Citation Nr: 1304809 Decision Date: 02/11/13 Archive Date: 02/21/13 DOCKET NO. 08-15 639 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUES 1. Entitlement to service connection for radial nerve damage of the right hand. 2. Entitlement to an initial disability rating in excess of 10 percent for a Haglund's deformity of the right foot. 3. Entitlement to an initial disability rating in excess of 10 percent for a Haglund's deformity of the left foot. 4. Entitlement to an initial disability rating in excess of 30 percent for depression with intermittent explosive disorder. 5. Entitlement to an initial disability rating in excess of 10 percent for a right elbow strain. 6. Entitlement to an initial disability rating in excess of 10 percent for patellofemoral syndrome of the left lower extremity. 7. Entitlement to an initial disability rating in excess of 10 percent for a lumbar strain. REPRESENTATION Appellant represented by: David L. Huffman, Attorney WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Thomas D. Jones, Counsel INTRODUCTION The Veteran served on active duty from November 1991 to February 1994, and from February 2003 to February 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from multiple rating decisions of the Huntington, West Virginia, Regional Office (RO) of the Department of Veterans Affairs (VA). In November 2012, the Veteran testified before a Veterans Law Judge seated at the RO. A written transcript of this hearing has been added to the claims file. The Veteran has also perfected his appeals of several additional issues, to include: entitlement to service connection for a psychiatric disorder, and entitlement to service connection for a right elbow disability. In an October 2010 rating decision, the Veteran was granted service connection for depression and for a right elbow strain. Because the appellant was awarded service connection for these disabilities, those specific issues are no longer on appeal before the Board. See generally Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997); Barrera v. Gober, 122 F.3d 1030 (Fed. Cir. 1997). As the Veteran has appealed the initial ratings assigned for these disabilities, however, the issues of entitlement to increased initial ratings for depression and for a right elbow strain remain on appeal. The issues of entitlement to service connection for radial nerve damage of the right hand and increased ratings for lumbosacral strain and for a patellofemoral syndrome of the left lower extremity 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. The Veteran's Haglund's deformity of the right foot results in pain and tenderness of the heel of the foot, the weight of the lay and medical evidence does not demonstrate skin breakdown, tenderness of the Achilles tendon, or other marked deformity resulting in more than moderate impairment. 2. The Veteran's Haglund's deformity of the left foot results in pain and tenderness of the heel of the foot, the weight of the lay and medical evidence does not demonstrate skin breakdown, tenderness of the Achilles tendon, or other marked deformity resulting in more than moderate impairment. 3. The Veteran's depressive disorder has been productive of such symptoms as a depressed mood, anxiety, and heightened irritability and anger resulting in occupational and social impairment characterized by reduced reliability and productivity. 4. The Veteran's right elbow strain results in right elbow flexion of 130 degrees and extension of 0 degrees, without additional musculoskeletal or neurological impairment. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial disability rating in excess of 10 percent for Haglund's deformity of the right foot have not been met. 38 U.S.C.A. §§ 1155, 5103(a), 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.20, 4.40, 4.45, 4.46, 4.71a, Diagnostic Codes 5276-84 (2012). 2. The criteria for entitlement to an initial disability rating in excess of 10 percent for Haglund's deformity of the left foot have not been met. 38 U.S.C.A. §§ 1155, 5103(a), 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.20, 4.40, 4.45, 4.46, 4.71a, Diagnostic Codes 5276-84 (2012). 3. The criteria for entitlement to an initial disability rating of 50 percent and no higher for depression with intermittent explosive disorder have been met. 38 U.S.C.A. §§ 1155 , 5103(a), 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102 , 3.159, 4.3, 4.7, 4.130, Diagnostic Code 9434 (2012). 4. The criteria for entitlement to an initial disability rating in excess of 10 percent for a right elbow strain have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.40, 4.45, 4.46, 4.71a, Diagnostic Codes 5205-13 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Assist and Notify The Veterans Claims Assistance Act of 2000 (VCAA) enhanced VA's duty to notify and assist claimants in substantiating a claim for VA benefits, as codified in pertinent part at 38 U.S.C.A. §§ 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.326(a) (2012). For the reasons to be discussed, the Board finds that VA has satisfied its duties to the appellant under the VCAA. A VCAA notice consistent with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) must (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). VCAA notice requirements apply to all five elements of a service connection claim (1) veteran status; (2) existence of disability; (3) connection between service and the disability; (4) degree of disability; and (5) effective date of benefits where a claim is granted. Dingess v. Nicholson, 19 Vet. App. 473, 484 (2006). VA has made all reasonable efforts to assist the Veteran in the development of his claims, has notified him of the information and evidence necessary to substantiate the claims, and has fully disclosed VA's duties to assist him. In February 2006, March 2006, June 2008, April 2009 and March 2011 letters, the Veteran was notified of the information and evidence needed to substantiate and complete the claims on appeal. Additionally, the March 2006 letter provided him with the general criteria for the assignment of an effective date and initial rating. Id. The Board notes that, in the present case, initial notice was issued prior to the adverse determinations on appeal; thus, no timing issue exists with regard to the notice provided the claimant. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). With regard to the initial rating issues, in cases such as this, where service connection has been granted and an initial disability rating and effective date have been assigned, the typical service connection claim has been more than substantiated, it has been proven, thereby rendering 38 U.S.C.A. § 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Dingess, 19 Vet. App. at 473; Dunlap v. Nicholson, 21 Vet. App. 112 (2007). The appellant bears the burden of demonstrating any prejudice from defective notice with respect to the downstream elements. Goodwin v. Peake, 22 Vet. App. 128 (2008). That burden has not been met in this case. The Board further finds that VA has complied with the duty to assist by aiding the appellant in obtaining evidence. It appears that all known and available records relevant to the pending appeal have been obtained and are associated with the Veteran's claims files. The RO has obtained the Veteran's service treatment records, as well as VA and non-VA medical records. He has also been afforded VA medical examinations on several occasions, to include November 2006, September 2009, and March 2012 for his feet; July 2010 and March 2012 for his psychiatric disability, and; September 2010 and March 2012 for his right elbow. The Board notes that the VA medical evidence contains sufficiently specific clinical findings and informed discussion of the pertinent history and clinical features of the disability on appeal and is adequate for purposes of this appeal. In November 2012, the Veteran was afforded the opportunity to testify before a Veterans Law Judge. During the hearing, the Veterans Law Judge clarified the issue and asked about the possibility of forgotten records. Such actions supplement the VCAA and comply with 38 C.F.R. § 3.103. The Board is not aware, and the Veteran has not suggested the existence of, any additional pertinent evidence not yet received. Based on the foregoing, the Board finds that the Veteran has not been prejudiced by any failure of VA in its duties to notify and assist him, and that any such violations could be no more than harmless error. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). In any event, the Veteran has neither alleged nor demonstrated any prejudice with regard to the content or timing of VA's notices or other development. See Shinseki v. Sanders, 129 U.S. 1696 (2009) (reversing prior case law imposing a presumption of prejudice on any notice deficiency, and clarifying that the burden of showing that an error is harmful, or prejudicial, normally falls upon the party attacking the agency's determination). Thus, adjudication of his claims at this time is warranted. Increased Ratings Disability evaluations are based upon the average impairment of earning capacity as contemplated by the schedule for rating disabilities. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2012). In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). When, however, the assignment of initial ratings is under consideration, the level of disability in all periods since the effective date of the grant of service connection must be taken into account. Fenderson v. West, 12 Vet. App. 119 (1998). In cases in which a reasonable doubt arises as to the appropriate degree of disability to be assigned, such doubt shall be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. The Board recognizes that, when considering disability ratings, the degree of impairment during the entire pendency of the appeal must be considered, to include the possibility that a staged rating may be assigned. See Fenderson v. West, 12 Vet. App. 119 (1998). As such, the Board will consider whether staged ratings are appropriate to the pending appeals. When evaluating musculoskeletal disabilities, the Board must also consider 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 under any applicable diagnostic code pertaining to limitation of motion. See DeLuca v. Brown, 8 Vet. App. 202 (1995). Where, however, a musculoskeletal disability is evaluated at the highest rating available based upon limitation of motion, further DeLuca analysis is foreclosed. Johnston v. Brown, 10 Vet. App. 80 (1997). (CONTINUED ON NEXT PAGE) Haglund's Deformity - Bilateral feet The Veteran seeks a disability rating in excess of 10 percent each for his Haglund's deformity of the right and left feet. These disorders are rated under Diagnostic Code 5099-5019. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. Diagnostic Code 5019, for bursitis, states that the affected part will be rated based on limitation of motion, as degenerative arthritis. 38 C.F.R. § 4.71a, Diagnostic Code 5019. The Board also notes that several diagnostic criteria exist for the evaluation of disabilities of the feet. See 38 C.F.R. § 4.71a, Diagnostic Codes 5276-84. Diagnostic Code 5284, for other foot injuries, provides a 10 percent rating for impairment of moderate degree, a 20 percent rating for moderately severe impairment, and a 30 percent rating for severe impairment. 38 C.F.R. § 4.71a , Diagnostic Code 5284. Upon receipt of his claim, the Veteran was afforded a November 2006 VA examination of his feet. He reported pain of his bilateral heels since approximately 1993. This disorder has worsened since then, according to the Veteran. He was currently using shoe inserts, but denied any hospitalization or surgery of the feet. He reported pain, swelling, warmth, and redness of the heels, especially with use. He denied, however, stiffness, weakness, fatigability, or lack of endurance of the feet. He could stand for 15-30 minutes, and could walk over a quarter mile, but less than a full mile before his pain became too great. Physical examination of the left foot was negative for painful motion, swelling, tenderness, instability, weakness, abnormal weight bearing, hammer toes, hallux rigidus or valgus, pes cavus, a vascular deficiency, malunion or nonunion of the tarsal or metatarsal bones, or muscle atrophy. Physical examination of the right foot was also negative for painful motion, swelling, tenderness, instability, weakness, abnormal weight bearing, hammer toes, hallux rigidus or valgus, pes cavus, a vascular deficiency, malunion or nonunion of the tarsal or metatarsal bones, or muscle atrophy. A bony enlargement of the back of the heel was observed bilaterally, however. X-rays of the feet were negative for any fractures or degenerative changes, and were essentially within normal limits. A bilateral Haglund's deformity of the heels was diagnosed. These disorders caused some impairment of the Veteran's occupation as an electrician, according to the examiner, as the Veteran was on his feet regularly, resulting in increased foot pain bilaterally. Next, the Veteran was afforded a VA medical examination of his feet in September 2009. His feet continued to result in chronic pain, especially with use. He took medication for his foot pain and used shoe inserts, but denied any surgery or hospitalizations. The Veteran reported pain, swelling, redness, weakness, fatigability, and lack of endurance for both feet. His pain was present in the posterior heel, medial aspect of the heel and ankle, and along his arch of the feet. He stated that with use, his pain worsened, requiring him to rest for 30-45 minutes. He could walk up to a quarter of a mile. Physical examination of the left foot was negative for painful motion, swelling, instability, weakness, hammer toes, hallux rigidus or valgus, pes cavus, a vascular deficiency, malunion or nonunion of the tarsal or metatarsal bones, or muscle atrophy. Physical examination of the right foot was also negative for painful motion, swelling, instability, weakness, hammer toes, hallux rigidus or valgus, pes cavus, a vascular deficiency, malunion or nonunion of the tarsal or metatarsal bones, or muscle atrophy. Both feet, however, exhibited tenderness and abnormal weight bearing, verified by the presence of callosities, as well as bony protrusions of the posterior heels. X-rays of the feet were unremarkable. Haglund's deformity bilaterally was confirmed. The Veteran was currently employed, but his bilateral foot disorders were noted to result in increased absenteeism. Most recently, the Veteran was afforded a VA medical examination in March 2012. He reported that his bilateral foot pain prevented him from walking more than a mile. His pain was in the back of the feet, the lateral aspects of the feet, and the ankle joints, left greater than right. Occasional swelling was also reported. He was not receiving regular treatment for his foot disorder. He used over-the-counter shoe inserts, which provided some relief. He was without Morton's neuroma, metatarsalgia, hammertoes, hallux valgus, hallux rigidus, pes clavus, bilateral weak foot, pes planus, or malunion or nonunion of the tarsal bones. No surgical scars were present. On direct pressure of the feet, mild pain and tenderness were reported. He was without pain of the plantar surface, arch, or plantar fascia bilaterally. He used no assistance devices. His Achilles tendons were nontender bilaterally, without evidence of tendonitis. No evidence of abnormal weightbearing was present. Imaging studies were negative for abnormal or arthritic findings. The examiner noted that the Veteran had to be on his feet a lot for work, which resulted in pain. Overall, the Veteran's bilateral foot disorder resulted in mild impairment, in the examiner's opinion. The Veteran has also received periodic VA outpatient treatment during the pendency of this appeal. He has consistently reported bilateral foot pain, worsening with use. The clinical findings have been consistent with those reported above, to include bilateral tenderness of the feet, especially over the bony prominences of heels. In January 2009, the Veteran testified at a personal hearing before a Decision Review Officer. He stated that his bilateral foot disorders have resulted in chronic pain of the feet, especially with use. He characterized his foot pain as moderate, and stated it was chiefly present in his heels. He blamed his service boots as the source of his disorder. Another personal hearing before a Decision Review Officer was afforded the Veteran in February 2012. He reported that he continued to have heel growths bilaterally which resulted in chronic foot pain. He used insoles in his shoes, but these provided only partial relief. Finally, the Veteran testified in person before a Veterans Law Judge in November 2012. He stated that his feet continued to swell and cause him pain, especially with use. He used over-the-counter inserts for his feet, but these provided only limited relief. After considering the totality of the record including the lay and medical evidence, the Board finds the preponderance of the evidence to be against the award of disability ratings in excess of 10 percent each for the Veteran's Haglund's deformity of the right and left foot. While the Board notes that the Veteran has chronic pain of his bilateral feet as the result of his Haglund's deformity, he is also able to ambulate on his own, without assistance devices such as a cane or walker. He does use shoe inserts, but has not required hospitalization or surgery for his bilateral foot disorders. He has also not displayed objective evidence of vascular changes, skin breakdown, bowing or tenderness of the Achilles tendons, or hallux rigidus or valgus. While abnormal weight bearing was observed on VA examination in 2009, no evidence of abnormal weight bearing was seen in 2012. On his most recent VA examination, the examiner characterized his level of disability as mild bilaterally. Overall, the Board finds the weight of the lay and medical evidence does not demonstrate moderately severe impairment of either foot, for which a 20 percent disability rating would be warranted for each foot under Diagnostic Code 5284. Additionally, no examiner has stated the Veteran experiences additional limitation of motion or other impairment as the result of pain, pain on use, fatigability, incoordination, or weakness, such that an increased rating would be warranted on that basis. See DeLuca, 8 Vet. App. at 202. Finally, as the Veteran has not displayed a level of impairment in excess of that noted above at any point during the pendency of this appeal, a staged rating is not warranted at the present time. See Fenderson, 12 Vet. App. at 119. The Board has also considered whether a higher evaluation is warranted under other diagnostic codes. See 38 C.F.R. § 4.20; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). The record, however, contains no supporting objective evidence of the presence of unilateral or bilateral flat foot; claw foot (pes cavus); or malunion of, or nonunion of tarsal or metatarsal bones. Thus, Diagnostic Codes 5276, 5278, and 5283 are not for consideration. See 38 C.F.R. § 4.71a , Diagnostic Codes 5276, 5278, 5283. Evaluation of the Veteran's bilateral Haglund's deformity under other diagnostic criteria of the feet would not result in disability ratings in excess of 10 percent. Entitlement to an extraschedular evaluation shall be considered below. The Board acknowledges that the Veteran, despite being a layperson, is competent to describe his observable symptomatology, such as bilateral foot pain. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). The Veteran has also submitted various lay statements from his family and friends detailing his impairment resulting from his bilateral foot disorder. The Board does not, however, find such assertions to carry more probative weight as compared to the probative clinical findings discussed above. To the extent that the Veteran and other lay parties contend the presence of a level of impairment in excess of that already compensated by his current ratings for his bilateral foot disorders, the Board finds the objective clinical findings and the medical examiners' conclusions to be more probative than the Veteran's and other lay contentions regarding the state of these disabilities. Thus, based on these clinical findings, disability ratings in excess of 10 percent are not warranted. See 38 C.F.R. §§ 4.7, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). In conclusion, the preponderance of the evidence is against disability ratings in excess of 10 percent for the Veteran's Haglund's deformity of the right and left feet. As a preponderance of the evidence is against the award of increased ratings, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). Depression The Veteran seeks a disability rating in excess of 30 percent for his service-connected depression with intermittent explosive disorder. The Veteran's depressive disorder is rated under Diagnostic Code 9434, and utilizes the General Rating Formula for Mental Disorders. Under this Code, a 30 percent disability rating is warranted where there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of an inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, and mild memory loss. A 50 percent rating is warranted where there is occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty understanding complex commands; impairment of short and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted where there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. A 100 percent evaluation for a psychiatric disability is warranted for total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9434. In evaluating psychiatric disorders, the Board is mindful that the use of the term "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve only as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). During the course of his appeal, the Veteran has been assigned various Global Assessment of Functioning (GAF) scores by VA and private examiners. The GAF is a scale reflecting the subject's psychological, social, and occupational functioning. Carpenter v. Brown, 8 Vet. App. 240 (1995). A GAF of 51-60 indicates moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (few friends, conflicts with peers or co-workers). A GAF score of 41-50 is indicative of serious symptoms (e.g., suicidal ideation, severe obsessive rituals, frequent shoplifting), or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). A GAF score of 40-31 is indicative of some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school.). See American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (4th. ed., 1994) (DSM-IV). The Veteran underwent a private psychological evaluation in May 2009, upon referral by his representative. This examination was performed by S.B.W., Ph.D., a clinical psychologist. The Veteran stated that prior to entering service, he was without psychiatric symptomatology. He described his childhood as normal, without any instances of abuse or neglect. During his second period of active duty service, the Veteran was stationed in Iraq, and spent part of his time escorting convoys within that country. He was previously married and had been divorced for the past year. He had two children. He maintained contact with his children and other family members. A few acquaintances were reported, but no real friends. He denied any recent drug or alcohol abuse. The Veteran was currently employed but described his occupation as unsatisfying. He enjoyed hunting and fishing. On objective examination, the Veteran was appropriately groomed and dressed. He was cooperative with the examiner, and made fair eye contact. His speech was of a normal flow and pace, and reflected a coherent train of thought, without disturbances of logic or bizarre thought patterns. His affect was variable, and he characterized his mood as angry and sad. On clinical testing, the Veteran was positive for depression and anxiety. His cognitive functioning was normal. His memory, both recent and remote, was intact, and both his insight and judgment were within normal limits. Other reported symptoms included feelings of hopelessness and lack of love from others, guilt, poor sleep, and low self-esteem. He was without evidence of psychotic distortions, such as hallucinations or delusions. He reported a 2005 suicide attempt involving a self-inflicted knife wound to the abdomen requiring hospital treatment. This act followed a break-up with his fiancé. He denied any subsequent attempts, but reported some suicidal thoughts. Heightened irritability was also reported. The examiner determined the Veteran was competent to manage his own self-care in all major areas of daily life. Based on her examination of the Veteran, Dr. W. diagnosed posttraumatic stress disorder (PTSD), major depressive disorder, generalized anxiety disorder, and an intermittent explosive disorder. A GAF score of 40 was assigned. The Veteran was afforded a VA psychiatric examination in July 2010. He reported that his parents divorced when he was an infant. He stated his father "liked to drink" and was verbally abusive. He was partially raised by his grandparents. He also reported shoplifting and a suicide attempt as a teenager, prior to service. Since service separation, he has been convicted of domestic violence on two occasions. A 2005 suicide attempt was also noted. He previously attended two years of college, and was a licensed electrician. He had been laid off in the past year, and was not currently employed. He remained divorced and single, and had regular contact with one of his two sons. He occasionally had contact with childhood friends and frequently saw other family members. He reported being the victim of a sexual assault perpetrated by another male shortly after service separation. He was currently living alone and taking college courses. He continued to receive occasional VA outpatient treatment for his psychiatric medications, and used medications. His prior alcohol abuse was in remission, by his report. On objective evaluation, he was clean and neat in appearance, alert and oriented, with a cooperative attitude and no psychomotor activity. His affect was blunted and his mood was anxious and dysphoric. His judgment, insight, and intelligence were all within normal limits, and he denied delusions or hallucinations. He denied panic attacks, obsessive or ritualistic behavior, or homicidal or suicidal thoughts or plans. Although he had a past history of violence, his current impulse control was good. Recent and remote memory were both good. The examiner found the Veteran competent to manage his own self-care and finances. A diagnosis of depression with intermittent explosive disorder was provided, and a GAF score of 60 was assigned. The Veteran's psychiatric disorder was not found to result in total occupational or social impairment. In an October 2010 addendum to this examination report, the VA examiner attributed the Veteran's current depressive disorder as 51 percent related to his in-service experiences in Iraq, and 49 percent related to various pre-service factors. In January 2011, the Veteran was again afforded a private psychological evaluation performed by W.C., Ph.D., a clinical psychologist, upon referral by his representative. The Veteran's reported symptoms were noted to include anxiety, depression, and loss of motivation. Other symptoms included irritability, poor concentration, and frequent arguments with others. He reported that, prior to service, he had a stable home life growing up, without any abuse or neglect. Currently, he remained single, and denied any romantic relationships. He did, however, maintain contact with some members of his extended family, and lived with his grandparents. He was currently taking college courses, and was not currently employed. He smoked cigarettes, but denied any current drug or alcohol abuse, and denied any current legal difficulties. On objective evaluation, he was alert and fully oriented, with a normal appearance and hygiene. His eye contact, responses, and cooperation with the examiner were all normal. No psychomotor abnormalities were observed. His speech was relevant and appropriate in rate and volume. He denied any hallucinations or delusions, and his thought processes were spontaneous, logical, and coherent. Cognitive functioning was also intact, and his insight and judgment were good. His memory was fully intact, and concentration was adequate. The examiner found the Veteran competent to manage his own self-care and finances. His prior 2005 suicide attempt was noted, but he denied any current suicidal or homicidal thoughts or plans. He was able to follow verbal instructions. The examiner concluded the following diagnoses were warranted: major depressive disorder, single episode, without psychotic features; generalized anxiety disorder; a pain disorder secondary to psychological factors and his general medical condition, and; intermittent explosive disorder, by history. A GAF score of 35 was assigned. Most recently, the Veteran was afforded a March 2012 VA psychiatric examination. The Veteran continued to take college courses. He also worked part time, and taught two courses for electricians at a local community college. He remained single and denied being involved in any romantic relationships. He had contact with his younger son, but not his older son, who was "locked up". He was also in regular contact with some family members. He denied any current legal difficulties, and his alcohol abuse remained in remission. He denied drug use. On objective evaluation, the Veteran was alert and fully oriented, with a neat and clean appearance. His mood was depressed and anxious. His speech was normal in rate and tone, and his thought processes were coherent. His recent and remote memory was within normal limits, and he denied panic attacks or any detachment from reality, including delusions or hallucinations. His insight, judgment, intelligence, and impulse control were also within normal limits. He reported some hypervigilance, involving regular checks of door locks and windows. The examiner found the Veteran competent to manage his own self-care and finances. A mood disorder was diagnosed, and a GAF score of 65 was assigned. The examiner noted that the Veteran's psychiatric symptoms had improved due to medication use, but such use would likely be required to continue to maintain improvement. The Veteran's occupational or social impairment was described as mild or transient. The Veteran has received VA outpatient treatment for his psychiatric symptoms for several years. He has consistently reported such symptoms as a depressed mood, overwhelming sadness, social isolation, and heightened anger and irritability. In February 2005, he was hospitalized at a VA medical center following a suicide attempt. Depression was diagnosed. Clinical notations from 2006 note a recent history of legal difficulties related to domestic violence, as well as alcohol abuse, in partial remission. He was otherwise described as calm, alert, fully oriented, and motivated for treatment. In May 2007, a GAF score of 50 was assigned. In January 2009, the Veteran testified at a personal hearing before a Decision Review Officer. He stated that he first began abusing alcohol following his service deployment in Iraq, where he had a mental breakdown and became violent toward other members of his unit. Another personal hearing before a Decision Review Officer was afforded the Veteran in February 2012. He testified that his social interaction was chiefly limited to his immediate family. He was currently a full-time student. Finally, the Veteran testified in person before a Veterans Law Judge in November 2012. He reported that subsequent to his service in Iraq, he has experienced a depressed mood, poor motivation, anxiety, and difficulty managing his temper. He described himself as socially isolated, and reported some memory difficulties. The Veteran has also submitted lay statements from friends and family, to include his ex-wife. These parties have stated the Veteran has exhibited chronic anxiety, depression, and irritability since his return from service in Iraq. The Veteran's ex-wife also stated that following his return from service, he displayed heightened anger and irritability, culminating in a physical assault upon her, with substantial facial injuries. After considering the totality of the record including the lay and medical evidence, the Board finds the evidence sufficient to support an increased initial rating, to 50 percent, for his depression with intermittent explosive disorder. The Veteran has consistently reported such symptoms as a lack of motivation, a depressed mood, and a loss of interest in social and recreational activities. The Board also observes that he had a suicide attempt in 2005, and was twice convicted of domestic abuse following physical assaults on his wife. In light of 38 C.F.R. §§ 4.3 and 4.7, the Board finds that an increased initial rating, to 50 percent and no higher, is warranted for his service-connected depression. The Board also concludes, however, that a preponderance of the evidence of record, including the various VA and private examination reports and VA outpatient treatment records, is against the award of a higher rating of 70 percent or higher for the Veteran's depression. According to the evidence for this period, although the Veteran had one suicide attempt in 2005, he has more recently denied any such intent to harm himself or to harm others. He has also denied obsessional rituals which interfered with routine activities. His speech was also not intermittently illogical, obscure, or irrelevant; at all times of record during this period, he was been able to converse with others in a clear, coherent manner. Though he has exhibited a depressed mood, he did not exhibit near-continuous panic or depression affecting his ability to function independently, appropriately and effectively, as all examiners of record have found him able to maintain his personal hygiene, finances, and household without assistance. Subsequent to his arrests for domestic violence, he has not displayed impaired impulse control, such as unprovoked irritability with periods of violence, and he has denied any recent legal difficulties. All VA and private examination reports indicate he had been fully alert and oriented at all times of record, and he was employed for several years until he was laid off. Thereafter, he has attended college classes and even served as a college instructor. His GAF scores have also generally been in the moderate range during this period. Thus, the Board concludes a disability rating in excess of 50 percent is not warranted. In so deciding, the Board is aware of the private May 2009 and January 2011 examination reports which found, among other conclusions, that GAF scores of 40 and 35, respectively, were warranted, indicative of some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school.). See American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (4th. ed., 1994) (DSM-IV). The Board does not find, however, that these GAF scores are consistent with either the other evidence of record, to include the examiners' observations within the May 2009 and January 2011 examination reports themselves. For example, both private examiners have found the Veteran to be alert and fully oriented, without hallucinations, delusions, or other signs of psychotic thinking. Additionally, his memory was described by both as intact, and he was able to converse in a normal, coherent manner. While the Veteran had in the past attempted suicide in 2005, he was noted to have had no further attempts since that time, and had managed to control his anger sufficient to avoid any further legal difficulties following his domestic violence convictions. Finally, these private examiners, like all examiners of record, determined the Veteran was competent and able to manage his own personal care and finances. Thus, the Board does finds that these private examination reports and GAF scores do not, in light of all evidence of record, warrant a 70 percent or higher rating for the Veteran's depression with intermittent explosive disorder, and the preponderance of the evidence remains against such an award. Additionally, as the Veteran has not displayed a level of impairment in excess of that currently displayed at any time during the appeals period, a staged rating is also not warranted. See Fenderson, 12 Vet. App. at 119. The Board acknowledges that the Veteran, despite being a layperson, is competent to describe his observable symptomatology, such as a depressed mood and irritability. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). The Veteran has also submitted various lay statements from his family and friends detailing his impairment resulting from his depression and intermittent explosive disorder. The Board does not, however, find such assertions to carry more probative weight as compared to the various clinical findings discussed above. To the extent that the Veteran and other lay parties contend the presence of a level of impairment in excess of that already compensated by his current rating for his depressive disorder, the Board finds the objective clinical findings and the medical examiners' conclusions to be more probative than the Veteran's contentions regarding the state of his psychiatric disability. Thus, based on these clinical findings, a disability rating in excess of 50 percent is not warranted. See 38 C.F.R. §§ 4.7, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). Right Elbow Strain The Veteran seeks an initial rating in excess of 10 percent for his right elbow strain. This disorder is currently rated under Diagnostic Code 5024, for tenosynovitis. This code in turn makes reference to Diagnostic Code 5003, for degenerative arthritis. Diagnostic Code 5003 states that degenerative arthritis established by X-ray findings will be rated based on limitation of motion of the affected joint, with a minimum 10 percent evaluation for limitation of motion of a major joint. Limitation of motion of the elbow is rated under various diagnostic codes. Normal ranges of motion of the elbow and forearm are 0 degrees to 145 degrees in elbow flexion. See 38 C.F.R. § 4.71, Plate I. As the Veteran is right handed, the disability ratings for the major extremity will be used. Under Diagnostic Code 5206, flexion of the major forearm limited to 110 degrees is rated as 0 percent disabling; flexion limited to 100 degrees is rated 10 percent; flexion limited to 90 degrees is rated 20 percent; flexion limited to 70 degrees is rated 30 percent; flexion limited to 55 degrees is rated 40 percent; and flexion limited to 45 degrees is rated 50 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5206. Diagnostic Code 5207 provides that extension of the major forearm limited to 45 degrees is rated 10 percent; extension limited to 60 degrees is also rated 10 percent; extension limited to 75 degrees is rated 20 percent; extension limited to 90 degrees is rated 30 percent; extension limited to 100 degrees is rated 40 percent; and extension limited to 110 degrees is rated 50 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5207. Diagnostic Code 5208 provides that major forearm flexion limited to 100 degrees with forearm extension limited to 45 degrees is rated 20 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5208. In September 2010, the Veteran was afforded a VA medical examination of his right elbow. He stated he initially injured his right elbow while playing football during service. Since that time, he has experienced chronic right elbow pain of varying intensity, from 4-8/10. He uses Motrin when his pain is at its worst. Other reported symptoms included stiffness in the morning and with use, some giving way of the joint, limitation of motion, and loss of strength. His right elbow was otherwise without deformity, instability, weakness, incoordination, dislocation or subluxation, effusion, or inflammation. On objective evaluation, the elbow was tender medially over the margin of the olecranon fossa and in the space between the medial epicondyle and the olecranon fossa. Range of motion testing of the right elbow indicated flexion to 136 degrees, extension to 0 degrees, pronation to 46 degrees, and supination to 85 degrees. He exhibited no additional limitation of motion with repetitive use, or due to such factors as pain, pain with use, incoordination, weakness, or fatigability. X-rays of the right elbow were within normal limits, without indications of fracture, dislocation, or other abnormality in the right elbow joint. The final diagnosis was of a right elbow strain. As noted above, the Veteran was afforded a March 2011 VA neurological examination of the right upper extremity. As this examination has already been described in detail within this Board decision, a summary of the examination report need not be repeated here. Most recently, the Veteran was afforded a VA examination of his right elbow in March 2012. He reported chronic shooting pain of the right elbow, traveling down his right forearm to his wrist and hand. His pain worsened with use. He also reported loss of strength of the right hand. He reported some stiffness of the right elbow, but denied any swelling. He took over-the-counter medication and put ice on his elbow as needed. No surgeries or hospitalizations due to his elbow disorder were noted. Range of motion testing indicated flexion to 130 degrees and extension to 0 degrees. No objective evidence of painful motion was noted. His range of motion did not decrease with repetitive motion, or due to such factors as pain, pain with use, incoordination, weakness, or fatigability. Strength was 5/5 at the right elbow with both flexion and extension. No ankylosis, joint fracture, flail joint, or impairment of supination or pronation was evident. X-rays of the right elbow were negative for any degenerative changes. A right elbow strain was confirmed. The examiner noted that the Veteran's right elbow disorder was aggravated by his use of tools while at work. At a January 2009 Decision Review Officer hearing at the RO, the Veteran testified that he has experienced right elbow pain since service, but was not actively seeking treatment for it at the time. The Veteran made similar assertions at his February 2012 Decision Review Officer hearing. He also reported loss of strength, pain, and numbness in his right upper extremity. In November 2012, the Veteran testified before a Veterans Law Judge seated at the RO. He stated his right elbow strain results in a loss of strength of the right upper extremity, and was further aggravated by use of his right hand and forearm. His prior occupations included work as an electrician and a welder, and his prolonged use of hand tools caused pain and numbness of his right hand and forearm. The Veteran has also received VA outpatient treatment during the pendency of this appeal. While his VA clinical records confirm his reports of chronic right elbow pain, they do not contain clinical findings markedly different from those already noted above. After considering the totality of the record including the lay and medical evidence, the Board finds the preponderance of the evidence to be against the award of a disability rating in excess of 10 percent for the Veteran's service-connected right elbow strain. According to the examination reports the Veteran does not have right elbow flexion limited to 90 degrees or less, or extension limited to 75 degrees or greater, as would support a disability rating in excess of 10 percent. Additionally, he does not exhibit flexion limited to 100 degrees with forearm extension limited to 45 degrees, as would warrant a 20 percent disability rating under Diagnostic Code 5208. Additionally, no examiner has stated the Veteran experiences additional limitation of motion with repetitive use, or due to such factors as pain, pain with use, incoordination, weakness, or fatigability. Thus, an increased initial rating on this basis is not warranted. See DeLuca, 8 Vet. App. at 202. Finally, as the Veteran has not exhibited a level of impairment during the pendency of this appeal in excess of that currently displayed, a staged rating is not warranted at the current time. See Fenderson, 12 Vet. App. at 119. Evaluation of the Veteran's right elbow disability under other diagnostic criteria for the right elbow is also not warranted based on the objective evidence of record. He does not display ankylosis of the right elbow or impairment of the ulna or radius. While pronation of the right forearm was only to 46 degrees in September 2010, he displayed pronation to 80 degrees in March 2011. According to the March 2011 VA examination report and EMG study, the Veteran's right elbow strain also does not result in any neurological impairment of the right upper extremity. Overall, the Board does not find an objective basis for a disability rating in excess of 10 percent for the Veteran's right elbow strain under other diagnostic criteria for the elbow joint. See 38 C.F.R. § 4.71a, Diagnostic Codes 5205-13. The Board acknowledges that the Veteran, despite being a layperson, is competent to describe his observable symptomatology, such as chronic right elbow pain. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). The Board does not, however, find such assertions to carry more probative weight as compared to the various clinical findings discussed above. To the extent that the Veteran and other lay parties contend the presence of a level of impairment in excess of that already compensated by his current rating for his right elbow strain, the Board finds the objective clinical findings and the medical examiners' conclusions to be more probative than the Veteran's contentions regarding the state of this disability. Thus, based on these clinical findings, a disability rating in excess of 10 percent is not warranted. See 38 C.F.R. §§ 4.7, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). In conclusion, the preponderance of the evidence is against a disability rating in excess of 10 percent for the Veteran's right elbow strain. As a preponderance of the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). Extraschedular consideration Consideration has also been given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the Veteran. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009) (claim for an increased rating includes consideration of whether a total disability rating by reason of individual unemployability is warranted under the provisions of 38 C.F.R. § 4.16). Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. To accord justice in an exceptional case where the schedular standards are found to be inadequate, the RO is authorized to refer the case to the Chief Benefits Director or the Director, Compensation and Pension Service for assignment of an extraschedular evaluation commensurate with the average earning capacity impairment. 38 C.F.R. § 3.321(b)(1). The criterion for such an award is a finding that the case presents an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical application of regular schedular standards. Id. The Court has held that the Board is precluded by regulation from assigning an extraschedular rating under 38 C.F.R. § 3.321(b)(1) in the first instance; however, the Board is not precluded from raising this question, and in fact is obligated to liberally read all documents and oral testimony of record and identify all potential theories of entitlement to a benefit under the law and regulations. Floyd v. Brown, 9 Vet. App. 88 (1996). The Court further held that the Board must address referral under 38 C.F.R. §3.321(b)(1) only where circumstances are presented which the Director of VA's Compensation and Pension Service might consider exceptional or unusual. Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). In Thun v. Peake, 22 Vet. App. 111 (2008), the Court clarified the analytical steps necessary to determine whether referral for extraschedular consideration is warranted. Either the RO or the Board must first determine whether the schedular rating criteria reasonably describe the Veteran's disability level and symptomatology. Id. at 115. If the schedular rating criteria do reasonably describe the Veteran's disability level and symptomatology, the assigned schedular evaluation is adequate, referral for extraschedular consideration is not required, and the analysis stops. If the RO or the Board finds that the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology, then either the RO or the Board must determine whether the Veteran's exceptional disability picture includes other related factors such as marked interference with employment and frequent periods of hospitalization. Id. at 116. If this is the case, then the RO or the Board must refer the matter to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for the third step of the analysis, determining whether justice requires assignment of an extraschedular rating. Id. In this case, the symptoms described by the Veteran fit appropriately with the criteria found in the relevant Diagnostic Codes for the disabilities at issue. Specifically, the symptomatology and impairment caused by the Veteran's bilateral foot disorders, depression, and right elbow strain are specifically contemplated by the pertinent schedular rating criteria, and no referral for extraschedular consideration is required. The schedular rating criteria specifically provide for disability ratings based on a combination of the symptoms claimed by the Veteran and clinical findings and other objective evidence of record. In this case, the Veteran has reported pain and tenderness of his feet resulting from his bilateral foot disorder, a depressed mood, anxiety, and heightened anger and irritability resulting from his depressive disorder, and some pain and limitation of motion resulting from his right elbow strain These symptoms are part of or similar to symptoms listed under the pertinent schedular rating criteria. For these reasons, the Board finds that the schedular rating criteria are adequate to rate the disabilities on appeal, and referral for consideration of an extraschedular evaluation is not warranted. ORDER Entitlement to an initial disability rating in excess of 10 percent for a Haglund's deformity of the right foot is denied. Entitlement to an initial disability rating in excess of 10 percent for a Haglund's deformity of the left foot is denied. Entitlement to an initial disability rating of 50 percent and no higher for depression with intermittent explosive disorder is granted. Entitlement to an initial disability rating in excess of 10 percent for a right elbow strain is denied. REMAND In an April 2012 rating decision, the Veteran was awarded service connection for patellofemoral syndrome of the left lower extremity, and for a lumbar strain. Initial ratings of 10 percent were granted for these service-connected disabilities. The Veteran responded by filing a July 2012 notice of disagreement regarding these initial rating determinations. To date, it does not appear the Veteran has been afforded a statement of the case regarding these issues, as a statement of the case does not appear within either the claims file or VA's electronic claims processing system, Virtual VA. In such situations, a remand requesting the agency of original jurisdiction (AOJ) issue a statement of the case on these issues is necessary. 38 C.F.R. § 19.26; Manlincon v. West, 12 Vet. App. 238 (1999). With regard to the claim of service connection for radial nerve damage of the right hand, an additional VA examination and opinion are necessary. The March 2011 VA examiner, after reviewing the Veteran's claims file and performing a contemporaneous examination, rendered an impression of paresthesia of the right hand, of unknown etiology. The examiner stated that the Veteran's paresthesia of the right hand was not caused by his service-connected right elbow strain. The examination report indicates that the examiner was not asked to address whether the claimed right hand disorder is aggravated by the service-connected right elbow strain. Service connection is also permitted for the degree of disability resulting from aggravation of a nonservice-connected disability by a service-connected disability. See 38 C.F.R. § 3.310(b) ; Allen v. Brown , 7 Vet. App. 439, 448 (1995). An additional VA medical opinion is necessary. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); see also Stefl v. Nicholson, 21 Vet. App 120 (2007). The RO should arrange for the Veteran's claims file to be reviewed by the examiner who conducted the March 2011 VA examination (or a suitable substitute if that VA examiner is unavailable) for the purpose of preparing an addendum. Accordingly, the case is REMANDED for the following action: 1. Furnish the Veteran's entire claims file to the VA examiner who conducted the March 2011 VA examination (or a suitable substitute if that VA physician is unavailable). The examiner must review of all pertinent evidence of record and prepare an addendum opinion as to whether it is at least as likely as not (50 percent probability or more) that current right hand disorder, claimed as radial nerve damage to the right hand, is proximately due to or aggravated by the service-connected right elbow disorder. If the examiner finds that the right hand disorder is aggravated by the service-connected right elbow disorder, he/she should indicate the degree of disability before aggravation and the current degree of disability. If the examiner finds that the right hand disorder is not proximately due to or aggravated by the service-connected right elbow disorder, he/she must explicitly state so. The examiner must provide a full explanation for all opinions rendered, and include notation of the facts, medical evidence, and/or medical principles used to reach such conclusions. If the examiner cannot provide the requested information without resort to speculation, it must be so stated with reasons why, and if an additional clinical evaluation is necessary to render the requested information, then that opportunity should be made available. 2. After completion of the above development, the claim for service connection for radial nerve damage of the right hand should be readjudicated. If the benefit sought on appeal is not granted, the Veteran and his representative should be furnished with a Supplemental Statement of the Case (SSOC), and should be afforded an opportunity to respond before the file is returned to the Board for further appellate consideration. 3. Provide the Veteran with a statement of the case on the issues of entitlement to increased initial ratings for patellofemoral syndrome and for a lumbar strain. The Veteran and his representative should be clearly advised of the need to file a timely substantive appeal if the Veteran wishes to complete an appeal on these issues. The issues should only be returned to the Board for appellate consideration of these issues if a timely substantive appeal is filed. 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. 2012). ______________________________________________ K. J. ALIBRANDO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs