Citation Nr: 1007289 Decision Date: 02/26/10 Archive Date: 03/05/10 DOCKET NO. 03-28 055 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to a disability rating in excess of 10 percent for connective tissue disease prior to November 16, 2006. 2. Entitlement to a disability rating in excess of 40 percent for fibromyalgia (previously rated as undifferentiated connective tissue disease, thoracic spine sprain, low back sprain, and cervical myofascitis with segmented dysfunction) from November 16, 2006. 3. Entitlement to a total disability rating based on individual unemployability, due to service-connected disability (TDIU). REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD T. Azizi-Barcelo, Counsel INTRODUCTION The Veteran had active service from October 1983 to September 1995. This matter is before the Board of Veterans' Appeals (Board) on appeal from a May 2003 decision of the Department of Veterans Affairs (VA), Regional Office (RO), in Montgomery, Alabama. In January 2009, the Board remanded the case for additional development. As the requested development has been completed, no further action is necessary to comply with the Board's remand directives. Stegall v. West, 11 Vet. App. 268 (1998). In a statement in January 2009, the Veteran inquired as to the status of her claims of service connection for degenerative disc disease and a claim for an increased rating for posttraumatic stress disorder (PTSD). The Board notes that by a rating decision in March 2004, the RO denied a claim of service connection for degenerative disc disease and continued the Veteran's 50 percent disability rating for PTSD. The Veteran filed a timely notice of disagreement and was issued a Statement of the Case. The Veteran did not, however, perfect an appeal of these issues by timely filing a substantive appeal. These issues, therefore, are not within the Board's jurisdiction and will not be discussed in the decision, below. As noted in the January 2009 Board remand, the record has suggested that the Veteran may be entitled to a TDIU. In Rice v. Shinseki, 22 Vet. App. 447 (2009), the United States Court of Appeals for Veterans' Claims (Court) held that a TDIU claim is part of an increased disability rating claim when such claim is raised by the record. The Court further held that when evidence of unemployability is submitted at the same time that the Veteran is appealing the rating assigned for a disability, the claim for TDIU will be considered part and parcel of the claim for benefits for the underlying disability. Id. As such, the issues before the Board are as set forth above. The issue of entitlement to a TDIU is REMANDED to the RO via the Appeals Management Center and is discussed in the REMAND section of this decision. FINDINGS OF FACT 1. Resolving all doubt in favor of the Veteran, the Board finds that from October 31, 2002, to November 16, 2006, the Veteran's fibromyalgia was productive of symptoms that were constant or nearly constant, and were refractory to therapy. 2. During the rating period under consideration, the Veteran's fibromyalgia is not shown to be productive of exacerbations lasting a week or more, two or three times per year. CONCLUSIONS OF LAW 1. From October 31, 2002, to November 16, 2006, the schedular criteria for a 40 percent disability rating for fibromyalgia have been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2009); 38 C.F.R. §§ 4.7, 4.71a Diagnostic Code 5025, 4.88b Diagnostic Code 6350 (2009). 2. During the rating period under consideration, the criteria for a rating higher than 40 percent for fibromyalgia have not been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2009); 38 C.F.R. §§ 4.7, 4.71a Diagnostic Code 5025, 4.88b Diagnostic Code 6350 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSION Duty to notify and to assist Upon receipt of a complete or substantially complete application, VA must provide notice to the claimant that: (1) informs the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) informs the claimant about the information and evidence that VA will seek to provide; and (3) informs the claimant about the information and evidence the claimant is expected to provide. 38 U.S.C.A. §§ 5103, 5103A, 5107 (West 2002 & Supp. 2008); 38 C.F.R. § 3.159 (2009); Pelegrini v. Principi, 18 Vet. App. 112 (2004); 73 Fed. Reg. 23,353 (Apr. 30, 2008). The RO sent correspondence in December 2002, November 2003, and February 2009; a rating decision in May 2003; Statements of the Case in September 2003, and November 2004; and a Supplemental Statement of the Case in January 2008. Those documents discussed specific evidence, particular legal requirements applicable to the claims herein decided, evidence considered, pertinent laws and regulations, and reasons for the decision. VA made all efforts to notify and to assist the appellant with evidence obtained, the evidence needed, and the responsibilities of the parties in obtaining the evidence. The Board finds that any defect of timing or content of the notice to the appellant is harmless because of the thorough and informative notices provided throughout the adjudication and because the appellant had a meaningful opportunity to participate effectively in the processing of the claims with an adjudication of the claims by the RO subsequent to the claimant's receipt of compliant notice. There has been no prejudice to the appellant, and any defect in the timing or content of the notices has not affected the fairness of the adjudication. Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006) (specifically declining to address harmless error doctrine); Dingess v. Nicholson, 19 Vet. App. 473 (2006). Thus, VA has satisfied its duty to notify the appellant and had satisfied that duty prior to the final adjudication in the September 2009 supplemental statement of the case. A statement of the case or supplemental statement of the case can constitute a readjudication decision that complies with all applicable due process and notification requirements if adequate notice is provided prior to that adjudication. Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007). The provision of adequate notice prior to a readjudication, including in a statement of the case or supplemental statement of the case, cures any timing defect associated with inadequate notice or the lack of notice prior to the initial adjudication. Prickett v. Nicholson, 20 Vet. App. 370 (2006). In addition, all relevant, identified, and available evidence has been obtained, and VA has notified the appellant of any evidence that could not be obtained. The appellant has not referred to any additional, unobtained, relevant, available evidence. VA has also obtained medical examinations in relation to the claims. Thus, the Board finds that VA has satisfied both the notice and duty to assist provisions of the law. Furthermore, the Board finds that if there is any deficiency in the notice to the Veteran or the timing of the notice it is harmless error because the appellant had a meaningful opportunity to participate effectively in the processing of the claims. Overton v. Nicholson, 20 Vet. App. 427 (2006) (Board erred in relying on various post-decisional documents for concluding adequate notice was provided, but the Veteran was afforded a meaningful opportunity to participate effectively in the adjudication of his claim, and therefore the error was harmless). Background The Veteran was originally granted service connection for undifferentiated connective tissue disease in a rating decision dated March 1996. The RO evaluated the Veteran's disability under 38 C.F.R. § 4.88b, Diagnostic Code 6399-6350 as 10 percent disabling, effective September 6, 1995. The Board notes that the Veteran's particular disability was not listed in the rating schedule. However, unlisted disabilities can be rated analogously with the first two digits selected from that part of the rating schedule most closely identifying the part or system of the body involved, and the last two digits will be "99." See 38 C.F.R. § 4.20, 4.27 (2009) (outlining principles related to analogous ratings). The RO determined that the most closely analogous Diagnostic Code was 6350, lupus erythematosus, systemic (disseminated). A subsequent rating decision dated July 1999 continued the Veteran's 10 percent disability rating for undifferentiated connective tissue disease. VA treatment records starting in 2000, recorded complaints of soreness of the joints, depression, anxiety, insomnia, low energy, poor motivation, joint stiffness, sores of the tongue, nasal sore, and dry mouth. In a rheumatology treatment note in May 2002, a clinician noted no symptoms of connective tissue disease other than occasional arthralgias and nasal soreness. On physical examination, there was no evidence of active lupus. In July and August 2002, the Veteran was treated for depression associated with stress and problems at work. At the time, she was also attending college to obtain a bachelor's degree. In December 2002, the Veteran reported that she had not worked since October of that year. She described her job as stressful and indicated that she was seeking other employment and continuing her college studies. On October 31, 2002, the RO received the Veteran's claim for an increased disability rating for her service-connected connective tissue disease. The RO continued the Veteran's 10 percent disability rating for connective tissue disease in a rating decision dated May 2003. The Veteran timely perfected an appeal of the RO's decision. On VA examination in January 2003, the Veteran complained of constant back pain with flare-ups in pain of 10/10. She also reported swelling of the fingers, along with a burning and itching sensation in the lower extremities treated with steroid injections, pain medication and muscle relaxers. In November 2003, the Veteran related tingling of the arms. On VA general examination in December 2003, the Veteran complained of fatigue, arthralgia, numbness and tingling of the upper and lower extremities. The examiner diagnosed connective tissue disorder with mild functional impairment, history of cervical myofascitis and segmental dysfunction with mils residuals, and intermittent back pain with normal X-rays. The examiner noted no evidence of degenerative disc disease or arthritis on X-rays. The examiner was unable to determine whether the Veteran suffered from fibromyalgia. Similarly, a private clinician in June 2004, noted there was no blood work or definitive diagnosis of fibromyalgia, but there definitely was a myalgia type process with sleep interruption. The Veteran related chronic low back pain with numbness and tingling. Examination was positive for soft tissue myofascial and fibromyalgia type pain excluding any other problems. On VA examination in April 2006, the Veteran complained of constant joint pain, dry mouth, nasal sores, sores in her tongue, numbness and weakness of the lower extremities. The spine was tender on palpitation. She reported periods of exacerbation of the disease process, characterized by nasal sores 4 to 6 times a year and lasting for 3 weeks. The Veteran was afforded a VA examination in September 2007. After reviewing the Veteran's claims file as well as citing to various general medical articles found on the Internet about fibromyalgia, and X-rays of the Veteran's cervical and lumbar spine, the VA examiner opined that the Veteran's complaints of spine pain with normal X-rays were related to fibromyalgia features rather than her underlying differentiated tissue disorder. The examiner explained that it was almost impossible to identify the Veteran's specific connective tissue disorder because it was not properly worked-up when she initially presented symptoms in service and post-service discharge, however, the symptoms appeared to have been more on the side of fibromyalgia. In addition, the examiner concluded that the Veteran's symptoms, including spine pain, were "due more so to her fibromyalgia coupled with a complex regional syndrome than to her reported connective tissue disease which remains unspecified at this time." Based on the information provided in the September 2007 VA examination, the RO elected to re-phrase the issue on appeal as an evaluation of fibromyalgia (previously rated as undifferentiated connective tissue disease, thoracic spine sprain, low back sprain, and cervical myofascitis with segmental dysfunction). A November 2007 rating decision increased the Veteran's disability rating under 38 C.F.R. § 4.71a, Diagnostic Code 5025 to 40 percent, effective November 16, 2006. In statements in 2008 and 2009, the Veteran claimed entitlement to a 40 percent disability rating for fibromyalgia (previously rated as undifferentiated connective tissue disease, thoracic spine sprain, low back sprain, and cervical myofascitis with segmental dysfunction) dating back to September 1995, on the basis that her fibromyalgia was present in service and had remained equally symptomatic post- discharge from active duty, but it had been misdiagnosed by medical providers. In October 2008, the Veteran was diagnosed with mild obstructive sleep apnea. At the time the Veteran complained of progressive problems with loud snoring, reflux, night sweats, morning headaches, dry mouth, nocturia x1, some mood disturbance, depression, anxiety and irritability. In January 2009, the Board remanded the claim for a medical opinion as to when the Veteran's symptoms first began to more nearly approximate the rating criteria for fibromyalgia. The examiner was also asked to assess the severity of the Veteran's fibromyalgia, to include commenting on how, if at all, the claimed increase in severity of her service- connected disability affected her employment and daily life. On VA examination for fibromyalgia in April 2009, the Veteran complained of myalgia of the arms, tingling of the extremities, multiple joint and muscle pain, muscle weakness, stiffness, trigger points, headaches, unexplained fatigue, sleep disturbance, paresthesias, constipation, abdominal cramps, and difficulty concentrating. Exacerbating factors were stress, overexertion, insufficient sleep, and being unemployed. Continuous medication for pain was required. Response to treatment was noted as refractory. The examiner noted that the Veteran's symptomatology had onset in 1994 while in service. The examiner described the fibromyalgia as severe. The Veteran exhibited tender points on the right and left side of the body. The examiner opined that the Veteran's complaints of spine pain with normal X-rays were related to fibromyalgia features rather than her underlying differentiated tissue disorder, since most films with fibromyalgia are usually normal, particularly in the early stages. The examiner explained that it was almost impossible to identify the Veteran's specific connective tissue disorder because it was not properly worked-up when she initially presented symptoms in service and post-service discharge, however, the symptoms appeared to have been more on the side of fibromyalgia. The Veteran had been employed as a contract recruiter for over 2 years. She related missing 4 weeks of work in the previous year due to musculoskeletal pain. The examiner described significant impact on the Veteran's occupational activities, to include pain, decreased stamina, strength and mobility, which had resulted in different work duty assignments. General Rating Principles A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If two disability ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Diagnostic Code 5025 provides that fibromyalgia (fibrositis, primary fibromyalgia syndrome) with widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud's-like symptoms, is to be rated 10 percent disabling if the symptoms require continuous medication for control; 20 percent disabling if the symptoms are episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but symptoms that are present more than one-third of the time; and 40 percent disabling if the symptoms are constant or nearly constant, and are refractory to therapy. A Note to Diagnostic Code 5025 provides that widespread pain means pain in both the left and right sides of the body, that is both above and below the waist, and that affects both the axial skeleton (i.e., cervical spine, anterior chest, thoracic spine, or low back) and the extremities. When there is no diagnostic code specific to the disability for which the Veteran is service-connected, the service- connected disability is rated by analogy under a diagnostic code for a closely related condition that approximates the anatomical localization, symptomatology and functional impairment. See 38 C.F.R. §§ 4.20, 4.27 (2009). The RO initially rated the Veteran's undifferentiated connective tissue disease by analogy under Diagnostic Code 6399-6350. Under Diagnostic Code 6350 for systemic lupus erythematosus (disseminated), a 10 percent rating is assigned for exacerbations once or twice a year or symptomatic during the past 2 years; a 60 percent rating is assigned for exacerbations lasting a week or more, 2 or 3 times per year; and a 100 percent rating is assigned for acute manifestations with frequent exacerbations, producing severe impairment of health. An associated Note states that this condition may be evaluated either by combining the evaluations for residuals under the appropriate system, or by evaluating under Diagnostic Code 6350, whichever method results in a higher evaluation. 38 C.F.R. § 4.88b, Diagnostic Code 6350. Under 38 U.S.C.A. § 5110(a) and (b)(2), the effective date of an evaluation and award of compensation based on a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later, and unless specifically provided on basis of facts found. 38 C.F.R. §§ 3.400, 3.400(o)(1), (2). In general, in a claim for increase where the increase does not precede the date of claim, the effective date is governed by the later of the date that it is shown that the requirements for an increased evaluation are met or the date the claim for an increased evaluation is received. Harper v. Brown, 10 Vet. App. 125 (1997). Analysis By a rating decision in March 1996, the RO granted service connection for undifferentiated connective tissue disease, and assigned a 10 percent rating effective September 6, 1995. In a rating decision in July 1999, the RO continued the Veteran's 10 percent disability rating for undifferentiated connective tissue disease. The Veteran did not appeal that decision. The rating decisions by the RO from March 1996, and July 1999, became final based on the evidence of record. 38 U.S.C.A. § 7105; 38 C.F.R. § 3.104. By operation of law, a previous rating decision by the RO is binding and will be accepted as correct in the absence of clear and unmistakable error. 38 C.F.R. §§ 3.104, 3.105(a). The Veteran has not raised clear and unmistakable error in the above rating decisions by the RO. For this reason, there is no legal basis for an effective date earlier than receipt of the current claim for increase, to wit, October 31, 2002. The Veteran's service-connected fibromyalgia (previously rated as undifferentiated connective tissue disease, thoracic spine sprain, low back sprain, and cervical myofascitis with segmented dysfunction) was rated as 10 percent disabling prior to November 16, 2006. On November 16, 2004, the Veteran's disability rating was increased to 40 percent. On VA general examination in December 2003, the examiner was unable to determine whether the Veteran suffered from fibromyalgia. Similarly, a private clinician in June 2004, noted there was no blood work or definitive diagnosis of fibromyalgia, but examination was positive for soft tissue myofascial and fibromyalgia type pain. However, a VA examiner in September 2007, and in April 2009, following a review of the Veteran's claims file an examination of the Veteran, and citing to various general medical articles found on the Internet about fibromyalgia, diagnosed fibromyalgia with onset in service. The examiner concluded that it was almost impossible to identify the Veteran's specific connective tissue disorder because it was not properly worked-up when she initially presented symptoms in service and post-service discharge, however, the symptoms appeared to have been more on the side of fibromyalgia. Accordingly, the Board will first address whether the criteria for a scheduler rating higher than 10 percent under Diagnostic Code 5025 for fibromyalgia, were met prior to November 16, 2004. VA and private treatment records prior to November 16, 2004, recorded complaints of constant soreness of the joints, depression, anxiety, insomnia, low energy, fatigue, poor motivation, joint stiffness, chronic back pain, sores of the tongue, arthralgia, numbness and tingling of the upper and lower extremities, nasal sores, swelling of the fingers, burning and itching sensations in the lower extremities, and dry mouth. In June 2004, examination was positive for soft tissue myofascial and fibromyalgia type pain. Resolving all reasonable doubt in the Veteran's favor, the Board finds that prior to November 16, 2004, the Veteran's fibromyalgia more closely resembles a 40 percent disability rating where her symptoms are near constant despite medication. The evidence supports a finding that the Veteran's symptoms were constant or nearly so. Additionally, the treatment records show that the Veteran's response to treatment has been poor as her condition has progressively worsened. As noted by the VA examiner in September 2007 and April 2009, the Veteran's fibromyalgia was refractory to therapy. Accordingly, the Board finds that the Veteran's fibromyalgia more closely resembles a 40 percent disability rating from October 31, 2002 (the date of the Veteran's claim for an increased disability rating) to November 16, 2004. A 40 percent disability rating is the maximum available under Diagnostic Code 5025. During the rating period under consideration, the Veteran's fibromyalgia is rated as 40 percent disabling. Therefore, a higher scheduler disability rating is not available under Diagnostic Code 5025. The Board has considered whether the Veteran is entitled to a higher rating under Diagnostic Code 6350. Under Diagnostic Code 6350, the criterion for the next higher rating of 60 percent, requires exacerbations lasting a week or more, two or three times per year. A review of the record reveals on VA examination in April 2006, the Veteran reported periods of exacerbation of the disease process characterized by nasal sores 4 to 6 times a year and lasting for 3 weeks. On VA examination in April 2009, the Veteran related missing 4 weeks of work in the previous year due to musculoskeletal pain, however no such episodes have been documented. In the absence of such documentation, the criteria for the next higher rating have not been met. For the above reasons, the preponderance of the evidence is against a rating higher than 40 percent for fibromyalgia (previously rated as undifferentiated connective tissue disease, thoracic spine sprain, low back sprain, and cervical myofascitis with segmented dysfunction) throughout the appeal period, and the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C.A. § 5107(b) ); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER A disability rating of 40 percent for fibromyalgia from October 31, 2002, to November 16, 2006, is granted, subject to the law and regulations, governing the award of monetary benefits. A disability rating higher than 40 percent for fibromyalgia is denied. REMAND As noted above, the January 2009 Board remand referred the issue of entitlement to a TDIU to the RO for adjudication. Since the last remand, the Court has held that TDIU is an element of all appeals for a higher initial or increased rating. See Rice, 22 Vet. App. at 447. The law provides that a TDIU may be granted upon a showing that the Veteran is unable to secure or follow a substantially gainful occupation due solely to impairment resulting from his service-connected disabilities. See 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. Consideration may be given to a Veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his or her age or the impairment caused by non-service-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. To qualify for a total rating for compensation purposes, the evidence must show (1) a single disability rated as 100 percent disabling; or (2) that the disabled person is unable to secure or follow a substantially gainful occupation as a result of his or her service-connected disabilities and there is one disability ratable at 60 percent or more, or, if more than one disability, at least one disability ratable at 40 percent or more and a combined disability rating of 70 percent. Id. In determining whether appellant is entitled to a TDIU, neither appellant's non-service-connected disabilities nor advancing age may be considered. See 38 C.F.R. § 3.341(a); Hersey v. Derwinski, 2 Vet. App. 91, 94 (1992). Since the record reflects that the Veteran may be unable to work, the Board will also consider whether referral for extraschedular consideration is warranted in this case. To accord justice in an exceptional case where the scheduler standards are found to be inadequate, the field station is authorized to refer the case to the Chief Benefits Director or the Director, Compensation and Pension Service for assignment of an extraschedular evaluation commensurate with the average earning capacity impairment. 38 C.F.R. § 3.321(b)(1). Such a rating can include a TDIU. 38 C.F.R. § 4.16. To date, the Veteran has not been afforded a VA medical examination regarding whether his service-connected disabilities prevent her from securing or following a substantially gainful occupation. As such, the Board must remand this claim for such on opinion to be obtained. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, this appeal is REMANDED for the following: 1. The RO/AMC shall schedule the Veteran for the appropriate VA examination to evaluate the impact of her service- connected disabilities (major depression disorder with PTSD, fibromyalgia, thoracic spine sprain, right rotator cuff tendonitis, low back strain, cervical myofascitis with segmental dysfunction, and a fractured left lateral malleolus) on her ability to obtain and maintain gainful employment. The examiner should review the claims file and note such review in the examination report or in an addendum. All tests deemed necessary should be undertaken. The examiner should provide an opinion as to whether the service-connected disabilities, at least as likely as not (50 percent probability) prevent the Veteran from obtaining or maintaining gainful employment for which her education and occupational experience would otherwise qualify her. The examiner is also asked to comment on the impact of the severity of the service-connected disabilities, if any, on the her employment and activities of daily life. The examination report must include a complete rationale for all opinions expressed. 2. 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. 3. The RO/AMC will then readjudicate the Veteran's claim. If the benefit sought on appeal remains denied, the Veteran and her 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 she is so informed. She 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 or the United States Court of Appeals for Veterans Claims for development or other action must be handled in an expeditious manner. 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