Citation Nr: 1002146 Decision Date: 01/13/10 Archive Date: 01/22/10 DOCKET NO. 08-08 940 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to a compensable rating for degenerative changes of the lumbar spine prior to December 11, 2008. 2. Entitlement to a rating in excess of 10 percent for degenerative changes of the lumbar spine for the period since December 11, 2008. 3. Entitlement to a separate compensable rating for radiculopathy of the right lower extremity. 4. Entitlement to a compensable rating for hypertension. 5. Entitlement to service connection for sarcoidosis. 6. Entitlement to service connection for left knee patellofemoral syndrome. 7. Entitlement to service connection for right knee meniscus degeneration and chondromalacia patella. REPRESENTATION Appellant represented by: Military Order of the Purple Heart of the U.S.A. ATTORNEY FOR THE BOARD Donna D. Ebaugh, Associate Counsel INTRODUCTION The Veteran served on active duty from June 1980 to June 2006. This matter is before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA), Regional Office (RO), in Nashville, Tennessee. The issue of a compensable rating for hypertension 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. Throughout the rating period prior to December 11, 2008, the Veteran's low back disability has been productive of subjective complaints of pain; objective findings include flexion to 90 degrees, no muscle spasm, guarding, or tenderness, and no incapacitating episodes requiring hospitalization or bed rest as prescribed by a physician. 2. Throughout the rating period since December 11, 2008, the Veteran's low back disability has been productive of subjective complaints of pain; objective findings include flexion to 90 degrees, no muscle spasm or guarding, and no incapacitating episodes requiring hospitalization or bed rest as prescribed by a physician. 4. As a result of his low back disability, the Veteran experiences occasional numbness and tingling in the lower right extremity. 3. Sarcoidosis was incurred in service. 4. Left knee patellofemoral syndrome was incurred in service. 5. Right knee meniscus degeneration and chondromalacia patella was incurred in service. CONCLUSIONS OF LAW 1. The criteria for a compensable rating for the period prior to December 11, 2008, for degenerative changes of the lumbar spine, have not been met. 38 U.S.C.A. §§ 1155, 5103(a), 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Code 5242 (2009). 2. The criteria for a rating in excess of 10 percent for the period since December 11, 2008, for degenerative changes of the lumbar spine, have not been met. 38 U.S.C.A. §§ 1155, 5103(a), 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Code 5242 (2009). 3. The criteria for a separate compensable rating for radiculopathy of the right lower extremity have been met for the entire period on appeal. 38 U.S.C.A. §§ 1155, 5103(a), 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.71a, DC 8520 (2009). 4. Sarcoidosis is presumed to have been incurred in service. 38 U.S.C.A. §§ 1110, 5103(a), 5103A (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2009). 5. Left knee patellofemoral syndrome was incurred in service. 38 U.S.C.A. §§ 1110, 5103(a), 5103A (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.159, 3.303 (2009). 6. Right knee meniscus degeneration and chondromalacia patella was incurred in service. 38 U.S.C.A. §§ 1110, 5103(a), 5103A (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.159, 3.303 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist In correspondence dated in November 2007, the RO satisfied its duty to notify the Veteran under 38 U.S.C.A. § 5103(a) (West 2002 & Supp. 2009) and 38 C.F.R. § 3.159(b) (2009). Specifically, the RO notified the Veteran of: information and evidence necessary to substantiate the claims; information and evidence that VA would seek to provide; and information and evidence that the Veteran was expected to provide. In November 2007, the RO also notified the Veteran of the process by which initial disability ratings and effective dates are established. Dingess v. Nicholson, 19 Vet. App. 473 (2006). For an increased-compensation claim, the VCAA requirement is generic notice, that is, the type of evidence needed to substantiate the claim, namely, evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on employment, as well as general notice regarding how disability ratings and effective dates are assigned. See Vazquez-Flores v. Shinseki, 580 F. 3d 1270 (Fed. Cir. 2009); Wilson v. Mansfield, 506 F.3d 1055 (Fed. Cir. 2007). In this case, the Veteran was provided pertinent information in the above mentioned letters and other correspondence provided by the RO. Specifically, VA informed the Veteran of the necessity of providing, on his own or by VA, medical or lay evidence demonstrating a worsening or increase in severity of the respective disability, and the effect that the worsening has on his employment and daily life. The Veteran was informed that should an increase in disability be found, a disability rating would be determined by applying the relevant diagnostic codes; and examples of pertinent medical and lay evidence that he could submit relevant to establishing entitlement to increased compensation. The Veteran was also provided notice of the applicable relevant diagnostic code provisions. VA has done everything reasonably possible to assist the Veteran with respect to his claim for benefits in accordance with 38 U.S.C.A. § 5103A (West 2002 & Supp. 2009) and 38 C.F.R. § 3.159(c) (2009). Service treatment records have been associated with the claims file. All identified and available treatment records have been secured. The Veteran has been medically evaluated in conjunction with his claims. Thus, the duties to notify and assist have been met. Increased Rating Claims Disability ratings are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1 (2009). Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2009). However, the Board has been directed to consider only those factors contained wholly in the rating criteria. See Massey v. Brown, 7 Vet. App. 204, 208 (1994); but see Mauerhan v. Principi, 16 Vet. App. 436 (2002) (finding it appropriate to consider factors outside the specific rating criteria in determining level of occupational and social impairment). Where there is a question as to which of two separate disability ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2009). 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 Veteran. 38 C.F.R. § 4.3 (2009). The Board acknowledges that in rating musculoskeletal disabilities, consideration must be given to additional functional limitation due to factors such as pain, weakness, fatigability, and incoordination. See 38 C.F.R. §§ 4.40, 4.45 (2009); DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). Diagnostic codes predicated on limitation of motion do not prohibit consideration of a higher rating based on functional loss due to pain on use or due to flare-ups under 38 C.F.R. §§ 4.40, 4.45, and 4.59 (2009). VA regulations require that a finding of dysfunction due to pain must be supported by, among other things, adequate pathology. 38 C.F.R. § 4.40 (2009) ("functional loss due to pain is to be rated at the same level as the functional loss when flexion is impeded"); see Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1993). A VA General Counsel opinion has also held that Diagnostic Code 5293, intervertebral disc syndrome, involved loss of range of motion and that consideration of 38 C.F.R. §§ 4.40 and 4.45 was applicable. See VAOPGCPREC 37-97. The Board has reviewed all of the evidence in the Veteran's claims file, with an emphasis on the medical evidence for the rating period on appeal. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to each claim. The Veteran is claiming entitlement to increased ratings for his low back disability. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, where the evidence contains factual findings that show a change in the severity of symptoms during the course of the rating period on appeal, assignment of staged ratings would be permissible. See Hart v. Mansfield, 21 Vet. App. 505 (2007). As an initial matter, the Board notes that the Veteran underwent VA examinations in March 2006 and December 2008. The Board finds that the evaluations are adequate for rating purposes, although the Board notes that the March 2006 examiner was not attentive to the Veteran's comments. Both examiners obtained a history from the Veteran and conducted a thorough examination. There is no indication that the examiners were not fully aware of the Veteran's past medical history or that they misstated any relevant facts. Therefore, the Board can proceed to adjudicate the claims on appeal. Low Back Disability Initially, the Veteran received a noncompensable rating for his low back disability; however in March 2009, the RO increased the rating to 10 percent, under Diagnostic Code 5242, effective December 11, 2008. For the period prior to December 11, 2008, in order to warrant a compensable rating, the evidence must show: * forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, * the combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, * muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, * vertebral body fracture with loss of 50 percent or more of height; or, * with X-ray evidence of involvement of two or more major joints or two or more minor joint groups; or, * intervertebral disc syndrome with incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months (all at 10 percent). Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2): For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Moreover, an "incapacitating episode" is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that required bed rest prescribed by a physician and treatment by a physician. The Board has reviewed the evidence of record and finds that the weight of evidence does not support a compensable rating. Indeed, the March 2006 VA examination revealed forward flexion from zero to 90 degrees. Therefore, a compensable rating is not warranted for limited motion. Next, the March 2006 VA examination noted no muscle spasm or tenderness. The examiner did not note the presence or absence of guarding. Therefore, a higher rating is not warranted on this basis. Further, the evidence does not show vertebral body fracture with loss of 50 percent or more of height. Next, the evidence does not show X-ray evidence of involvement of degenerative disc disease in two or more major joints or two or more minor joint groups. The Board notes that X-rays taken in conjunction with the March 2006 VA examination revealed "mild levoscoliosis and minimal diffuse spondylosis of the lumbar spine along with mild localized degenerative disc space narrowing L4-5." However, the X-ray evidence did not show involvement in two or more major joints or two or more minor joint groups. Therefore, a compensable rating is not warranted under Diagnostic Code 5003. Lastly, a compensable rating is not warranted for incapacitating episodes. While the Veteran has reported back pain, the evidence does not show that he has been ordered bed rest by a physician. The Board notes that at the March 2006 VA examination, he reported flare-ups on a monthly basis which lasted approximately 1 to 2 days at a time. At that time, he reported that his disability did not cause incapacitation. Based on the foregoing, the Board finds that a compensable rating is not warranted for the period prior to December 11, 2008. In order to warrant a higher rating for the period since December 11, 2008, the evidence must show: * forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, * the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, * muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spine contour such as scoliosis, reversed lordosis, or abnormal kyphosis; or, * intervertebral disc syndrome with incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months (all at 20 percent). The Board has reviewed the evidence of record and finds that the weight of evidence does not support the next-higher 20 percent rating. Indeed, the December 2008 VA examination revealed forward flexion from zero to 90 degrees. Next, the evidence does not show any muscle spasm or guarding. Therefore, a higher rating is not warranted on this basis. Additionally, while the Veteran has reported back pain and flare-ups, the evidence does not show that he has been ordered bed rest by a physician. The Board notes that at the December 2008 VA examination, the Veteran reported flare-ups four to five times per year that last three to five days. During the flare-ups, he has to lie down to work on his laptop. He denied any incapacitating episodes. As the evidence does not demonstrate that he experienced incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months, a rating of 20 percent is not for application. Radiculopathy After reviewing the evidence on file, the Board finds that pursuant to Note (1), the Veteran is entitled to a separate compensable rating for radiculopathy of the lower right extremity under Diagnostic Code 8520. A rating for lower extremity radiculopathy is warranted when the evidence shows the following: * Mild incomplete paralysis (10 percent). The term "incomplete paralysis," with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor. Specifically, the evidence reflects neurologic symptomatology in February 2008. For example, a private magnetic resonance imaging (MRI) study dated in February 2008 noted radiation to the right hip and leg with associated numbness. Further, at the December 2008 VA examination, he reported occasional numbness and tingling and radiation down the right lower extremity. The Board finds that the medical evidence detailed above supports a finding of mild neurological manifestations of the lower right extremity, but no more. As the evidence shows complaints of numbness and tingling but no MRI or X-ray evidence of nerve stenosis, the Board will consider the diagnostic code for sciatic nerve symptoms. As such, a 10 percent rating is warranted for mild incomplete paralysis of the right lower extremity beginning in February 2008. The next higher rating for radiculopathy is warranted when moderate incomplete paralysis is present. As the evidence does not reveal moderate incomplete paralysis, the next higher 20 percent rating is not for application. In sum, higher ratings are not warranted for either period on appeal regarding the low back disability. Nonetheless, a separate compensable rating is warranted for the neurologic manifestations of the lower right extremity. In reaching these conclusions, the benefit of the doubt doctrine has been applied where appropriate. Further, even considering the Veteran's subjective complaints of pain and numbness, the evidence does not warrant a higher rating, under the rating schedule or in contemplation of additional factors affecting limitation of motion as set forth in DeLuca, because the additional factors result in worsening range of motion but not are sufficient to warrant a higher rating. With respect to all of the increased rating claims, the Board has also considered the Veteran's statements and his buddy statements. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). In this case, the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. at 470. Similarly, his family and colleagues are competent to report symptoms they have observed with their senses. However, low back pathology is not the type of disorder that a lay person can provide competent evidence on the degree of severity. The Board acknowledges the Veteran's belief that his symptoms are of such severity as to warrant higher ratings; however, disability ratings are made by the application of a schedule of ratings which is based on average impairment of earning capacity as determined by the clinical evidence of record. Therefore, the Board finds that the medical findings, which directly address the criteria under which the disabilities are evaluated, more probative than the Veteran's assessment or his buddy's assessment of the severity of his disabilities. In sum, after a careful review of the evidence of records, the Board finds that the benefit of the doubt rule is not applicable and the appeals are denied as to the low back disability. Next, the Board will consider whether referral for an extraschedular rating is warranted. The question of an extraschedular rating is a component of a claim for an increased rating. Bagwell v. Brown, 9 Vet. App. 337, 339 (1996). Although the Board may not assign an extraschedular rating in the first instance, it must specifically adjudicate whether to refer a case for extraschedular rating when the issue either is raised by the claimant or is reasonably raised by the evidence of record. Barringer v. Peake, 22 Vet. App. 242 (2008). Under the provisions of 38 C.F.R. § 3.321(b)(1) (2009), the Under Secretary for Benefits or the Director, Compensation and Pension Service, is authorized to approve an extraschedular evaluation if the case "presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards." Id. Therefore, there must be a comparison between the level of severity and symptomatology of the claimant's service- connected disability with the established criteria found in the rating schedule for that disability. Thun v. Peake, 22 Vet. App. 111 (2008). In this case, while the Veteran reported in his April 2007 statement that his pain limits his employability, his physicians have not ordered him to be on bed rest or otherwise indicated that he was unable to work. Further, at the March 2006 VA examination, he reported that his disability did not cause him to miss work. He also did not report that he missed work at the December 2008 VA examination. Moreover, the rating criteria reasonably describe his disability levels and symptomatology, and provide for higher ratings for additional or more severe symptoms than currently shown by the evidence. Thus, his disability picture is contemplated by the rating schedule, and the assigned schedular evaluations are, therefore, adequate. Consequently, referral to the Under Secretary for Benefits or the Director, Compensation and Pension Service, under 38 C.F.R. § 3.321 (2009) is not warranted. Service Connection Claims Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110 (West 2002). If a chronic disease is shown in service, subsequent manifestations of the same chronic disease at any later date, however remote, may be service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b) (2009). However, continuity of symptoms is required where a condition in service is noted but is not, in fact, chronic or where a diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b) (2009). Further, service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b) (West 2002); 38 C.F.R. § 3.303(d) (2009). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert, 1 Vet. App. at 57. Sarcoidosis Service treatment records reflect a diagnosis of sarcoidosis during service in March 1990 and treatment thereafter. As sarcoidosis is identified as a chronic disease and subject to presumptive service connection under 38 U.S.C.A. § 1101, 38 C.F.R. §§ 3.307, 3.309, service connection is granted on a presumptive basis. Knees Service records reflect that the Veteran noted on his report of medical history, in February 1980, that he had a "trick" knee and experienced joint pain. However, pre-service X- rays, dated in March 1980 indicated normal bilateral knees. As knee disorders were not noted by the Department or a medical professional upon entry, the Veteran's knees were not aggravated by service. Next, the Board will consider service connection on a direct basis. Service treatment records reflect repeated complaints of bilateral knee pain beginning in April 1999. Left knee patellofemoral syndrome and right knee meniscus degeneration and chondromalacia patella were diagnosed in service. The Veteran received regular treatment for bilateral knee pain from April 1999 until he left service in June 2006. Post-service evidence includes one unfavorable VA examination in March 2006. The evidence also includes the Veteran's statements and buddy letters asserting continuity of symptoms. The Board acknowledges that lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In this case, the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. 465, 470 (1994). Similarly, his family and colleagues are competent to report their observations of his disorders. He has indicated that he has experienced bilateral knee pain since service. In this case, the Board finds that the Veteran's reported history of continued symptomatology since active service, both competent and credible. As the Veteran filed his claim prior to his discharge from service, was treated for bilateral knee pain during the same month in which he made his claim, and service treatment records contain diagnoses for left knee patellofemoral syndrome and right knee meniscus degeneration and chondromalacia patella, the Board finds that he had current diagnoses despite the VA examination to the contrary. As such, the Board resolves all doubt in the Veteran's favor and grants the claims for right and left knee disorders because he experienced continuity of symptomatology in both knees from the time of service. ORDER A compensable rating for degenerative changes of the lumbar spine for the period prior to December 11, 2008, is denied. A rating in excess of 10 percent for degenerative changes of the lumbar spine for the period since December 11, 2008, is denied. A separate compensable rating for mild radiculopathy of the lower right extremity is granted, subject to governing criteria applicable to the payment of monetary benefits. Service connection for sarcoidosis is granted. Service connection for left knee patellofemoral syndrome is granted. Service connection for right knee meniscus degeneration and chondromalacia patella is granted. REMAND Regarding the Veteran's claim for an increased initial rating for hypertension, the Board finds that additional development is required in order to satisfy VA's obligations under the VCAA. Specifically, a review of the record reveals that there are outstanding post-service VA treatment records as well as private treatment records. In the Veteran's April 2007 statement, he indicated that he was treated in March 2007 for his hypertension at the VA clinic in Clarksville, Tennessee. He also reported that he was treated for hypertension by a private doctor in April 2007. These records should be obtained. Accordingly, the case is REMANDED for the following action: 1. The RO/AMC shall obtain all outpatient treatment records regarding hypertension or blood pressure readings from the VA clinic in Clarksville, TN. 2. Upon receipt of the proper waiver, the RO/AMC shall obtain private treatment records regarding hypertension or blood pressure readings from Dr. Kasper, Premier Medical Group. 3. The RO/AMC will then review the Veteran's claims file and ensure that the foregoing development actions have been conducted and completed in full, and that no other notification or development action, in addition to those directed above, is required. If further action is required, it should be undertaken prior to further claim adjudication. 4. The RO/AMC will then readjudicate the Veteran's claim. If the benefit sought on appeal remains denied, the Veteran and his representative should be provided with a Supplemental Statement of the Case. An appropriate period of time should be allowed for response. Thereafter, if appropriate, the case is to be returned to the Board, following applicable appellate procedure. The Veteran need take no action until he is so informed. He has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the RO. Kutscherousky v. West, 12 Vet. App. 369 (1999). The purposes of this remand are to obtain additional information and comply with all due process considerations. No inference should be drawn regarding the final disposition of this claim as a result of this action. 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. 2009). ______________________________________________ DEMETRIOS G. ORFANOUDIS Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs