obtain any additional evidence for which the appellant provides sufficient information and, if necessary, authorization, following the current procedures prescribed in 38 C.F.R. § 3.159 (2007). The actions identified herein are consistent with the duties imposed by the Veterans Claim Act of 2000 (VCAA). See 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2007). However, identification of specific actions requested on remand does not relieve the RO of the responsibility to ensure full compliance with the VCAA and its implementing regulations. Hence, in addition to the actions requested above, the RO should also undertake any other development and/or notification action deemed warranted by the VCAA prior to adjudicating the claim remaining on appeal. Accordingly, this matter is hereby REMANDED to the RO, via the AMC, for the following action: 1. The RO should obtain all outstanding pertinent records of evaluation and/or treatment of the veteran's service- connected schizophrenia from the VA outpatient clinic in Arecibo, Puerto Rico (from January 2004 to the present), and from the San Juan VAMC (from April 2000 to the present). The RO must follow the procedures set forth in 38 C.F.R. § 3.159(c) as regards requesting records from Federal facilities. All records and/or responses received should be associated with the claims file. 2. The RO should send to the veteran and his representative a letter requesting that the veteran provide sufficient information, and if necessary, authorization to enable it to obtain any additional evidence pertinent to the claim on appeal that is not currently of record. The RO should specifically request that the veteran provide any necessary authorization to enable it to obtain the treatment records of Dr. E.J.O. The RO should also invite the veteran to submit all pertinent evidence in his possession, and explain the type of evidence that is his ultimate responsibility to submit. The RO should request that the veteran submit all evidence in his possession, and ensure that its letter meets the requirements of Dingess/Hartman and Vazquez-Flores v. Peake (cited to and discussed above), as appropriate. The RO's letter should clearly explain to the veteran that he has a full one-year period to respond (although VA may decide the claim within the one-year period). 3. If the veteran responds, the RO should assist him in obtaining any additional evidence identified by following the current procedures set forth in 38 C.F.R. § 3.159. All records and responses received should be associated with the claims file. If any records sought are not obtained, the RO should notify the veteran and his representative of the records that were not obtained, explain the efforts taken to obtain them, and describe further action to be taken. 4. After all records and/or responses received from each contacted entity have been associated with the claims file, the RO should arrange for the veteran to undergo VA examination, by a psychiatrist, at an appropriate VA medical facility. The entire claims file, to include a complete copy of this REMAND, must be made available to the physician designated to examine the veteran, and a report of the examination should include discussion of the veteran's documented medical history and assertions. All necessary tests and studies, (to include psychological testing, if warranted), should be accomplished (with all findings made available by the psychiatrist prior to the completion of his or her report), and all clinical findings should be reported in detail. The examiner should render specific findings with respect to the existence and extent (or frequency, as appropriate) of: obsessional rituals; memory loss; depressed mood; anxiety; panic attacks; sleep impairment; impaired judgment, speech, impulse control and/or thought processes; neglect of personal hygiene and appearance; suicidal ideation; spatial disorientation; delusions and/or hallucinations; difficulty in adapting to stressful circumstances; and inability to establish and maintain effective relationships. The examiner should render a multi-axial diagnosis, including assignment of a GAF scale score that represents the level of impairment due to the veteran's psychiatric disability, and an explanation of what the score means. The physician should set forth all examination findings, along with the complete rationale for conclusions reached, in a printed (typewritten) report. 5. If the veteran fails to report to the scheduled examination, the RO must obtain and associate with the claims file (a) copy(ies) of any notice(s) of the date and time of the examination sent to the veteran by the pertinent VA medical facility. 6. To help avoid future remand, the RO must ensure that all requested actions have been accomplished (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. See Stegall v. West, 11 Vet. App. 268 (1998). 7. After completing the requested actions, and any additional notification and/or development deemed warranted, the RO should readjudicate the claim for a rating in excess of 50 percent for schizophrenia, undifferentiated type. If the veteran fails to report to the scheduled examination, the RO should apply the provisions of 38 C.F.R. § 3.655(b), as appropriate, in adjudicating the claim for increase. Otherwise, the RO should adjudicate the claim in light of all pertinent evidence and legal authority. 8. If the benefit sought on appeal remains denied, the RO must furnish to the veteran and his representative an appropriate SSOC that includes clear reasons and bases for all determinations, and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. The purpose of this REMAND is to afford due process and to accomplish additional development and adjudication, and it is not the Board's intent to imply whether the benefits requested should be granted or denied. The veteran need take no action until otherwise notified, but he may furnish additional evidence and/or argument during the appropriate time period. See Kutscherousky v. West, 12 Vet. App. 369 (1999); Colon v. Brown, 9 Vet. App. 104, 108 (1996); Booth v. Brown, 8 Vet. App. 109 (1995); Quarles v. Derwinski, 3 Vet. App. 129, 141 (1992). 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 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). ______________________________________________ JACQUELINE E. MONROE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs