Citation Nr: 1033430 Decision Date: 09/03/10 Archive Date: 09/13/10 DOCKET NO. 04-24 279 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUES 1. Entitlement to service connection for the residuals of a right ankle injury. 2. Entitlement to service connection for the residuals of a left shoulder injury. 3. Entitlement to service connection for a right foot disorder. 4. Entitlement to service connection for a left hip disorder. 5. Entitlement to service connection for a muscle injury of the chest. 6. Entitlement to service connection for residuals of renal trauma. 7. Entitlement to service connection for an acquired psychiatric disorder, to include major depressive disorder and posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Robert J. Burriesci, Associate Counsel INTRODUCTION The Veteran's active military service extended from April 1978 to May 1980. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated February 2002 and October 2004 by the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. In April 2008, a hearing was held before the undersigned Veterans Law Judge who was designated by the Chairman to conduct that hearing, pursuant to 38 U.S.C.A. § 7107(b) (c) (West 2002). A copy of the transcript of that hearing is of record. Concerning the issue of whether service connection is warranted for a right ankle disability, the Board notes that the RO treated the issue as a claim subject to reopening by new and material evidence as there is a notice letter in the claims folder dated in November 1981, which notified the Veteran that his claim for a right ankle condition had been denied. The rating decision and the records considered by the RO in its denial are not of record as VA is now working with a rebuilt file. As the original documents are not of record, the Board will not require the Veteran to submit new and material evidence to reopen the claim. The documents are not of record through no fault of the Veteran and to ensure that no prejudice results to the Veteran, the claim will be considered on the merits. The issues of entitlement to service connection for the residuals of a entitlement to service connection for the residuals of a left shoulder injury; entitlement to service connection for a left hip disorder; and entitlement to service connection for a muscle injury of the chest are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The medical evidence of record establishes that the Veteran's residuals of a right ankle injury are at least as likely as not related to the Veteran's in-service motor vehicle accident. 2. The medical evidence of record establishes that the Veteran's right foot disorder is at least as likely as not related to the Veteran's in-service motor vehicle accident. 3. The Veteran does not have residuals of renal trauma. 4. The competent medical evidence associates the Veteran's acquired psychiatric disorder with the pain and residuals of the Veteran's in-service motor vehicle accident. CONCLUSIONS OF LAW 1. Residuals of a right ankle injury were incurred in service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2009). 2. A right foot disorder was incurred in service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2009). 3. Residuals of renal trauma were not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2009). 4. An acquired psychiatric disorder is proximately due to the pain associated with the Veteran's in-service motor vehicle accident. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110, 1131; 38 C.F.R. § 3.303. 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 C.F.R. § 3.303(d). In addition, where a Veteran served 90 days or more, and arthritis becomes manifest to a degree of 10 percent or more within one year from date of termination of such service, such diseases shall be presumed to have been incurred in or aggravated by service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Generally, to establish service connection, there must be (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in- service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus between the current disability and the in-service disease or injury. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that a Veteran seeking disability benefits must establish the existence of a disability and a connection between service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). In addition to the elements of direct service connection, service connection may also be granted on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); Wallin v. West, 11 Vet. App. 509, 512 (1998). Evidence of a temporary flare-up, without more, does not satisfy the level of proof required to establish an increase in disability. Cf. Davis v. Principi, 276 F. 3d 1341, 1346-47 (Fed. Cir. 2002); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). The United States Court of Appeals for the Federal Circuit has recognized the Board's "authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence." Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A. Residuals of a Right Ankle Injury The Veteran seeks entitlement to service connection for residuals of a right ankle injury. The Veteran's service treatment and personnel records reveal that the Veteran was the driver of a motorcycle in a motor vehicle accident in September 1978. In March 2001 the Veteran was afforded a VA Compensation and Pension (C&P) joints examination. The Veteran reported that he had been in a motor vehicle accident in service and that he had right foot pain. Upon physical examination the Veteran was noted to have no abnormalities of the ankles. After examination the Veteran was not diagnosed with any right ankle disorder. In a statement dated in May 2003, Dr. D.J. diagnosed the Veteran in part with chronic pain syndrome, status post right ankle injury. The physician rendered the opinion that the "current medical manifestations are more likely than not all directly related to the motor vehicle accident." In a VA treatment note, dated in September 2004, the Veteran's right ankle was noted to be tender without erythema or increased heat. X-rays of the right ankle were ordered. Subsequently, in October 2004 the Veteran complained of right ankle pain and was diagnosed with ankle pain and prescribed a cane "[g]iven the possibility of a bone fragment on X-ray." In August 2005 the Veteran was diagnosed with recurrent subluxation of the peroneal tendon of the right ankle. In February 2010 the Veteran was afforded a VA C&P joints examination. The Veteran reported that he was injured in a motor vehicle accident in 1978 and that he has had right ankle problems since that time. The Veteran indicated that he was treated for his right ankle disorder with bracing. Physical examination of the right ankle revealed that the ankle was tender with normal angulation. An X-ray of the right ankle revealed a normal right ankle. After examination the Veteran was diagnosed with chronic residuals of a right ankle sprain. The examiner rendered the opinion that the Veteran's right ankle disorder was at least as likely as not a residual of the injuries sustained as a result of a motor vehicle accident in during service in 1978. The Board finds that entitlement to service connection for residuals of a right ankle injury is warranted. The Veteran is currently diagnosed with chronic residuals of a right ankle sprain and has been diagnosed during the period on appeal with recurrent subluxation of the peroneal tendon of the right ankle. The Veteran sustained multiple injuries in service as a result of a motor vehicle accident. After examination in February 2010, the Veteran's diagnosed right ankle disorder was found to be at least as likely as not related to the Veteran's injuries sustained in a motor vehicle accident in service. In addition, the Veteran has credibly reported continuity of symptoms since the injury. As such, entitlement to service connection for residuals of a right ankle injury is granted. B. Right Foot Disorder The Veteran seeks entitlement to service connection for a right foot disorder. As noted above, the Veteran service treatment and personnel records reveal that the Veteran was the driver of a motorcycle in a motor vehicle accident in September 1978. In March 2001 the Veteran was afforded a VA C&P joints examination. The Veteran reported that he experienced pain in his right foot. Upon examination the Veteran was noted to have no abnormalities of the feet. After examination the Veteran was not diagnosed with any right foot disorder. In a private treatment note, dated in May 2003, the Veteran was noted to have right foot and ankle pain as a result of his accident in 1978. The physician noted that the Veteran's service treatment records were not available for review. The physician noted that the "preponderance of the medical history and physical exams indicates that, more likely than not, his current physical pain syndromes are medically related to his 1978 chest wall and shoulder and ankle injury." The physician diagnosed the Veteran with chronic pain syndrome, status post right ankle injury, and right chest wall pain secondary to post traumatic intercostals neuralgia and neuropathy and rendered the opinion that the Veteran's current medical manifestations are more likely than not all directly related to the motor vehicle accident. In VA treatment records dated in September 2004 and August 2005 the Veteran was diagnosed with osteoarthritis of the first metatarsalphalangeal (MTP) joint of the right foot. In February 2010 the Veteran was afforded a VA C&P foot examination. The Veteran reported that he injured his right foot in a motorcycle accident in service. Upon physical examination the Veteran's right foot, the Veteran was noted to have no appreciable range of motion of the first MTP joint. The Veteran was also noted to have swelling and tenderness at the MTP. The MTP joint was noted to be plantarflexed hallux and to have minimal motion. X-ray examination of the right foot revealed severe degenerative joint disease of the right first MTP joint. The Veteran was diagnosed with degenerative joint disease of the first MTP joint and hallux rigidus. The examiner rendered the opinion that the Veteran's right foot disorder is at least as likely as not related to the Veteran's in service motorcycle accident. The examiner provided the rationale that if the foot was pinned or injured during the accident his degenerative joint disease could have been a result based upon the radiographic appearance and the clinical evidence. In addition the examiner noted that the medical text and literature supports that an acute injury can be the cause of severe degenerative joint disease of the first MTP joint. The Board finds that entitlement to service connection for a right foot disorder is warranted. The Veteran's service treatment and personnel records reveal that the Veteran was injured in a motor vehicle accident in service. The Veteran is currently diagnosed with severe degenerative joint disease of the first MTP joint of the right foot and after examination in February 2010, the examiner rendered the opinion that the Veteran's right foot disorder is at least as likely as not related to the Veteran's in-service motorcycle accident if the Veteran's right foot was pinned or injured in the accident. Although the records regarding the Veteran's treatment after the motorcycle accident in September 1978 are unavailable and, therefore, have not been associated with the claims folder, the Board finds the Veteran's report that he injured his right foot to be competent, as the Veteran is competent to report that he injured his foot, and credible, in light of the examiner's indication that the radiographic evidence is consistent with a traumatic injury. He has also credibly reported continuity of symptoms since the injury in service. As such, entitlement to service connection for a right foot disorder is granted. C. Residuals of Renal Trauma The Veteran seeks entitlement to service connection for residuals of renal trauma. The Veteran contends that he suffers from a renal disorder due to trauma incurred in a motorcycle accident in service. As noted above, the Veteran's service treatment and personnel records reveal that the Veteran was injured as the driver of a motorcycle involved in a motor vehicle accident in September 1978. The Veteran's post service treatment records do not reveal any diagnosis of any renal disorder. In March 2005 the Veteran underwent an ultrasound of the abdomen, including the kidneys. The ultrasound revealed no hydronephrosis or nephrolithiasis. In February 2010 the Veteran was afforded a VA C&P genitourinary examination. The examiner noted that the Veteran was involved in a motor vehicle accident in 1978 and suffered a blunt abdominal trauma that required emergency surgery. However, the Veteran did not require a nephrectomy. The examiner reported that from the Veteran's statements the Veteran suffered a urethral injury from a Foley catheter placement and that since that time he has had increased difficulty with urination. Upon review the examiner noted that the Veteran did not have a history of any renal dysfunction or renal failure, acute nephritis, or hydronephrosis. The examiner reported that a February 2009 renal ultrasound was normal with two kidneys and no hydronephrosis. The examiner diagnosed the Veteran with kidney trauma and stated that the Veteran had no evidence of any resultant kidney damage or problems from his accident in 1978. The examiner provided the rationale that the Veteran had a normal creatinine, glomerular filtration rate (GFR), ultrasound, and urinalysis. He stated that the Veteran had urethral trauma but that it has not resulted in any blockage to the kidney or damage to the kidney. The Board finds that entitlement to service connection for residuals of renal trauma is not warranted. The Veteran's service treatment and personnel records reveal that the Veteran was injured in a motorcycle accident in September 1978. However, there is no indication in the records that the Veteran complained of, was diagnosed with, or was treated for any renal disorder. The Veteran's post service treatment records do not reveal any diagnosis of any renal disorder or residual of any renal trauma and upon ultrasound examination in March 2005 the Veteran was noted to have no hydronephrosis and no nephrolithiasis. After examination in February 2010 the Veteran was diagnosed the Veteran with kidney trauma and the examiner rendered the opinion that the Veteran had no evidence of any resultant kidney damage or problems from his accident in 1978. The examiner based the opinion upon the Veteran's normal creatinine, glomerular filtration rate (GFR), ultrasound, and urinalysis results. As there is no evidence associating any current residuals of renal trauma to the Veteran's active service, including the Veteran's in-service motorcycle accident, entitlement to service connection for residuals of renal trauma must be denied. The Board has considered the Veteran's statement that he has a kidney problem that is related to service but finds that it is outweighed by the more probative medical evidence which shows that he does not have a kidney disability. The medical opinion was based on a physical examination and testing and it outweighs the Veteran's lay statements that he has a disability. Moreover, the Board finds that the Veteran, while competent to report symptoms such as difficulty urinating, is not competent as a lay person to diagnose a kidney disability. The Veteran has asserted that the examination was inadequate in an April 2010 statement but he did not explain how. In that regard, the Board notes that the examiner considered the Veteran's reported symptoms and conducted a physical examination with testing in reaching the opinion that the Veteran did not have a kidney disorder. Accordingly, the Board finds that the examination was adequate. In reaching the decisions above the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against entitlement to service connection, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). D. Psychiatric Disorder The Veteran seeks entitlement to service connection for an acquired psychiatric disorder, to include PTSD. The Veteran contends that his PTSD is due to the accident in service. The Veteran's service treatment and personnel records do not reveal any complaint, diagnosis or treatment for any psychiatric disorder. In April 1985 the Veteran was afforded a VA C&P examination. After psychiatric examination the Veteran was noted to have "no psychiatric symptomatology noted at the present time." The Veteran was not diagnosed with any psychiatric disorder. In February 2001 the Veteran was afforded a VA C&P psychiatric examination. No psychiatric history was reported regarding the Veteran. After examination the Veteran was not diagnosed with any psychiatric disorder. In July 2004 the Veteran was noted to have symptoms of PTSD. In November 2004 the Veteran was diagnosed with depression. In June 2005 the Veteran was diagnosed with depression and PTSD. In February 2010 the Veteran was afforded a VA C&P psychiatric examination. The examiner noted that the Veteran had the stressor of being in a motor vehicle accident. After examination the Veteran was diagnosed with major depressive disorder, recurrent, moderate without psychotic features. The examiner rendered the opinion that the Veteran's major depressive disorder is at least as likely as not due to or aggravated by the significant physical pain associated with the injuries sustained in the Veteran's motor vehicle accident. The Board finds that entitlement to service connection for an acquired psychiatric disorder is warranted. Although the Veteran's service treatment and personnel records do not reveal any complaint, diagnosis, or treatment for any acquired psychiatric disorder, the Veteran has been diagnosed post service with PTSD and depression. After examination in February 2010, the Veteran was diagnosed with major depressive disorder and the examiner rendered the opinion that the Veteran's major depressive disorder is at least as likely as not due to or aggravated by the significant physical pain associated with the injuries sustained in the Veteran's motor vehicle accident. There is no competent and probative evidence to the contrary. As such, entitlement to service connection for an acquired psychiatric disorder is granted. II. Duties to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any 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); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from 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 in accordance with 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). Here, the VCAA duty to notify with respect to the renal disorder claim was satisfied by way of a letter sent to the appellant in April 2001 that fully addressed all notice elements and was sent prior to the initial AOJ decision in this matter. The letter informed the appellant of what evidence was required to substantiate the claim and of the appellant's and VA's respective duties for obtaining evidence. In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the United States Court of Appeals for Veterans Claims (Court) held that, upon receipt of an application for a service-connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating, or is necessary to substantiate, each of the five elements of the claim, including notice of what is required to establish service connection and that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. In this case, although the notice provided did not address either the rating criteria or effective date provisions that are pertinent to the appellant's claim of entitlement to service connection for residuals of renal trauma, such error was harmless given that service connection is being denied, and hence no rating or effective date will be assigned with respect to this claimed condition. VA has a duty to assist the Veteran in the development of the claim. This duty includes assisting the Veteran in the procurement of service treatment records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the appellant. See Bernard v. Brown, 4 Vet. App. 384 (1993). The RO has obtained pertinent VA treatment records. The Veteran submitted treatment notes from Slidell Memorial Hospital and Dr. D.J., and was provided an opportunity to set forth his contentions during the hearing before the undersigned Veterans Law Judge. VA's duty to assist includes the responsibility to obtain any relevant records from the Social Security Administration. Voerth v. West, 13 Vet. App. 117, 121 (1999); Hayes v. Brown, 9 Vet. App. 67, 74 (1996). In this respect, the Veteran has reported that he was first granted and then denied entitlement to SSA disability benefits. An attempt was made to obtain the records regarding the Veteran's application for SSA benefits. In a response dated in April 2010, the SSA indicated that after a thorough search they were unable to locate the Veteran's records and that further efforts to do so would be futile. The Veteran reported that he received treatment by Dr. S at the Covington Orthopedic Clinic. An attempt was made to obtain the Veteran's treatment records from Dr. S at the Covington Orthopedic Clinic. However, in a response letter, dated in March 2001, the Covington Orthopedic Clinic responded that as the records were more than six years old they were no longer retained. The Veteran reported that he received treatment at Keesler Air Force Base (AFB). An attempt was made to obtain the Veteran's treatment records from this unit. However, in a letter received in October 2001, the 81st MDOS/SGORO at Keesler AFB responded that they do not have any records regarding the Veteran. Therefore, to Board finds that VA has complied with the duty to assist in attempting to obtain the records regarding the Veteran's SSA benefits application. See also Soyini v. Derwinski, 1 Vet. App. 541 (1991) (declining to require strict adherence to technical requirements and impose additional burdens on VA when there was no benefit flowing to the claimant). In addition, the Board notes that the Veteran was informed of the unavailability of these records in a Statement of the Case, dated in June 2004, and a Supplemental Statement of the Case, dated in April 2010, pursuant to 38 C.F.R. § 3.159. The appellant was afforded a VA medical examination in February 2010. Significantly, neither the appellant nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. Hence, no further notice or assistance to the appellant is required to fulfill VA's duty to assist the appellant in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). In regard to the claims of entitlement to service connection for residuals of right ankle injury, entitlement to service connection for a right foot disorder, and entitlement to service connection for an acquired psychiatric disorder, the Board is granting in full the benefits sought on appeal. Accordingly, assuming, without deciding, that any error was committed with respect to either the duty to notify or the duty to assist, such error was harmless and will not be further discussed. ORDER Entitlement to service connection for a right ankle disorder is granted Entitlement to service connection for a right foot disorder is granted. Entitlement to service connection for renal trauma is denied. Entitlement to service connection for an acquired psychiatric disorder is granted. REMAND The Veteran seeks entitlement to service connection for a left shoulder disorder, left hip disorder, and residuals of a muscle injury of the chest. The Veteran contends that his current shoulder, hip, and chest disorders are related to his injuries sustained in a motor vehicle accident in service in September 1978. As noted above, the Veteran's service treatment and personnel records reveal that the Veteran was injured as the driver of a motorcycle involved in a motor vehicle accident in September 1978. This case was previously before the Board in June 2008 and was remanded for the RO to conduct a VA C&P examination to determine the etiology of the Veteran's left shoulder disorder, left hip disorder, and residuals of a muscle injury of the chest. The remand requested that the examiner render an opinion regarding whether the Veteran's disorders were related to the Veteran's in service motor vehicle accident. In February 2010, the Veteran was afforded VA C&P joint, nerves, and muscles examinations. After the VA joint examination the Veteran was diagnosed with chronic bursitis of the left hip, mild degenerative arthritis of the left hip, degenerative changes in the glenohumeral joint, and chronic bursititis of the left shoulder. Although the examiner stated that there were no records of treatment for the left shoulder or left hip immediately after the Veteran's in service accident and for two years thereafter, the examiner did not render an opinion regarding whether the Veteran's current disorders may be related to the Veteran's accident or active service. The Court has held "that a remand by . . . the Board confers on the Veteran or other claimant, as a matter of law, the right to compliance with the remand orders." Stegall v. West, 11 Vet. App. 268, 271 (1998). Accordingly, the Veteran's claims of entitlement to service connection for a left shoulder and left hip disorders must be remanded for an opinion to be rendered regarding whether the disorders are related to the Veteran's active service, including the Veteran's in-service motor vehicle accident. Pursuant to the June 2008 Board remand, in February 2010 the Veteran was afforded a VA C&P muscles examination. Upon physical examination the Veteran was noted to have bone damage, manifested by a palpable depressed area of abdominal muscle where the rib was removed from the right lower rib cage, and to have limitation of motion of a joint due to muscle injury. After examination the Veteran was diagnosed with status post muscle injury 1978. However, the examiner stated that there is no objective data of any residuals of injuries sustained by the Veteran as a result of the motorcycle accident and that the examiner stated that the disability from the chest scars and the pneumothorax have already been service-connected. In addition, the examiner further stated that it is at least as likely as not that there are other residuals of injuries sustained by the Veteran as a result of the motorcycle accident during service. The Board notes that once VA undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). As the February 2010 is internally inconsistent as it states that the Veteran has physical evidence of a chest injury, diagnosed the Veteran with status post muscle injury 1978, and rendered the opinion that it is at least as likely as not that there are other residuals of injuries sustained by the Veteran as a result of the motorcycle accident during service, although at the same time stating that there is no objective data of any residuals of injuries sustained by the Veteran as a result of the motorcycle accident, the Board finds that the Veteran must be afforded another VA examination regarding his residuals of a chest muscle injury. Since the claims file is being returned it should be updated to include VA treatment records compiled since November 2009. See 38 C.F.R. § 3.159(c)(2); see also Bell v. Derwinski, 2 Vet. App. 611 (1992). Accordingly, the case is REMANDED for the following action: 1. Attempt to obtain VA medical records pertaining to the Veteran that are dated since November 2009. 2. Thereafter, arrange for the Veteran to undergo an appropriate VA examination to determine the nature, extent, onset and etiology of any left hip, left shoulder, and/or residuals of a chest muscle injury found to be present. The claims folder should be made available to and reviewed by the examiner. All indicated studies should be performed, and all findings should be reported in detail. The examiner should consider the Veteran's report regarding the onset and continuity of symptomatology and opine as to whether it is at least as likely as not (a 50 percent or greater probability) that any left hip, left shoulder, and/or residuals of a chest muscle injury found to be present is related to or had its onset during service, and particularly, to his in-service motor vehicle accident. The rationale for all opinions expressed should be provided in a legible report. 3. Thereafter, readjudicate the Veteran's claims. If the benefits sought on appeal are not granted, the RO should issue the Veteran and his representative a supplemental statement of the case and provide the Veteran an opportunity to respond. The appellant has the right to submit additional evidence and argument on the 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). ______________________________________________ S. S. TOTH Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs