Citation Nr: 1237793 Decision Date: 11/05/12 Archive Date: 11/09/12 DOCKET NO. 10-35 018 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUES 1. Entitlement to service connection for tinnitus. 2. Entitlement to service connection for a right knee disorder. 3. Entitlement to service connection for a sinus disorder to include sinusitis and rhinitis. 4. Entitlement to service connection for a lumbar spine disorder. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD H. Bunker, Associate Counsel INTRODUCTION The Veteran served on active duty from August 1956 to August 1976. This case comes before the Board of Veterans' Appeals (Board) on appeal from a November 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. The Veteran's August 2010 VA Form 9 included a request for a hearing. However, in July 2012, the Veteran withdrew that hearing request. Therefore, Board adjudication of the current appeal may go forward without a hearing. See 38 C.F.R. §§ 20.703, 20.704 (2011). Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2011). 38 U.S.C.A. § 7107(a)(2) (West 2002). The issues of entitlement to service connection for sinus and lumbar spine disorders are addressed in the REMAND portion of the decision below and are REMANDED to the Department of Veterans Affairs Regional Office. FINDINGS OF FACT 1. The Veteran's tinnitus is not shown to be due to a disease or injury in service or to any incident of his military service. 2. The Veteran's right knee disorder is not shown to be due to a disease or injury in service or to any incident of his military service; arthritis did not manifest to a compensable degree within one year of service. CONCLUSIONS OF LAW 1. The Veteran's tinnitus was not incurred in or aggravated by military service. 38 U.S.C.A. §§ 1101, 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2011). 2. The Veteran's right knee disorder was not incurred in or aggravated by military service nor may any arthritis be presumed to be of service onset. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2011). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board has thoroughly reviewed all the evidence in the Veteran's claims folder. Although the Board has an obligation to review the entire record, the Board does not have to discuss each piece of evidence reviewed. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the veteran). It is VA's defined and consistently applied policy to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt it is meant that an approximate balance of positive and negative evidence exists which does not satisfactorily prove or disprove the claim. Reasonable doubt is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102 (2011). The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). The notice requirements were met in this case by a letter sent to the Veteran in November 2008. This letter advised the Veteran of the information necessary to substantiate his claims and of his and VA's respective obligations for obtaining specified types of evidence. See Quartuccio v. Principi, 16 Vet. App. 183 (2002); 38 C.F.R. § 3.159(b). This letter also advised the Veteran of how disability ratings and effective dates are determined. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Veteran has not alleged that VA failed to comply with the notice requirements of the VCAA, and he was afforded a meaningful opportunity to participate effectively in the processing of his claim, and has in fact provided additional arguments at every stage. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005). The notice required by 38 U.S.C.A. § 5103(a) should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004); see also Mayfield v. Nicholson, 19 Vet. App. 103 (2005). That was done in this case. The Veteran's service treatment records and VA treatment records are in the file. The VA has also obtained private treatment records and associated them with the claims file. The RO requested records from the Womack Army Medical Center from 1970 to the present and obtained records beginning in October 2006. There were no additional records provided. The Veteran has not indicated that there are any additional outstanding records to be obtained. As such, the Board finds the duty to assist with obtaining medical records has been satisfied. The duty to assist also includes providing a medical examination or obtaining a medical opinion when such is necessary to make a decision on the claim, as defined by law. 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. The Veteran was afforded VA medical examinations in August and November 2009 for his claims. These opinions were rendered by medical professionals following a thorough examination and interview of the appellant and review of the claims file. The examiners obtained an accurate history and listened to the appellant's assertions. The examiners laid a factual foundation and reasoned basis for the conclusions that were reached. Therefore, the Board finds that the examinations are adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In light of the foregoing, the Board is satisfied that all relevant facts have been adequately developed to the extent possible; no further assistance to the appellant in developing the facts pertinent to the issue on appeal is required to comply with the duty to assist. 38 U.S.C.A. §§ 5103, 5103A; 38 C.F.R. § 3.159. 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 injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for the claimed disorder on a direct basis, generally there must be probative evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection may also be granted for a chronic disease, including arthritis, when it is manifested to a compensable degree within one year of separation from service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2011). The Board has reviewed the Veteran's service treatment records and notes that he was given multiple medical examinations throughout service. At his entrance examination in August 1956 the Veteran reported that he was in good health and the only defect noted by the examiner was a left varicocele. At an examination in June 1958 again the Veteran reported he was in good health. He specifically denied any ear trouble or knee problems and he was found qualified for reenlistment. At a November 1961 examination the Veteran was noted to have two tattoos as well as scars from an appendectomy and varicocele. No further defects were noted. In an April 1964 medical examination the Veteran denied knee problems and ear problems. At an October 1967 medical examination the Veteran reported no change in his health since his previous examination. In a January 1969 treatment record the Veteran denied knee problems and ear trouble. At the Veteran's separation examination in April 1976 the Veteran reported ear trouble. On further notation the examiner stated the Veteran had left ear hearing loss and right ear hearing loss, secondary to trauma, which had resolved. He denied knee problems. The Board observes that while the Veteran was treated for multiple conditions while in service, there is no evidence of a diagnosis of a chronic disability, to include tinnitus or a right knee disorder, which existed at separation from service. The Board acknowledges that even if a chronic condition is not shown during service, service connection may be established under 38 C.F.R. § 3.303(b) by evidence of continuity of symptomatology or under 38 C.F.R. § 3.303(d) if the evidence shows a disease first diagnosed after service was incurred in service. The first post-service evidence of tinnitus comes from the Veteran's claim for service connection, which was filed in November 2008. The first reference to a right knee disorder comes from a February 2007 private treatment record, approximately 31 years after separation from service. The Board may, and will, consider in its assessment of a service connection the passage of a lengthy period of time wherein the veteran has not complained of the malady at issue. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); see also Forshey v. Principi, 284 F.3d 1335, 1358 (Feb. Cir. 2002) (en banc). An April 1983 private treatment record noted the Veteran was in excellent health except for a hiatal hernia with reflux and some irritable bowel syndrome symptoms which were controlled. The only disorder reported pertained to erectile dysfunction. In a check up from September 1988 the Veteran was noted to be generally healthy except for reflux esophagitis, which was treated with prescription medication. The Veteran reported he had a complete physical examination one month earlier for his insurance and everything was within normal limits. The Veteran did not indicate that he had complained of, or was diagnosed with, tinnitus or a right knee disorder. At a private examination in April 1993 the Veteran reported a history of reflux esophagitis with stricture and chronic anxiety. There were no complaints of tinnitus or a right knee disorder at this appointment, nor were either of these disabilities diagnosed. The Veteran was examined in September 1998. He reported he was generally doing well and his diagnoses included anemia, gastroesophageal reflux disease (GERD), mild anxiety, and impotence. The Veteran did not complain of tinnitus or a right knee disorder, nor were either of these disabilities diagnosed. At a January 2001 appointment the Veteran was noted to suffer from osteoarthritis of the right hip, GERD, anemia, and mild anxiety. At an annual checkup in April 2005 the Veteran's assessment included: possible mild Parkinson's disease, history of sleep apnea, unipolar depressive disorder, history of GERD, history of pernicious anemia, osteoarthritis, and varicose veins. There was no reference to tinnitus or a right knee disorder, either as a complaint by the Veteran or as a diagnosis. The Veteran was noted to be receiving treatment for a right knee disorder in 2007. A February 2007 private treatment record noted the Veteran stated his right knee pain began approximately 10 months earlier when he hit it against a door jamb getting out of a car. On x-ray he was diagnosed with lateral meniscal tearing and degenerative joint disease. See also June 2007 private treatment record noting injections for pain in the right knee. The Veteran was afforded a VA examination in August 2009 for his tinnitus. He reported that he was not currently experiencing tinnitus and he had last experienced tinnitus approximately 6 months earlier. He indicated his tinnitus occurred once or twice a year as a very subtle and short sound in the right ear. The examiner opined the Veteran did not have tinnitus because the Veteran's reported symptoms could not lead to a diagnosis of tinnitus. At his November 2009 VA knee examination the Veteran reported that he injured his right knee around 2007 when he injured it exiting a car. He reported that he used to bowl and be more active, but that he could no longer do so due to his right knee and back pain. He stated that he had had multiple injections over the past year which had helped with the right knee pain. The examiner noted an x-ray from July 2007 showed moderate effusion and his private examiner had diagnosed degenerative joint disease. The examiner performed a physical examination and diagnosed the Veteran with traumatic and degenerative joint disease of the right knee. He opined the right knee disorder was not due to service, to include a left knee injury in service. His rationale was that the Veteran reported first injuring his knee around 2007, prior to that he had been physically active with no other right knee problems. As noted above, the Veteran has been diagnosed with a right knee disorder. However, this diagnosis was made over 25 years after the Veteran separated from service. As such the objective evidence does not document continuous symptoms or complaints since the Veteran's separation from service in 1976. In addition to the absence of documented post-service symptomatology related to the Veteran's claimed disorders for decades, the evidence includes the Veteran's statements and testimony asserting continuity of symptoms with respect to his tinnitus and right knee disorder since active duty service. The Board acknowledges that lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent, regardless of the lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir.1996) (table); Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). In this case, there is no dispute that the Veteran is competent to report symptoms of pain in his right knee, as well as suffering from tinnitus. Layno v. Brown, 6 Vet. App. 465, 470 (1994). 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. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 at n.4 (Fed. Cir. 2007) ("Sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer."). In such cases, the Board is within its authority to weigh that testimony and to make a credibility determination. Here, the Board finds that the Veteran's reported history of continued tinnitus, and a right knee disorder since active service, while competent, is nonetheless not credible. Great emphasis is placed on the gap between discharge from active duty service, in 1976, and the initial reported symptoms and diagnoses over 25 years after separation from service. See Maxson, supra. Emphasis is also placed on the fact that the Veteran was regularly treated by his private physician since separation from service and he did not report either of the claimed disorders. Next, the Board notes that there are inconsistencies in the history reported by the Veteran as it pertains to continuity of symptomatology. At his August 2009 VA examination he reported that he was not currently experiencing tinnitus and that it only occurred once or twice a year. He did not mention that tinnitus began in active duty, nor did he complain of tinnitus throughout his extensive private treatment records. However, in his December 2009 Notice of Disagreement he stated that he had ringing in his ears since active duty. In a February 2007 private treatment record the Veteran reported that he had been experiencing right knee pain for the previous 10 months, since he hit it with a car door. However, in his December 2009 Notice of Disagreement he stated that he had problems with his right knee beginning on active duty. The Veteran's own reported history of his disorders is inconsistent, which undermines the veracity of his statements. Accordingly, the Board finds the Veteran's statements asserting continuity of symptomatology since service lack credibility and are without probative value. See, e.g. Madden v. Gober, 125 F.3d 1477, 1481 (1997) (the Board is entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence); Pond v. West, 12 Vet. App. 341 (1999). Further, service connection may be granted when the evidence establishes a nexus between active duty service and current complaints. In this case, the Board finds that the weight of the competent evidence does not attribute the Veteran's claimed disorders to active duty. To that end, the Board has considered the November 2009 VA examination report to specifically address the Veteran's claim. As has been discussed, the examiner found that the Veteran's claimed right knee disorder was not related to service. Although the August 2009 VA examiner found the Veteran could not be diagnosed with tinnitus based on his described symptomatology, the Board is mindful of the fact that tinnitus is a disability that lends itself to lay observation. See Charles v. Principi, 16 Vet. App. 370 (2002); Jandreau, supra. As such, the Board will concede that the Veteran is competent to report he is currently suffering from tinnitus. The Board finds that the November 2009 VA examination and opinion are adequate for evaluation purposes. Specifically, the examiner reviewed the claims file, interviewed the Veteran, and conducted a physical examination before offering an opinion with a complete rationale. Therefore, the Board finds the VA examiner's opinion to be of significant probative value. The Board acknowledges the statements of the Veteran, his friend, and his daughters, that he has been suffering from these disabilities since service. See e.g., December 2009 statements. However, laypersons are generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997); see also Bostain v. West, 11 Vet. App. 124, 127 (1998) citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Lay testimony is competent, however, to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Id. Here, while the Veteran is competent to describe his in-service pain, as well as his current symptoms, the Board accords his statements regarding the etiology of such disorders little probative value as he is not competent to opine on such complex medical questions. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. West, 12 Vet. App. 460, 465 (1999). Additionally, the Veteran has offered only his conclusory statements regarding the relationship between his in-service right knee pain and his current disorder. In contrast, the November 2009 VA examiner reviewed his service and post-service treatment records, considered his reported history, and examined the Veteran. Therefore, the Board finds that the November 2009 VA examiner's opinion is the most probative evidence of record. As such, the preponderance of the evidence weighs against a finding that the Veteran's claimed disorders are due to any event or injury in service. With respect to a presumption of service connection for arthritis, there is no evidence the Veteran was diagnosed with osteoarthritis within one year of separation from service. As such, the presumption does not apply. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2011). The Board finds that the preponderance of the evidence is against the Veteran's claims of service connection for tinnitus and a right knee disorder. The Board finds credible the Veteran's reports that he has occasional noise in his right ear and pain in his right knee. However, there is no credible evidence indicating that these disorders began during service or that the Veteran experienced a continuity of symptomatology since service. Furthermore, the VA examiner's negative opinions weigh against the Veteran's statements. Accordingly, the Board concludes that the competent, probative evidence is against the claims of service connection and the benefit of the doubt rule does not apply. See 38 U.S.C.A. § 5107 (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). ORDER Entitlement to service connection for tinnitus is denied. Entitlement to service connection for a right knee disorder is denied. REMAND The Veteran contends that his sinus and lumbar spine disorders are related to service. Specifically, the Veteran contends that both of these disorders began in service and have continued since separation from service. On April 1964 reenlistment examination the Veteran's medical history included sinusitis. Service treatment records also show January 1969 treatment for an upper respiratory infection. At an April 1969 annual examination, the Veteran reported either currently having, or having a history of, sinusitis. The accompanying summary and elaboration of data indicated that the Veteran had mild chronic sinusitis. The Veteran again reported either currently having, or having a history of, sinusitis on retirement physical examination in April 1976. Post-service, the Veteran was noted to have sinusitis with an upper respiratory infection in March 2005. Also, the Veteran was afforded a VA examination in November 2009 for his sinus disorder. At this VA examination the Veteran reported having a chronic drippy/runny nose. He was not on medication for this condition and he reported that he had not brought it to medical attention because he was just living with it. The diagnosis was perennial rhinitis and the examiner indicated that this was not related to an isolated episode of sinus infection in service and found further, that the Veteran had not had problems in the interim until two years prior. However, as noted above, the Veteran's service records show a diagnosis of mild chronic sinusitis, and the Veteran reported a history of such on at least three occasions. Further, the November 2009 VA examiner did not take into account the Veteran's competent statements that he had had a sinus condition since service, but that he did not bring it to anyone's attention because he was just living with it. As such, an addendum opinion should be obtained, which takes into account all of the relevant service treatment records as well as the lay evidence. Service treatment records show March 1969 complaints of a several year history of lower back pain. A March 1969 x-ray showed spondylolisthesis and spondylolysis L5, and spina bifida of L5. An associated treatment note indicated that x-rays showed grade I spondylolisthesis with degenerative changes L5-S1 and the Veteran was given a L3 profile. On April 1969 examination, the Veteran did not report a history of recurrent back pain. On April 1975 retirement examination, the Veteran was noted to have spondylolisthesis L5-S1 although at that time the Veteran denied a history of recurrent back pain. Post-service, the Veteran was afforded a VA examination in November 2009 for his lumbar spine disorder. Although the examiner noted the Veteran had been diagnosed with spondylolisthesis in-service, he did not reference the March 1969 x-ray showing degenerative changes of L5-S1, spondylolysis, and spina bifida of L5. Further, the examiner did not comment on the other references to low back pain including a 1969 report of a several year history of such symptoms. Furthermore, it does not appear the November 2009 VA examiner x-rayed the Veteran's lumbar spine to determine if he still had the disabilities shown in the Veteran's service treatment records. The United States Court of Appeals for Veterans Claims has held that once VA undertakes a duty to provide a medical examination, due process requires VA to notify the claimant prior to the adjudication of the claim of any inability to obtain evidence sought (including a VA examination with medical opinion). See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Daves v. Nicholson, 21 Vet. App. 46, 51 (2007), citing Green v. Derwinski, 1 Vet. App. 121, 123-124 (1991); Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report "if further evidence or clarification of the evidence... is essential for a proper appellate decision"). Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2011). 38 U.S.C.A. § 7107(a)(2) (West 2002). Accordingly, the case is REMANDED for the following action: 1. Request that the November 2009 VA examiner review the claims file and offer an addendum opinion regarding the Veteran's claimed sinus disorder to include sinusitis and rhinitis. Taking all the evidence into account, including the Veteran's statements, the examiner should offer an opinion as to whether it is at least as likely as not that the Veteran's sinus disorder is related to service. The examiner should provide a complete rationale for any opinion provided as to each tenable diagnosis of sinusitis and/or rhinitis. The examiner should comment on the several references to sinusitis in the Veteran's service treatment records as well as the Veteran's competent lay statements that he has had continuous sinus symptoms since service. Conversely, if the examiner concludes that an etiological opinion cannot be provided, he or she should clearly and specifically so specify in the examination report, with an explanation as to why this is so. If the November 2009 VA examiner is not available to provide an additional report, make arrangements for the file to be reviewed by another examiner who should be requested to supply the requested addendum opinion. If further examination of the Veteran is necessary to provide the requested opinion, the Veteran should be scheduled for an additional examination, and he should be notified that it is his responsibility to report for any examination scheduled, and to cooperate in the development of the case, and that the consequences of failing to report for a VA examination without good cause may include denial of the claim. See 38 C.F.R. §§ 3.158, 3.655 (2011). 2. Schedule the Veteran for a VA examination to determine the nature and etiology of any current lumbar spine disorder. The claims file, including a copy of this REMAND, must be made available to the examiner for review, and the examination report should reflect that such a review was completed. The examiner should take x-rays, in addition to other required testing. Following such testing, the examiner should (a) identify all current low back disabilities, and as to each diagnosed low back disability, (b) state whether it is at least as likely as not that such disability is etiologically related to the Veteran's service to include his reports of recurrent low back pain in service as well the March 1969 x-ray evidence of spondylolisthesis and spondylolysis L5, and spina bifida of L5. It would be helpful if the examiner would use the following language, as may be appropriate: "more likely than not" (meaning likelihood greater than 50%), "at least as likely as not" (meaning likelihood of at least 50%), or "less likely than not" or "unlikely" (meaning that there is less than 50% likelihood). The term "at least as likely as not" does not mean "within the realm of medical possibility." Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of that conclusion as it is to find against it. The examiner should provide a complete rationale for any opinion provided. Conversely, if the examiner concludes that an etiological opinion cannot be provided, (s)he should clearly and specifically so specify in the examination report, with an explanation as to why. The Veteran must be advised of the importance of reporting to the scheduled VA examination and of the possible adverse consequences, to include the denial of his claim, of failing to so report. See 38 C.F.R. § 3.655 (2011). 3. After completing the above, and any other development deemed necessary, the RO should readjudicate the Veteran's claims. If the benefits sought on appeal are not granted, the Veteran and his representative should be furnished with a supplemental statement of the case and afforded a reasonable opportunity to respond before the record is returned to the Board for further 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. 2011). ____________________________________________ S. L. Kennedy Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs