Citation Nr: 1040171 Decision Date: 10/26/10 Archive Date: 11/01/10 DOCKET NO. 04-29 050 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected hypertension and transient ischemic attacks. 2. Entitlement to an initial compensable evaluation for transient ischemic attacks (TIA). 3. Entitlement to an effective date earlier than August 16, 2005 for the grant of service connection for posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Florida Department of Veterans Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD D. Van Wambeke, Counsel INTRODUCTION The Veteran served on active duty from May 1962 to May 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, in August 2003 and August 2005 and a rating decision issued by the Appeals Management Center (AMC) in June 2010. The August 2003 rating decision granted service connection for TIA with a noncompensable evaluation effective May 21, 2003. The August 2005 rating decision denied a claim for entitlement to service connection for dysthymic disorder, also claimed as obsessive compulsive disorder and depression. The June 2010 rating decision granted entitlement to service connection for PTSD and assigned a 50 percent evaluation effective August 16, 2002. The Veteran testified before the Board in July 2007. The Veterans Law Judge (VLJ) who conducted the hearing is no longer employed by the Board. In November 2007, the Veteran was notified of this and of the fact that the hearing transcript had portions which were inaudible. He was offered the opportunity for another hearing, and he subsequently requested one. In February 2008, the Board remanded the Veteran's claim so that he could be afforded another hearing. The Veteran thereafter presented testimony before the undersigned VLJ at a videoconference hearing in June 2008. A transcript of the hearing is of record. The claims for service connection for an acquired psychiatric disorder, to include as secondary to service-connected hypertension and transient ischemic attacks, and for an initial compensable evaluation for TIA were remanded by the Board in December 2008 for additional development and to address due process concerns. More specifically, the RO/AMC was instructed to obtain additional VA treatment records and to schedule the Veteran for appropriate VA examinations. The actions directed by the Board pertaining to the Veteran's claim for service connection have been accomplished and the matter returned for appellate review. As will be discussed in greater detail below, however, the actions directed by the Board pertaining to the claim for increased rating have not been fully accomplished. The Board also remanded a claim for service connection for PTSD in December 2008. As noted above, service connection for this disability was subsequently granted by the AMC in a June 2010 rating decision. As such, the issue of whether the Veteran is entitled to service connection for PTSD is no longer before the Board for appellate review. The Board notes at this juncture that during the pendency of this appeal, the United States Court of Appeals for Veterans Claims (Court) held that claims for service connection for PTSD encompass claims for service connection for all psychiatric disabilities. Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009) (the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record). In this case, however, as service connection for PTSD has already been established, the Board will only adjudicate whether the Veteran is entitled to service connection for acquired psychiatric disorder, to include as secondary to service-connected hypertension and TIA, as reflected on the title page. The Board also notes that a statement from the Veteran's wife was received directly at the Board in August 2010, after the May 2010 supplemental statement of the case (SSOC) was issued, without a waiver of consideration by the agency of original jurisdiction (AOJ). Review of the evidence submitted reveals that it relates to the symptomatology exhibited by the Veteran's PTSD and, therefore, is not pertinent to the issue being adjudicated in this decision. Based on the foregoing, the Board finds that the evidence need not be remanded to the AOJ. See 38 C.F.R. § 20.1304. The issue of entitlement to an initial compensable rating for TIA and the issue of entitlement to an effective date earlier than August 16, 2005 for the grant of service connection for PTSD are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the AMC in Washington, DC. FINDING OF FACT The medical evidence indicates that the Veteran's PTSD, which is directly related to service, accounts for his psychiatric symptomatology such that separate diagnoses of major depressive disorder, dysthymic disorder and/or obsessive compulsive disorder are not merited. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, to include as secondary to service-connected hypertension and transient ischemic attacks, have not been met. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2009). REASONS AND BASES FOR FINDING AND CONCLUSION To establish service connection for a claimed disability, the evidence must demonstrate that a disease or injury resulting in current disability was incurred during active service or, if pre- existing, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2009). That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b) (2009). Service connection may also be granted for any injury or disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d) (2009). Certain chronic diseases, including psychoses, may be presumed to have been incurred during service if they become disabling to a compensable degree within one year of separation from active duty. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309 (2009). Service connection may be granted on a secondary basis for a disability that is proximately due to or the result of an established service-connected disorder. 38 C.F.R. § 3.310(a) (2009). Similarly, any increase in severity of a nonservice- connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. 38 C.F.R. § 3.310(b) (2008); Allen v. Brown, 7 Vet. App. 439 (1995). In the latter instance, the nonservice- connected disease or injury is said to have been aggravated by the service-connected disease or injury. 38 C.F.R. § 3.310(b) (2009). In cases of aggravation of a Veteran's nonservice- connected disability by a service-connected disability, the Veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.322 (2009). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A lay witness is competent to testify as to the occurrence of an in-service injury or incident where such issue is factual in nature. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In some cases, lay evidence will also be competent and credible on the issues of diagnosis and etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Robinson v. Shinseki, 557 F.3d 1355 (2009). Specifically, lay evidence may be competent and sufficient to establish a diagnosis where (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau, 492 F.3d at 1377; see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). A layperson is competent to identify a medical condition where the condition may be diagnosed by its unique and readily identifiable features. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in- service injury or disease, and receipt of medical treatment for such symptoms. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994); Charles v. Principi, 16 Vet. App 370, 374 (2002). The Veteran contends that he has an acquired psychiatric disorder, reported as depression, obsessive compulsive disorder, stress, and dysthymic disorder. It appears that he is claiming this disorder is a result of service and that he also asserts it manifested from his service-connected hypertension and ischemic attack. The Veteran contends that he has been told that his psychiatric condition, to include depression and dysthymic disorder, might be related to his hypertension or TIA. See July 2004 VA Form 9; VA Forms 21-4138 dated December 2004, November 2005; July 2007 and June 2008 hearing transcripts; As noted above, service connection for PTSD was granted in a June 2010 rating decision. As such, any arguments and treatment records pertaining to PTSD will not be discussed in this decision. The Veteran's service treatment records are largely devoid of reference to complaint of, or treatment for, any psychiatric problems, to include depression, obsessive compulsive disorder, stress and/or dysthymic disorder. The Veteran did report increased tension in April 1976, at which time an impression of anxiety was made. See health record. This is the only notation pertaining to any psychiatric problem during the Veteran's 20 years in service. In fact, the Veteran denied frequent trouble sleeping, depression or excessive worry, and nervous trouble of any sort during an August 1979 examination and clinical evaluation of his psychiatric functioning was normal. See reports of medical examination and history. The same was noted at the time of the Veteran's March 1982 discharge examination. See id. The post-service medical evidence of record does reflect that the Veteran has received treatment related to psychiatric complaints. In pertinent part, VA treatment records report obsessive compulsive traits and disorder and depression. See progress notes dated June 2001, July 2001, October 2001, February 2002, May 2002 and September 2002. On occasion, these findings would be accompanied by a diagnosis of PTSD. On many other occasions, however, in fact in the majority of VA treatment records, the only Axis I diagnosis rendered was (chronic) PTSD. See e.g., February 2001 mental health initial integrated treatment plan note; mental health biopsychosocial integrated treatment notes dated September 2005 and July 2009; August 2005 consult and screening evaluation STP note; December 2008 psychiatry MD OPT note; September 2009 PTSD medication management note; see also June 2005 letter from M. Bailey at the Vet Center in St. Petersburg (has been diagnosed with PTSD). The VA treatment records also reveal that the Veteran was undergoing group therapy for PTSD throughout the appeal. The Board notes that a June 2001 psychiatry consult note contains an impression of no Axis I diagnosis; no evidence of any major mood disorder or obsessive compulsive qualities. A July 2005 psychology consult note contains an impression of other or unspecified psychological factors affecting medical condition, and in June 2009, the impression was "complaints of stress and anxiety currently felt best accounted for by PTSD by prior providers." See psychiatry MD OPT note. In October 2002, a VA doctor reported that the Veteran was a patient at the South Saint Petersburg primary care clinic and that he had followed the Veteran since November 1998. In pertinent part, the VA doctor provided a diagnosis of PTSD/obsessive compulsive traits. See letter from Dr. D. Layer. Also in October 2002, a duty status report contains a description of clinical findings that noted depression and PTSD. In a November 2002 report from Dr. G.E. Boutin, it was noted that the Veteran had been seen on a regular basis since May 2002, initially for depression and stress as a result of work. An Axis I diagnosis of major depressive disorder was provided by Dr. Boutin, who noted that the Veteran had a significant fear of stroke over work-related stress and that the Veteran was unable to take psychiatric medications due to his TIA and hypertension. In April 2003, Dr. Boutin provided Axis I diagnoses of major depressive disorder and PTSD. The Veteran has undergone two VA compensation and pension (C&P) examinations in connection with his claim. During an April 2004 mental disorders examination, at which time the Veteran's claims folder and medical records were reviewed, an Axis I diagnosis of dysthymic disorder was provided following mental status evaluation. The examiner noted that a review of his records and the results of the interview indicate that the Veteran appears to be suffering from depressive symptoms consistent with dysthymic disorder. The examiner reported that the Veteran indicated that his symptoms became noticeable over the past few years as the stress of his work began to overwhelm him. The examiner indicated that this assertion was confirmed by his private psychologist, who indicated that the Veteran's work "is seen as severely stressful" and that he should not return to such employment. The examiner also noted that a November 2002 report indicated that the Veteran "has a significant fear of stroke over work related stress." The examiner asserted that in view of the above, it seemed apparent that the Veteran's depressive symptoms are related to the stress of his past work and that it is less likely as not that these symptoms are a result of his service-connected conditions. The Veteran underwent a VA C&P initial evaluation for PTSD examination in March 2009, at which time his claims folder and medical records were reviewed. Following mental status examination, an Axis I diagnosis of PTSD was provided, which the examiner indicated was etiologically related to active service. In a May 2010 addendum, the VA examiner reported that in summary, his opinion was that the Veteran had chronic PTSD most likely caused as a result of his in-service traumatic experiences. The examiner noted that PTSD is commonly associated with varying degrees of depression over a chronic intermittent course and that the Veteran's depression appears to be secondary to his PTSD and does not appear to be related to his service-connected hypertension (to include its treatment) or to TIA, which by definition was transient without sequela. It was the examiner's opinion that PTSD is sufficient explanation for his symptomatology and separate diagnoses of major depressive disorder, dysthymic disorder or obsessive compulsive disorder are not merited. The examiner went on to note that the Veteran's private psychologist, Dr. Boutin, diagnosed major depressive disorder in a letter dated November 2002, but that none of four psychiatrists and two psychiatric ARNPs who subsequently saw the Veteran concur, nor do they give him a separate diagnosis of dysthymic disorder. Instead, the Veteran is diagnosed with chronic PTSD and is treated in the Stress Treatment Program (STP) from August 2005 onwards. The examiner also noted that three psychiatrists, including his present psychiatrist, diagnose the Veteran with PTSD without separate diagnosis of depression or OCD and treat him with antidepressants, which are used/effective for both PTSD and depression. The examiner also noted that Dr. Layer, the Veteran's primary care physician (PCP), referred the Veteran to psychiatry in October 2000 to rule out OCD, which was done when they stated "no Axis I diagnosis; no evidence of any major mood disorder or obsessive compulsive qualities." The examiner noted that Dr. Boutin referred to "O.C. personality characteristics" in his November 2002 letter, but it was the examiner's opinion in retrospect that the intrusive thoughts and lock- checking/hypervigilant behavior of his PTSD could have been misconstrued as OCD. The evidence of record does not support the claim for service connection for an acquired psychiatric disorder on either a direct or secondary basis. As an initial matter, and as noted above, the Veteran's service treatment records are largely devoid of reference to complaint of, or treatment for, any psychiatric problems, and the Veteran consistently denied any psychiatric problems following a single notation of anxiety in April 1976. As such, there is no evidence of a chronic psychiatric condition during service. Secondly, the medical evidence does not support a finding of continuity of symptomatology following the Veteran's 1982 discharge from service. Rather, the first record of complaint is June 2001, approximately 19 years after the Veteran's discharge from service, at which time obsessive compulsive traits were noted. See progress note. The Board notes that a subsequent June 2001 psychiatry consult note contains an impression of no Axis I diagnosis; no evidence of any major mood disorder or obsessive compulsive qualities. Lastly, while the Board acknowledges that the April 2004 VA examiner diagnosed the Veteran with dysthymic disorder, the March 2009 VA examiner determined that the only Axis I diagnosis warranted was PTSD. The May 2009 VA examiner also determined that PTSD provided sufficient explanation for the Veteran's symptomatology such that separate diagnoses of major depressive disorder, dysthymic disorder and/or obsessive compulsive disorder were not merited. The 2009 VA examiner supported his conclusion with an adequate rationale, noting that PTSD is commonly associated with varying degrees of depression over a chronic intermittent course and that the Veteran's depression appears to be secondary to his PTSD. The examiner also noted the diagnoses of major depressive disorder and obsessive compulsive disorder. Regarding the former, the 2009 VA examiner noted that the Veteran had been treated for PTSD from August 2005, onwards, and that none of his treating psychiatrists diagnosed him with major depressive disorder, though he was treated with antidepressants, which are also effective for depression. Regarding the latter, the examiner noted that although the Veteran was referred to psychiatry related to a diagnosis of obsessive compulsive disorder, no Axis I diagnosis could be provided and rather, there was no evidence of any major mood disorder or obsessive compulsive qualities. The examiner also noted that, in retrospect, intrusive thoughts and lock-checking and hypervigilant behavior could have been misconstrued as OCD instead of being diagnosed as PTSD. As noted several times above, service connection for PTSD is already in effect. Symptoms such as depressed mood, disturbances of mood, obsessional rituals, and depression are contemplated when assigning a disability rating for PTSD. See 38 C.F.R. § 4.130, Diagnostic Code 9411 (2009). Given the evidence as described above (in particular the detailed and probative opinion provided by the March 2009 VA examiner) indicating that a separate diagnosis of a major depressive disorder, dysthymic disorder, and/or obsessive compulsive disorder is not merited, the preponderance of the evidence is against the claim for service connection on a direct basis and secondary basis. See Brammer v. Derwinski, 3 Vet. App. 233, 225 (1992) (noting that service connection presupposes a current diagnosis of the claimed disability). As the preponderance of the evidence is against the claim, the benefit of the doubt rule is inapplicable. 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2009). VA's duties to notify and assist claimants in substantiating a claim for VA benefits are found at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2009). 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) (West 2002 & Supp. 2009); 38 C.F.R. § 3.159(b) (2009); Quartuccio v. Principi, 16 Vet. App. 183 (2002). In accordance with 38 C.F.R. § 3.159(b)(1), proper 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; and (3) that the claimant is expected to provide. Notice should be provided to a claimant before the initial unfavorable decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The notice requirements apply to all five elements of a service- connection claim, including: (1) Veteran status; (2) existence of a disability; (3) a connection between the Veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. Prior to the issuance of the August 2005 rating decision that is the subject of this appeal, the Veteran was advised of the evidence needed to substantiate a claim for service connection and of his and VA's respective duties in obtaining evidence. See November 2004 letter. The Veteran was provided notice of the appropriate disability rating and effective date of any grant of service connection, as required by Dingess/Hartman, in an April 2006 letter and the claim was readjudicated in a statement of the case dated August 2006. Accordingly, the duty to notify has been fulfilled. VA also has a duty to assist claimants in obtaining evidence needed to substantiate a claim. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2009). This duty has also been met as the Veteran service, private and VA treatment records have been obtained. He was also afforded appropriate VA examinations in connection with his claim, and the opinion requested by the Board in its December 2008 remand was provided. The record does not suggest the existence of additional, pertinent evidence that has not been obtained. For the reasons set forth above, the Board finds that no further notification or assistance is necessary, and deciding the appeal is not prejudicial to the Veteran. ORDER Entitlement to service connection for an acquired psychiatric disorder, to include major depressive disorder, dysthymic disorder and/or obsessive compulsive disorder, is denied. REMAND Unfortunately, a remand is required in regards to the remaining claims. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran's claims so that he is afforded every possible consideration. Such development would ensure that his due process rights, including those associated with 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, and 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326, are met. The Board previously remanded the Veteran's claim for an initial compensable evaluation for TIA for an appropriate VA examination. In its remand, the Board noted that although a March 2007 VA examiner had indicated that the Veteran did not have any residuals from his TIA, the Veteran did report experiencing dizziness and shortness of breath at the time of that examination. The Veteran also subsequently indicated that he had headaches, dizziness, sexual malfunction, memory damage/loss, and speech difficulties/damage. See July 2004 VA Form 9; hearing transcripts. The Board noted that the etiology of the Veteran's complaints had not been clearly established and remanded the claim for another examination so that the Veteran's complaints could be evaluated. A remand by the Board confers on the claimant, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268 (1998). Review of the claims folder reveals that the Veteran underwent a VA C&P brain and spinal cord examination in February 2009. The VA examiner did not address the complaints noted above. It appears that the AMC noted this discrepancy and indicated in a January 2010 VA Form 21-6789 that the opinion was inadequate for rating purposes and that a supplemental opinion was needed that specifically discusses the etiology of the Veteran's complaints of headaches, dizziness, memory loss, shortness of breath, sexual dysfunction, speech difficulties, sleep disturbances and cognitive dysfunction. It appears that the AMC returned the claims folder to C&P services, but in a January 2010 addendum opinion, it was noted that the only request associated with the 2009 examination was to evaluate TIA and that if "you need other medical condition evaluated please submit as exam request that specifies exams, background, AND WHAT OPINIONS ARE necessary. The TIA exam was totally adequate and no opinion asked." No further action was undertaken by the AMC. As the Veteran's complaints of headaches, dizziness, memory loss, shortness of breath, sexual dysfunction, speech difficulties, sleep disturbances and cognitive dysfunction have still not been addressed, as requested in the Board's December 2008 remand, this must be accomplished on remand. Recent VA treatment records should also be obtained. The Veteran is hereby notified that it is his responsibility to report for any scheduled examination and to cooperate in the development of the case, and that the consequences of failing to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158 and 3.655 (2009). Service connection for PTSD was granted in a June 11, 2010 rating decision. A 50 percent evaluation was assigned, effective August 16, 2005. The Veteran submitted a statement directly to the Board, which was received in August 2010, indicating that he disagreed with the date that his claim should start and reporting that he was misdiagnosed with a work-related stress problem rather than PTSD. This document is construed as a notice of disagreement regarding the effective date assigned for the grant of service connection for PTSD. The United States Court of Appeals for Veterans Claims (Court) has held that where a notice of disagreement has been filed with regard to an issue, and a SOC has not been issued, the appropriate Board action is to remand the issue to the RO for issuance of a SOC. Manlincon v. West, 12 Vet. App. 238 (1999). Accordingly, the case is REMANDED for the following action: 1. Obtain the Veteran's treatment records from the Bay Pines VA Medical Center, dated from May 2010. 2. Thereafter, return the claims file and a copy of this remand to the VA examiner who conducted the February 2009 brain and spinal cord examination. The examiner should be asked to review the claims folder. The examiner must specifically discuss of the etiology of the Veteran's complaints of headaches, dizziness, memory loss, shortness of breath, sexual dysfunction, speech difficulties, sleep disturbance, and cognitive dysfunction, to include whether these are residuals of the TIA. If the February 2009 VA examiner is not available, or if the requested opinion cannot be given without further examination of the Veteran, a new VA examination should be scheduled. The examiner should identify all residuals related to the TIA, to include a discussion of the etiology of the veteran's complaints of headaches, dizziness, memory loss, shortness of breath, sexual dysfunction, speech difficulties, sleep disturbance, and cognitive dysfunction. If there are no residuals related to the TIA, the examiner should provide an explanation of this. The examiner must provide a comprehensive report including complete rationales for all conclusions reached. 3. Review the claims file and ensure that all of the foregoing development actions have been conducted and completed in full. If any development is incomplete, appropriate corrective action is to be implemented. Specific attention is directed to the examination report. If the requested report does not include an adequate response to the specific opinion requested, the report must be returned for corrective action. 4. Provide the Veteran a statement of the case with respect to the issue of entitlement to an effective date earlier than August 16, 2005 for the grant of service connection for PTSD. The Veteran should be informed of the actions necessary to perfect an appeal on this issue. Thereafter, this issue is to be returned to the Board only if an adequate and timely substantive appeal is filed. 5. Finally, readjudicate the claim for entitlement to an increased initial rating for TIA. If the benefit sought on appeal remains denied, the Veteran and his representative should be provided a supplemental statement of the case (SSOC), and given an opportunity to respond, before the case is returned to the Board. 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 or by the U.S. 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). ______________________________________________ P.M. DILORENZO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs