Citation Nr: 1046830 Decision Date: 12/15/10 Archive Date: 12/22/10 DOCKET NO. 08-29 218 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUES 1. Entitlement to a disability rating in excess of 50 percent for service-connected posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for glaucoma to include as secondary to service-connected diabetes mellitus. 3. Entitlement to service connection for peripheral neuropathy of the upper extremities to include as secondary to service- connected diabetes mellitus. 4. Entitlement to service connection for peripheral neuropathy of the lower extremities to include as secondary to service- connected diabetes mellitus. 5. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU). REPRESENTATION Appellant represented by: Heather E. Vanhoose, Attorney at Law WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J.M. Seay, Associate Counsel INTRODUCTION The Veteran had active service from November 1967 to November 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia. A hearing was held on June 28, 2010, in Huntington, Virginia, before Kathleen K. Gallagher, a Veterans Law Judge who was designated by the Chairman to conduct the hearing pursuant to 38 U.S.C.A. § 7107(c) (West 2002) and who is rendering the determination in this case. A transcript of the hearing is in the claims file. At the time of the hearing, the Veteran withdrew his claim of entitlement to service connection for malaria. Thus, the claim is no longer before the Board for appellate consideration. After the hearing, the appellant submitted additional evidence to the Board, along with a written waiver of initial RO review of this evidence. See 38 C.F.R. § 20.1304 (2010). As will be discussed in greater detail below, the Board has found that the issue of entitlement to a TDIU has been reasonably raised by the record. This issue is considered part and parcel to the Veteran's claim for an increased rating for PTSD. Rice v. Shinseki, 22 Vet. App. 447 (2009). Thus, the issues of entitlement to a disability rating in excess of 50 percent for service-connected PTSD, entitlement to service connection for glaucoma to include as secondary to service-connected diabetes mellitus, entitlement to service connection for peripheral neuropathy of the lower extremities, and entitlement to a TDIU 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. All relevant evidence necessary for an equitable disposition of the Veteran's appeal has been obtained. 2. There is no diagnosis of peripheral neuropathy of the upper extremities. CONCLUSION OF LAW Peripheral neuropathy of the upper extremities was not incurred in active service and is not proximately due to, the result of, or aggravated by the Veteran's service-connected diabetes mellitus. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310 (2010). REASONS AND BASES FOR FINDINGS AND CONCLUSION VA's Duties to Notify and Assist Upon receipt of a substantially complete application for benefits, VA must notify the claimant what information or evidence is needed in order to substantiate the claim and it must assist the claimant by making reasonable efforts to get the evidence needed. 38 U.S.C.A. §§ 5103(a), 5103A; 38 C.F.R. § 3.159(b); see Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The notice required must be provided to the claimant before the initial unfavorable decision on a claim for VA benefits, and it must (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. 38 U.S.C.A. §§ 5103(a); 38 C.F.R. § 3.159(b)(1); Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004). The notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 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. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). 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 the elements of the claim as reasonably contemplated by the application. Additionally, this notice must include notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. In this case, the RO provided the appellant with notice in September 2006, prior to the initial decision on the claim in January 2007. Therefore, the timing requirement of the notice as set forth in Pelegrini has been met. Moreover, the requirements with respect to the content of the notice were met in this case. The RO informed the Veteran in the September 2006 notice letter about the information and evidence that is necessary to substantiate his claim for service connection. Specifically, the letter stated that the evidence must show that he had an injury in military service or a disease that began in, or was made worse during military service, or that there was an event in service that caused injury or disease; that he has a current physical or mental disability; and, that there is a relationship between his current disability and an injury, disease, or event in military service. The letter also informed the Veteran of what the evidence must show to substantiate a claim of entitlement to secondary service connection. In addition, the RO notified the Veteran in the notice letter about the information and evidence that VA will seek to provide. The September 2006 letter indicated that reasonable efforts would be made to help him obtain evidence necessary to support his claim, including that VA would request any pertinent records held by Federal agencies, such as military records, and VA medical records. The Veteran was also informed that a medical examination would be provided or that a medical opinion would be obtained if it was determined that such evidence was necessary to make a decision on his claim. The RO also informed the Veteran about the information and evidence that he was expected to provide. The September 2006 letter notified the Veteran that he must provide enough information about his records so that they could be requested from the agency or person that has them. The letter also requested that the Veteran complete and return the enclosed VA Form 21-4142, Authorization and Consent to Release Information to the Department of Veterans Affairs, if there were any private medical records that he would like VA to obtain on his behalf. In addition, the letter informed him that it was his responsibility to ensure that VA received all requested records that are not in the possession of a Federal department or agency. Finally, the Board recognizes that the September 2006 letter did not notify the Veteran regarding the assignment of disability ratings and effective dates. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). However, as the Board herein concludes that the preponderance of the evidence is against the Veteran's service connection claim, any questions as to the assignment of disability ratings and effective dates are rendered moot. In addition, the duty to assist the Veteran has also been satisfied in this case. The Veteran's private treatment records, service treatment records, and VA treatment records were obtained in connection with the Veteran's case and reviewed by both the RO and the Board. The Board acknowledges that the Veteran was not afforded a VA examination with respect to his claim for service connection for peripheral neuropathy of the upper extremities. The case of McLendon v. Nicholson, 20 Vet. App. 79 (2006), held that an examination is required when (1) there is evidence of a current disability, (2) evidence establishing an "in-service event, injury or disease," or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. See also 38 C.F.R. § 3.159(c)(4). The Board concludes an examination is not required as the medical evidence of record is sufficient to decide the claim. Here, the Veteran has requested service connection for peripheral neuropathy of the upper extremities. During the June 2010 hearing, the Veteran testified that he had tingling and numbness in his hands. The Board is cognizant that a Veteran can provide testimony as to lay-observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, the medical evidence of record evaluated the Veteran's symptoms and did not provide a diagnosis of peripheral neuropathy of the upper extremities. The November 2004 VA treatment record noted that the Veteran complained of tingling in his fingers. The musculoskeletal examination showed that muscle strength was equal in upper and lower extremities with slight difference on left side deep tendon reflexes. The neurological examination showed that there was no motor or sensory deficit noted and that CN II- XII was grossly intact. The upper extremities and lower extremities reflexes were +2/+4 bilaterally. In addition, the September 2006 VA examination report noted that the Veteran reported tingling and numbness of his fingers. The examiner noted that sensory was intact vibration, light touch, pressure, and positions to all of his extremities. Muscle strength was 5/5 with normal tone, bulk, dexterity, and coordination. Thus, the Board finds that the competent medical evidence of record evaluated the Veteran's symptoms and noted that the examinations were normal and did not provide any diagnosis of peripheral neuropathy of the upper extremities. Thus, the evidence of record is sufficient to decide the claim. In addition, there is no evidence of persistent or recurrent symptoms with respect to the Veteran's hands. Id. The VA treatment records were obtained in conjunction with the Veteran's appeal and contain only two notations when the Veteran complained of tingling in the fingers. In addition, the Veteran submitted private treatment records which contain no evidence related to peripheral neuropathy of the upper extremities or any complaints related to the upper extremities. Indeed, the Veteran remarked during his June 2010 hearing that he had tingling and numbness in his hands, but that his feet were "much worse" than his hands. In light of the above, the Board finds that there is sufficient medical evidence to adjudicate the Veteran's claim and, therefore, a remand for a VA examination is not required. 38 C.F.R. § 3.159(c)(4); see also Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) (noting that a veteran's conclusory generalized statement that a service illness caused his present medical problems was not enough to entitle him to a VA medical examination since all veterans could make such a statement, and such a theory would eliminate the carefully drafted statutory standards governing the provision of medical examinations and require VA to provide such examinations as a matter of course in virtually every disability case). The Board concludes the Veteran was provided the opportunity to meaningfully participate in the adjudication of his claim and did in fact participate. Washington v. Nicolson, 21 Vet. App. 191 (2007). Hence, there is no error or issue that precludes the Board from addressing the merits of this appeal. LAW AND ANALYSIS Service connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C.A. § 1110. 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). 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 order to establish direct service connection for a disorder, there must be (1) competent evidence of the current existence of the disability for which service connection is being claimed; (2) competent evidence of a disease contracted, an injury suffered, or an event witnessed or experienced in active service; and (3) competent evidence of a nexus or connection between the disease, injury, or event in service and the current disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009); cf. Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). In many cases, medical evidence is required to meet the requirement that the evidence be "competent." However, when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to service connection for peripheral neuropathy of the upper extremities. In this case, the medical evidence of record is completely absent for any diagnosis of peripheral neuropathy of the upper extremities. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. § 1110, 1131; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that the Veteran currently has the disability for which benefits are being claimed. The Board recognizes the Veteran's assertions that he has peripheral neuropathy of the upper extremities. Indeed, during his June 2010 hearing, the Veteran stated that he experiences tingling and numbing in his hands. Lay assertions may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C.A. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, in this case, the Veteran's statements regarding his symptoms have been evaluated by medical examiners and no diagnosis of peripheral neuropathy has been provided. The November 2004 VA treatment record noted that the Veteran complained of tingling in his fingers. The musculoskeletal examination showed that muscle strength was equal in upper and lower extremities with slight difference on left side deep tendon reflexes. The neurological examination showed that there was no motor or sensory deficit noted and that CN II-XII was grossly intact. The upper extremities and lower extremities reflexes were +2/+4 bilaterally. There was no diagnosis of peripheral neuropathy of the upper extremities provided. In addition, the September 2006 VA examination report noted that the Veteran reported tingling and numbness of his fingers. The examiner noted that sensory was intact vibration, light touch, pressure, and positions to all of his extremities. Muscle strength was 5/5 with normal tone, bulk, dexterity, and coordination. The examiner did not provide any diagnosis. The private treatment records only note the Veteran's complaints related to his lower extremities and are completely absent for any complaints related to his hands. Thus, the medical evidence reveals that the Veteran's reported symptoms have been examined, but no diagnosis has been provided as the examinations were normal and the examining physicians noted that there was no sensory deficit upon examination. In conclusion, the Veteran has not been shown to have a current disability. Thus, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for peripheral neuropathy of the upper extremities. Because the preponderance of the evidence is against the Veteran's claim, the benefit of the doubt provision does not apply. Accordingly, the Board concludes that service connection for peripheral neuropathy of the upper extremities is not warranted. See 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310 (2010). ORDER Entitlement to service connection for peripheral neuropathy of the upper extremities is denied. REMAND Reasons for Remand: To obtain a clarifying opinion, provide new VA examinations, and adjudicate the issue of entitlement to a TDIU. The law provides that VA shall make reasonable efforts to notify a claimant of the evidence necessary to substantiate a claim and requires the VA to assist a claimant in obtaining that evidence. 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2010). Such assistance includes providing the claimant a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on a claim. 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2010). The record reveals that the Veteran was last provided a VA examination for his service-connected PTSD in September 2006. In conjunction with the current appeal, the Veteran has requested a new VA examination. See October 2007 notice of disagreement. In addition, in a March 2008 statement, the Veteran asserted that his PTSD was getting worse and not improving. The treatment records associated with the claims file, particularly the October 2006 VA treatment record, indicate that the Veteran's service- connected disability has gotten worse. The Board recognizes that the Veteran was evaluated in July 2007 and February 2010 by private psychiatrists; however, the evaluations do not fully address the pertinent rating criteria with respect to PTSD. See 38 C.F.R. § 4.130, Diagnostic Code 9411. As such, the Board finds that a more recent VA examination is in order for the purpose of ascertaining the current severity and manifestations of the Veteran's service-connected PTSD. See 38 C.F.R. § 3.159 (2010). See also Palczewksi v. Nicholson, 21 Vet. App. 174, 181- 82 (2007), citing Caluza v. Brown, 7 Vet. App. 498, 505- 06 (1998) ("Where the record does not adequately reveal the current state of the claimant's disability...the fulfillment of the statutory duty to assist requires a thorough and contemporaneous medical examination."). The record shows that the Veteran was afforded a VA examination with respect to his claim for service connection for glaucoma in December 2007. The Veteran has asserted that his glaucoma is related to his service-connected diabetes mellitus. The December 2007 VA examination report reveals a diagnosis of primary open- angle glaucoma. The examiner explained that since diabetes was a small vessel disease and it causes ischemia to the ocular structures, he could not rule out the possibility of ischemia to the operative nerve, triggering glaucoma. The examiner then opined that the Veteran's primary open angle glaucoma was less likely if not caused by or a result of his diabetes. The Veteran and his representative have requested that a new VA examination be provided as it is unclear whether the examiner intended to provide a negative nexus opinion due the notation that he was unable to rule out the possibility of ischemia, triggering glaucoma. The Court has held that medical evidence that is speculative, general or inconclusive in nature cannot support a claim. See Obert v. Brown, 5 Vet. App. 30, 33 (1993); see also Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996); Libertine v. Brown, 9 Vet. App. 521, 523 (1996). Thus, the Board finds that a clarifying medical opinion from the December 2007 examiner is required to determine the etiology of the Veteran's glaucoma. 38 U.S.C.A. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4); McLendon, 20 Vet. App. at 86. Finally, the Veteran has not been afforded a VA examination for his peripheral neuropathy of the lower extremities. The Veteran states that his peripheral neuropathy is related to his service- connected diabetes mellitus. The private treatment records show that the Veteran has complained of burning and tingling feet and contain a diagnosis of peripheral neuropathy of the lower extremities. Furthermore, in a January 2010 letter, the Veteran's private physician stated that the Veteran had bilateral lower extremity neuropathy secondary to diabetes mellitus with numbness from the knees down and particularly in the feet. However, the examiner noted that the disorder had an onset of July 1967 - during the Veteran's period of active service. The medical evidence of record shows that the Veteran was not diagnosed with diabetes mellitus until the 2000s, more than 30 years after separation from active service. See Obvert v. Brown, 5 Vet. App. 30, 33 (1993); see also Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996); Libertine v. Brown, 9 Vet. App. 521, 523 (1996). Furthermore, contrary to the January 2010 letter regarding the etiology of the Veteran's peripheral neuropathy, the November 2004 VA treatment record noted that the Veteran's bilateral foot numbness was related to post-surgeries of the Veteran's spine. In light of the above, the Board concludes that further development is required to address the nature and etiology of the peripheral neuropathy of the lower extremities. Although VA may not order additional development for the sole purpose of obtaining evidence unfavorable to a claimant, see Mariano v. Principi, 17 Vet. App. 305, 312 (2003), VA has discretion to determine when additional information is needed to adjudicate a claim. See Kowalski v. Nicholson, 19 Vet. App. 171 (2005) (stating that VA has discretion to schedule a Veteran for a medical examination where it deems an examination necessary to make a determination on the Veteran's claim); Shoffner v. Principi, 16 Vet. App. 208, 213 (2002) (holding that VA has discretion to decide when additional development is necessary). Thus, the Board must remand this matter to afford the Veteran a VA examination to determine the etiology of the peripheral neuropathy of the lower extremities. See Colvin v. Derwinski, 1 Vet. App. at 175. The Court has recently held that if the claimant or the record reasonably raises the question of whether the Veteran is unemployable due to the disability for which an increased rating is sought, then part and parcel to that claim for an increased rating is whether a total rating based on individual unemployability (TDIU) as a result of that disability is warranted. Rice v. Shinseki, 22 Vet. App. 447 (2009). In this case, there is some evidence that the Veteran may be unemployed due at least in part to his service-connected PTSD. For example, in the July 2007 private psychiatric evaluation, the examining psychiatrist noted that the Veteran's PTSD precluded him from obtaining gainful employment. As such, the evidence of record reasonably raises the question of whether the Veteran is unemployed as a result of his service-connected PTSD for which an appeal of the disability rating is pending. Therefore, the RO should develop a claim for TDIU in accordance with Rice v. Shinseki, 22 Vet. App. 447 (2009). Accordingly, the case is REMANDED for the following action: 1. The Veteran and his representative should be provided with appropriate notice under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), which includes an explanation of the evidence required to establish service connection on a direct and secondary basis and what the evidence must show to substantiate a claim for a higher disability rating for service- connected PTSD. In addition, the AMC/RO should send the Veteran the appropriate application form for a claim for TDIU. 2. The Veteran should be afforded a VA examination to ascertain the severity and manifestations of his service- connected PTSD. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file and to comment on the severity of the Veteran's service-connected disability. The examiner should report all signs and symptoms necessary for rating the Veteran's disability under the rating criteria. To the extent possible, the examiner should separate the effects of the service-connected PTSD from nonservice-connected disorder(s). The examiner should also, based on the examination and a review of the record, render an opinion as to whether the Veteran's service-connected PTSD renders him unable to obtain or retain substantially gainful employment. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Since it is important "that each disability be viewed in relation to its history [,]" 38 C.F.R. § 4.1 (2010), copies of all pertinent records in the appellant's claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. The RO should refer the Veteran's claims file to the December 2007 VA examiner, or, if he is unavailable, to another suitably qualified VA examiner for a clarifying opinion as to the etiology of any glaucoma that may be present. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and statements. The examiner should then state an opinion as to whether it is at least as likely as not that the Veteran's glaucoma was caused and/or aggravated by the service-connected diabetes mellitus. By aggravation the Board means a permanent increase in the severity of the underlying disability beyond its natural progression. The examiner should also provide an opinion as to whether it is at least as likely as not that any existing glaucoma is causally or etiologically related to active service. In rendering the opinion, the examiner should not resort to mere speculation, but rather should consider that the phrase "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it. Thus, unless the examiner concludes that the current disability is either likely or unlikely the result of an event, injury, or disease incurred in service, the examiner should state whether it is at least as likely that the current disability is the result of an event, injury, or disease incurred in service as opposed to its being the result of some other factor or factors. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Since it is important "that each disability be viewed in relation to its history [,]" 38 C.F.R. § 4.1 (2010), copies of all pertinent records in the appellant's claims file, or in the alternative, the claims file, must be made available to the examiner for review. 4. Schedule the Veteran for a VA examination regarding his claim for service connection for peripheral neuropathy of the lower extremities. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and statements. The examiner should then state an opinion as to whether it is at least as likely as not that any current peripheral neuropathy of the lower extremities is causally or etiologically related to the Veteran's active service. The examiner should also provide an opinion as to whether it is at least as likely as not that the Veteran's peripheral neuropathy of the lower extremities was caused and/or aggravated by his service- connected diabetes mellitus. By aggravation the Board means a permanent increase in the severity of the underlying disability beyond its natural progression. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a conclusion as it is to find against it.) In rendering the opinion, the examiner should not resort to mere speculation, but rather should consider that the phrase "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it. Thus, unless the examiner concludes that the current disability is either likely or unlikely the result of an event, injury, or disease incurred in service, the examiner should state whether it is at least as likely that the current disability is the result of an event, injury, or disease incurred in service as opposed to its being the result of some other factor or factors. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Since it is important "that each disability be viewed in relation to its history [,]" 38 C.F.R. § 4.1 (2010), copies of all pertinent records in the Veteran's claims file, or in the alternative, the claims file, must be made available to the examiner for review. 5. Thereafter, the RO should readjudicate the Veteran's claims for service connection and his claim for entitlement to a disability rating in excess of 50 percent for service- connected PTSD in light of all the evidence of record. If any benefit sought on appeal remains denied, the Veteran and his representative should be provided a SSOC. The SSOC must contain notice of all relevant actions taken on the claims for benefits, to include a summary of the evidence received, and any evidence not received, and all applicable laws and regulations considered pertinent to the issues currently on appeal. A reasonable period of time should be allowed for response. 6. The RO then should adjudicate the TDIU claim. If the issue is denied, the RO must notify the Veteran of his appellate rights on the issue, and inform him that to vest the Board with jurisdiction over the issue, a timely Substantive Appeal must be filed. 38 C.F.R. § 20.202 (2010). If the Veteran perfects the appeal as to this issue, the RO should undertake all appropriate action. After the Veteran and his representative have had an adequate opportunity to respond, the appeal should be returned to the Board for appellate review. 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). ______________________________________________ KATHLEEN K. GALLAGHER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs