Citation Nr: 0814801 Decision Date: 05/05/08 Archive Date: 05/12/08 DOCKET NO. 06-34 517 ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office Center in Wichita, Kansas THE ISSUES 1. Entitlement to an initial evaluation in excess of 10 percent for post-traumatic stress disorder (PTSD). 2. Entitlement to a compensable evaluation for residuals of a shrapnel wound to the left temple, superficial. 3. Entitlement to service connection for hepatitis C. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD Kristi L. Gunn, Associate Counsel INTRODUCTION The veteran served on active duty from February 1968 to June 1969. This case comes before the Board of Veterans' Appeals (Board) on appeal from a June 2005 rating decision of the Wichita, Kansas, Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for post-traumatic stress disorder (PTSD) and assigned a 10 percent evaluation, effective March 2005. In the same rating decision, the RO continued the noncompensable evaluation for residuals of a shrapnel wound to the left temple, superficial, and denied service connection for hepatitis C. In February 2008, the veteran testified at a travel board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. During the hearing, the veteran waived initial RO consideration of the new evidence submitted in conjunction with the hearing. 38 C.F.R. § 20.1304(c) (2007). The issue of entitlement to an initial evaluation in excess of 10 percent for post-traumatic stress disorder (PTSD) is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. The veteran's service-connected residuals of a shrapnel wound to the left temple, superficial, is considered a resolved scar of the scalp. 3. Competent evidence of a nexus between the post service diagnosis of hepatitis C and service is not of record. CONCLUSIONS OF LAW 1. The criteria for a compensable evaluation for residuals of a shrapnel wound to the left temple, superficial, have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7800 (2007). 2. Hepatitis C was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.303 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Decision A. Residuals of a Shrapnel Wound to the Left Temple, Superficial The veteran contends that his residuals of a shrapnel wound to the left temple, superficial, warrant a compensable evaluation. By way of procedural background, in a June 1980 rating decision, service connection was granted for a shrapnel wound to the head, and assigned a noncompensable evaluation under Diagnostic Code 7800, effective March 1980. The RO concluded that based upon the in-service report of a superficial shrapnel wound to the left temple in November 1968, a noncompensable evaluation was warranted. Under the applicable criteria, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4 (2007). Separate diagnostic codes identify the various disabilities. VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Although the Board has thoroughly reviewed all medical evidence of record, the Board will focus primarily on the more recent medical findings regarding the current level of impairment related to each of the veteran's disabilities. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. As previously stated, the veteran's service-connected scar is currently rated noncompensable under Diagnostic Code 7800. The rating schedule authorizes the assignment of a zero (noncompensable) rating in every instance in which the rating schedule does not provide such a rating and the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. Under Diagnostic Code 7800, a 10 percent evaluation is warranted for scars of the head, face, and neck when there is one characteristic of disfigurement. A 30 percent evaluation requires visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with two or three characteristics of disfigurement. A 50 percent evaluation requires visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips) or; with four or five characteristics of disfigurement. An 80 percent evaluation requires visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips) or; with six or more characteristics of disfigurement. 38 C.F.R. § 4.118, Diagnostic Code 7800 (2007). Under note (1), the eight characteristics of disfigurement for purposes of evaluation under Diagnostic Code 7800, are: a scar 5 or more inches (13 or more cm.) in length; scar at least one-quarter inch (0.6 cm.) wide at widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo-or hyper- pigmented in an area exceeding six square inches (39-sq. cm.); skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.); underlying soft tissue missing in an area exceeding six square inches (39-sq. cm.); skin indurated and inflexible in an area exceeding six square inches (39- sq. cm.). Under note (3) the adjudicator is required to take into consideration unretouched color photographs when evaluating scars under these criteria. 38 C.F.R. § 4.118, Code 7800 (2007). Scars that are superficial and unstable will be rated as 10 percent disabling. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. A superficial scar is one not associated with underlying soft tissue damage. Scars that are superficial and painful on examination will be rated as 10 percent disabling. 38 C.F.R. § 4.118, Diagnostic Codes 7803, 7804. Scars may also be rated on the basis of limitation of function of the affected part. 38 C.F.R. § 4.118, Diagnostic Code 7805. In May 2005, the veteran was afforded a VA examination for his service-connected residuals of a shrapnel wound to the left temple, superficial. The veteran reported to the examiner that he received the scar due to a shrapnel fragmentation wound during military service. Upon examination of the veteran, the examiner noted that he was unable to locate a scar on the left scalp where the veteran contends it was located. No tenderness on palpation, inflammation, elevation, keloid formation, depression, induration, inflexibility, adherence to underlying tissue, pain, or skin breakdown was noted in the area of the scar. The color of the scar was normal as well as the texture of the scarred area. There was no disfigurement of the head, face, or neck that resulted in limitation of motion or loss of function. The examiner diagnosed the veteran with resolved scar of the scalp. Post service treatment records contain no complaints or treatment associated with the veteran's service-connected residuals of a shrapnel wound to the left temple, superficial. Based upon the evidence of record, the Board finds that a compensable evaluation is not warranted for the veteran's service-connected residuals of a shrapnel wound to the left temple, superficial. The veteran's service-connected scar does not represent any of the characteristics of disfigurement to warrant a compensable rating. More importantly, as noted by the May 2005 VA examiner, there was no scar located on the face, neck, or scalp. Therefore, the Board finds that the veteran's service-connected residuals of a shrapnel wound to the left temple, superficial, warrant no more than a noncompensable evaluation under Diagnostic Code 7800. The Board has considered the veteran's service-connected scar disability under all other potentially appropriate diagnostic codes. However, since the veteran's scar has been considered resolved, Diagnostic Codes 7803 through 7805 are not for application. The Board recognizes that there are situations in which the application of 38 C.F.R. §§ 4.40 or 4.45 is warranted in order to evaluate the existence of any functional loss due to pain, or any weakened movement, excess fatigability, incoordination, or pain on movement of the veteran's joints. See DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). However, in this case, where the diagnostic code under which the veteran is rated, in this case, Diagnostic Code 7800, is not predicated on loss of range of motion, §§ 4.40 and 4.45 do not apply. See Johnson v. Brown, 9 Vet. App. 7 (1996). It is also noted that the mandates of Hart v. Mansfield, 21 Vet. App. 505 (2007), wherein the Court held that "staged ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings" have been considered. Nonetheless, the Board finds that "staged ratings" are not appropriate in this case. During the rating period on appeal, the veteran's disability has appropriately been rated as noncompensably disabling. The veteran is competent to report his symptoms. The Board does not doubt the sincerity in the veteran's belief that his disability is worse than the current evaluation; however, the objective medical evidence does not support the contention for a compensable evaluation. The Board finds that the preponderance of the evidence is against the claim for a compensable evaluation for residuals of a shrapnel wound to the left temple, superficial, and the benefit-of-the-doubt rule is not for application. See Gilbert, 1 Vet. App. at 55. B. Hepatitis C The veteran contends that service connection is warranted for his hepatitis C. In a March 2005 personal statement, the veteran denied having an organ transplant, blood transfusions, or being placed on dialysis. He stated that he does not have any tattoos or body piercings, and has never used drugs intravenously or engaged in high risk sexual activity. The veteran explained that after receiving a shrapnel wound during his military service, he was exposed to "blood products," and asserts that his hepatitis C is attributable to his military service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110. Service connection may be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The chronicity provision of 38 C.F.R. § 3.303(b) is applicable where the evidence, regardless of its date, shows that the veteran had a chronic condition in service or during an applicable presumptive period and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under the Court's case law, lay observation is competent. Savage v. Gober, 10 Vet. App. 488, 498 (1997). In addition, if a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b). The United States Court of Appeals for Veterans Claims (Court) has held that in order to prevail on the issue of service connection on the merits, there must be medical evidence of a (1) current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247, 253 (1999). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the clam or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The veteran has a competent medical diagnosis of hepatitis C, as stated in an August 2001 private medical laboratory report and May 2005 VA examination report. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (holding VA's interpretation of the provisions of 38 U.S.C.A. § 1110 to require evidence of a present disability to be consistent with congressional intent); Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (the law limits entitlement to service-related diseases and injuries to cases where the underlying in-service incident resulted in a disability). The question of whether the veteran's current diagnosis had its onset in or is otherwise related to active service, involves competent medical evidence as to medical causation. Grottveit v. Brown, 5 Vet. App. 91, 92 (1993). Service medical records do not reflect any complaints, findings or treatment associated with either hepatitis C or known risk factors for hepatitis C. However, post service treatment records reflect continuing complaints and treatment for hepatitis C. As previously stated, an August 2001 private treatment record contains a diagnosis of hepatitis C. The private treatment record also indicates that the veteran denied any liver problems or symptoms, but admitted to taking heroin intravenously many years ago. In June 2003, the veteran returned for follow-up treatment and the physician discussed the importance of hepatitis C treatment. The physician requested that the veteran stop drinking and after three months of sobriety, he could return for treatment. Finally, a February 2006 VA outpatient treatment record states that the veteran admitted to experimenting with illicit drugs after service. Based upon the evidence in the claims file, the first time the veteran's hepatitis C is shown is in the August 2001 private medical record, which is many years following the veteran's discharge from service. The Board acknowledges that the veteran has contended, in essence, that his hepatitis C has existed since his military service. The veteran is also competent to state that he was exposed to blood products during his military service. Additionally, the Board, is of course, aware of the provisions of 38 C.F.R. § 3.303(b), relating to chronicity and continuity of symptomatology; however, there is no objective medical evidence of record of hepatitis C being caused by in-service blood exposure during service or immediately thereafter. In this regard the Board also notes that the absence of evidence in support of an alleged fact clearly is an evidentiary circumstance that weighs against the existence of the alleged fact. Forshey v. Principi, 284 F.3d 1335, 1363 (Fed. Cir. 2002) (holding that negative evidence means that "which tends to disprove the existence of an alleged fact"). Moreover, in Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000), the Court held that "evidence of a prolonged period without medical complaint can be considered, along with other factors concerning the veteran's health and medical treatment during and after military service." Id. at 1333. Given the service medical records, the absence of complaint or treatment until many years after service, and the absence of any medical evidence showing continuity of symptomatology, the Board finds that the evidence weighs against the veteran's claim. See Voerth v. West, 13 Vet. App. 117, 120- 21 (1999) (there must be medical evidence on file demonstrating a relationship between the veteran's current disability and the claimed continuous symptomatology, unless such a relationship is one as to which a lay person's observations is competent). In March 2005, the veteran was afforded a VA examination for his hepatitis C. The veteran reported to the examiner that during his military service, a shrapnel was removed from his head, and subsequently thereafter, he was diagnosed with hepatitis C in 2002. The veteran admitted to a history of intranasal cocaine use and high risk sexual practices after his military service, and stated that he has a long history of drinking a twelve pack of beer weekly. After physical examination, the examiner diagnosed the veteran with hepatitis C, no current residuals. He opined that the veteran's shrapnel wound sustained during service did not transmit hepatitis C nor is it considered a known risk factor. He explained that the veteran has other, more likely acknowledged risk factors for hepatitis C, which includes intranasal cocaine use, alcohol abuse, and unsafe sexual practices. The Board notes that even though the VA examiner did not have access to the veteran's claims file upon examination of the veteran, the examiner determined that the veteran was exposed to hepatitis C by known risk factors of hepatitis C, which were reported by the veteran. Therefore, without evidence of a nexus between the veteran's military service and his hepatitis C, service connection for hepatitis C must be denied. The Board is aware of the veteran's contentions that his hepatitis C is somehow etiologically related to service; however, as the record does not reflect that the veteran possesses a recognized degree of medical knowledge, his assertions as to the existence, nature and etiology of the current diagnosis are not competent. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). In the absence of competent medical evidence linking the veteran's current diagnosis to service, service connection for hepatitis C is denied. Accordingly, for the reasons stated above, the Board finds that a preponderance of the evidence is against the claim for service connection for hepatitis C, and there is no doubt to be resolved. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). II. Duty to Notify & Assist The Veterans Claims Assistance Act of 2000 (VCAA) imposes obligations on VA in terms of its duty to notify and assist claimants. When VA receives a complete or substantially complete application for benefits, it is required to notify the claimant and the representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b) (2007); Quartuccio v. Principi, 16 Vet. App. 183 (2002). In Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004), the Court held that VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide; and that (4) VA will request that the claimant provide any evidence in his possession that pertains to the claim. In regards to the veteran's claim of service connection for hepatitis C, the Board finds that the VCAA notice requirements have been satisfied by the August 2004 letter sent to the veteran. In the letter, VA informed the veteran that in order to substantiate a claim for service connection, the evidence needed to show she had a current disability, a disease or injury in service, and evidence of a nexus between the post-service disability and the disease or injury in service, which was usually shown by medical records or medical opinions. Turning to the veteran's increased-compensation claim, section § 5103(a) requires, at a minimum, that the Secretary notify the claimant that, to substantiate a claim, the claimant must provide, or ask the Secretary 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. Vazquez- Flores v. Peake, 22 Vet. App. 37 (2008). Further, 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 that worsening has 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. Additionally, the claimant must be notified that, should an increase in disability be found, a disability rating will be determined by applying relevant Diagnostic Codes, which typically provide for a range in severity of a particular disability from noncompensable to as much as 100 percent (depending on the disability involved), based on the nature of the symptoms of the condition for which disability compensation is being sought, their severity and duration, and their impact upon employment and daily life. As with proper notice for an initial disability rating and consistent with the statutory and regulatory history, the notice must also provide examples of the types of medical and lay evidence that the claimant may submit (or ask the Secretary to obtain) that are relevant to establishing entitlement to increased compensation-e.g., competent lay statements describing symptoms, medical and hospitalization records, medical statements, employer statements, job application rejections, and any other evidence showing an increase in the disability or exceptional circumstances relating to the disability. Id. In this case, the RO sent a letter to the veteran in August 2004 regarding the VCAA notice requirements. In the letter, the veteran was informed him that on his behalf, VA would make reasonable efforts to obtain records that were not held by a federal agency, such as records from private doctors and hospitals. The letter stated that he would need to give VA enough information about the records so that it could obtain them for him. Finally, he was told to submit any evidence in his possession that pertained to the claim. While the Board acknowledges the August 2004 letter, the VCAA duty to notify has not been satisfied because the letter did not specifically inform the veteran that the evidence necessary to substantiate the claim for an increased evaluation would be evidence showing that his disability is worse than the current evaluation contemplates. Additionally, the letter did not advise the veteran that he could provide medical or lay evidence demonstrating a worsening or increase in severity of his disability and the effect that worsening has on his employment and daily life. The letter also failed to notify the veteran that he may submit evidence such as lay statements, medical statements, employer statements, job application rejections, and any other evidence indicative of an increase in his disabilities or exceptional circumstances relating to the disabilities. In Sanders v. Nicholson, 487 F.3d 881 (Fed. Cir. 2007), the United States Court of Appeals for the Federal Circuit held that any error by VA in providing the notice required by 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b)(1) is presumed prejudicial, and that once an error is identified as to any of the four notice elements the burden shifts to VA to demonstrate that the error was not prejudicial to the appellant. The Federal Circuit stated that requiring an appellant to demonstrate prejudice as a result of any notice error is inconsistent with the purposes of both the VCAA and VA's uniquely pro-claimant benefits system. Instead, the Federal Circuit held in Sanders that all VCAA notice errors are presumed prejudicial and require reversal unless VA can show that the error did not affect the essential fairness of the adjudication. To do this, VA must show that the purpose of the notice was not frustrated, such as by demonstrating: (1) that any defect was cured by actual knowledge on the part of the claimant, see Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008) ("Actual knowledge is established by statements or actions by the claimant or the claimant's representative that demonstrate an awareness of what was necessary to substantiate his or her claim.") (citing Dalton v. Nicholson, 21 Vet. App. 23, 30-31 (2007)); (2) that a reasonable person could be expected to understand from the notice what was needed; or (3) that a benefit could not have been awarded as a matter of law. Sanders, 487 F.3d at 889. Additionally, consideration also should be given to "whether the post-adjudicatory notice and opportunity to develop the case that is provided during the extensive administrative appellate proceedings leading to the final Board decision and final Agency adjudication of the claim ... served to render any pre-adjudicatory section 5103(a) notice error non-prejudicial." Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008). In this case, the Board finds that the notice errors did not affect the essential fairness of the adjudication because the veteran had actual knowledge of what was necessary to substantiate his claim for increased rating, which is shown by his statements contending that his disability has worsened in severity and affect his overall daily functioning. See also Board hearing transcript dated February 2008. The Board finds that by way of the veteran's actual knowledge and the overall development of his claim throughout the pendency of this appeal, the errors of notice are non-prejudicial to the veteran. In addition to the foregoing analysis, to whatever extent the recent decision of the Court in Dingess v. Nicholson, 19 Vet. App. 473 (2006), requires more extensive notice in claims for compensation, e.g., as to potential downstream issues such as disability rating and effective date, the Board finds no prejudice to the veteran in proceeding with the present decision. Since the claims on appeal are being denied, any such effective date questions are moot. The veteran has had ample opportunities to meaningfully participate in the adjudicative claims process. Any error or deficiency in this regard is harmless, and not prejudicial. VA must also make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate the claim for the benefit sought, unless no reasonable possibility exists that such assistance would aid in substantiating the claims. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159 (2007). In connection with the current appeal, VA obtained the veteran's service medical records, VA outpatient treatment records dated May 2005 to June 2006, and private medical records from June 1978 to May 1979. The veteran was also provided a VA examination in connection with his claims. For the foregoing reasons, the Board concludes that all reasonable efforts were made by VA to obtain evidence necessary to substantiate the claims. The evidence of record provides sufficient information to adequately evaluate the claims. Therefore, no further assistance to the veteran with the development of evidence is required, nor is there notice delay or deficiency resulting in any prejudice to the veteran. 38 U.S.C.A. § 5103A(a)(2); 38 C.F.R. § 3.159(d); see Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). ORDER Entitlement to a compensable evaluation for residuals of a shrapnel wound to the left temple, superficial is denied. Entitlement to service connection for hepatitis C is denied. REMAND The record as it stands is currently inadequate for the purpose of rendering a fully informed decision as to the claim of entitlement to an initial evaluation in excess of 10 percent for post-traumatic stress disorder. Where the record before the Board is inadequate to render a fully informed decision, a remand to the RO is required in order to fulfill its statutory duty to assist the veteran to develop the facts pertinent to the claim. Ascherl v. Brown, 4 Vet. App. 371, 377 (1993). Review of the evidentiary record shows that during the February 2008 hearing, the veteran testified that he was currently receiving treatment for his PTSD at the Wichita VA Medical Center (VAMC). VA records are considered part of the record on appeal since they are within VA's constructive possession, and these records must be considered in deciding the veteran's claim. Therefore, as VA has notice of the existence of additional VA records, they must be retrieved and associated with the other evidence already on file. See Bell v. Derwinski, 2 Vet. App. 611 (1992); see also Epps v. Brown, 9 Vet. App. 341 (1996); Robinette v. Brown, 8 Vet. App. 69 (1995). The veteran's last VA examination for compensation purposes was conducted in May 2005. Given the veteran's appellate assertions, a more recent VA examination is needed. Therefore, in order to give the veteran every consideration with respect to the present appeal and to ensure due process, it is the Board's opinion that further development of the case is necessary. Accordingly, the case is REMANDED for the following actions: 1. Obtain and associate with the claims file all outstanding records of treatment pertaining to the veteran's service- connected PTSD from the Wichita VAMC. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact should clearly be documented in the claims file. 2. Arrange for the veteran to undergo a VA psychiatric examination to determine the current severity of his service- connected PTSD. All indicated tests and studies should be completed and all clinical manifestations should be reported in detail. For the veteran's PTSD, the psychiatric examiner is requested to discuss the veteran's symptoms, degree of social and industrial impairment, and to include a Global Assessment Functioning Scale score with an explanation of what the assigned score represents. 3. Readjudicate the claim for entitlement to an evaluation in excess of 10 percent for PTSD. If the benefits sought in connection with the claim remain denied, the veteran should be provided with an appropriate Supplemental Statement of the Case (SSOC) and given the opportunity to respond. The appellant has the right to submit additional evidence and argument on the matter or matters 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 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). ______________________________________________ C. CRAWFORD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs