Citation Nr: 1045083 Decision Date: 12/02/10 Archive Date: 12/10/10 DOCKET NO. 07-03 279A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUES 1. Entitlement to service connection for a lung disorder, to include as due to asbestos exposure. 2. Entitlement to service connection for a heart disorder, to include coronary artery disease. 3. Entitlement to service connection for a central nervous system disorder. 4. Entitlement to service connection for an acquired psychiatric disability, to include post-traumatic stress disorder (PTSD). 5. Entitlement to service connection for hypertension. 6. Entitlement to service connection for a digestive disorder. 7. Entitlement to service connection for a prostate disorder. 8. Entitlement to service connection for a rash. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD D. M. Donahue, Associate Counsel INTRODUCTION The Veteran served on active duty in the United States Navy from April 1960 to March 1964. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2005 rating decision by the Huntington, West Virginia Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran has presented personal testimony during hearings before a Decision Review Officer (DRO) at the RO and before undersigned Veterans Law Judge. Transcripts of the hearings are of record. In August 2008 the Board remanded the claims for further development. The Board notes that, in the December 2005 rating decision, the RO denied service connection for PTSD. The RO has continued to characterize this claim as entitlement to service connection for PTSD. However, review of the claims file reflects that the Veteran has been diagnosed with other psychiatric disabilities, including panic disorder and anxiety disorder. Given the diagnoses of record, the Board has recharacterized this issue on appeal as entitlement to service connection for an acquired psychiatric disability, to include PTSD. See Clemons v. Shinseki, 23 Vet. App. 1 (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). The issues of entitlement to service connection for an acquired psychiatric disorder is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. All notification and development action needed to fairly adjudicate each claim on appeal has been accomplished. 2. In a February 2010 letter, the Veteran indicated that he did not wish to pursue the issues of service connection for a heart disorder (coronary artery disease), hypertension, a central nervous system disorder, a skin rash, or a prostate disorder. 3. Persuasive evidence of record indicates that the Veteran's respiratory disorder was caused by his active service. 4. Persuasive evidence of record indicates that the Veteran's digestive disorder was not caused or aggravated by his active service. CONCLUSIONS OF LAW 1. The criteria for withdrawal of a Substantive Appeal by the Veteran concerning the matter of entitlement to service connection for a heart disorder (coronary artery disease) have been met and that appeal is dismissed. 38 U.S.C.A. § 7105(b)(2), (d)(5) (West 2002); 38 C.F.R. §§ 20.202, 20.204 (2010). 2. The criteria for withdrawal of a Substantive Appeal by the Veteran concerning the matter of entitlement to service connection for a central nervous system disorder have been met and that appeal is dismissed. 38 U.S.C.A. § 7105(b)(2), (d)(5) (West 2002); 38 C.F.R. §§ 20.202, 20.204 (2010). 3. The criteria for withdrawal of a Substantive Appeal by the Veteran concerning the matter of entitlement to service connection for hypertension have been met and that appeal is dismissed. 38 U.S.C.A. § 7105(b)(2), (d)(5) (West 2002); 38 C.F.R. §§ 20.202, 20.204 (2010). 4. The criteria for withdrawal of a Substantive Appeal by the Veteran concerning the matter of entitlement to service connection for a prostate disorder have been met and that appeal is dismissed. 38 U.S.C.A. § 7105(b)(2), (d)(5) (West 2002); 38 C.F.R. §§ 20.202, 20.204 (2010). 5. The criteria for withdrawal of a Substantive Appeal by the Veteran concerning the matter of entitlement to service connection for a rash have been met and that appeal is dismissed. 38 U.S.C.A. § 7105(b)(2), (d)(5) (West 2002); 38 C.F.R. §§ 20.202, 20.204 (2010). 6. A respiratory disability was incurred during active duty service. 38 U.S.C.A. §§ 1110, 5103A, 5107 (West 2002); 38 C.F.R. § 3.303, 3.307, 3.309 (2010). 7. A digestive disorder was not incurred during or aggravated by active duty service. 38 U.S.C.A. §§ 1110, 5103A, 5107 (West 2002); 38 C.F.R. § 3.303, 3.307, 3.309 (2010). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Withdrawal of Claims Under 38 U.S.C.A. § 7105 (West 2002 & Supp. 2010), the Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. A substantive appeal may be withdrawn on the record during a hearing, and at any time before the Board promulgates a decision. See 38 C.F.R. §§ 20.202, 20.204 (2010). Withdrawal may be made by the Veteran or by his or her authorized representative. See 38 C.F.R. § 20.204 (2010). In a letter dated February 2, 2010, the Veteran requested withdrawal of the appeal as to service connection for a heart disorder (coronary artery disease), central nervous system disorder, hypertension, prostate disorder, and rash. Hence, there remain no allegations of errors of fact or law for appellate consideration with respect to those claims. Accordingly, the Board does not have jurisdiction to review the appeal as to issues of entitlement to service connection for a heart disorder, central nervous system disorder, hypertension, prostate disorder, and rash, and they must be dismissed. Service Connection for a Lung Disorder and a Digestive Disorder VCAA The provisions of the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a), and as interpreted by the United States Court of Appeals for Veterans Claims (the Court) have been fulfilled. In this case, the Veteran's claims for service connection were received in May 2004. Thereafter, he was notified of the provisions of the VCAA by the RO in correspondence dated in June 2004, April 2005, and December 2008. These letters notified the Veteran of VA's responsibilities in obtaining information to assist the Veteran in completing his claims, identified the Veteran's duties in obtaining information and evidence to substantiate his claims, and provided other pertinent information regarding the VCAA. Thereafter, the claims were reviewed and a supplemental statement of the case (SSOC) was issued in December 2009. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a), Quartuccio v. Principi, 16 Vet. App. 183 (2002), Pelegrini v. Principi, 18 Vet. App. 112 (2004). See also Mayfield v. Nicholson, 19 Vet. App. 103, 110 (2005), reversed on other grounds, 444 F.3d 1328 (Fed. Cir. 2006); Mayfield v. Nicholson (Mayfield II), 20 Vet. App. 537 (2006); Mayfield v. Nicholson (Mayfield III), 499 F.3d 1317 (Fed. Cir. 2007). The Board notes that 38 C.F.R. § 3.159 was revised, effective May 30, 2008, removing the sentence in subsection (b)(1) stating that VA will request the claimant provide any evidence in the claimant's possession that pertains to the claim. Subsection (b)(3) was also added and notes that no duty to provide § 5103(a) notice arises "[u]pon receipt of a Notice of Disagreement" or when "as a matter of law, entitlement to the benefit claimed cannot be established." See 73 Fed. Reg. 23,353-23,356 (Apr. 30, 2008). During the pendency of this appeal, the United States Court of Appeals for Veterans Claims (hereinafter "the Court") in Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), found that the VCAA notice requirements applied to all elements of a claim. Notice as to this matter was provided in December 2008. The Veteran has been made aware of the information and evidence necessary to substantiate his claims and has been provided opportunities to submit such evidence. A review of the claims file also shows that VA has conducted reasonable efforts to assist him in obtaining evidence necessary to substantiate his claims during the course of this appeal. His service treatment records, all relevant VA and private treatment records pertaining to his claims have been obtained and associated with his claims file. The Board notes the Veteran was provided with VA examinations in May 2009 and November 2009 to determine the nature and etiology of the Veteran's claimed disabilities. Furthermore, the Veteran has not identified any additional, relevant evidence that has not otherwise been requested or obtained. He has been notified of the evidence and information necessary to substantiate his claim, and he has been notified of VA's efforts to assist him. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). As a result of the development that has been undertaken, there is no reasonable possibility that further assistance will aid in substantiating his claims. Laws and Regulations Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. See 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303. Service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. See 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability on the basis of the merits of such claim is focused upon (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. See Cuevas v. Principi, 3 Vet. App. 542 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). For the showing of chronic disease in service, there are required a combination of manifestations sufficient to identify a disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. Continuity of symptomatology is required only where the condition noted during service is not, in fact, shown to be chronic or when the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (2010). Finally, in a claim for service connection, the ultimate credibility or weight to be accorded evidence must be determined as a question of fact. The Board determines whether (1) the weight of the evidence supports the claim, or (2) the weight of the "positive" evidence in favor of the claim is in relative balance with the weight of the "negative" evidence against the claim: the appellant prevails in either event. However, if the weight of the evidence is against the appellant's claim, the claim must be denied. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Lung Disorder Factual Background and Analysis The Veteran claims he has a current respiratory disorder as a result of exposure to chemicals while painting in a confined area and exposure to asbestos while lagging pipe while serving in the Navy. Service personnel records reflect that the Veteran served aboard the USS Haleakala (AE-25) as a fireman (FN), and as a boiler technician (BT). He also served aboard the USS Markab (AR-23) as a BT. Performance evaluations during this time indicate the Veteran assisted in the repair of the fire room and axillaries and later was in charge of maintenance and cleanliness of check level, and maintained and repaired boilers and associate machinery. Service treatment records (STR), including an April 1960 enlistment physical examination report, an April 1964 separation physical examination report, and April 1966 enlistment examination for reserve duty report noted normal lungs and chest. Associated medical histories, fail to show any complaints or diagnosis of a chronic respiratory disorder. In a January 1963 STR, the Veteran complained of vomiting and a cough for two days, as well as a sore throat. The examiner diagnosed an upper respiratory infection. In a February 1963 STR, the Veteran again complained of a cold and sore throat. In a November 1965 private treatment record, the Veteran reported he developed a cold two days previously, and the examiner noted his lungs revealed scattered wheezes over both hilar areas. The diagnosis was upper respiratory infection with bronchitis. In a December 1966 private treatment record, the examiner diagnosed an upper respiratory infection with cough. In a December 1966 follow-up, the Veteran reported he has been slightly ill for six weeks with nasal and sinus congestion, cough and occasional wheezing. The examiner noted lungs with scattered medium wheeze, and diagnosed bronchitis and post nasal drainage. The examiner reported the Veteran smoked less than one pack a day and advised he should stop smoking. An X-ray report from that time noted a negative chest. An August 1968 chest X-ray report noted a negative chest. Private treatment records indicate a diagnosis of bronchitis in March 1975, October 1976, and April 1977. An October 1988 private X-ray report found calcific rounded densities in the hilar regions bilaterally and also in the left mid lung, with no pleural effusions. The report noted findings are typical of prior granulomatous inflammation, compatible with coccidioidomucosis. Private treatment records indicate the Veteran was treated for bronchitis in June 1989, January 1990, November 1992, April 1999, June 2001, and April 2009. In an April 1997 private treatment record, the Veteran indicated he did not smoke. An X-ray report dated in November 2002 also noted granulomatous changes seen in the hilar regions and over the mid lung region on the left. A June 2003 private treatment record indicated a diagnosis of asthmatic bronchitis. An October 2003 X-ray report found calcified granulomas and fibrotic changes with no infiltrates or consolidations. In an April 2006 letter, T. C. indicated he served with the Veteran upon the USS Haleakala munitions ship. He reported that they worked in a somewhat confined area and often worked on the same equipment together. He asserted that the Veteran worked hands on, operating and repairing the ships boilers and auxiliary equipment and that such work included lagging steam lines with asbestos insulation, painting equipment, and working in confined spaces such a boiler fire boxes and boiler airways. In an October 2004 VA progress note, the examiner noted that on a review of outside treatment records, the diagnoses included occupational lung disease. The examiner commented that on objective examination, the lungs were clear. In a June 2005 VA progress note, the Veteran complained of allergy problems with his chest which he has had for years, and some pain in the left lung with breathing and night time wheezing. The examiner noted his symptoms were exactly like pervious presentations. The examiner diagnosed allergies. An October 2008 X-ray report found calcified granulomas. In an August 2009 statement, the Veteran reported that he worked for Pacific Gas and Electric Company in California, but he did not have intimate contact with asbestos that he experienced aboard the USS Haleakala. He stated while during his work with PG&E he was trained in matters of safety and the company required he adhere to safety policy which included the use of proper safety attire. The Veteran further reported that while he was in the Navy Reserves he helped dismantle a machine shop from one of the WWII battle ships which also exposed him to asbestos. During a May 2009 VA examination, the Veteran reported he has been treated intermittently with an Albuteral inhaler, cough medicine, and antibiotics, and that he uses the inhaler more frequently in the autumn and with pollens. The Veteran gave a history of asthma with bronchitis two or three times per year, cough once or several times daily, occasional dyspnea, occasional chest pain. An X-ray report found small stable nodule in the left mid lung, likely a granuloma. A June 2009 CT scan report found evidence of old granulomatous disease. A pulmonary function test found normal spirometry, lung volumes, and diffusing capacity with no post bronchodialator response. The examiner noted it would be mere speculation as to whether his bronchial condition is allergic bronchitis or recurrent bronchitis since his exposure to carbon tetrachloride in the Navy. The examiner noted no evidence of asbestosis. In an August 2009 addendum, the examiner stated it is at least as likely as not that his bronchitis, in the absence of cigarette smoking, is otherwise related to his period of military service. As an initial matter, the Board finds that the Veteran is competent to describe trouble breathing and observable symptoms related to his respiratory disability. See 38 C.F.R. § 3.159(a)(2) (2009) (defining "competent lay evidence"). The Board also finds that his statements and complaints regarding recurring bronchitis are credible because they are generally consistent throughout the record. Based on the evidence of record the Board finds that service connection for a respiratory disorder is warranted. It has been stated by the May 2009 examiner that it is at least as likely as not that his bronchitis, in the absence of cigarette smoking, is otherwise related to his period of military service. Present medical evidence confirms that the Veteran is suffering from a current respiratory disability to include recurrent bronchitis. Although the November 1965 private treatment record indicates the Veteran smoked less than a pack a day, and was advised to quit, there are no other findings that the Veteran continued smoking. In fact, in a 1997 VA progress note, the Veteran specifically denied smoking. In conclusion, service connection is awarded. The evidence of record shows that the Veteran was treated for a respiratory problem in service, that he currently has a diagnosis of a respiratory disorder, and that the Veteran is credible and competent to state that he has had ongoing respiratory problems including recurrent bronchitis since service. As such, the Board finds that the requirements for service connection for service connection for a respiratory disorder have been met. Digestive Disorder Factual Background and Analysis The Veteran claims he has a current digestive disorder as a result of exposure to chemicals while painting in a confined area and exposure to asbestos while lagging pipe while serving on a ship in the Navy. Service treatment records (STR), including an April 1960 enlistment physical examination report, an April 1964 separation physical examination report, and April 1966 enlistment examination for reserve duty report fail to show any complaints or diagnosis of a chronic digestive disorder. A December 1968 private esophogram and upper GI series found hypopharynx and esophagus were normal with no evidence of hiatal hernia, and negative stomach and duodenum. In a February 1991 private treatment record, the Veteran was diagnosed with reflux. November 1992 private testing found a moderate hiatal hernia with a Schatzki's ring. January and July 1993 private treatment records, included the diagnosis of hiatal hernia and Schatzki's ring. Private treatment records dated from July 1993 to November 2000 indicate continued treatment for a hiatal hernia and reflux. May 2001 to October 2002 private treatment records indicate a diagnosis and treatment of gastroesophageal reflux disease (GERD). A May 2005 VA upper GI series found focal cricopharyngeal hypertrophy with indentation of the posteriors aspect of the proximal portion of the esophagus. The test also found a small sliding-type hiatal hernia. No significant reflux was seen, and the irregular distal esophageal mucosa suggested mild focal esophagitis. VA progress notes dated thru December 2006 indicate treatment for GERD. During a November 2009 VA examination, the Veteran stated that almost all of the GERD resolved after he stopped drinking 5 cups of coffee daily and that he only filed for compensation after he lost his category 8 status. The examiner stated there is no documentation of digestive issues in service, and opined that his digestive disorder is not caused by or a result of his military service. The examiner further opined that his digestive disorder was not caused by panic attacks. Based upon the evidence of record, the Board finds that a digestive disorder is not shown to have developed as a result of an established event, injury, or disease during active service. Evidence of a diagnosis of a chronic digestive disorder is first shown in 1991, more than 25 years after separation from active service. The Board also notes that the passage of many years between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); Shaw v. Principi, 3 Vet. App. 365 (1992). Significantly, the record also includes no competent medical opinion establishing a nexus or medical relationship between a current digestive disorder diagnosed post- service and events during the Veteran's active service or claimed psychiatric disability. Neither the Veteran nor his representative have presented, identified, or alluded to the existence of, any such opinion. In fact, during the November 2009 VA examination, the Veteran stated that his digestive problems ceased after he stopped drinking five cups of coffee a day. Consequently, the Board finds that entitlement to service connection for a digestive disorder is not warranted. The Board has carefully considered the Veteran's statements regarding his digestive disorder. While the Board does not doubt the sincerity of his belief that his digestive disorder is the result of his active service this claim turns on a medical matter. Though the Veteran may be competent to testify as to the sensory perceptions of his current disorder, questions of medical diagnosis and causation are within the province of medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). Lay persons are limited to attesting to factual matters of which they have first-hand knowledge, e.g., experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). As a layperson without the appropriate medical training or expertise, the Veteran is not competent to render a probative opinion on such a medical matter. See 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"). Hence, the submitted assertions in this regard do not constitute persuasive evidence in support of the claim for service connection. When all the evidence is assembled VA is then 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. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). The preponderance of the evidence is against the Veteran's claim. ORDER Entitlement to service connection for a lung disorder, to include as due to asbestos exposure, is allowed. Entitlement to service connection for a heart disorder, to include coronary artery disease, is dismissed. Entitlement to service connection for a central nervous system disorder is dismissed. Entitlement to service connection for hypertension is dismissed. Entitlement to service connection for a digestive disorder is denied. Entitlement to service connection for a prostate disorder is dismissed. Entitlement to service connection for a rash is dismissed. REMAND The provisions of the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a), and as interpreted by the United States Court of Appeals for Veterans Claims (the Court) are applicable to this appeal. Service treatment records (STR), including an April 1960 enlistment physical examination report, an April 1964 separation physical examination report, and April 1966 enlistment examination for reserve duty report as well as associated medical histories, fail to show any complaints or diagnosis of a psychiatric disorder. In a December 1972 private treatment record, the Veteran complained of episodes of sleep paralysis for a number of years. He indicated he also had very vivid nightmares and bad dreams in which he sees snakes in bed with him. An October 1974 private treatment record was to the effect that the Veteran stated he had nerve problems for 10 years. In a June 1978 VA treatment record, the Veteran was diagnosed with anxiety neurosis. Ongoing private and VA medical records note treatment for several psychiatric disorders, including anxiety, panic attacks, depression, and a dysthymic disorder. In an April 2005 VA progress note, the Veteran reported he first started experiencing panic attacks in service when he was forced to work in a closed-in environment with poor ventilation that led to an illness. He stated after getting leave to deal with his illness, he learned his father had terminal lung cancer and his family home was destroyed due to flooding. He reported when he returned to the ship, he ran into trouble with a Chief Petty Officer who would become intoxicated and molest younger enlisted men. The examiner diagnosed anxiety disorder, with mixed features of depression and anxiety. The examiner further reported the Veteran was a poor historian. In an October 2005 VA progress note, the Veteran complained of panic attacks for over 40 years. He indicated that in 1967 or 1968 he developed sleep paralysis and that he has had a problem with his "nerves" since he had to paint inside a "boiler box" while in the military. He reported he had panic attacks and under a work situation they would occur daily. The Veteran stated that he is still bothered by the men reporting sexual abuse to him by one of the sergeants and his inability to properly address the issue as a supervisor. The examiner diagnosed anxiety disorder. In a March 2006 letter, the Veteran reported that while in service he discovered that the Chief was molesting members of his command. He indicated he panicked, and ran, and that it was the beginning of a lifetime of panic attacks. He stated it was traumatic as he was ashamed of the way he handled the situation. VA treatment records dated thru September 2006 indicate ongoing treatment for anxiety and depression. In a letter dated in February 2008, V. R., LCSW, stated that it was her clinical opinion that the Veteran's anxiety, hallucinations, nightmares, ongoing depression, feelings of hopeless and helplessness, feelings of inadequacy, the strained relationship with his wife and family were directly related to his traumatic experiences during his Navy service. In a November 2009 VA examination report, the psychologists stated that the stressor reported by the Veteran did not meet the stressor criteria for PTSD. The examiners stated that while the Veteran described some anxiety related to an incident that occurred in the military, this anxiety alone did not meet diagnostic criteria for a disorder. When the anxiety related to this incident was considered in conjunction with anxiety related to other issues, symptoms meet the diagnostic criteria for an anxiety disorder. It was further noted that the medical records indicate that the Veteran has not reported the incident that occurred in the military as a significant source of distress during any past mental health encounter, but has reported anxiety related to experiences that are not related to military service. The examiners indicated that what occurred during military service is not assessed to be a stressor from which any mental disorder, including PTSD, could have arisen. Despite the fact that the VA examiner determined that the Veteran does not meet the criteria for PTSD, the examiners did note that the anxiety caused by the Veteran's claimed in-service stressor combined with the anxiety created by other issues meet the diagnostic criteria for an anxiety disorder. Although the Veteran's claims of an in-service sexual assault cannot be verified, the Board accepts that the Veteran was required to work in a small, unventilated fire-room as a verified stressor. In light of the foregoing, the Board finds that a VA examination is necessary to obtain a medical opinion which clearly addresses the question of whether the Veteran's current psychiatric disorder was aggravated or due to his active service to include a verified stressor of painting a small fire-room. Accordingly, the case is REMANDED for the following action: 1. The AMC/RO should contact the Veteran and obtain the names and addresses of all medical care providers, VA and non-VA, who treated the Veteran for his psychiatric disability. After the Veteran has signed the appropriate releases, those records should be obtained and associated with the claims folder. All attempts to procure records should be documented in the file. If the AMC/RO cannot obtain records identified by the Veteran, a notation to that effect should be inserted in the file. The Veteran and his representative are to be notified of unsuccessful efforts in this regard, in order to allow the Veteran the opportunity to obtain and submit those records for VA review. 2. The Veteran's claims file should be returned to the November 2009 VA examining psychologists, if available, for an opinion as to whether the Veteran's current psychiatric disorder is related to his military service, and if his psychiatric disorder is determined to have preexisted service, the examiner should also address the issue of whether his condition was aggravated by service. The examiners must specifically address the verified in-service stressor of painting a small boiler fire room and it's relation to any diagnosed psychiatric disorder. If the November 2009 VA examiners are unavailable, schedule another VA examination of the Veteran, and request the VA psychologist or psychiatrist to offer an opinion as to whether the Veteran's current psychiatric disorder is related to his military service to include a verified stressor of painting a small fire-room, and if his psychiatric disorder is determined to have preexisted service, the examiner must also address the issue of whether his condition was aggravated by service. Prior to the examination, the claims folder must be made available to the psychiatrist or psychologist for review of the case. A notation to the effect that this record review took place should be included in the report of the physician. All indicated tests and studies are to be performed. Opinions should be provided based on the results of examination, a review of the medical evidence of record, and sound medical principles. 3. The Veteran must be given adequate notice of the date and place of any requested examination. A copy of all notifications, including the address where the notice was sent must be associated with the claims folder. The Veteran is to be advised that failure to report for a scheduled VA examination without good cause shown may have adverse effects on his claim. 4. After ensuring that the development is complete, the RO should re-adjudicate the claim. If not fully granted, issue a supplemental statement of the case before returning the claims to the Board, if otherwise in order. 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). ____________________________________________ RENÉE M. PELLETIER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs