Citation Nr: 1237757 Decision Date: 11/05/12 Archive Date: 11/09/12 DOCKET NO. 09-25 527 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Togus, Maine THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a personality disorder. 2. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), mood disorder, bipolar disorder, major depressive disorder, and dysthymia. 3. Entitlement to an increased rating for a scar on the right hand, currently evaluated as 10 percent disabling. 4. Entitlement to an increased rating for residuals of a right hand laceration, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J. Barone, Counsel INTRODUCTION The Veteran had active service from May 1982 to December 1986. This matter comes before the Board of Veterans' Appeals (Board) from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Providence, Rhode Island. Jurisdiction over the Veteran's claims file currently resides with the RO at Togus, Maine. The Board observes that the Veteran carries various psychiatric diagnoses. With respect to the issue of entitlement to service connection for a personality disorder, the Board notes that the claim was previously denied in an August 1996 rating decision. As such, the question of whether new and material evidence has been received to reopen that claim must be addressed. Regarding service-connection for an acquired psychiatric disorder, the Board notes that in Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the United States Court of Appeals for Veterans Claims (Court) clarified how the Board should analyze claims for psychiatric disorders. As emphasized in Clemons, though a Veteran may only seek service connection for PTSD, his claim "cannot be a claim limited only to that diagnosis, but must rather be considered a claim for any mental disability that may be reasonably encompassed...." Id. In essence, the Court found that a Veteran does not file a claim to receive benefits for a particular psychiatric diagnosis, such as PTSD, that is named on a claims form, but instead makes a general claim for compensation for the affliction posed by the Veteran's mental condition. As such, the Board has recharacterized the issue as noted on the first page of this decision and will analyze the Veteran's current claim under this framework. The issues of entitlement to service connection for an acquired psychiatric disorder and an increased rating for residuals of a laceration of the right hand 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. Service connection for a personality disorder was denied in an August 1996 rating decision; the Veteran did not appeal. 2. The evidence received since the August 1996 rating decision is cumulative or redundant of evidence previously of record, and does not raise a reasonable possibility of substantiating the claim of entitlement to service connection for a personality disorder. 3. The Veteran's right hand scar is productive of pain. CONCLUSIONS OF LAW 1. The August 1996 rating decision is final. 38 U.S.C.A. §§ 7104, 7105 (West 2002); 38 C.F.R. §§ 3.160(d), 20.1100, 20.1103, 20.1104 (2011). 2. New and material evidence has not been received to reopen the claim of entitlement to service connection for a personality disorder. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2011). 3. The criteria for a rating in excess of 10 percent for a scar on the right hand have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.159, 4.10 (2012); 38 C.F.R. § 4.118, Diagnostic Codes 7800, 7801, 7802, 7803, 7804, 7805 (as in effect prior to October 23, 2008). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative 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. 2011); 38 C.F.R. § 3.159(b) (2012); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. VCAA notice should be provided to a claimant before the initial unfavorable RO decision on a claim. See Pelegrini v. Principi, 18 Vet. App. 112 (2004); Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). On March 3, 2006, the Court of Appeals for Veterans Claims (Court) issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), which held that the VCAA 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. The Court held that upon receipt of an application for a service-connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. Id. at 486. The Court has also issued a decision which held that, in the context of a claim to reopen, VCAA notice must include an explanation of 1) the evidence and information necessary to establish entitlement to the underlying claim for the benefit sought; and 2) what constitutes new and material evidence to reopen the claim as determined by the evidence of record at the time of the previous final denial. See Kent v. Nicholson, 20 Vet. App. 1 (2006). The Court further explained that a notice letter must describe what evidence would be necessary to substantiate the element or elements required to establish the underlying claim that were found insufficient in the previous denial. See id. A February 2008 letter discussed the evidence necessary to support the Veteran's claims. He was specifically advised that his claim for a personality disorder had been previously denied and that new and material evidence was required to reopen that claim. This letter discussed the meaning of new and material evidence and advised the Veteran of the basis for the previous final denial of his claim. The evidence of record was listed and the Veteran was told how VA would assist him in obtaining additional relevant records. The Veteran was encouraged to submit or identify pertinent evidence. This letter also discussed the manner in which VA determines disability ratings and effective dates. The Board finds that the content of the notice provided to the Veteran fully complied with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) regarding VA's duty to notify. The Veteran has been provided with every opportunity to submit evidence and argument in support of his claim and to respond to VA notices. Further, the Board finds that the purpose behind the notice requirement has been satisfied because the Veteran has been afforded a meaningful opportunity to participate effectively in the processing of his claim. With respect to VA's duty to assist, relevant VA records have been obtained and associated with the record. VA examinations have been carried out. The Board finds that the examinations were adequate in that they were performed by neutral, skilled providers who reviewed the record, interviewed the Veteran, and performed appropriate physical examinations prior to providing their conclusions. Neither the Veteran nor his representative has identified any additional evidence or information which could be obtained to substantiate the claims. The Board is also unaware of any such outstanding evidence or information. Moreover, the Board observes that with respect to a previously denied claim, until a claim is reopened, VA does not have a duty to provide a medical examination or obtain a medical opinion. See 38 C.F.R. § 3.159(c)(1). Therefore, the Board is also satisfied that the RO has complied with the duty to assist requirements of the VCAA and the implementing regulations. For the foregoing reasons, it is not prejudicial to the appellant for the Board to proceed to a final decision in this appeal. Petition to Reopen Claim for Personality Disorder Generally, a claim which has been denied in an unappealed RO decision or an unappealed Board decision may not thereafter be reopened and allowed. 38 U.S.C.A. §§ 7104(b), 7105(c) (West 2002). The exception to this rule is 38 U.S.C.A. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). But see Duran v. Brown, 7 Vet. App. 216 (1994) ("Justus does not require the Secretary [of VA] to consider the patently incredible to be credible"). As noted, service connection was denied for a personality disorder in August 1996. The RO noted that a personality disorder is a congenital or developmental defect and not subject to service connection. It explained that under the law, a personality disorder was not a ratable condition for which service connection might be considered. Evidence of record at the time of the August 1996 rating decision included the Veteran's service treatment records. They reflect that in August 1982 the Veteran was treated for lacerations of the wrists. The discharge diagnosis was adjustment reaction with depressed mood, resolving. In July 1983, the Veteran was assessed by a psychiatrist who found no evidence of mental disease and recommended the Veteran's return to full duty. A message from the Veteran's ship to Navy Personnel Command indicates that the Veteran had severe borderline personality disorder and was unsuitable for further service. Evidence added to the record since the August 1996 rating decision includes VA treatment records reflecting an Axis II diagnosis of personality disorder. The report of a September 2011 VA examination indicates personality disorder not otherwise specified with borderline, paranoid, and antisocial features. The report of a March 2012 VA examination reflects personality disorder with antisocial and borderline traits. Upon close review of the evidence pertaining to this claim, the Board has concluded that new and material evidence has not been submitted to reopen the claim of entitlement to service connection for a personality disorder. As an initial matter, the Board observes that personality disorders are not diseases or injuries under VA regulations and therefore are not disabilities for which service connection can be granted. 38 C.F.R. § 3.303(c)(2012). As discussed, the RO denied the Veteran's claim of entitlement to service connection for a personality disorder on that basis. Since the August 1996 rating decision, no evidence has been added to the record that would result in any finding other than the one reached by the RO in August 1996. In essence, the evidence added to the record since the August 1996 rating decision does not raise a reasonable possibility of substantiating the claim for a personality disorder. The defect existing at the time of the prior final decision has not been cured, and the claim of entitlement to service connection for a personality disorder may not be reopened. In reaching this conclusion, the Board notes that the Veteran has also filed an appeal of the denial of the separate issue of entitlement to service connection for an acquired psychiatric disorder. This issue is addressed in the Remand below. Increased Rating for Scar of the Right Hand Disability ratings are based upon schedular requirements that reflect the average impairment of earning capacity occasioned by the state of a disorder. 38 U.S.C.A. § 1155. Separate rating codes identify the various disabilities. 38 C.F.R. Part 4 (2012). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. 38 C.F.R. §§ 4.1, 4.2 (2012); see also Francisco v. Brown, 7 Vet. App. 55 (1994). In Hart v. Mansfield, 21 Vet. App. 505 (2007), however, the Court held that "staged ratings" are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. In this case the Board has concluded that the disability has not significantly changed and that a uniform evaluation is warranted for the period considered. In determining the level of impairment, the disability must be considered in the context of the entire recorded history, including service medical records. 38 C.F.R. § 4.2 (2012). An evaluation of the level of disability present must also include consideration of the functional impairment of the Veteran's ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10 (2012). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). On VA hand examination in March 2008 the examiner noted that the Veteran was right handed. The Veteran reported pain in the scar, numbness in the lateral right index finger, and a weakened grasp. He noted that cold, pressure, and inadvertent scratching precipitated his pain. He related that his fine motor skills were limited and that he tried to avoid using his right hand when possible. Physical examination revealed warm, dry, and intact skin. There were no rashes or suspicious lesions. The right hand scar was 5.5 by 0.2 cm and linear, originating on the dorsal hand between the first web space, extending over the palmar surface. The Veteran endorsed pain in the scar on palpation. There were no adhesions. The scar was hypopigmented, flat, and well healed. There was no inflammation or edema. On VA scar examination in March 2010, the Veteran's history was reviewed. The examiner noted that the scar in question was at the right hand web space between the thumb and first finger, and slightly around into the palm. She indicated that the maximum width of the scar was 0.3 cm and that its maximum length was 7.8 cm. The scar was not painful. There were no signs of skin breakdown, and the scar was noted to be superficial. There was no inflammation, edema, or keloid formation. The examiner indicated that the scar had no other disabling effects. The Board notes that VA recently amended the Schedule for Rating Disabilities by revising that portion of the schedule that addresses the skin, so that it more clearly reflects VA's policies concerning the evaluation of scars, and specifically, 38 C.F.R. § 4.118, Diagnostic Codes 7800-7805; however, the amendment is effective for claims filed on and after October 23, 2008. See 73 Fed. Reg. 54708-4712 (September 23, 2008). As the Veteran's claim for increase was submitted in February 2008, the newer regulations do not apply. Moreover, the Veteran has not requested review under the revised regulation. See 77 Fed. Reg. 2910-10 (January 20, 2012). Scars, other than on the head, face, and neck, are to be rated under 38 C.F.R. § 4.118, Diagnostic Codes 7801-7805. Diagnostic Code 7801 assigns a 10 percent rating for scars that are deep or cause limited motion. As noted above, the Veteran's scar has been described as superficial, and it has not been found to cause limited motion. Diagnostic Code 7802 compensates for scars, other than on the head, face, and neck, that are superficial and do not cause limited motion. However, a 10 percent evaluation is only available for scars whose area or areas are 144 square inches (929 square centimeters) or greater. As discussed, the Veteran's scar is 7.8 centimeters by 0.3 centimeters and is therefore not large enough to be considered under these criteria. Diagnostic Code 7803 applies to scars that are superficial and unstable. While the Veteran's scar is superficial, it is also stable. Therefore, these criteria are also inapplicable. Diagnostic Code 7804 is assigned for scars that are superficial and painful on examination. Here, there is pain associated with the Veteran's scar, and an appropriate 10 percent evaluation is assigned. A rating in excess of 10 percent is not available under this diagnostic code Diagnostic Code 7805, for scars, other, assigns a rating based on limitation of function of the affected part. However, the evidence does not show that the Veteran's scar itself results in limitation of function of the hand. To the extent that the Veteran's scar may have a neurological competent, limitation of function of the underlying nerve has been separately compensated under Diagnostic Code 8515 for impairment of the median nerve. The issue of entitlement to a higher rating based on this neurological impairment is addressed in the remand below. Thus, the Board finds that evaluation under Diagnostic Code 7805 for the scar is also not warranted. The Board has considered the Veteran's arguments with respect to this disability, and acknowledges that he is competent to report his symptoms and their perceived severity. However, the more probative evidence consists of that prepared by neutral skilled professionals, and such evidence demonstrates an evaluation in excess of that currently assigned for the Veteran's scar is not warranted. In reaching the conclusion above, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Extraschedular Consideration Ordinarily, the VA Schedule will apply unless there are exceptional or unusual factors which would render application of the schedule impractical. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). According to the regulation, an extraschedular disability rating is warranted upon a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards. See 38 C.F.R. § 3.321(b)(1)(2012); see also Fanning v. Brown, 4 Vet. App. 225, 229 (1993). Under Thun v. Peake, 22 Vet. App. 111 (2008), there is a three-step inquiry for determining whether a Veterans entitled to an extraschedular rating. First, the Board must first determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Second, if the schedular evaluation does not contemplate the level of disability and symptomatology and is found to be inadequate, the Board must then determine whether the claimant's disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a Veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extraschedular rating. With respect to the initial inquiry posed by Thun, the Board has been unable to identify an exceptional or unusual disability picture with respect to the Veteran's service-connected scar. The medical evidence fails to demonstrate symptomatology of such an extent that application of the ratings schedule would not be appropriate. In fact, as discussed in detail above, the symptomatology of the Veteran's scar is specifically contemplated under the appropriate rating criteria. Accordingly, the Board finds that the Veteran's disability picture has been contemplated by the ratings schedule. Since the available schedular evaluation adequately contemplates the Veteran's level of disability and symptomatology, the second and third questions posed by Thun become moot. In short, the evidence does not support the proposition that the Veteran's service connected disability presents such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards and warrant the assignment of an extraschedular rating under 38 C.F.R. § 3.321(b)(1) (2012). ORDER New and material evidence having not been submitted, the petition to reopen the claim of entitlement to service connection for a personality disorder is denied. Entitlement to an evaluation in excess of 10 percent for a scar of the right hand is denied. REMAND Acquired Psychiatric Disorder The Veteran seeks service connection for an acquired psychiatric disorder. Service treatment records do reflect that the Veteran was assessed for various psychiatric and behavioral concerns during service. Diagnoses shown in the VA treatment records include PTSD, mood disorder, bipolar disorder, major depressive disorder, and dysthymia. A January 2005 VA psychiatric hospitalization discharge summary indicates an Axis I diagnosis of bipolar I disorder. A September 2008 VA psychiatric hospitalization discharge summary notes mood disorder not otherwise specified. An October 2009 record notes the Veteran's history of bipolar disorder and depression, and indicates that he was prescribed psychotropic medication. Recurrent major depressive disorder is noted in a January 2010 VA psychiatry record. Bipolar disorder is noted in a February 2010 VA social work note. However, VA examinations have not resulted in any Axis I diagnoses aside from those relating to substance abuse. Specifically, the Veteran underwent examination for PTSD in January 2011. The examiner acknowledged that the Veteran had mental health problems in service, and noted that his symptom constellations could support several diagnoses but not bipolar disorder or PTSD. She concluded that the Veteran did not meet the criteria for PTSD, and noted that complicating factors including an alleged machete attack during service could explain his symptoms during service. Notably, this examiner specified that there was no record of the alleged machete attack; however, the record does in fact show that the Veteran sustained an injury to his right hand during service when a man accosted him with a knife or machete. It is unclear to the Board whether knowledge of this verified incident might result in a different opinion from this examiner. On VA mental disorders examination in September 2011, the Axis I diagnoses were cannabis dependence and nicotine dependence. The examiner noted that he saw no current evidence of bipolar disorder. While he noted the various diagnoses found in the record in his recitation of the Veteran's history, to include various references to bipolar disorder, he did not provide sufficient rationale for his apparent ruling out of those diagnoses. Finally, an additional PTSD examination was carried out in March 2012. The examiner indicated that there was no diagnosis of PTSD, assessing only polysubstance dependence on Axis I. She provided a recitation of the Veteran's treatment history, but as with the September 2011 examiner, did not provide any rationale for essentially ruling out the other working diagnoses. Because of the above-described deficiencies in previous VA examinations, the Board concludes that an additional examination which encompasses the questions presented above is warranted. In this regard, the Board notes that once VA provides an examination, it must be adequate or VA must notify the Veteran why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Right Hand The Veteran seeks a higher evaluation for residuals of a laceration of the right hand. Service treatment records reflect that he sustained a knife injury in June 1984, which involved the radial distal nerve. The most recent examination of this disability was conducted in February 2010. At that time, the Veteran noted that he had begun to experience greater numbness in his index or first finger. He indicated that he had difficulty using his right hand and noted that it affected his work and daily activities. The examiner stated that it was difficult to tell whether the disability had increased without speculation. The Board notes that none of the evidence pertaining to this neurological injury indicates whether the disability involves mild, moderate, or severe partial paralysis of the median nerve. As such, the Board finds that an additional examination is warranted. In light of the above discussion, the Board has determined that additional action by the AOJ is necessary. Accordingly, the case is REMANDED for the following action: 1. Schedule the Veteran for a VA psychiatric examination to determine the nature and etiology of any currently present Axis I diagnosis. The claims file should be provided to the examiner for review. Any and all studies, tests and evaluations deemed necessary by the examiner should be performed. The examiner should also elicit a complete history from the Veteran, the pertinent details of which should be included in the examination report. Upon completion of the examination, the examiner should identify all currently present Axis I diagnoses. In so doing, the examiner should discuss all working diagnoses noted in the record and indicate his or her basis for ruling out any such working diagnosis. The examiner should also provide an opinion regarding whether it is at least as likely as not (i.e., probability of 50 percent or greater) that any currently present Axis I diagnosis is etiologically related to the Veteran's active service. A discussion of the complete rationale for all opinions expressed should be included in the examination report. If the examiner is unable to offer any of the requested opinions, it is essential that he offer a rationale for the conclusion that an opinion cannot be provided without resort to speculation, together with a statement as to whether there is additional evidence that might enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382 (2010). 2. Schedule the Veteran for a VA examination to determine the severity of his service-connected residuals of his right hand laceration. The claims file should be provided to the examiner for review. Any and all studies, tests and evaluations deemed necessary by the examiner should be performed. The examiner should also elicit a complete history from the Veteran, the pertinent details of which should be included in the examination report. The examiner should identify all current functional impairment resulting from the Veteran's right hand laceration. This should include a complete description of all manifestations of the median nerve residuals to include whether there is evidence of complete paralysis of the ulnar nerve, or whether existing incomplete paralysis is mild, moderate, or severe. Additionally, the examiner should indicate whether the Veteran's right hand laceration results in limitation of motion of the right hand. If so, the examiner should comment on the severity of such limitation of motion to whether the disability is manifested by weakened movement, excess fatigability, incoordination, pain or flare-ups; and note whether there is any additional limitation of motion attributable to those factors. Such additional limitation of motion should be expressed in degrees. A discussion of the complete rationale for all opinions expressed should be included in the examination report. If the examiner is unable to offer the requested opinion, it is essential that he offer a rationale for the conclusion that an opinion cannot be provided without resort to speculation, together with a statement as to whether there is additional evidence that might enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382 (2010). 3. The Veteran is hereby notified that it is his responsibility to report for any examination, and to cooperate in the development of the claim. The consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655. 4. Then, readjudicate the Veteran's claims, with application of all appropriate laws, regulations, and case law, and consideration of any additional information obtained as a result of this remand. If the decision remains adverse to the Veteran, he and his representative should be furnished a supplemental statement of the case and afforded an appropriate period of time within which to respond thereto. 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. 2011). ____________________________________________ DAVID L. WIGHT Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs