Citation Nr: 1012297 Decision Date: 04/01/10 Archive Date: 04/14/10 DOCKET NO. 07-05 814 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston- Salem, North Carolina THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for cervical/vaginal inflammation. 3. Entitlement to service connection for irritable bowel syndrome (IBS), claimed as due to exposure to environmental hazards and/or chemicals in the Gulf War, or as due to an undiagnosed illness. 4. Entitlement to service connection for a bilateral foot disorder. 5. Entitlement to service connection for hypertension. 6. Entitlement to service connection for a bilateral knee disorder. 7. Entitlement to service connection for chronic sinusitis. 8. Entitlement to service connection for myofascial pain syndrome, claimed as muscle aches. 9. Entitlement to service connection for a cervical spine disorder, claimed as neck pain. 10. Entitlement to service connection for a disorder manifested by dizziness. 11. Entitlement to service connection for chronic fatigue syndrome, to include as due to an undiagnosed illness. REPRESENTATION Appellant represented by: North Carolina Division of Veterans Affairs ATTORNEY FOR THE BOARD L. A. Rein, Counsel INTRODUCTION The Veteran served on active duty from April 1971 to February 1974, February 1991 to June 1991, April 1999 to August 1999 (to include service in Bosnia and Germany), and December 2000 to July 2002. She also had numerous periods of verified reserve component active duty for training (ACDUTRA) but specific dates are not indicated. With respect to the Veteran's claim for service connection for PTSD, the Board has expanded the claim on appeal to encompass variously diagnosed psychiatric disorders consistent with the recent decision of the Court of Veterans Appeals (Court) in Clemons v. Shinseki, 23 Vet. App. 1 (2009) (indicating that a Veteran's claim for service connection for psychiatric symptoms should not be limited to consideration of a specific diagnosis where the pleadings and evidence suggest a claim of broader scope). In light of the favorable decision on this matter, this action will not prejudice the Veteran. The issues of service connection for IBS, a bilateral foot disorder, hypertension, a bilateral knee disorder, chronic sinusitis, myofascial pain syndrome, a cervical spine disorder, and chronic fatigue syndrome will be considered within the Remand section of this document below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the Veteran when further action, on her part, is required. FINDINGS OF FACT 1. All notification and development action needed to fairly adjudicate each claim herein decided has been accomplished. 2. The medical evidence of record shows that the Veteran's currently diagnosed depressive disorder is more likely than not related to her military service. 3. The competent medical evidence establishes that the Veteran does not currently have a diagnosed gynecological disorder. 4. There is no competent evidence establishing that the Veteran has a current disorder manifested by dizziness. CONCLUSIONS OF LAW 1. With resolution of reasonable doubt in the Veteran's favor, the criteria for service connection for an acquired psychiatric disorder, diagnosed as depressive disorder, are met. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2009). 2. The criteria for service connection for cervical/vaginal inflammation are not met. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2009). 3. The criteria for service connection for a disorder manifested by dizziness are not met. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2009) includes enhanced duties to notify and assist claimants for VA benefits. VA regulations implementing the VCAA have been codified, as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2009). Notice requirements under the VCAA essentially require VA to notify a claimant of any evidence that is necessary to substantiate the claim, as well as the evidence that VA will attempt to obtain and which evidence he or she is responsible for providing. See, e.g., Quartuccio v. Principi, 16 Vet. App. 183 (2002) (addressing the duties imposed by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)). As delineated in Pelegrini v. Principi, 18 Vet. App. 112 (2004), after a substantially complete application for benefits is received, proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim, in accordance with 38 C.F.R. § 3.159(b)(1). The Board notes that, effective May 30, 2008, 38 C.F.R. § 3.159 has been revised, in part. See 73 Fed. Reg. 23,353- 23,356 (April 30, 2008). Notably, the final rule removes the third sentence of 38 C.F.R. § 3.159(b)(1), which had stated that VA will request that a claimant provide any pertinent evidence in his or her possession. VA's notice requirements apply to all five elements of a service connection claim: Veteran status, existence of a disability, a connection between the Veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VCAA-compliant notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO, to include the AMC). Id; Pelegrini, 18 Vet. App. at 112. See also Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). However, the VCAA notice requirements may, nonetheless, be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Id. In this appeal, December 2008 and January 2009 post rating letters provided notice to the Veteran of the evidence and information needed to substantiate her claims for service connection decided herein. These letters also informed the Veteran of what information and evidence must be submitted by the Veteran, and what information and evidence would be obtained by VA. The letters further requested that the Veteran submit any additional information or evidence in her possession that pertained to her claims. In addition, these letters provided the Veteran with information regarding disability ratings and effective dates consistent with Dingess/Hartman. After issuance of the above letters, and proving the Veteran and her representative additional opportunity to respond, the RO readjudicated each issue on appeal in a January 2010 supplemental statement of the case (SSOC). Hence, the Veteran is not shown to be prejudiced by the timing of VCAA-compliant notice. See Mayfield v. Nicholson, 20 Vet. App. 537, 543 (2006). See also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as in a statement of the SOC or SSOC, is sufficient to cure a timing defect). Additionally, the record also reflects that VA has made reasonable efforts to obtain or to assist in obtaining all relevant records pertinent to the matter decided herein. Pertinent medical evidence of record includes some of the Veteran's service treatment records, her service personnel records, VA medical records, private medical records, and the reports VA examinations. Also of record and considered in connection with the appeal are various written statements provided by the Veteran as well as by her representative, on her behalf. In summary, the duties imposed by the VCAA have been considered and satisfied. Through various notices of the RO, the appellant has been notified and made aware of the evidence needed to substantiate the claims herein decided, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. There is no additional notice that should be provided, nor is there any indication that there is additional existing evidence to obtain or development required to create any additional evidence to be considered in connection with any claim(s). Consequently, any error in the sequence of events or content of the notice is not shown to prejudice the appellant or to have any effect on the appeal. Any such error is deemed harmless and does not preclude appellate consideration of the matters herein decided, at this juncture. See Mayfield, 20 Vet. App. at 543 (rejecting the argument that the Board lacks authority to consider harmless error). See also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. Analysis Service connection may be granted for disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Such a determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). A. Acquired psychiatric disorder, to include PTSD In addition to the above, establishing service connection for PTSD requires: (1) Medical evidence diagnosing PTSD; (2) credible supporting evidence that the claimed inservice stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed inservice stressor. 38 C.F.R. § 3.304(f). The evidence necessary to establish that an in service stressor actually occurred depends upon whether the Veteran "engaged in combat with the enemy." 38 C.F.R. § 3.304(f); See also Hayes v. Brown, 5 Vet. App. 60, 66-67 (1993). If the evidence shows that the Veteran engaged in combat with the enemy or was a prisoner of war (POW) and the claimed stressor is related to those experiences, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, his lay testimony alone may establish the occurrence of the claimed in service stressor. Id. If, however, the Veteran did not engage in combat with the enemy and was not a POW, or the claimed stressor in unrelated to the Veteran's combat or POW experiences, some evidence corroborating the Veteran's lay statements is required in order to establish that an in service stressor actually occurred. The Veteran asserts that she has a psychiatric disorder, variously diagnosed as PTSD, depression, dysthymic disorder, and panic disorder with agoraphobia, that is related to service. In this case, the Board notes that VA medical records dated from August 2004 to April 2009 and a December 2007 VA mental disorders examination report reflect that the Veteran has been diagnosed with PTSD related to her military service. In a June 2005 letter, the Veteran stated that during service in the Bosnia conflict and the Gulf War she witnessed dead bodies, mass graves, extremely hazardous living conditions, and frequent exposure to fumes, fuels, and other chemical agents. However, the Veteran's stressors have not yet been verified as the RO determined that the Veteran has not provided information specific enough to request confirmation from U.S. Army and Joint Services Records Research Center, hence, a valid diagnosis of PTSD related to an in-service stressor can not be made for the purposes of satisfying the criteria of 38 C.F.R. § 3.304(f). However, in the December 2007 VA mental disorders examination, the VA examiner opined that the Veteran's depressive disorder is caused by or a result of exposure to traumatic stressors during Operation Noble Anvile (Kosovo operation) and exposure to loss of life (trauma) of September 11, 2001. Specifically, the examiner noted that the Veteran had displayed symptoms of depression related to exposure to traumatic conditions (death and dying). In this case, service records associated with the claims file confirm that the Veteran served during Operation Noble Anvile in Bosnia. VA adjudicators are not free to ignore or disregard the medical conclusions of VA medical professionals, and are not permitted to substitute their own judgment on a medical matter. See Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). Therefore, by resolving all reasonable doubt in favor of the Veteran, service connection for an acquired psychiatric disorder, diagnosed as depressive disorder, is granted. B. Cervical/vaginal inflammation Service treatment record reflect that in July 2001 the Veteran underwent a PAP smears and a colposcopy and was diagnosed with atypical squamous cells of uncertain significance, can not exclude low grade squamous intraepithelial lesion. A June 2002 colposcopy was negative for intraepithelial lesion or malignancy. Cellular changes were associated with inflammation and/or repair. A September 2007 PAP smear report shows a low grade squamous intraepithelial lesion. A November 2007 colposcopy revealed atypical squamous epithelium with chronic inflammation, most likely presenting reactive atypia. An October 2008 VA medical record reflects that a PAP smear was normal. A May 2009 VA gynecological examination report reflects that the examiner reviewed the claims file, noted pertinent medical records, considered the Veteran's assertions, and performed a thorough physical examination. A PAP smear was negative for intraepithelial lesion and malignancy. The diagnosis was normal PAP smear and perimenopausal symptoms. The VA examiner stated that the Veteran currently has a normal PAP smear, thus, her abnormal PAP smear condition has resolved. The VA examiner concluded that there was no current gynecological pathology. VA adjudicators are not free to ignore or disregard the medical conclusions of VA medical professionals, and are not permitted to substitute their own judgment on a medical matter. See Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). In this case, the Board finds that the medical evidence fails to establish that the Veteran has a current gynecological condition, and neither the Veteran nor her representative has presented, identified, or even alluded to the existence of any medical evidence of a current diagnosed gynecological condition. Furthermore, the Board notes that inflammation complained of by the Veteran is a symptom and without medical diagnosis or evidence of underlying pathology, does not constitute a disability for which service connection can be granted. Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001). Thus, notwithstanding the Veteran's complaints, without competent evidence of a diagnosed or identifiable underlying malady or condition, such does not constitute a disability for which service connection can be granted. As indicated above, Congress has specifically limited entitlement to service connection for disease or injury incurred or aggravated in service to cases where such incidents have resulted in disability. See 38 U.S.C.A. § 1131. Hence, where, as here, competent evidence does not establish the disability for which service connection is sought, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In the instant case, the claim for service connection for cervical/vaginal inflammation must be denied because the first essential criterion for a grant of service connection- evidence of a current disability upon which to predicate a grant of service connection, on any basis -has not been met. C. Disorder manifested by dizziness An undated service treatment record reflects that the Veteran complained of sinuses, pressure around nose and eyes, and sense dizziness at points. The diagnosis was upper respiratory infection, suspect viral. A December 2006 VA general medical examination report is negative for complaints, findings, or diagnosis of a disorder manifested by dizziness. An April 2008 VA medical record reflects that the Veteran complained of shortness of breath and chest pains. She also had mild intermittent dizziness. No diagnosis of a disorder manifested by dizziness was indicated. In this case, the Board finds that the medical evidence fails to establish that the Veteran has a disorder manifested by dizziness, and neither the Veteran nor her representative has presented, identified, or even alluded to the existence of any medical evidence of a current diagnosis of a disorder manifested by dizziness. Therefore, the claim for service connection for a disorder manifested by dizziness must be denied because the first essential criterion for a grant of service connection- evidence of a current disability upon which to predicate a grant of service connection-has not been met. See Brammer, supra. The Board has considered the Veteran's written statements as well as her representative's written assertions; however, none of this evidence provides a basis for allowance of the claim for service connection for a disorder manifested by dizziness. Matters of diagnosis and etiology are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). As the Veteran and her representative are not shown to be other than laypersons without the appropriate medical training and expertise, neither is competent to render a probative (persuasive) opinion on a medical matter. See, e.g., Bostain v. West , 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). Here, the Veteran is capable of reporting that she has experienced dizziness, but the Veteran is not competent (i.e., professionally qualified) to diagnose a disability manifested by dizziness or to offer an opinion as to the cause of this claimed condition. Hence, the lay assertions in this regard have no probative value. ORDER Service connection for an acquired psychiatric disorder, diagnosed as depressive disorder, is granted. Service connection for cervical/vaginal inflammation is denied. Service connection for a disorder manifested by dizziness is denied. REMAND Initially, the Board notes that some of the Veteran's service treatment records are missing from the claims file. The RO has made several attempts to obtain the records. It is not clear however, that the Veteran's Navy reserve unit was contacted to ascertain if it might have medical records. It is also not clear that the National Personnel Records Center was contacted. In addition, while a July 2009 RO letter to the Veteran indicated that they have requested copies of treatment records from the National Naval Medical Center, no response is associated with the claims file. Thus, the Board finds that a remand is warranted for the RO/AMC to contact the National Personnel Records Center (NPRC), the National Naval Medical Center, and the Veteran's Reserve unit and request all service treatment records for the Veteran. With regard to the claim for service connection for chronic sinusitis, the Board notes that there is a question of whether such condition pre-existed one of the Veteran's period of active military service. Although a December 2006 VA examiner opined that such condition was not permanently aggravated by the Veteran's military service, the Board finds that a final decision on this matter is premature until all of the Veteran's service treatment records are obtained. With regard to the Veteran's claims for hypertension and for IBS, although the December 2006 VA examiner diagnosed the Veteran with these disabilities, he did not provide a nexus opinion to service. After all service treatment records are associated with claims file, the Veteran should be afforded appropriate VA examinations to determine whether her diagnosed hypertension and IBS are related to service. See 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006) With regard to the claims for service connection for myofascial pain syndrome, a cervical spine disorder, bilateral knee disorder, and chronic fatigue syndrome, the Board notes that in a February 2010 letter, the Veteran stated that these disabilities were the result of her service-connected degenerative disc disease (DDD) of the lumbar spine; however, the RO has only had the opportunity to adjudicate service connection for these claims on a direct basis, and not as secondary to the Veteran's service- connected lumbar spine disability. Thus, on remand, the RO should expand these claims and consider service connection for myofascial pain syndrome, claimed as muscle aches, for a cervical spine disorder, claimed as neck pain, for bilateral knee disorder and for chronic fatigue syndrome, to include as secondary to service-connected DDD of the lumbar spine. Under 38 C.F.R. § 3.310(a), service connection may be granted for disability that is proximately due to or the result of a service-connected disease or injury. That regulation permits service connection not only for disability caused by service- connected disability, but for the degree of disability resulting from aggravation to a nonservice-connected disability by a service-connected disability. See 38 C.F.R. § 3.310(b) (2009); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). With regard to the claim for service connection for a bilateral foot disorder, the RO denied this claim on the basis that the Veteran suffered a foot injury in April 1991 during a period of non-active service and that while the Veteran underwent bilateral foot surgery in March 2001, there is no indication of any injury or condition that resulted in this surgical repair secondary to service. However, the Board notes that the Veteran was on active military service in April 1991 when she sustained trauma to her left foot and in May 1991 when she was assessed with tendonitis. Thereafter, in March 2001, during a later period of active military service, the Veteran was diagnosed with adductovarus hammer toes, fifth digit bilaterally and underwent arthroplasty. A December 2006 VA general medical examination report reflects that no bilateral foot disorder was diagnosed; however, VA medical records reflect that she is diagnosed with osteoarthritis of the right fifth metatarsal. In addition, there is a potential for residual scarring of each foot from the Veteran's in-service surgery, and should be considered in adjudicating this matter. Hence, a remand is warranted for an additional VA examination to determine whether the Veteran has a current bilateral foot disorder, to include residual scarring, related to service. Accordingly, the RO should arrange for the Veteran to undergo VA examination(s), by examiner(s) with the appropriate expertise, at a VA medical facility. The Veteran is advised that a failure to report to any scheduled examination(s), without good cause, may result in a denial of the claim(s). See 38 C.F.R. § 3.655 (2009). Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant and death of an immediate family member. If the Veteran fails to report to the scheduled examination, the RO should obtain and associate with the claims file copies of any notice(s) of the date and time of the examination sent to the Veteran by the pertinent VA medical facility. Lastly, the RO/AMC should ensure that the Veteran is properly notified of what evidence is needed to support her claims for secondary service connection under 38 C.F.R. § 3.310 (revised effective in October 2006) and Allen v. Brown, 7 Vet. App. 439, 448 (1995). Accordingly, these matters are REMANDED for the following actions: 1. The RO/AMC should contact the NPRC, the National Naval Medical Center, and the Veteran's Navy Reserve unit to request all outstanding service treatment records. The appellant's assistance in identifying the unit and possible location of records should be requested as needed. All records and/or responses received should be associated with the claims file. 2. The RO/AMC should send to the Veteran a letter requesting that she provide sufficient information, and if necessary, authorization, to enable it to obtain any additional evidence pertinent to the claims on appeal that is not currently of record. The RO/AMC should also explain the type of evidence that is her ultimate responsibility to submit, to specifically include notice as to the evidence need to support her claims for service connection for myofascial pain syndrome, a cervical spine disorder, bilateral knee disorder, and chronic fatigue syndrome, to include as secondary to service-connected DDD of the lumbar spine, under the provisions of 38 C.F.R. § 3.310 (revised effective in October 2006). 3. Thereafter, the RO/AMC should arrange for the Veteran to undergo appropriate VA examination(s), to determine the nature, extent and likely etiology of the claimed disabilities remaining on appeal. The entire claims file must be made available to each examiner designated to examine the Veteran. All appropriate tests or studies (to include x-rays as indicated) should be accomplished (with all findings made available to each examiner prior to the completion of his or her report), and all clinical findings should be reported in detail. A complete rationale must be given for all opinions and conclusions. If a determination cannot be made without resort to speculation, that should be noted. a) With regard to the Veteran's chronic sinusitis, the designated examiner is requested to opine whether such disability preexisted the Veteran's active military service, noting which period and evidence relied upon, and, if so, whether such disability was aggravated (i.e., permanently worsened) beyond the natural progression during or as a result of service OR whether the symptoms and treatment that the Veteran received during service represented the initial onset of her chronic sinusitis. b) With regard to the Veteran's hypertension and IBS, the designated examiner should opine whether it is at least as likely as not (i.e., there is a 50 percent or greater probability) that these disabilities are the result of injury or disease incurred in or aggravated during the Veteran's military service. c) The designated examiner(s) should clearly identify whether the Veteran currently has myofascial pain syndrome, a cervical spine disorder, a bilateral knee disorder, and chronic fatigue syndrome. With respect to each diagnosed disability, the examiner should opine whether the disability is at least as likely as not (i.e., there is a 50 percent or greater probability) the result of injury or disease incurred in or aggravated during the Veteran's military service. Further, for each diagnosed disability, the examiner should opine whether it is at least as likely as not (i.e. there is a 50 percent or greater probability) that such disability (a) was caused, or (b) is aggravated by the Veteran's service-connected DDD of the lumbar spine. If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation, consistent with 38 C.F.R. § 3.310 (as revised effective in October 2006). d) With regard to the Veteran's claim for service connection for a bilateral foot disorder, the designated examiner is requested to identify any current bilateral foot disorder, to include residual scarring, if appropriate. The examiner should opine whether it is at least as likely as not (i.e., there is a 50 percent or greater probability) that such disability(s) is/are the result of injury or disease incurred in or aggravated during the Veteran's military service. 4. Thereafter, the RO/AMC should readjudicate each claim remaining on appeal in light of all pertinent evidence and legal authority (to include the current version of 38 C.F.R. § 3.310, as revised effective in October 2006 as it pertains to the Veteran's claims for service connection for myofascial pain syndrome, a cervical spine disorder, a bilateral knee disorder, and chronic fatigue syndrome, each as claimed as secondary to service- connected DDD of the lumbar spine). 5. If any benefit sought on appeal remains denied, the Veteran and her representative should be provided with a SSOC that contains notice of all relevant actions taken on each claim, to include a summary of the evidence and applicable law and regulations considered pertinent to the issues currently on appeal since the January 2010 SSOC. An appropriate period of time should be allowed for response before the claims file is returned to the Board for further appellate consideration. The Board intimates no opinion as to the outcome in this case by the action taken herein. 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. 2009). ______________________________________________ MICHAEL D. LYON Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs