Citation Nr: 0811944 Decision Date: 04/10/08 Archive Date: 04/23/08 DOCKET NO. 00-22 663A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUES 1. Entitlement to compensation benefits pursuant to 38 U.S.C.A. § 1151 for a hemangioma at the base of the tongue. 2. Entitlement to compensation benefits pursuant to 38 U.S.C.A. § 1151 for hemangiomas on the roof of the mouth, with a pedunculated mass at the anterior wall of the trachea, dysphagia, and hoarseness. 3. Entitlement to specially adapted housing or a special home adaptation grant. 4. Entitlement to financial assistance in the purchase of an automobile or other conveyance and/or adaptive equipment. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Theresa M. Catino, Counsel INTRODUCTION The veteran served on active military duty from September 1947 to October 1951. He was a prisoner-of-war of enemy forces for one day in December 1950. This matter comes before the Board of Veterans' Appeals (Board) on appeal from two rating actions of the Department of Veterans Affairs Regional Office (RO) in Pittsburgh, Pennsylvania. Specifically, in a May 2000 decision, the RO denied entitlement to compensation benefits pursuant to 38 U.S.C.A. § 1151 for a hemangioma at the base of the tongue and for hemangiomas on the roof of the mouth, with a pedunculated mass at the anterior wall of the trachea, dysphagia, and hoarseness. Also, in a June 2001 determination, the RO denied entitlement to specially adapted housing and a special home adaptation grant as well as entitlement to financial assistance in the purchase of an automobile or other conveyance and/or adaptive equipment. In August 2003 and August 2006, Board remanded these claims to the agency of original jurisdiction for further evidentiary development. Following completion of most of the requested development, and most recently in September 2007, the Appeals Management Center (AMC), in Washington, DC continued to deny these issues and thereafter returned the claims folder to the Board for further appellate review. The issue of entitlement to financial assistance in the purchase of an automobile or other conveyance and/or adaptive equipment will be addressed in the REMAND portion of the decision below and is being REMANDED to the RO via the AMC. FINDINGS OF FACT 1. The Heparin and Coumadin that the veteran took for six months in 1978 is not the proximate cause of his subsequent development of a hemangioma at the base of his tongue. 2. The Heparin and Coumadin that the veteran took for six months in 1978 is not the proximate cause of his subsequent development of hemangiomas on the roof of his mouth, with a pedunculated mass at the anterior wall of the trachea, dysphagia, and hoarseness. 3. The veteran's confinement to a wheelchair is the result of multiple disabilities, including several nonservice-connected disorders. CONCLUSIONS OF LAW 1. The requirements for compensation pursuant to 38 U.S.C.A. § 1151 for a hemangioma at the base of his tongue, claimed to have resulted from VA medical treatment, have not been met. 38 U.S.C.A. § 1151, 5107 (West 2002); 38 C.F.R. § 3.361 (2007). 2. The requirements for compensation pursuant to 38 U.S.C.A. § 1151 for hemangiomas on the roof of his mouth, with a pedunculated mass at the anterior wall of the trachea, dysphagia, and hoarseness, claimed to have resulted from VA medical treatment, have not been met. 38 U.S.C.A. § 1151, 5107 (West 2002); 38 C.F.R. § 3.361 (2007). 3. The basic eligibility requirements for specially adapted housing or a special home adaptation grant have not been met. 38 U.S.C.A. § 2101 (West 2002); 38 C.F.R. § 3.809 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties To Notify And To Assist The Veterans Claims Assistance Act of 2000 (VCAA), which was enacted on November 9, 2000, eliminated the concept of a well-grounded claim, redefined the obligations of VA with respect to the duty to assist, and imposed on VA certain notification requirements. Since the enactment of the law, the VCAA has been codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, & 5126. This change in the law is applicable to all claims filed on or after the date of enactment of the VCAA and to those claims which were filed before the date of enactment but which were not yet final as of that date. During the pendency of the current appeal, and specifically on March 3, 2006, the United States Court of Appeals for Veterans Claims (Court) issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006) which held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. The Court held that, upon receipt of an application for a service connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. Dingess/Hartman, 19 Vet. App. at 488. Additionally, this notice must include notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. In the present case, a September 2006 letter provided the veteran with the criteria for his § 1151 and housing claims. This document also notified the veteran that VA would make reasonable efforts to help him obtain necessary evidence with regard to these issues but that he must provide enough information so that the agency could request the relevant records. In addition, the letter informed the veteran of his opportunity to submit "additional things," "any other evidence or information that . . . [he thought would] support . . . [his] claim," as well as "any evidence in . . . [his] possession that pertains to . . . [his] claim." See Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II); VAOPGCPREC 1-2004 (February 24, 2004); and Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). Additionally, the September 2006 letter informed the veteran of the type of evidence necessary to establish the degree of disability (element #4) and an effective date (element #5). See Dingess/Hartman, 19 Vet. App. at 488. In any event, however, as will be discussed below, the Board finds that the evidence of record does not support a grant of either of the § 1151 claims on appeal. In light of these denials, no ratings or effective dates will be assigned. Thus, the Board finds that there can be no possibility of any prejudice to the veteran in proceeding with the issuance of a final decision of the claims adjudicated in this decision. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). The Court has also held that VCAA notice should be provided to a claimant before the initial unfavorable decision on the claim by the agency of original jurisdiction (AOJ). Pelegrini II. See also VAOPGCPREC 7-2004 (July 16, 2004) and Mayfield v. Nicholson, 444 F.3d at 1333. In the present case, the RO provided the veteran with an adequate VCAA notification letter in September 2006. Clearly, this letter was issued to the veteran after the initial denial of his housing claim in June 2001 and after the initial denial of his § 1151 claims in May 2000. In any event, the veteran was "provided the content-complying notice to which he [was] entitled." Pelegrini, 18 Vet. App. at 122. Furthermore, in September 2007, the § 1151 and housing claims were readjudicated, and a supplemental statement of the case (SSOC) was issued. Consequently, the Board finds that nothing about the evidence or any response to the RO's notification suggests that the § 1151 and housing issues adjudicated in this decision must be re-adjudicated ab initio to satisfy the requirements of the VCAA. The Board also finds that the duty to assist provisions of the VCAA have been met with respect to the current appeal. All relevant treatment records adequately identified by the veteran, have been obtained and associated with his claims folder. He has also been accorded pertinent VA examinations. Accordingly, the Board finds that VA has done everything reasonably possible to notify and to assist the veteran in the development of the § 1151 and housing claims adjudicated in this decision. Under the circumstances of this case, additional efforts to assist the veteran in accordance with the VCAA would serve no useful purpose. See, Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (which holds that strict adherence to requirements in the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case and that such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran). See also, Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (which holds that remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). Importantly, the veteran has pointed to no other pertinent evidence which has not been obtained. Consequently, the Board will proceed to adjudicate the following § 1151 and housing issues on appeal, based upon the evidence currently of record. See 38 U.S.C.A. §§ 5102 and 5103 (West 2002); 38 C.F.R. § 3.159(b) (2007); Pelegrini II; Quartuccio v. Principi, 16 Vet. App. 183 (2002). Analysis A. § 1151 Claims Effective October 1, 1997, 38 U.S.C.A. § 1151 provides in relevant part that (a) compensation under this chapter and dependency and indemnity compensation under chapter 13 of . . . [38 U.S.C.] shall be awarded for a qualifying additional disability or a qualifying death of a veteran in the same manner as if such additional disability or death were service-connected. For purposes of this section, a disability or death is a qualifying additional disability or qualifying death if the disability or death was not the result of the veteran's willful misconduct and-- (1) the disability or death was caused by hospital care, medical or surgical treatment, or examination furnished the veteran under any law administered by the Secretary, either by a Department employee or in a Department facility as defined in § 1701(3)(A) of . . . [38 U.S.C.], and the proximate cause of the disability or death was-- (A) carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the Department in furnishing the hospital care, medical or surgical treatment, or examination; or (B) an event not reasonably foreseeable For claims received by VA on or after October 1, 1997, to determine whether a veteran has an additional disability, VA compares the veteran's condition immediately before the beginning of the medical treatment upon which the claim is based to his/her condition after such treatment has stopped. 38 C.F.R. § 3.361(b) (2007). To establish that VA treatment caused additional disability, the evidence must show that the medical treatment resulted in the veteran's additional disability. Merely showing that a veteran received treatment and that the veteran has an additional disability does not establish cause. 38 C.F.R. § 3.361(c)(1) (2007). The proximate cause of disability is the action or event that directly caused the disability, as distinguished from a remote contributing cause. To establish that carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on VA's part in furnishing medical treatment proximately caused a veteran's additional disability, it must be shown that the medical treatment caused the veteran's additional disability; and (i) VA failed to exercise the degree of care that would be expected of a reasonable health care provider, or (ii) VA furnished the hospital care, medical or surgical treatment, or examination without the veteran's or, in appropriate cases, the veteran's representative's informed consent. 38 C.F.R. § 3.361(d) & (d)(1) (2007). Whether the proximate cause of a veteran's additional disability was an event not reasonably foreseeable is in each claim to be determined based on what a reasonable health care provider would have foreseen. The event need not be completely unforeseeable or unimaginable but must be one that a reasonable health care provider would not have considered to be an ordinary risk of the treatment provided. In determining whether an event was reasonably foreseeable, VA will consider whether the risk of that event was the type of risk that a reasonable health care provider would have disclosed in connection with the informed consent procedures of 38 C.F.R. § 17.32 of this chapter. 38 C.F.R. § 3.361(d)(2) (2007). Throughout the appeal in the present case, the veteran has asserted that he had an allergic reaction to medication (Heparin and Coumadin) that he was given in 1978 for treatment for phlebitis and that this reaction led to the development of hemangiomas at the base of his tongue and on the roof of his mouth with a pedunculated mass at the anterior wall of the trachea, dysphagia, and hoarseness. See, e.g., T. at 16, 20, 25-31. Pertinent medical records indicate that, during an approximate 5-week hospitalization for deep vein thrombosis of the left lower extremity secondary to a gunshot wound of the left leg between February and March 1978, the veteran was initially given Heparin. His medication was then changed to Coumadin, which he continued to take for six months until August 1978. Subsequent medical records reflect treatment for hoarseness and a varicocele at the base of the veteran's tongue in February 1982, a lesion at the base of his tongue between December 1982 and May 1983, dysphagia and chronic laryngitis in July 1983, a hemangioma on the roof of his mouth in July 1983, a hemiangoma at the base of his tongue in July 1984, a lingual hemangioma between July and August 1984, a hoarse and dry voice in June 2001, impaired swallowing in November 2002, hoarseness in March 2003, dysphagia with certain types of food (mostly of dry consistencies) and muscle tension dysphonia in June 2003, as well as moderate dysphonia and complaints of breathy and hoarse vocal quality in October 2003. The Board acknowledges that some medical evidence of record appears to indicate that the Heparin and Coumadin that the veteran had taken in the late 1970s may have contributed in some way to his subsequent development of hemangiomas at the base of his tongue and on the roof of his mouth. For example, in a July 1983 report, a treating VA physician stated that the veteran's anticoagulant therapy "brought out" the probably hereditary hemangiomas. Also, in an October 1984 letter, a private physician noted that the veteran had "some underlying circumstances that probably make the effect of the anticoagulants more evident." The doctor did not, however, specifically associate the medication that the veteran was prescribed in 1978 (e.g., the Heparin and the Coumadin) with his subsequent development of multiple hemangiomas at the base of his tongue and the roof of his mouth. Although in a February 1985 letter, this physician stated that "there may be some connection with regards to the current status of his vascular system," the doctor did not provide a more specific, or conclusionary, opinion. Further, in an undated report received at the RO in early 2000, a private biochemist concluded that the anticoagulant medicine that the veteran took in the late 1970s "may have exploited his genetic disposition to result in the observed symptoms." Also according to this medical professional, "[a]nother possibility is that another drug taken in the past or a prior condition or illness may have upset the [veteran's] hemostatic mechanism, and the anticoagulant Coumadin may then have 'opportunistically taken advantage of this condition' to cause further degeneration of the hemostatic mechanism." Significantly, however, these private medical professionals essentially provided hypothetical opinions that the Heparin and Coumadin that the veteran took in 1978 may have contributed in some way to his subsequent development of hemangiomas at the base of his tongue and the roof of his mouth. In any event, they did not specifically conclude that the proximate cause of the additional disability that the veteran incurred (e.g., the hemangiomas at the base of his tongue and on the roof of his mouth) was the result of carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing medical treatment (e.g., prescribing Heparin and Coumadin) or was an event not reasonably foreseeable. 38 U.S.C.A. § 1151; 38 C.F.R. § 3.361. Significantly, the claims folder contains conclusive medical opinions indicating that there is no association between the Heparin and Coumadin that the veteran took in the late 1970s and his subsequent development of multiple hemangiomas at the base of his tongue and the roof of his mouth. Specifically, in an August 1983 report, a treating VA physician explained that the hemangioma at the base of the veteran's tongue "is congenital and there is no evidence based on review of his record to indicate otherwise, nor is there evidence to indicate that this was related to a hematoma of the buttocks." In a December 1983 report, a private physician explained that he had examined the veteran in the prior month and had reviewed his "extensive" medical records. In pertinent part, the doctor provided an impression of cavernous hemangioma at the base of the tongue. Additionally, the physician concluded that he could find "no association between the anticoagulation therapy of 1978 and . . . [the veteran's] cavernous hemangioma which . . . [the doctor felt was] congenital in nature." The physician explained that "it is not rare for these to become manifest later in life." Further, in a report of an October 2003 VA outpatient treatment session, a treating physician expressed his opinion that "[i]t is somewhat questionable that . . . [the veteran] is continuing to have ongoing problems with spontaneous hematoma formation due to a medication that he received some 20 years ago." This doctor suspected "an intrinsic blood dyscrasia." [Previously, in February 1982, another VA physician had explained that, while hematomas could be a complication from the anti-coagulants, . . . this treatment was discontinued a long time ago."] A July 2003 VA mouth, lips, and tongue examination provided diagnoses of relaxation of the vocal cords with hoarseness as well as status post surgery to the oral cavity and pharynx times four by history. In March 2004, this examiner expressed his opinion that "[i]t is not as likely as not that the dysphagia or hoarseness is due to any VA . . . treatment" and that, to the best of his knowledge, Heparin and Coumadin do not cause hoarseness (which, according to this doctor, is the result of relaxation of the vocal chords). The examiner further noted that the subglottic polyp that the veteran had in 1983 (which had resulted from a prior tracheotomy) but did not have surgically removed was probably "coughed up." The examiner specifically stated that the polyp was not visible on examination in July 2003. In addition, the examiner explained that, although hemangiomas were not visible on examination, the multiple prior hemangiomas that the veteran had previously had in his mouth were "not related to any medications, specifically Coumadin and Heparin." The examiner reviewed, and concurred with, the August 1983 physician's opinion describing the veteran's hemangiomas as a congenital disorder. Of significance is the fact that most of the physicians who have concluded that the Heparin and Coumadin that the veteran took for six months in 1978 are not the proximate cause of the hemangiomas at the base of his tongue and on the roof of his mouth reviewed his extensive medical records prior to rendering their opinions. Thus, the Board finds their medical conclusions to be more persuasive than those of the physicians who concluded (without reviewing the medical records) that there may be an association between this medicine and the hemangiomas. Because the Heparin and Coumadin that the veteran took for six months in 1978 has been determined not to be the proximate cause of his subsequent development of hemangiomas at the base of his tongue and on the roof of his mouth, the Board need not address the matter of whether the proximate cause of the additional disability that the veteran incurred (e.g., the hemangiomas at the base of his tongue and on the roof of his mouth) was the result of carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing medical treatment (e.g., prescribing Heparin and Coumadin) or was an event not reasonably foreseeable. 38 U.S.C.A. § 1151; 38 C.F.R. § 3.361. Without competent evidence that the proximate cause of the anticoagulant therapy that the veteran took in the late 1970s resulted in his subsequent development of hemangiomas in his mouth, his claim for compensation benefits pursuant to 38 U.S.C.A. § 1151 for a hemangioma at the base of the tongue and for hemangiomas on the roof of the mouth, with a pedunculated mass at the anterior wall of the trachea, dysphagia, and hoarseness must be denied. 38 U.S.C.A. § 1151; 38 C.F.R. § 3.361. B. Specially Adapted Housing Or A Special Home Adaptation Grant A certificate of eligibility for assistance in acquiring specially adapted housing may be awarded to a veteran who is receiving compensation for permanent and total service-connected disability due to: (1) the loss, or loss of use, of both lower extremities, such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair, or (2) blindness in both eyes, having only light perception, plus, the anatomical loss or loss of use of one lower extremity, or (3) the loss or loss of use of one lower extremity together with residuals of organic disease or injury which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair, or (4) the loss or loss of use of one lower extremity together with the loss or loss of use of one upper extremity which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair, or (5) the loss, or loss of use, of both upper extremities such as to preclude use of the arms at or above the elbows. 38 U.S.C.A. § 2101; 38 C.F.R. § 3.809. The term "preclude locomotion" means the necessity for regular and constant use of a wheelchair, braces, crutches, or canes as a normal mode of locomotion although occasional locomotion by other methods may be possible. 38 C.F.R. § 3.809(d). A certificate of eligibility for assistance in acquiring a special home adaptation grant may be issued to a veteran who is not entitled to a certificate of eligibility for assistance in acquiring specially adapted housing and has not previously received assistance in acquiring specially adaptive housing under 38 U.S.C.A. § 2101; and is entitled to compensation for permanent and total disability which (1) is due to blindness in both eyes with 5/200 visual acuity or less, or (2) includes the anatomical loss or loss of use of both hands. 38 U.S.C.A. § 2101; 38 C.F.R. § 3.809(a). In the present case, service connection has been granted for the following disabilities: residuals of a gunshot wound to the left leg (Muscle Group XI) with myositis of the left thigh and left medial meniscectomy (30%), residuals of frostbite of the right foot (30%), residuals of frostbite of the left foot (30%), venous insufficiency of the left leg and thigh (20%), status post surgical repair epigastric hernia (0%), and residual scars of recurrent hematoma of the right buttock, status post surgical intervention (0%). In addition, the veteran has been in receipt of a total disability rating based on individual unemployability due to service-connected disability since November 1998. Throughout the current appeal, the veteran has contended that his service-connected disabilities have rendered him unable to use his legs and that this loss of use of his lower extremities has confined him to a wheelchair. He asserts that he needs some doors widened in his home, a sink lowered in his bathroom, and a special shower that will allow him to shower in his wheelchair. See, e.g., September 2002 hearing transcript (T.) at 15-16, 31-35, 37-40, 42-43. In a statement received at the RO in April 2003, one of the veteran's sons explained that he cares for his father on a daily basis and that his father essentially spends his days in "bed, . . . his wheelchair, . . . [or] his lift chair." The Board has carefully and thoroughly reviewed the evidence of record. At a May 2000 VA outpatient treatment session, the treating physician concluded that the veteran has significant arthritis in his left knee and that this disability "significantly limit[s] . . . his ability to perform activities of daily living." The veteran arrived at a June 2001 VA outpatient treatment session, however, "via wheelchair with . . . [complaints of] increased . . . [shortness of breath]." At that time, the examining registered nurse noted the veteran's history of chronic obstructive pulmonary disorder (COPD) with complaints of increased congestion in the lungs with productive cough of white sputum. Also, August 2001, November 2001, November 2002, and January 2003 VA outpatient treatment records indicate that the veteran was wheelchair-bound as a result of severe degenerative joint disease of both of his knees and severe chronic bilateral knee pain. The January 2003 report also includes the treating physician's opinion that the veteran's lower extremity pains were due in part to degenerative joint disease of his hips as well as his diabetic neuropathy. Indeed, following a VA housebound/aid and attendance examination in January 2002, the examiner concluded that the veteran's "activity . . . [was] very limited due [to his] dyspnea and bilateral knee pain . . . [secondary] to . . . degenerative joint disease" and that a wheelchair was required for his locomotion. The examiner observed that the veteran had dyspnea on very minimal exertion and diagnosed restrictive lung disease, chronic obstructive pulmonary disorder, and severe degenerative joint (knee) disease. In addition, following a VA housebound/aid and attendance examination in March 2003, another examiner concluded that the veteran was "essentially wheelchair bound." The examiner then listed the veteran's disabilities as: degenerative joint disease of the knees, coronary artery disease (CAD), chronic obstructive lung disease, diabetes mellitus (type II), post-phlebitic syndrome, peripheral neuropathy, residuals of frostbite, ventral hernia, and peripheral vascular disease. Significantly, as this evidence illustrates, while the veteran is indeed confined to his wheelchair, this confinement is the result of multiple disabilities, including several nonservice-connected disabilities such as severe degenerative joint disease of his right knee, degenerative joint disease of his hips, COPD, restrictive lung disease with dyspnea, diabetic neuropathy, diabetes mellitus (type II), and CAD. Clearly, therefore, the evidence of record does not demonstrate that the veteran has permanent and total service-connected disability resulting in the loss, or loss of use, of both of his lower extremities, such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair. Further, the evidence of record does not demonstrate, nor does the veteran contend, that he has permanent and total disability resulting in blindness in both eyes, having only light perception, plus, the anatomical loss or loss of use of one lower extremity; loss or loss of use of one lower extremity together with residuals of organic disease or injury which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; loss or loss of use of one lower extremity together with the loss or loss of use of one upper extremity which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; or loss, or loss of use, of both upper extremities such as to preclude use of the arms at or above the elbows. Consequently, the Board must conclude that the requirements for a certificate of eligibility for assistance in acquiring specially adapted housing have not been met. 38 U.S.C.A. § 2101; 38 C.F.R. § 3.809. Additionally, the evidence of record does not demonstrate, nor does the veteran contend, that he has a permanent and total service-connected disability that involves blindness in both eyes with 5/200 visual acuity or less or anatomical loss or loss of use of both hands. Thus, the Board must conclude that the requirements for a certificate of eligibility for assistance in acquiring a special home adaptation grant have not been met. 38 U.S.C.A. § 2101; 38 C.F.R. § 3.809(a). ORDER Entitlement to compensation benefits pursuant to 38 U.S.C.A. § 1151 for a hemangioma at the base of the tongue is denied. Entitlement to compensation benefits pursuant to 38 U.S.C.A. § 1151 for hemangiomas on the roof of the mouth, with a pedunculated mass at the anterior wall of the trachea, dysphagia, and hoarseness is denied. Entitlement to specially adapted housing or a special home adaptation grant is denied. REMAND In February 2004, the AMC issued a letter intended to satisfy the notification requirements of the VCAA with regard to the veteran's claim for financial assistance in the purchase of an automobile or other conveyance and/or adaptive equipment. See 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). Specifically, this document discussed VA's and the veteran's responsibilities in the development of relevant evidence and notified him of his opportunity to submit "additional evidence." Significantly, however, the letter did not discuss the type of information and evidence needed to substantiate this claim. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Pelegrini v. Principi, 18 Vet. App. 112, 120-121 (2004); VAOPGCPREC 1-2004 (February 24, 2004); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); and Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Consequently, in relevant part of the August 2006 remand, the Board asked the AMC to issue a corrective VCAA letter that provided such notice to the veteran. Pursuant to the Board's instructions, the AMC, in September 2006, issued purportedly proper VCAA notification of the veteran's automobile claim to him. Significantly, however, the September 2006 letter does not discuss the type of information and evidence necessary to substantiate the veteran's claim for financial assistance in the purchase of an automobile or other conveyance and/or adaptive equipment. The Board regrets the delay caused by this remand. Importantly, however, notice of the type of information and evidence necessary to support the claim for financial assistance in the purchase of an automobile or other conveyance and/or adaptive equipment has not been provided to the veteran, as was requested by the Board in its August 2006 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (which finds that, as a matter of law, a remand by the Board confers on the veteran the right to compliance with the remand orders and that a remand by the Board imposes upon the Secretary of Veterans Affairs a concomitant duty to ensure compliance with the terms of the remand). Accordingly, further appellate consideration will be deferred and this case is REMANDED to the AMC for the following actions: 1. The AMC should issue a corrective VCAA notification letter to the veteran and his representative with regard to issue of entitlement to financial assistance in the purchase of an automobile or other conveyance and/or adaptive equipment. The notification letter should fully comply with, and satisfy, the provisions of the VCAA. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Pelegrini v. Principi, 18 Vet. App. 112, 120-121 (2004); VAOPGCPREC 1-2004 (February 24, 2004); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); and Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). 2. Thereafter, the AMC should re- adjudicate the issue of entitlement to financial assistance in the purchase of an automobile or other conveyance and/or adaptive equipment. If the decision remains in any way adverse to the veteran, he should be provided with an SSOC. The SSOC must contain notice of all relevant actions taken on the claims for benefits, to include the applicable law and regulations considered pertinent to the issue remaining on appeal, as well as a summary of the evidence of record. An appropriate period of time should be allowed for response. The appellant has the right to submit additional evidence and argument on the matter that the Board has remanded. 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 or by the Court for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2006). ______________________________________________ D. C. SPICKLER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs