Citation Nr: 1304145 Decision Date: 02/06/13 Archive Date: 02/19/13 DOCKET NO. 09-04 481 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to an initial disability rating in excess of 10 percent for a service-connected cervical spine disability. 2. Entitlement to an initial disability rating in excess of 10 percent for a service-connected lumbar spine disability. 3. Entitlement to an initial rating for a service-connected left knee disability, evaluated as noncompensably disabling prior to December 9, 2011, and 10 percent disabling thereafter. 4. Entitlement to an initial disability rating for service-connected posttraumatic stress disorder (PTSD), evaluated as 30 percent disabling prior to December 9, 2011, and 50 percent disabling thereafter. 5. Entitlement to an initial compensable disability rating for status post sinus surgery with deviated nasal septum. 6. Entitlement to service connection for a bilateral elbow disorder, to include as a symptom of an undiagnosed illness. 7. Entitlement to service connection for a right wrist disorder, to include as a symptom of an undiagnosed illness. 8. Entitlement to service connection for a bilateral hip disorder, to include as a symptom of an undiagnosed illness. 9. Entitlement to service connection for a right knee disorder, to include as secondary to a service-connected left knee disability and as a symptom of an undiagnosed illness. 10. Entitlement to service connection for sinusitis, to include as a symptom of an undiagnosed illness. 11. Entitlement to service connection for hemorrhoids, to include as a symptom of an undiagnosed illness. 12. Entitlement to service connection for a bilateral foot disorder, to include as a symptom of an undiagnosed illness. REPRESENTATION Veteran represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD N. L. Northcutt, Counsel INTRODUCTION The Veteran served on active duty from July 1985 to April 1988 and from April 1990 to July 2006. These matters come before the Board of Veterans' Appeals (Board) on appeal from October 2006 and March 2012 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston Salem, North Carolina and Roanoke, Virginia, respectively. The issues of entitlement to service connection for bilateral shoulder disorders, a left ankle disorder, and a disorder manifested by right leg numbness and tingling were perfected for appeal. However, as the RO granted service connection for these claimed disabilities in March 2012 and June 2012 rating decisions, the Veteran has been granted the benefits sought, and these issues are no longer in appellate status. The issues of entitlement to increased disability ratings for PTSD and a deviated nasal septum, and the issues of service connection for sinusitis, hemorrhoids, and disorders of the bilateral hips, bilateral feet, right wrist, right elbow, and right knee 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. No evidence has been presented showing that the Veteran was prescribed bed rest to treat incapacitating episodes of neck or back pain. 2. The Veteran has demonstrated at least 45 degrees of forward cervical flexion and a combined range of cervical motion of 225 degrees, with no additional limitation of motion on repetition and no evidence of abnormal spinal contour. 3. The Veteran does not have any neurological impairments diagnosed as related to his cervical spine disability. 4. The Veteran has demonstrated at least 80 degrees of forward lumbar flexion and a combined range of thoracolumbar motion of 210 degrees, with no additional limitation of motion on repetition, and there is no evidence of abnormal spinal contour or an abnormal gait. 5. The Veteran does not have any neurological impairments diagnosed as related to his lumbar spine disability aside from his service-connected radiculopathy of his right lower extremity, which is not a subject of this appeal. 6. Prior to December 9, 2011, the Veteran demonstrated no limitation of left knee flexion or extension, including on repetitive motion, and his left knee was not productive of effusion or clinically assessed as unstable, ankylosed, or suggestive of an impaired tibia or fibula or genu recurvatum. 7. As of December 9, 2011, the Veteran has demonstrated left knee extension of 0 degrees, right knee flexion to 105 degrees (with at least 70 degrees of flexion after repetitive motion), and his left knee has not been productive of effusion or clinically assessed as unstable, ankylosed, or suggestive of an impaired tibia or fibula or genu recurvatum. 8. During service, the Veteran was diagnosed with left ulnar neuropathy affecting his left elbow based on the results of a nerve conduction study, and the Veteran's post-service treatment records continue to reflect a diagnosis of left ulnar neuropathy. 9. The Veteran has competently and credibly reported experiencing left elbow symptoms during and continually since service. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 10 percent for a cervical spine disability have not been met. 38 U.S.C.A. §§ 5103, 5103A and 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59 and 4.71a, Diagnostic Codes 5242, 5243 (2012). 2. The criteria for a disability rating in excess of 10 percent for a lumbar spine disability have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A and 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59 and 4.71a, Diagnostic Codes 5242, 5243 (2012). 3. The criteria for an increased disability rating for a service-connected left knee disability, rated as noncompensably disabling prior to December 9, 2011 and 10 percent disabling thereafter, have not been met. 38 U.S.C.A. § 1155 (West 2002 & Supp. 2009); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.71a, Diagnostic Codes 5003, 5256, 5258, 5259, 5260, 5261, 5262, 5263 (2012). 4. The criteria for service connection for left ulnar neuropathy (claimed as a left elbow disability) have been met. 38 U.S.C.A. §§ 1110, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VA's Duties to Notify and Assist The VA has a duty to provide notification to the Veteran with respect to establishing entitlement to benefits, and a duty to assist with development of evidence under 38 U.S.C.A. §§ 5103, 5103A; 38 C.F.R. § 3.159(b). In this decision, the Board grants service connection for a left elbow disability, diagnosed as left ulnar neuropathy. As this represents a complete grant of the benefit sought on appeal, no discussion of VA's duty to notify and assist with regard to this claim is necessary. With regard to the Veteran's claims for higher ratings, the Veteran's claims arise from his disagreement with the initial evaluations assigned following grants of service connection. Courts have held that in these circumstances, once notice has been satisfied in conjunction with the grant of service connection, additional notice is not required under 38 U.S.C.A. § 5103. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). As VA's duty to notify with regard to the Veteran's service connection claims have been satisfied, the appeal may be adjudicated without remand for further notification. The Board also finds that all relevant facts have been properly developed and that all evidence necessary for equitable resolution of the issues decided on appeal has been obtained, including the Veteran's VA treatment records. The Board also attempted to obtain the Veteran's Social Security Administration (SSA) records, but a response from this agency reflect that no such records exist. A January 2010 letter informed the Veteran of the unavailability of his SSA records and that he could provide the records himself or that VA would obtain alternate records from any sources he identified. The Veteran was also offered an opportunity to testify at a hearing before the Board, but he declined the offer. Furthermore, the Veteran was provided with several relevant VA examinations to assess the severity of his service-connected disabilities. The Board finds that these examinations are adequate for rating purposes, as the examination reports reflect a transcription of the Veteran's reported symptomatology, as well as medical findings applicable to the relevant rating criteria. For the foregoing reasons, the Board concludes that all reasonable efforts were made by the VA to obtain evidence necessary to substantiate the Veteran's claims decided on appeal. Therefore, no further assistance to the Veteran with the development of evidence is required. Increased Rating Claims Disability evaluations are determined by comparing the Veteran's present symptomatology with criteria set forth in the VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4 (2012). The Board considers all the evidence of record in making its determination, although it may not necessarily reference each and every document in its decision, but when a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Likewise, after careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Lumbar and Cervical Spine Disabilities The Veteran's service-connected lumbar and cervical spinal disabilities have each been evaluated as 10 percent disabling throughout the instant rating period. The Veteran contends that his spinal disabilities are more severe than his current evaluations contemplate. Spinal disabilities are rated under either the General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever would result in a higher rating. 38 C.F.R. § 4.71a. Diagnostic Code 5243 provides that a 10 percent rating is assigned when intervertebral disc syndrome causes incapacitating episodes with a total duration of at least 1 week, but less than 2 weeks, during the past 12 months; a 20 percent rating is assigned when intervertebral disc syndrome causes incapacitating episodes with a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months; and a 40 percent rating is assigned when intervertebral disc syndrome causes incapacitating episodes having a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months. A 60 percent rating is assigned when the incapacitating episodes have a total duration of at least 6 weeks during the past 12 months. An incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. As the record fails to reflect that the Veteran has been prescribed bed rest to treat either his cervical or lumbar spine disabilities, the Board concludes that it would be more advantageous to the Veteran to evaluate his spinal disabilities pursuant to General Rating Formula for Diseases and Injuries of the Spine. Pursuant to this rating criteria, a 10 percent rating is assigned for the orthopedic manifestations of a lumbar or cervical spine disability when forward flexion of the thoracolumbar spine is greater than 60 degrees, but not greater than 85 degrees; when forward flexion of the cervical spine is greater than 30 degrees, but not greater than 40 degrees; when the combined range of motion of the thoracolumbar spine is greater than 120 degrees, but not greater than 235 degrees; when the combined range of motion of the cervical spine is greater than 170 degrees, but not greater than 335 degrees; when there is muscle spasm, guarding, or localized tenderness that does not resulting in abnormal gait or abnormal spinal contour; or when there is a vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is assigned for the orthopedic manifestations of a spinal disability when forward flexion of the thoracolumbar spine is greater than 30 degrees, but not greater than 60 degrees; when forward flexion of the cervical spine is greater than 15 degrees, but not greater than 30 degrees; when the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; when the combined range of motion of the cervical spine is not greater than 170 degrees; or when muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. The rating criteria define normal range of motion for the various spinal segments for VA compensation purposes. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexions are zero to 30 degrees, and left and right lateral rotations are zero to 30 degrees. Normal forward flexion of the cervical is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexions are zero to 45 degrees, and left and right lateral rotations are zero to 80 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees, and the normal combined range of motion of the cervical spine is 340 degrees. The normal ranges of motion for each component of spinal motion are the maximum that can be used for calculation of the combined range of motion. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (2) (2012). When rating under the General Rating Formula for Diseases and Injuries of the Spine, any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are evaluated separately under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1) (2012). It is noted, however, that the regulations regarding spinal disabilities were written to take pain and other symptoms into account. Therefore, an evaluation based on pain alone would not be appropriate, unless there is specific nerve root pain, for example, that could be evaluated under the neurologic sections of the rating schedule. See 68 Fed. Reg. 51,455 (Aug. 27, 2003). When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). Recently, the Court clarified that although pain may be a cause or manifestation of functional loss, pain alone does not constitute functional loss under VA regulations that evaluate disabilities based upon loss of motion. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Thus, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1 (2011). Specifically, when rating spine disabilities, the Board must discuss any additional limitation of motion that a Veteran has due to pain, weakness, or fatigue. See Cullen v. Shinseki, 24 Vet. App. 74, 85 (2010). The Veteran's service-connected cervical and lumbar spinal disabilities were evaluated during a May 2006 examination performed for VA purposes (QTC examination). During the examination, the Veteran reported experiencing neck crunching, stiffness, and pain, with the pain traveling down his arms, and back stiffness and pain, with the pain traveling down his legs. On physical examination, the Veteran demonstrated a normal posture and gait. When examining the Veteran's cervical spine, the examiner found no evidence of radiating pain on movement, muscle spasm, tenderness, or ankylosis. On range of motion testing, the Veteran demonstrated 45 degrees of forward flexion, cervical extension to 20 degrees, bilateral lateral flexion to 20 degrees, and bilateral rotation to 60 degrees. The examiner stated that pain would have a functional impact on the Veteran's cervical spinal disability after repetitive use; however, the examiner referred to the Veteran's report of experiencing pain at the endpoints of the aforementioned ranges of motion when quantifying the functional limitation of motion. The examiner stated that there was no additional loss of motion following repetitive use due to fatigue, weakness, lack of endurance and coordination. The examiner concluded that there were zero degrees of additional limitation after repetitive use. The examiner diagnosed the Veteran with a chronic cervical spinal strain. When examining the Veteran's lumbar spine, the examiner found no evidence of radiating pain on movement, muscle spasm, tenderness, or ankylosis, but noted positive straight leg raise testing results bilaterally. On range of motion testing, the Veteran demonstrated 80 degrees of lumbar flexion, with pain occurring at 80 degrees; 20 degrees of extension, with pain occurring at 20 degrees; and 30 degrees of bilateral rotation and bilateral lateral flexion. The examiner stated that pain would have a functional impact on the Veteran's lumbar spine disability after repetitive use, but referred to the aforementioned endpoints of lumbar flexion and extension (80 and 20 degrees, respectively) when quantifying any additional limitation of motion. The examiner stated that there was no additional loss of motion after repetitive use due to fatigue, weakness, lack of endurance and incoordination. The examiner diagnosed the Veteran with lumbar degenerative disc disease. July 2010 VA treatment records reflect the Veteran's reports of experiencing neck pain, with no current radiating symptoms, and lower back pain, with pain radiating to his right lower extremity. In December 2011, the Veteran was afforded a second QTC examination to assess the severity of his spinal disabilities. The cervical spine portion of this examination report reflects that the Veteran reported experiencing flare-ups of his cervical spinal disability manifested by pain, stiffness, fatigue, paresthesia, and numbness. The Veteran reported that during flare-ups the impact was the same. When examining the Veteran's cervical spine, the examiner found no evidence of cervical tenderness, muscle spasm, or cervical radiculopathy. Specifically, the examiner found that the Veteran's bilateral upper extremities revealed normal muscle strength, reflexes, and sensation. On range of motion testing, the Veteran demonstrated 45 degrees or greater of forward flexion, extension and bilateral lateral flexion; and 80 degrees or greater of bilateral lateral rotation, all with no evidence of painful motion or additional limitation of motion after repetitive movement. The examiner further stated that the Veteran had no objective evidence of any functional loss or impairment after repetitive use. The lumbar spine portion of the examination report reflects that the Veteran reported experiencing flare-ups of his lumbar spine disability manifested by pain, stiffness, fatigue, paresthesia, and numbness. The Veteran reported that during flare-ups the impact was the same. When examining the Veteran's lumbar spine, the examiner found no evidence of pain on palpation or lumbar muscle spasm. The examiner further noted that all muscle strength, reflex, and sensory testing revealed normal results, and that the Veteran had lumbar radiculopathy of right lower extremity, but not the left. No other neurological abnormalities were noted. On range of motion testing, the Veteran demonstrated 80 degrees of lumbar flexion, with painful motion beginning at 10 degrees; extension to 10 degrees, with painful motion beginning at 10 degrees; and bilateral lateral flexion and bilateral lateral rotation to 30 degrees, with pain beginning at 10 degrees. However, after repetitive motion, the Veteran demonstrated no additional limitation of motion. Therefore, the examiner characterized the Veteran's cervical spine functional impairment as pain on movement and did not note any related additional limitation of motion. Turning first to the Veteran's cervical spinal disability, the evidence of record does not reflect a basis for awarding a disability rating in excess of 10 percent. The medical evidence of record reflects that the Veteran has demonstrated no muscular spasm resulting in an abnormal spinal contour, at least 45 degrees of forward flexion, and at least 225 degrees of combined cervical range of motion, none of which meet the rating criteria for a 20 percent evaluation based on the rating criteria for disabilities of the spine. See 38 C.F.R. § 4.71a, Diagnostic Code 5243 (assigning a 20 percent disability rating based on evidence of forward flexion of the cervical spine is greater than 15 degrees, but not greater than 30 degrees; when the combined range of motion of the cervical spine is not greater than 170 degrees; or when muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis). Furthermore, there is no medical evidence that the Veteran has any neurological disabilities related to her cervical spinal disability. The Veteran was not diagnosed with any radiculopathy or other neurological impairment of his upper extremities. Such findings were affirmatively ruled out on examination. The Veteran was affirmatively found not to have intervertebral disc syndrome. In light of the foregoing, a rating based on neurological impairment is not warranted. The Board has also considered whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca v. Brown, 8 Vet. App. 202 (1995). While the Veteran has reported experiencing flare-ups of his cervical spine disability, the Veteran reported that the impact of his function was the same. Thus, there is no evidence indicating that the criteria for a higher rating are met during flare-ups. Likewise, repetitive range of motion testing has failed to reveal any additional limitation of motion. Moreover, the 2006 VA examiner characterized the Veteran's only functional impairment as pain at the endpoints of his initial ranges of motion, and the 2011 VA examiner opined that the Veteran has no functional loss or impairment related to his cervical spine disability. As outlined above, pain alone does not constitute functional loss under VA regulations that evaluate disabilities based upon loss of motion. Accordingly, the assignment of an increased disability based on evidence of functional loss is not warranted. The Board specifically acknowledges its consideration of the lay evidence of record when deciding the Veteran's cervical spine disability increased rating claim, including the Veteran's reports of neck pain and stiffness and reports of pain traveling to his upper extremities. The Board further acknowledges that the Veteran is competent to report these symptoms, and the Board finds his report of pain to be credible. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (a lay person is competent to report symptoms based on personal observation when no special knowledge or training is required). The Board, however, finds that the Veteran is not competent to report that his pain causes any associated neurological impairment. The Board finds that the competent and probative medical evidence of record, including range of motion studies and objective physical examination findings, do not support a basis for awarding a rating in excess of 10 percent. Moreover, with regard to the Veteran's reports of radiating pain to his upper extremities, the Board notes that no neurological impairments with regard to the Veteran's cervical spine disability are currently diagnosed and that an examination has affirmatively found no associated neurological impairment. Turning next to the Veteran's lumbar spine disability, the Board notes that the Veteran's current 10 percent evaluation is assigned based on evidence of painful limitation of motion. However, the objective medical evidence of record does not provide a basis for awarding a 20 percent rating based on the rating criteria for the orthopedic manifestations of the Veteran's lumbar spine disability. The medical evidence of record reflects that the Veteran has demonstrated no abnormality in spinal contour or gait, 80 degrees of forward flexion, and at least 210 degrees of combined thoracolumbar range of motion. These ranges of motion findings far exceed the ranges of motion required for the assignment of a 20 percent rating. See 38 C.F.R. § 4.71a, Diagnostic Code 5243 (assigning a 20 percent rating based on evidence of forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; when the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or when muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis). The Board has also considered whether a higher disability evaluation is warranted for the Veteran's lumbar spine disability on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca v. Brown, 8 Vet. App. 202 (1995). While the Veteran has reported experiencing flare-ups of his lumbar spine disability, the Veteran reported that the impact of his function was the same. Thus, there is no evidence indicating that the criteria for a higher rating are met during flare-ups. Additionally, repetitive range of motion testing has failed to reveal any additional limitation of motion. Moreover, the 2006 and 2011 VA examiners characterized the Veteran's only functional impairment as pain on motion. As outlined above, pain alone, without evidence of a corollary limitation of motion, does not constitute functional loss under VA regulations that evaluate disabilities based upon loss of motion. Accordingly, the assignment of an increased disability based on evidence of functional loss is not warranted. With regard to any neurologic manifestations of the Veteran's lumbar spine disability, the Board notes that the Veteran has been diagnosed with lumbar radiculopathy of the right lower extremity and has been assigned a 10 percent rating under 38 C.F.R. § 4.124a, Diagnostic Code 8626, neuritis. The regulations provide that the Veteran's service-connected back is to be rated under orthopedic and neurological symptoms. As such, the Board will determine whether a higher rating is warranted based on associated neurological symptoms. Examination has revealed that the only associated neurological symptoms involve numbness and tingling of the right lower extremity. Diagnostic Code 8626 provides a 10 percent rating for mild incomplete paralysis of the anterior crural nerve (femoral), a 20 percent when moderate and a 30 percent rating when it is severe. A maximum 40 percent rating is assigned for complete paralysis, paralysis of quadriceps extensor muscles. The Veteran's neurological impairment involves numbness and involves only the right lower extremity. Although this numbness (paresthesias and/or dysesthesias) has been considered moderate on examination, the examiner found that the Veteran did not have any diminished lower extremity function. The regulations provide that when the nerve involvement is wholly sensory, the rating should be for the mild, or at the most, moderate degree. In light of the totality of the evidence of record, no more than mild incomplete paralysis is demonstrated. As such, a rating in excess of 10 percent based on neurological impairment is not warranted. The Veteran's service-connected back disability involves degenerative disc disease and he is currently rated under Diagnostic Code 5243 intervertebral disc syndrome. This code provides that the condition is to be rated either under the General Rating Formula for Disease and Injuries of the Spine or under the Formula for Rating Intervetebral Disc Syndrome based on incapacitating episodes, whichever method results in higher evaluations when all disabilities are combined. Examinations of record demonstrate that the Veteran has not had any incapacitating episodes during a 12 month period. For VA purposes, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. In light of the evidence of record, a higher rating under this formula is not warranted. The Board specifically acknowledges its consideration of the lay evidence of record when promulgating this decision, including the Veteran's reports of back pain and stiffness and reports of pain traveling to his right lower extremities. The Board further acknowledges that the Veteran is competent to report these symptoms, and the Board finds these reports to be credible, as they are uncontroverted by any evidence of record. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (a lay person is competent to report symptoms based on personal observation when no special knowledge or training is required). However, the probative, objective medical evidence of record, including range of motion studies and objective physical examination findings, do not support a basis for awarding a rating in excess of 10 percent. In sum, the Board finds that the evidence of record does not reflect a basis for awarding disability ratings in excess of the assigned ratings for either the Veteran's service-connected cervical or lumbar spine disabilities. Left Knee Disability The Veteran's service-connected left knee disability has been assigned a noncompensable disability rating prior to December 2011, and a 10 percent disability rating thereafter. The Veteran contends that his knee disability is very painful, warranting a higher evaluation. The Veteran's left knee disability has been evaluated pursuant to Diagnostic Code 5260, which outlines the rating criteria for limitation of knee flexion. 38 C.F.R. § 4.71a, Diagnostic Codes 5260. Diagnostic Code 5260 provides that limitation of flexion to 60 degrees is rated as noncompensably disabling; limitation of flexion to 45 degrees is rated as 10 percent disabling; limitation of flexion to 30 degrees is rated as 20 percent disabling; and limitation of flexion to 15 degrees is rated as 30 percent disabling. Diagnostic Code 5261 outlines the rating criteria for limitation of knee extension. Pursuant to this rating criteria, limitation of extension to 5 degrees is rated as noncompensably disabling; limitation of extension to 10 degrees is rated as 10 percent disabling; limitation of extension to 15 degrees is rated as 20 percent disabling; limitation of extension to 20 degrees is rated as 30 percent disabling; limitation of extension to 30 degrees is rated as 40 percent disabling; and limitation of extension to 45 degrees is rated as 50 percent disabling. Normal range of motion of the knee is from 0 to 140 degrees. 38 C.F.R. § 4.71a, Plate II. Pursuant to Diagnostic Code 5257, a 10 percent rating is warranted for slight recurrent subluxation or lateral instability. A 20 percent rating is assigned when moderate and a 30 percent rating is assigned when it is severe. Ratings are also available pursuant to Diagnostic Codes 5256, 5258, 5259, 5262, and 5263 when there is evidence of knee ankylosis, dislocated semilunar cartilage with locking episodes and effusion into the joint, symptomatic removed cartilage, tibia and fibula impairment, and genu recurvatum, respectively. See 38 C.F.R. § 4.71a Diagnostic Codes 5256, 5258, 5259, 5262, 5263. The severity of the Veteran's left knee disability was assessed during his May 2006 QTC examination. During this examination, the Veteran reported experiencing left knee cracking and crunching, as well as constant left knee pain. He reported that his left knee pain results in difficulty walking short distances, standing, running, and sitting. The Veteran reported that his condition did not result in any incapacitation. On physical examination, the Veteran's left knee exhibited signs of exostosis tibial tuberosity. The Veteran demonstrated full range of left knee motion, from 0 degrees of extension to 140 degrees of flexion, with no additional limitation of motion on repetitive use. There was no additional limitation of motion due to pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. Additionally, relevant diagnostic testing failed to reveal any indication of left knee instability. The anterior and posterior cruciate ligaments stability test was within normal limits and the medial and lateral collateral ligaments stability test was within normal limits. Left knee x-rays were interpreted to reveal normal results, and the examiner diagnosed the Veteran with a left knee strain. A July 2010 VA treatment record reflects the Veteran's report of experiencing ongoing left knee pain. The Veteran's left knee disability was also assessed during the December 2011 QTC examination. During the examination, the Veteran reported experiencing left knee weakness, stiffness, swelling, heat, redness, giving way, lack of endurance, locking deformity, tenderness, pain, and numbness. He also reported flare-ups that impact the function of the knee. His describes the impact as pain, weakness, numbness and swelling. On physical examination, the Veteran demonstrated normal muscle strength and no pain on palpation or objective evidence of instability. On range of motion testing, the Veteran demonstrated 105 degrees of flexion, with pain beginning at 35 degrees; and 0 degrees of extension, with no evidence of painful motion. On repetitive motion, the Veteran had no additional limitation of extension, but flexion was additionally limited to 70 degrees. Accordingly, the examiner stated that the Veteran had functional loss due to pain on movement. After reviewing the evidence of record, the Board finds that the evidence does not warrant the assignment of an increased rating for the Veteran's left knee disability. Turning first to the rating period prior to December 2011, during which the Veteran's left knee disability has been evaluated as noncompensably disabling, the evidence from this rating period reflects that the Veteran demonstrated no limitation of flexion or extension. Thus, an increased rating is not warranted for limitation of extension or flexion. 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5261. Additionally, the evidence of record for this rating period also fails to reflect the Veteran's reports of objective findings of knee instability, ankylosis, dislocated semilunar cartilage with frequent locking episodes and joint effusion, symptomatic removed cartilage, tibia and fibula impairment, or genu recurvatum, thereby failing to reflect a basis for awarding an increased or additional rating based on Diagnostic Codes 5256, 5258, 5259, 5262, 5263. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5258, 5259, 5262, 5263. Physical examination reveals that his ligament testing was normal. Additionally, as radiological studies from this rating period failed to reveal evidence of degenerative changes, and as the Veteran did not demonstrate any limitation of left knee motion, a compensable rating pursuant to Diagnostic Code 5003 for left knee arthritis is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5003. An increased disability rating during this rating period based on functional loss is also not warranted, as the Veteran did not demonstrate any additional limitation of motion on repetitive range of motion testing or due to pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. The Board notes that the Veteran did not report having any incapacitation (flare-ups), but reported that his pain was constant. In light of the foregoing, a higher rating based on Deluca factors is not warranted. With regard to the rating period commencing in December 2011, during which the Veteran's left knee disability has been evaluated as 10 percent disabling based on evidence of limitation of flexion, a rating in excess of 10 percent is not warranted. During this rating period, the Veteran demonstrated no limitation of extension and 105 degrees of flexion. As these ranges of motion far exceed the requisite findings for awarding an increased or additional rating, an increased rating is not warranted for limitation of extension or flexion. 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5261 (stating that limitation of flexion to 30 degrees is rated as 20 percent disabling; limitation of extension to 10 degrees is rated as 10 percent disabling; and limitation of extension to 15 degrees is rated as 20 percent disabling). Additionally, the evidence of record from this rating period also fails to reflect findings of knee ankylosis, dislocated semilunar cartilage with frequent locking episodes and joint effusion, symptomatic removed cartilage, tibia and fibula impairment, or genu recurvatum, thereby failing to reflect a basis for awarding an increased rating based on Diagnostic Codes 5256, 5258, 5259, 5262, 5263. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5258, 5259, 5262, 5263. Likewise, the Board finds that the Veteran is not entitled to an increased disability rating for left knee instability during this rating period. The Board acknowledges the Veteran's report during his December 2011 QTC examination that he experiences left knee weakness and giving way. The Board further acknowledges that the Veteran is competent to report experiencing his perception of having knee instability, and the Board finds the Veteran's reports to be credible. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (a lay person is competent to report symptoms based on personal observation when no special knowledge or training is required). While the record reflects the Veteran's subjective perception of experiencing knee instability, no objective evidence of knee instability has been assessed during the instant rating period. Rather, numerous diagnostic tests designed to detect knee instability performed during the Veteran's 2011 examination failed to reveal any evidence of instability. The Board finds this objective evidence more probative than the Veteran's perception of left knee giving way. As such, the Board concludes that while the record reflects that the Veteran experiences subjective symptoms of knee giving way, the objective evidence of record indicates that his knee is clinically stable. 38 C.F.R. § 4.71a, Diagnostic Code 5257. As such, a disability rating for instability is not warranted. Moreover, an increased disability rating based on evidence of functional loss is also not warranted. The Board acknowledges that the Veteran has reported experiencing severe left knee pain and difficulty ambulating and sitting for extended periods due to his service-connected left knee and that the Veteran is competent to report these symptoms and experiences. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (a lay person is competent to report symptoms based on personal observation when no special knowledge or training is required). Moreover, the Board finds his reported symptomatology to be credible, as it is uncontroverted by any evidence of record. However, the objective evidence of record fails to reflect that the quantifiable effect of this functional impairment is analogous to the rating criteria contemplated for a 20 percent evaluation. Specifically, during his 2011 examination, the Veteran demonstrated no limitation of extension after repetitive use, and his flexion was additionally limited to 70 degrees, which far exceeds the 30 degree limitation of flexion contemplated by a 20 percent evaluation. See 38 C.F.R. § 4.71a, Diagnostic Code 5260, 5261 (a 20 percent disability rating is assigned when there is limitation of knee flexion to 30 degrees). Moreover, a limitation of flexion to 70 degrees also exceeds the 60 degree limitation of flexion required for a noncompensable evaluation. As such, even considering the Veteran's functional impairment of an additional limitation of motion due to pain on repetitive use, an increased rating for his left knee disability based on functional loss is not warranted. Moreover, while the Veteran reports having flare-ups which impacts by way of pain, weakness, numbness and swelling, there is no probative evidence showing that such flare-ups results in limitation of motion which would warrant a higher rating. In sum, the evidence of record fails to reflect a basis for awarding increased disability ratings for the Veteran's service-connected left knee disability for either the period prior to or the period after December 2011. Extraschedular Consideration In exceptional cases an extraschedular rating may be provided. 38 C.F.R. § 3.321. The Court has set out a three-part test, based on the language of 38 C.F.R. § 3.321(b)(1), for determining whether a Veteran is entitled to an extraschedular rating: (1) the established schedular criteria must be inadequate to describe the severity and symptoms of the claimant's disability; (2) the case must present other indicia of an exceptional or unusual disability picture, such as marked interference with employment or frequent periods of hospitalization; and (3) the award of an extraschedular disability rating must be in the interest of justice. Thun v. Peake, 22 Vet. App. 111 (2008), aff'd, Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). The Board finds that the rating criteria adequately contemplate the Veteran's spinal and knee disabilities, as these disabilities are productive of pain, limitation of motion, and functional impairment, manifestations that are contemplated in the rating criteria. Moreover, the rating criteria also include bases for awarding higher disability ratings for more severe symptomatology. The rating criteria are therefore adequate to evaluate the Veteran's service-connected spinal and knee disabilities, and referral for consideration of extraschedular rating is not warranted. As the evidence of record reflects that the Veteran is currently employed, consideration as to whether a claim for entitlement to a total disability rating based on individual unemployability (TDIU) has been raised as part and parcel of the Veteran's increased rating claims is not warranted. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). Service Connection Claim The Veteran asserts that he has a current left elbow disability that began during service as the result of resting his elbow on the edge of a cockpit while performing his routine duties of operating a helicopter. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). The second and third elements may be established by showing continuity of symptomatology. Continuity of symptomatology may be shown by demonstrating "(1) that a condition was 'noted' during service or any applicable presumption period; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology." Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); see also Davidson, 581 F.3d at 1316; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). The Veteran's service treatment records reflect that the Veteran reported experiencing numbness in his upper left extremity in 2005, and subsequent nerve conduction studies confirmed a diagnosis of left ulnar neuropathy around the elbow, also referred to as cubital tunnel syndrome. Service treatment records from 2006 reflect the Veteran's ongoing treatment for this neurological impairment affecting his left elbow. A January 2009 VA fibromyalgia examination refers to a diagnosis of left ulnar neuropathy. A July 2010 VA treatment record reflects the Veteran's report of developing and being diagnosed with left ulnar neuropathy during service, and the treating medical professional's assessment reflects a continuation of this diagnosis. In his submitted statements, the Veteran has reported experiencing left arm numbness since service as the result of resting his arm on the helicopter window when operating a helicopter during service. The Board notes that the Veteran is competent to report both the onset and continuation of left elbow numbness, as these symptoms are capable of lay observation. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (a lay person is competent to report symptoms based on personal observation when no special knowledge or training is required). Moreover, the Board finds the Veteran's reports to be credible, as they are corroborated by his documented treatment during service, have remained consistent over time, and are uncontroverted by any evidence of record. Thus, the record reflects an in-service diagnosis of left ulnar neuropathy affecting the left elbow based on the results of a nerve conduction study; the Veteran's competent, credible reports of experiencing left elbow symptoms continually since service; and a current diagnosis of left ulnar neuropathy, as reflected in the Veteran's VA treatment records. Accordingly, the Board finds that a basis for granting service connection for a left elbow disorder, diagnosed as left ulnar neuropathy, has been presented. The Veteran's claim is therefore granted. See 38 C.F.R. § 3.303(b), (d). ORDER A disability rating in excess of 10 percent for a service-connected cervical spine disability is denied. A disability rating in excess of 10 percent for a service-connected lumbar spine disability is denied. An increased disability for a service-connected left knee disability, rated as noncompensably disabling prior to December 9, 2011 and 10 percent disabling thereafter, is denied. Service connection for left ulnar neuropathy (claimed as a left knee disability) is granted. REMAND The Veteran is seeking service connection for sinusitis, hemorrhoids, and disorders of the right elbow, bilateral hips, bilateral feet, right wrist and right knee, the symptoms of which he reports experiencing during service. Indeed, the Veteran's service treatment records document his sinus and orthopedic complaints. The Veteran was afforded VA examinations in May 2006 in conjunction with all of these claims and in December 2011 with regard to his sinusitis and right foot disorder. However, the examiners failed to diagnose the Veteran with any underlying disorders that are manifested by this reported symptomatology. Furthermore, the record reflects that the Veteran's claims have been denied based on the lack of any current diagnosis related to these claimed conditions. The Veteran had two periods of service in Southwest Asia. Although he has not specifically asserted service connection based on his service in the Persian Gulf, courts have held that proceedings before VA are nonadversarial and that VA's obligation to analyze claims goes beyond the arguments explicitly made. See Robinson v. Peake, 21 Vet. App. 545, 553 (2008), aff'd sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009); see also Schroeder v. West, 212 F.3d 1265, 1271 (Fed. Cir. 2000) (Upon the filing of a claim for benefits, VA generally must investigate the reasonably apparent and potential causes of the Veteran's condition and theories of service connection that are reasonably raised by the record or raised by a sympathetic reading of the claimant's filing.). In this regard, the Board notes that under 38 C.F.R. § 3.317, service connection may be warranted for a Persian Gulf Veteran for disability due to undiagnosed illness and medically unexplained chronic multi symptom illness. Pursuant to the regulation, the disability must have been manifest either during active military service in the Southwest Asia Theater of operations or to a degree of 10 percent or more not later than December 31, 2016. See 76 Fed. Reg. 81834 (Dec. 29, 2011) (to be codified at 38 C.F.R. § 3.317(a)(1)). To date, the Veteran's claims have not been considered under the provisions of 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317. In light of the foregoing, the Board finds that the RO must provide the Veteran with appropriate notice of the evidence needed establish service connection under the provisions of 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317. Additionally, as none of the Veteran's VA examinations include an assessment of whether the Veteran's subjective complaints related to his claimed conditions could be manifestations of an undiagnosed illness, the Veteran should be afforded a new VA examination that includes such an assessment. See McLendon v. Nicholson, 20 Vet. App. 79 (2006) (holding that a VA examination is warranted when the medical evidence suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits). In that regard, the Board notes that the Veteran was afforded a VA examination in January 2009 in conjunction with his service connection claim for fibromyalgia. However, the scope of that examination was limited to whether the Veteran currently has fibromyalgia and did not explore whether the Veteran's litany of subjective complaints are manifestations of an undiagnosed illness. With regard to the Veteran's right knee service connection claim, the Veteran has asserted that his right knee symptomatology is related to his service-connected left knee disability. As such, to the extent any right knee disorder is diagnosed during the requested VA examination, an opinion regarding this theory of secondary service connection must be obtained. The Veteran is also seeking a compensable disability rating for his service-connected deviated nasal septum. Pursuant to the applicable rating criteria, disability ratings are assigned based on evidence of the severity of the septal deviation, with a 10 percent rating assigned based on either a bilateral 50 percent obstruction or a complete obstruction of one side. See 38 C.F.R. § 4.97, Diagnostic Code 6502. However, while the May 2006 QTC examiner noted that the Veteran's nasal septum was deviated on both sides, he did not quantify the extent of the deviation. Moreover, rather confusingly, the 2011 QTC examiner found no evidence of septal deviation. Given these inadequate and conflicting findings, the Veteran should be afforded a new medical examination to determine the nature and extent of any deviation of the Veteran's nasal septum. With regard to the Veteran's PTSD increased rating claim, the record reflects the existence of relevant VA treatment records that have not been obtained. In that regard, the Veteran's VA treatment of record is exclusively from the facilities within the Richmond VA Medical Center (VAMC) system. However, these 2010 treatment records reflect the Veteran's report of having previously received psychiatric treatment for his service-connected PTSD from the Fayetteville VAMC. As no records from the Fayetteville VAMC are of record or have been requested by the RO, such a records request should be made. Additionally, the Veteran's recent VA treatment records from the Richmond VAMC, last obtained by the RO in February 2011, should also be requested. Accordingly, the case is REMANDED for the following action: 1. Obtain all of the Veteran's VA psychiatric treatment records from the Fayetteville VAMC, and the Veteran's VA treatment records from the Richmond VAMC from February 2011 to the present. The Veteran should be given an opportunity to identify any other facilities which have treated him for his service-connected PTSD and thereafter, appropriate steps should be taken to obtain the identified records. 2. Provide the Veteran notice pursuant to the Veterans Claims Administration Act (VCAA) under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), that includes the criteria required for a claim based on Persian Gulf service under 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317. 3. After associating any outstanding records with the claims folder, schedule the Veteran for an appropriate VA examination to determine the nature, etiology and/or onset of any sinus disorder (other than his service-connected deviated septum); hemorrhoids; bilateral hip, bilateral feet, right wrist, right elbow, and right knee disorders. The claims folder must be made available and reviewed by the examiner. All necessary tests should be conducted. The examiner should be advised that the Veteran is competent to report symptoms and injuries, his history, and any continuity of symptoms, and that such statements must be considered in formulating the necessary opinions. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). The examiner must state whether it is at least as likely as not (at least a 50-50 probability) that the Veteran's claimed sinusitis, hemorrhoids, and bilateral hip, bilateral feet, right wrist, right elbow, and right knee disorders are attributable to a known clinical diagnosis. Specifically state whether the Veteran's claim complaints concerning the right elbow, right wrist, bilateral hip, right knee, and bilateral foot cannot be attributable to a known clinical diagnosis. The examiner should state whether there are objective indications of a chronic disability concerning the right elbow, right wrist, bilateral hip, right knee, bilateral foot. In this regard, the examiner should note that objective indications of chronic disability include both signs in the medical sense of objective evidence perceptible to an examining physician, and other, non medical indicators that are capable of independent verification. If the Veteran's claimed disorders (right elbow, right wrist, bilateral hip, right knee, sinus, hemorrhoids, bilateral foot) are attributable to a known clinical diagnosis, the examiner must identify such diagnosis and then opine as to whether it is at least as likely as not (at least a 50-50 probability) that the disability is related to or had its onset in service, to include any incident of service. In giving this opinion, the examiner must address the Veteran's assertions concerning any service event, symptoms, etc. The examiner should clarify whether the Veteran does indeed have a right foot disorder. In so doing, the examiner should address the relevance of 2010 and 2011 VA x-ray studies. The examiner should opine whether it is at least as likely as not (at least a 50-50 probability) that any diagnosed right knee disorder is caused by or aggravated by the Veteran's service-connected left knee disability. If the service-connected left knee disability aggravates the right knee disability, the examiner should identify that aspect of the disability which is due to aggravation. In so doing, the examiner should identify the baseline level of severity prior to aggravation. State whether the Veteran has a bilateral hip, and/or bilateral feet disability which is caused by the service-connected left knee disability or any service-related disability as claimed by the Veteran and is currently on appeal. If not caused by, please state whether any service-connected/related disability aggravates a bilateral hip, and/or bilateral feet disability. If so that aspect of the disability which is due to aggravation must be identified. The baseline of disability prior to aggravation must also be identified. The examiner is advised that the term "aggravation" means a permanent increase in the claimed disability; that is, an irreversible worsening of the condition beyond the natural clinical course and character of the condition due to the service-connected disability as contrasted to a temporary worsening of symptoms. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 4. After associating any outstanding records with the claims folder, schedule the Veteran for an appropriate VA examination to determine the current severity of his service-connected deviated nasal septum. The examiner should conduct all relevant diagnostic studies and should specifically state whether the Veteran's deviated nasal septum results in 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. 5. After completing any additional development suggested by the record (to include providing the Veteran with a new VA PTSD examination, if deemed necessary based on the lapse of time and any evidence indicating an increase in severity since his 2011 examination), readjudicate the appeal. In doing so, the RO must consider 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317. If any benefit sought remains denied the Veteran should be issued a supplemental statement of the case (SSOC) that addresses actions taken since the issuance of the last SSOC and given the opportunity to respond. The case should then be returned to the Board, if in order. The Veteran has the right to submit additional evidence and argument on matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board 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). ______________________________________________ K. OSBORNE Chief Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs