Citation Nr: 1304451 Decision Date: 02/07/13 Archive Date: 02/19/13 DOCKET NO. 06-17 970 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUES 1. Entitlement to service connection for glaucoma of the left eye. 2. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU). REPRESENTATION Veteran represented by: The American Legion WITNESSES AT HEARINGS ON APPEAL The Veteran and his spouse ATTORNEY FOR THE BOARD J.A. Flynn, Associate Counsel INTRODUCTION The Veteran served on active duty from June 1974 to July 1978. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2004 rating decision of the Winston-Salem, North Carolina, Regional Office (RO) of the Department of Veterans Affairs (VA), which denied the Veteran's claims. This matter was previously before the Board in August 2008, when it remanded the case for additional development of the medical evidence of record. As an initial matter, the Board notes that when its remand orders are not complied with, it errs as a matter of law when it fails to ensure compliance. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In the instant case, the Board remanded the claims in order to provide the Veteran with an additional VA examination addressing the nature and etiology of his glaucoma. The Veteran was provided with additional VA examinations, and the Board solicited an opinion from the Veterans Health Administration (VHA) as a result of the findings in these examinations. The Board finds that there has been effective compliance with the Board's remand instructions. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (noting that Stegall requires substantial compliance with remand orders, rather than absolute compliance.) The issue of entitlement to a TDIU is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, D.C. VA will notify the Veteran if further action is required on his part. FINDING OF FACT The weight of the probative evidence is against a finding that the Veteran's glaucoma of the left eye is the result of, or is aggravated by, the Veteran's military service or any other service-connected conditions. CONCLUSION OF LAW The Veteran's glaucoma of the left eye was neither incurred in or aggravated by active military service nor the result of, or aggravated by, a service-connected disability. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION The Board has thoroughly reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim decided herein. 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). The Board must assess the credibility and weight of all evidence to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Duties to Notify and Assist VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326 (2012). Under the VCAA, when VA receives a complete or substantially complete application for benefits, it is required to notify the claimant and his representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim. See 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2012); Quartuccio v. Principi, 16 Vet. App. 183 (2002). In Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II), the United States Court of Appeals for Veterans Claims (Court) held that VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) request that the claimant provide any evidence in his possession that pertains to the claim. Prior to initial adjudication of the Veteran's claim, a letter dated December 2003 fully satisfied the duty to notify provisions for the first three elements. See 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b)(1) (2012); Quartuccio, at 187. The Veteran was aware that it was ultimately his responsibility to provide VA with any evidence pertaining to the claim. The December 2003 letter told him to provide any relevant evidence in his possession. See Pelegrini II, at 120-21. Any questions as to the appropriate disability ratings or effective dates to be assigned are moot, and no further notice is needed, because the Board has concluded that the preponderance of the evidence is against the claim for service connection. See Dingess v. Nicholson, 19 Vet. App. 473 (2006). The Board also concludes VA's duty to assist has been satisfied. The Veteran's service treatment records and VA medical records are in the file. Private medical records identified by the Veteran have been obtained, to the extent possible. The Veteran has at no time referenced outstanding records that he wanted VA to obtain or that he felt were relevant to the claim. When VA provides a VA examination or obtains a VA opinion, it must ensure that the examination or opinion is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In the instant case, the Veteran was provided with a number of examinations of his eyes. With respect to the adequacy of these examinations, the Board finds that the examiners reviewed the Veteran's claims file and past medical history, recorded his current complaints, conducted appropriate evaluations, and rendered appropriate diagnoses and opinions consistent with the remainder of the evidence of record. The Veteran also received several opinions from VHA experts regarding the etiology of his glaucoma that addressed the questions posed with rationales that referred to the probative evidence of record. The Board concludes that these examination reports and opinions are adequate for the purpose of rendering a decision in the instant appeal. See 38 C.F.R. § 4.2 (2012) see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Veteran has not alleged weaknesses in these examinations. The Veteran was sent a letter in November 2012 informing him that the Veterans Law Judge who conducted his February 2011 hearing at the VA RO was no longer employed by the Board. The November 2012 letter advised the Veteran that he had the option to testify at a hearing before another Veterans Law Judge. See 38 C.F.R. §§ 20.707, 20.717 (2012). The Veteran was further informed that he had 30 days from the date of the letter to respond, and that if no response was received, the Board would assume that he did not want another hearing. To date, no response has been received from the Veteran or his representative. The Board finds that there is no indication in the record that any additional evidence relevant to the issue to be decided herein is available and not part of the claims file, and it is not contended otherwise. See Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007). Thus, the duties to notify and assist have been met, and the Board will proceed to a decision. Service Connection The Veteran essentially contends that he suffers from glaucoma of the left eye either as a direct result of military service or secondary to the Amitriptyline medication that he has taken in treatment of his service-connected depression. Service connection may be granted for disease or injury incurred in or aggravated by active service. See 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303(a) (2012). Service connection may also be granted for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in service. See 38 U.S.C.A. § 1113(b) (West 2002); 38 C.F.R. § 3.303(d) (2012); Cosman v. Principi, 3 Vet. App. 503 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. Continuity of symptomatology is required when the condition noted during service is not shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. See 38 C.F.R. § 3.303(b) (2012). To establish service connection, there must be (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247 (1999). Service connection may also be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310(a) (2012); see also Harder v. Brown, 5 Vet. App. 183, 187 (1993). Additional disability resulting from the aggravation of a non-service-connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In order to establish service connection for a claimed disability on a secondary basis, there must be (1) medical evidence of a current disability; (2) a service-connected disability; and (3) medical evidence of a nexus between the service-connected disease or injury and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Turning to the facts in the instant case, regarding the first Hickson/Wallin element, evidence of a current disability, the evidence of record indicates that the Veteran has been diagnosed with primary open-angle glaucoma of both eyes. The first Hickson/Wallin element, evidence of a current disability, is accordingly met. With respect to the second Hickson element, an in-service disease or injury, the Board notes that the Veteran received treatment in service on several occasions for issues relating to his eyes. For example, in November 1976, the Veteran complained of eye pain, and the treating physician noted that the Veteran had a healed abrasion to the iris. The Veteran suffered a corneal abrasion in October 1977 following an accident involving battery acid in his eyes. The second Hickson element is accordingly met. With respect to the second Wallin element, a service-connected disability, the Veteran is currently service-connected for depressive disorder, which is treated with the medication Amitriptyline. The second Wallin element is accordingly met. With respect to the third Hickson/Wallin element, medical nexus, the determination of the relationship, if any, between the Veteran's lumbar spine condition and his other service-connected conditions is essentially medical in nature. The Board is prohibited from exercising its own independent judgment to resolve medical questions. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). In a February 2006 examination for VA compensation and pension purposes, the examiner opined that the Veteran's glaucoma was not a result of a chemical burn to the left eye. The examiner noted that the chemical burn was not severe, and there was no damage to the anterior chamber. In February 2006 and August 2006, a private optometrist indicated that the Veteran's "trauma to the left eye in March 1977" contributed to "decreased vision in the left eye." While the Board acknowledges the competency of this opinion, the Board notes that the physician did not indicate that he reviewed the Veteran's claims file, nor did he specifically associate an event from March 1977 to the Veteran's glaucoma; instead he related the March 1977 event generally to "decreased vision." Accordingly, the Board places little probative weight on this opinion. The Veteran received a VA examination in March 2007 that primarily addressed the Veteran's unrelated claim for service connection for his macular scar of the left eye. The examiner noted, however, that the Veteran stated that a "rock thrown from the tank track" caused his glaucoma. While the examiner opined that the etiology of the Veteran's glaucoma was unknown, he noted that African Americans were more likely to develop glaucoma. The examiner noted that the Veteran's right eye had no history of injury, and the onset of bilateral glaucoma was 19 years after the injury to the left eye. The Veteran received a VA examination in August 2009. The examiner reviewed the Veteran's claims file and conducted a physical examination of the Veteran. The examiner noted that there was no evidence of traumatic angle recession by gonioscopy. The examiner noted that the Veteran's previous traumatic eye injuries were self-limiting and would not be a causative factor in primary open angle glaucoma. The examiner further observed that the Veteran's condition was bilateral, which is typical of primary open angle glaucoma. The examiner opined that it was less likely than not that the Veteran's glaucoma in the left eye was secondary to any trauma. The Veteran received an examination for VA compensation and pension purposes in January 2010. The examiner diagnosed the Veteran with primary open-angle glaucoma of both eyes, and a quiet chorioretinal scar of the left eye. The examiner reviewed the Veteran's in-service and post-service history of injury involving the eyes. The examiner opined that the Veteran's glaucoma was not caused or aggravated by the Veteran's injury to his left eye. For an injury in-service to have caused glaucoma, the examiner reasoned, the injury would have to have been severe enough to show significant changes in the anterior chamber, and there were no such changes in that chamber. The examiner reasoned that the Veteran had glaucoma in both eyes, and the injury to the left eye did not explain the occurrence of glaucoma in the right eye. The examiner noted that the Veteran's corneal abrasion was mild and on the very front surface of the eye. In a hearing conducted in February 2011, the Veteran contended that the glaucoma involving his left eye was attributable to the Amitriptylene medication that he took for service-connected depression. The Veteran noted at this hearing that known side effects of this medication include blurry vision and increased intraocular pressure, and these side effects, the Veteran stated, can cause glaucoma. In July 2011, the Board determined that additional development of the medical evidence of record was warranted and solicited an expert opinion from a physician with the VHA. The Board asked the VHA physician to opine whether the Veteran's glaucoma was as likely as not caused or aggravated by the medication that the Veteran took in treatment of his service-connected depression. In October 2011, a VHA physician indicated that Amitriptyline can cause angle closure glaucoma in patients with narrow angles. The Veteran, the examiner noted, had open-angle glaucoma and not narrow-angle or angle-closure glaucoma. The Veteran's glaucoma of the left eye, the examiner opined, was not caused by the Veteran's Amitriptyline. In February 2012, the Board determined that an additional VHA opinion was necessary in order to address whether Amitriptyline aggravated the Veteran's glaucoma. In August 2012, the Board received an additional VHA opinion, in which the examiner noted that he reviewed the Veteran's service treatment records, noting that the Veteran sustained a macular scar on his left eye. The examiner noted that the Veteran had been diagnosed with bilateral primary open angle glaucoma, which occurred sometime after discharge. The examiner opined that the Veteran's condition was unrelated to service. The examiner noted that the Veteran had "variable compliance" with therapy. The examiner observed bilateral open angles on gonioscopy, with no evidence of angle recession as might be seen in trauma or injury. With regard to the relationship between the Veteran's condition and the medication that he took in treatment of his service-connected depression, the examiner observed that the medication was a tricyclic antidepressant with anticholinergic effects. These side effects can include dry eye, blurry vision (decreased focusing ability), and mydriasis (dilation of the pupil). In patients with narrow angles (this Veteran, the examiner noted, had documented open angles), there can be a risk of increased intraocular pressure or angle closure. The examiner noted that the Veteran had documented open angle glaucoma with no documentation of exacerbation (in the form of angle closure or worsening eye pressure) while taking the medication in treatment of his depression. Accordingly, the examiner concluded that the Veteran's medication did not aggravate or cause his open angle glaucoma. Upon review of this evidence, the Board finds that VA examiners have consistently been unable to link the Veteran's glaucoma with either any incident that occurred in active service or to the medication that the Veteran takes in treatment of his service-connected depression. As noted above, while a private physician linked the Veteran's left eye decreased vision to an incident in service, he did not link such incident specifically to the Veteran's glaucoma, and he did not review the Veteran's claims file in rendering this decision. As noted above, the Board accordingly affords this opinion with little probative weight. With respect to the opinions offered by VA examiners, however, the Board finds these opinions to be highly probative because their conclusions regarding etiology occurred following an examination of the Veteran and a review of the Veteran's claims file and pertinent medical history. Furthermore, a VHA expert reviewed the opinions of VA physicians in addition to the rest of the claims file, and he opined that the Veteran's conditions were unrelated either directly to active duty service or indirectly to the medication that the Veteran took for depression, providing a rationale for the opinion. To the extent that the Veteran himself believes that his glaucoma is related to either his military service or to his Amitriptyline medication, the Board notes that the Veteran is competent to provide testimony concerning factual matters of which he has first-hand knowledge (that is, experiencing physical symptoms associated with glaucoma). See Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). Further, under certain circumstances, lay statements may support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability, or symptoms of disability, susceptible of lay observation. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Indeed, VA provided the Veteran with examinations based on the competency of these observations. A layperson is generally not deemed competent, however, to opine on a matter that requires medical knowledge, such as the determination of etiology of a chronic disability. See Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). The Board has reviewed the Veteran's VA treatment records for any suggestion that his current glaucoma is related to his taking the medication Amitriptyline and has found none. Accordingly, with no support in the medical evidence of record that the Veteran's glaucoma is related to either his military service or to his other service-connected disabilities or treatment therefor, the Board places little probative weight on the Veteran's lay opinion regarding the etiology of his condition. The Board notes that the Veteran has offered not only his opinion regarding the possible etiology of his glaucoma, but he has also submitted a variety of secondary sources discussing the possibility of a relationship between Amitriptyline and glaucoma. Medical treatise evidence can, in some circumstances, constitute competent medical evidence. See Wallin v. West, 11 Vet. App. 509, 514 (1998); see also 38 C.F.R. § 3.159(a)(1) (2012) (noting that competent medical evidence may include statements contained in authoritative writings such as medical and scientific articles and research reports and analyses.) Medical evidence that is speculative, general, or inconclusive in nature, however, cannot support a claim. See Obert v. Brown, 5 Vet. App. 30, 33 (1993); see also Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996); Libertine v. Brown, 9 Vet. App. 521, 523 (1996). In this case, the submitted evidence does not specifically relate to the Veteran's particular case. These submissions do not analyze the relationship between the Veteran's service-connected conditions and his glaucoma, and they do not consider the relationship between the Veteran's glaucoma and conditions for which the Veteran was not service-connected. The internet research submitted by the Veteran is both inconclusive and general. As such, the Board places no weight on these submissions. The Board acknowledges that VA is statutorily required to resolve the benefit of the doubt in favor of the veteran when there is an approximate balance of positive and negative evidence regarding the merits of an outstanding issue. That doctrine, however, is not applicable in this case because the preponderance of the evidence is against the claim. See 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The preponderance of the competent and probative evidence of record indicates that the Veteran's glaucoma is not related to his military service or to any other service-connected condition. Accordingly, the third Hickson/Wallin element, competent evidence of nexus, has not been satisfied, and the claim fails on that basis. The benefit sought on appeal is accordingly denied. ORDER Service connection for glaucoma of the left eye is denied. REMAND The Veteran's claim for a TDIU must be remanded for further development. Although the Board regrets the delay, it is necessary to ensure due process is followed and that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. Beyond the ratings contemplated by the Rating Schedule, VA regulations establish objective and subjective standards for an award of a TDIU. See 38 C.F.R. § 4.16(a) (2012). If the veteran's schedular rating is less than total, a total disability rating may be assigned when the veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided, in pertinent part, that if the veteran has two or more disabilities, at least one disability is rated at 40 percent or more and additional disabilities bring the veteran's combined disability rating to 70 percent or more. See 38 C.F.R. §§ 3.340, 3.341, 4.16(a) (2012). In the instant case, the Board observes that the Veteran is in receipt of a 50 percent disability rating for depressive disorder, a 30 percent disability rating for migraine headaches, and a 10 percent disability rating for left eye injury. The Veteran's total combined disability rating is 70 percent. The Veteran has thus satisfied the above schedular requirements for a TDIU, and the remaining determination is whether the Veteran is unable to secure or follow a substantially gainful occupation as a result of such disabilities. "Substantially gainful employment" is employment that is ordinarily followed by the nondisabled to earn a livelihood, with earnings common to the particular occupation in the community where the employee resides. See VA Adjudication Manual, M-21-1MR, Part IV, sub. ii, Ch. 2, Sec. F, 24(d). This term suggests a living wage. Ferraro v. Derwinski, 1 Vet. App. 326, 332 (1991). The ability to work sporadically or to obtain marginal employment is not substantially gainful employment. See 38 C.F.R. § 4.16(a) (2012); Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). A veteran may be considered unemployable upon termination of employment that occurred because of disability, or in which special consideration was given on account of the same, when it is satisfactorily shown that the veteran is unable to secure further employment. See 38 C.F.R. § 4.18 (2012). The determination as to whether a TDIU is appropriate should not be based solely upon demonstrated difficulty in obtaining employment in one particular field, which could also potentially be due to external bases such as economic factors, but rather to all reasonably available sources of employment under the circumstances. See Ferraro v. Derwinski, 1 Vet. App. 326, 331-32 (1991). Any consideration as to whether the Veteran is unemployable is a subjective one, that is, one that is based upon the Veteran's actual level of industrial impairment, not merely the level of industrial impairment experienced by the average person. See Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Prec. Op. VA Gen. Counsel 75-91 ("Unemployability" in VA Regulations on Total Rating Compensation, Inability to Secure and Follow Substantially Gainful Employment; No Average Person Standard, 57 Fed. Reg. 2317 (1992)). Advancing age and nonservice-connected disability may not be considered in the determination of whether a veteran is entitled to a TDIU. See 38 C.F.R. § 3.341(a), 4.19 (2012). The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough. A high rating for service-connected disability, in itself, is recognition that the impairment makes it difficult to obtain and keep employment. Instead, the question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether the Veteran can find employment. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The evidence of record does not contain an examination considering the ability of the Veteran to obtain substantially gainful employment. Accordingly, the Board finds that there is insufficient medical evidence to decide the claim, and a VA examination and medical opinion is required to determine whether the Veteran's service-connected disabilities preclude substantially gainful employment. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, the case is REMANDED for the following actions: 1. Copies of updated treatment records, VA and non-VA, should be obtained and added to the claims folder. 2. Following completion of the above, schedule the Veteran for an examination to evaluate the effects of his service-connected disabilities on his ability to obtain substantially gainful employment. The examiner should offer an opinion regarding the Veteran's ability to procure and maintain gainful employment consistent with his education and occupational experience. This opinion should be offered irrespective of age and any nonservice-connected disorders. The claims file must be made available for review and the examiner's report should reflect that such review occurred. Specifically, the examiner is requested to offer an opinion as to whether the Veteran's service-connected disabilities are alone or in concert so severe as to preclude him from securing or following a substantially gainful occupation. If the Veteran's nonservice-connected disabilities preclude substantially gainful employment, such should be stated. The examiner should not base the opinion solely upon demonstrated difficulty in obtaining employment in one particular field, which could also potentially be due to external bases such as economic factors, but rather to all reasonably available sources of employment under the circumstances. Ferraro v. Derwinski, 1 Vet. App. 326, 331-32 (1991). If any of the above inquiries cannot be addressed, the examiner should provide a complete explanation as to why they cannot be addressed. The complete rationale for all opinions expressed should be provided in the examination report, to include reference to pertinent evidence where appropriate. If the examiner determines that he/she is unable to provide the requested opinion(s) without resort to speculation, he/she must provide a reasoned explanation for such conclusion, which includes appropriate references to pertinent evidence of record. 3. The Veteran is hereby notified that it is his responsibility to report for any examination, and to cooperate in the development of the claim. The consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655. 4. Then, after ensuring any other necessary development has been completed, readjudicate the Veteran's claim. If action remains adverse to the Veteran, provide the Veteran and his representative with a supplemental statement of the case and allow an appropriate opportunity to respond. Thereafter, the case should be returned to the Board. The appellant has the right to submit additional evidence and argument on the matter 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. 2012). ____________________________________________ BARBARA B. COPELAND Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs