Citation Nr: 1305861 Decision Date: 02/20/13 Archive Date: 02/27/13 DOCKET NO. 06-25 886 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUES 1. Entitlement to an effective date earlier than February 5, 2005, for entitlement to a total disability rating based on individual unemployability (TDIU). 2. Entitlement to an effective date earlier than February 5, 2005, for the grant of eligibility for Dependents' Educational Assistance (DEA) under 38 U.S.C. Chapter 35. 3. Entitlement to an effective date earlier than January 9, 2012, for the grant of service connection for radiculopathy, left lower extremity. 4. Entitlement to an effective date earlier than January 9, 2012, for the grant of service connection for radiculopathy, right lower extremity. 5. Entitlement to a rating in excess of 10 percent for radiculopathy, left lower extremity. 6. Entitlement to a rating in excess of 10 percent for radiculopathy, right lower extremity. 7. Entitlement to a rating in excess of 10 percent for psoriatic arthritis, right hand, to include entitlement to a compensable rating prior to November 15, 2002. 8. Entitlement to a rating in excess of 10 percent for psoriatic arthritis, left hand, to include entitlement to a compensable rating prior to November 15, 2002. 9. Entitlement to service connection for psoriatic arthritis of the bilateral hips as secondary to the service-connected psoriatic arthritis. 10. Entitlement to service connection for chronic costochondritis/Tietze disease of the thoracic rib cage as secondary to the service-connected psoriasis (claimed as skin condition). 11. Entitlement to service connection for bilateral carpal tunnel syndrome (CTS) as secondary to the service-connected disability of psoriatic arthritis, left and right wrist. 12. Entitlement to service connection for cicatricial neuromacutis (also claimed as headaches). 13. Whether new and material evidence has been submitted to reopen a claim for service connection for posttraumatic stress disorder (PTSD) due to sexual trauma (also claimed as PTSD to include all traumatically induced psychiatric conditions). 14. Entitlement to service connection for PTSD due to sexual trauma or any other diagnosed psychiatric disorders as secondary to service, whether due to sexual trauma or otherwise, or as secondary to service-connected disability. (The issue of whether the denial of the Montgomery GI Bill delimiting date (the date benefits expire) extension request was proper is issued today under a separate docket number.) REPRESENTATION Appellant represented by: Darla J. Lilley, Esq. ATTORNEY FOR THE BOARD Michael J. Skaltsounis, Senior Counsel INTRODUCTION The Veteran had active service from June 1991 to August 1998. These matters come before the Board of Veterans' Appeals (Board) on appeal from January 2005, June 2005, May 2006, September 2010, April 2012, and June 2012 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. In April 2009, the Board denied claims for entitlement to earlier effective dates for the grant of service connection for psoriatic arthritis of the right shoulder, left shoulder, right wrist, left wrist, right ankle and left ankle, and remanded claims for increased ratings for psoriasis, right and left hand psoriasis, degenerative disc disease, T12 with disc bulge at L4-5, psoriatic thoracic and lumbar spondyloarthropathy, and entitlement to a TDIU. The Veteran appealed the Board's April 2009 decision to the United States Court of Appeals for Veterans Claims (Court), and in December 2010, the Court vacated the Board's April 2009 decision and remanded the matter to the Board for action consistent with the December 2010 decision. Thereafter, in a June 2011 decision, the Board denied entitlement to earlier effective dates for the grant of service connection for psoriatic arthritis of the right shoulder, left shoulder, right wrist, left wrist, right ankle, and left ankle, and entitlement to increased ratings for psoriasis and degenerative disc disease, T12, with disc bulge at L4-5, psoriatic thoracic and lumbar spondyloarthropathy. The issues of entitlement to increased ratings for psoriatic arthritis of the right and left hands and entitlement to TDIU were remanded to the RO, and the RO subsequently granted TDIU, effective February 5, 2005. The Veteran has now perfected an appeal of the effective date assigned for TDIU, and continued his appeal with respect to entitlement to compensable ratings for psoriatic arthritis of the right and left hands. The Veteran has also now additionally perfected appeals with respect to the September 2010 rating decision's denial of his claims for service connection for psoriatic arthritis of the bilateral hips, chronic costochondritis/Tietze disease of the thoracic rib cage, bilateral CTS, cicatricial neuromacutis (also claimed as headaches), whether new and material evidence has been submitted to reopen a claim for service connection for PTSD due to sexual trauma, and the April 2012 rating decision's assignment of February 5, 2005, as the effective date for eligibility for DEA benefits and January 9, 2012, as the effective date for the grant of service connection for radiculopathy, left and right lower extremity, and the noncompensable ratings assigned for these disabilities. A June 2012 rating decision increased the ratings for the Veteran's left and lower extremity disabilities to 10 percent, and he has continued his appeal as to these claims. In July 2012, he withdrew the issues of whether the RO's decision to grant service connection for psoriatic arthritis of the hands, effective from August 8, 1998, was clearly and unmistakably erroneous. Although the Board has determined that new and material evidence has been submitted to reopen the claim for service connection for PTSD due to sexual trauma, it has further determined that remand is now required for procedural considerations. Based on the holding in the case of Clemons v. Shinseki, 23 Vet. App. 1 (2009), the Board further finds that the claim for service connection should now be recharacterized to include any other diagnosed psychiatric disorders as secondary to service, whether due to sexual trauma or otherwise, or as secondary to service-connected disability, and has additionally set forth this issue on the title pages of this decision. The issue of entitlement to service connection for hyperacusis has been raised by the record, but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it and it is referred to the AOJ for appropriate action. The issue of entitlement to service connection for cicatricial neuromacutis (also claimed as headaches) and PTSD and any other psychiatric disorders as secondary to service, whether due to sexual trauma or otherwise, or as secondary to service-connected disability is addressed in the REMAND portion of the decision below and is REMANDED to the Department of Veterans Affairs Regional Office. FINDINGS OF FACT 1. The Veteran initially filed a claim for TDIU on July 26, 1999. A July 2000 rating decision denied entitlement because he did not meet the threshold schedular requirements and there was no basis to submit the matter for extraschedular consideration. He filed a notice of disagreement with the decision but did not perfect the appeal and it became final. 2. The Veteran again filed a claim for TDIU on February 27, 2004, but since he was not removed from his full time employment until February 4, 2005, TDIU was granted effective the day after his removal, February 5, 2005. 3. The Veteran's entitlement to DEA benefits was based on his entitlement to TDIU. 4. Since the effective date of entitlement to TDIU benefits is February 5, 2005, this is also the earliest effective date for entitlement to DEA benefits. 5. Subsequent to the filing of the claim for TDIU, left and right lower extremity radiculopathy was not diagnosed until January 9. 2012. Entitlement to service connection for left and right lower extremity radiculopathy therefore arose on that date. 6. During the entire period relevant on appeal, left lower extremity radiculopathy has not been manifested by more than mild incomplete paralysis of the sciatic nerve. 7. During the entire period relevant on appeal, right lower extremity radiculopathy has not been manifested by more than mild incomplete paralysis of the sciatic nerve. 8. During the entire period relevant on appeal, psoriatic arthritis of the right hand has not been manifested by more than noncompensable limitation of motion with pain. 9. During the entire period relevant on appeal, psoriatic arthritis of the left hand has not been manifested by more than noncompensable limitation of motion with pain. 10. There is no current diagnosis of psoriatic arthritis of the bilateral hips that has been related to service or as secondary to the service-connected psoriatic arthritis. 11. There is no current diagnosis of chronic costochondritis/Tietze disease of the thoracic rib cage that has been related to service or as secondary to the service-connected psoriasis (claimed as skin condition). 12. There is no current diagnosis of bilateral CTS that has been related to service or as secondary to the service-connected disability of psoriatic arthritis, left and right wrist. 13. A claim for service connection for PTSD due to sexual trauma was denied by a rating decision in July 2000 that was not appealed. 14. The evidence submitted since the July 2000 rating decision pertinent to the claim for service connection for PTSD due to sexual assault is new and relates to an unestablished fact necessary to substantiate the claim for service connection for PTSD due to sexual assault, is neither cumulative nor redundant of the evidence of record in July 2000, and otherwise raises a reasonable possibility of substantiating the claim. CONCLUSIONS OF LAW 1. Prior to February 5, 2005, the criteria for an award of TDIU were not satisfied. 38 U.S.C.A. § 5110 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.340, 3.400, 4.15, 4.16 (2012). 2. Prior to February 5, 2005, the criteria for eligibility to DEA benefits were not satisfied. 38 U.S.C.A. §§ 3500, 3501, 5110 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.340, 3.400, 3.807 (2012). 3. Prior to January 9, 2012, the criteria for the grant of service connection for left lower extremity radiculopathy were not met. 38 U.S.C.A. § 5110 (West 2002 & Supp. 2011); 38 C.F.R. § 3.400 (2012). 4. Prior to January 9, 2012, the criteria for the grant of service connection for right lower extremity radiculopathy were not met. 38 U.S.C.A. § 5110 (West 2002 & Supp. 2011); 38 C.F.R. § 3.400 (2012). 5. The criteria for a rating in excess of 10 percent for left lower extremity radiculopathy have not been met. 38 U.S.C.A. § 1155, 5107 (West 2002); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.124a, Diagnostic Code (DC) 8520 (2012). 6. The criteria for a rating in excess of 10 percent for right lower extremity radiculopathy have not been met. 38 U.S.C.A. §§ 1155, 5103(a), 5103A, 5107 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.124a, Diagnostic Code (DC) 8520 (2012). 7. The criteria for a rating in excess of 10 percent for psoriatic arthritis of the right hand, to include a compensable rating prior to November 15, 2002, have not been met. 38 U.S.C.A. §§ 1155, 5103(a), 5103A, 5107 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.71a, DCs 5003, 5228 (2012). 8. The criteria for a rating in excess of 10 percent for psoriatic arthritis of the left hand, to include a compensable rating prior to November 15, 2002, have not been met. 38 U.S.C.A. §§ 1155, 5103(a), 5103A, 5107 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.71a, DCs 5003, 5228 (2012). 9. Psoriatic arthritis of the bilateral hips was not incurred in service or as secondary to service-connected disability. 38 U.S.C.A. §§ 1131, 5103(a), 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2012). 10. Chronic costochondritis/Tietze disease of the thoracic rib cage was not incurred in service or as secondary to service-connected disability. 38 U.S.C.A. §§ 1131, 5103(a), 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2012). 11. Bilateral CTS was not incurred in service or as secondary to service-connected disability. 38 U.S.C.A. §§ 1131, 5103(a), 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2012). 12. The July 2000 rating decision that denied the Veteran's claim for service connection for PTSD due to sexual trauma is final. 38 U.S.C.A. § 7105(c) (West 2002); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2012). 13. New and material evidence has been submitted to reopen the claim for service connection for PTSD due to sexual trauma, and the claim is reopened. 38 U.S.C.A. §§ 5103, 5103A, 5107, 5108, 7105 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.159, 3.156 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board has reviewed all of the evidence in the Veteran's claims folder. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claims. Earlier Effective Date Claims According to applicable law and regulation, except as otherwise provided, the effective date of an award of compensation based upon an original claim will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C.A. § 5110(a); 38 C.F.R. § 3.400. The date of entitlement to an award of service connection will be the day following separation from active service or the date entitlement arose if the claim is received within one year after separation from service; otherwise, it will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2)(i). The general rule for claims for increase is that the award is effective the date of receipt of claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(o)(1). A TDIU claim is a claim for increased compensation, and the effective date rules for increased compensation apply to a TDIU claim. Hurd v. West, 13 Vet. App. 449 (2000). A TDIU may be assigned when service-connected disabilities result in such impairment of mind or body that the average person would be precluded from following a substantially gainful occupation. 38 C.F.R. §§ 3.340, 4.15. If there is only one service-connected disability, it must be rated at 60 percent or more; if there are two or more service-connected disabilities, at least one must be rated at 40 percent or more and the combined rating must be at least 70 percent. 38 C.F.R. § 4.16(a). In evaluating a veteran's employability, consideration may be given to his or her level of education, special training, and previous work experience in arriving at a conclusion, but not to his or her age or to impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19 (2012). The Veteran initially filed a claim for TDIU on July 26, 1999. A July 2000 rating decision denied entitlement because he did not meet the threshold schedular requirements and there was no basis to submit the matter for extraschedular consideration. He filed a notice of disagreement with the decision but did not perfect the appeal and it became final. The Veteran again filed a claim for TDIU on February 27, 2004, but since he was not removed from his full time employment until February 4, 2005, TDIU was granted effective the day after his removal, February 5, 2005. The Board finds that notwithstanding the fact that he met the schedular requirements for TDIU as of January 12, 2004 (rating decision of April 2012), he was not precluded from substantial gainful activity until February 5, 2005. Consequently, this is the earliest date entitlement to TDIU can be assigned. See 38 C.F.R. § 3.400(o)(1). The Veteran's entitlement to DEA benefits was predicated on his entitlement to TDIU. Since the effective date for such benefits was directly related to a finding that he had a total disability permanent in nature, by virtue of his TDIU rating, February 5, 2005, is the earliest date on which he could establish eligibility for Chapter 35, DEA benefits. Accordingly, entitlement to an earlier effective date for such benefits is also denied. Similarly, with respect to the issue of entitlement to an effective date earlier than January 9, 2012, for the grant of service connection for left and right lower extremity radiculopathy, the Board notes that such entitlement was also predicated on the February 2004 claim for TDIU, since the subsequent examination of the back that revealed relevant diagnoses was associated with further development arising out of the TDIU claim. However, as was the case with TDIU, entitlement based on left and right lower extremity radiculopathy did not arise until the diagnosis of these disabilities pursuant to examination on January 9, 2012. More specifically, VA treatment records from March 2005 reflect that the Veteran underwent electromyography (EMG) at this time but that the examiner was unable to rule out radiculopathy or diagnose such disability because the Veteran was unable to tolerate the needle. Subsequent records also show complaints of back pain radiating into the legs, and there were assessments of back pain with radicular symptoms. However, the records do not reflect a diagnosis of radiculopathy affecting either extremity until the VA back examination on January 9, 2012. Thus, the earliest effective date for the grant of service connection for these disorders would be January 9, 2012. See 38 C.F.R. § 3.400(o)(1). Increased Rating Claims Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1 (2012). Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2012). However, the Board has been directed to consider only those factors contained wholly in the rating criteria. See Massey v. Brown, 7 Vet. App. 204, 208 (1994); but see Mauerhan v. Principi, 16 Vet. App. 436 (2002) (finding it appropriate to consider factors outside the specific rating criteria in determining level of occupational and social impairment). Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the veteran. 38 C.F.R. § 4.3 (2012). While a veteran's entire history is reviewed when assigning a disability evaluation, where service connection has already been established and an increase in the rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). In determining the present level of a disability for any increased evaluation claim, the Board must consider the application of staged ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In other words, where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings would be necessary. Increased Ratings for Left and Right Lower Extremity Radiculopathy The Veteran's left S1 lumbar radiculopathy is rated under DC 8520 (for impairment of the sciatic nerve). 38 C.F.R. § 4.124a. Incomplete paralysis of the sciatic nerve warrants a 10 percent rating when mild, a 20 percent rating when moderate, a 40 percent rating when moderately severe, and a 60 percent rating when severe, with marked muscular atrophy. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124. The Board observes that the words "slight," "moderate," and "severe" are not defined in the Rating Schedule. Rather than applying a mechanical formula the Board must evaluate all of the evidence to the degree that its decisions are "equitable and just." 38 C.F.R. § 4.6. It should also be noted that use of descriptive terminology such as "mild" by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in order to arrive at a decision regarding an increased rating. 38 U.S.C.A. § 7104; 38 C.F.R. §§ 4.2, 4.6. After careful review of the evidence, and with consideration of the benefit of the doubt doctrine, the Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for both the Veteran's left and right lower radiculopathy. Specifically, VA examination in January 2012 revealed that the Veteran complained of pain that began in his buttocks and that radiated down the sides of both legs to the outside of the toes. Physical examination of both extremities revealed normal motor strength without atrophy, normal deep tendon reflexes, and normal sensory findings. However, the examiner did find that the Veteran experienced radiating pain bilaterally, which he found to be moderate in degree. The examiner also determined that the Veteran's service-connected thoracic and lumbar spine disorders rendered the Veteran unemployable for heavy duty employment but not sedentary employment. A July 2012 rating decision granted service connection for left and right lower extremity radiculopathy (as neurological symptoms of the service-connected back disability pursuant to an examination conducted in connection with the Veteran's TDIU claim), each rated 10 percent disabling, effective January 9, 2012. As was noted by the RO, despite the lack of objective clinical findings with respect to reflexes, motor function, and sensory evaluation, the January 2012 examiner found moderate radiculopathy, apparently based on the Veteran's subjective complaints of pain and the diagnostic findings the examiner considered consistent with such complaints. Thus, the Board cannot conclude that lower extremity radiculopathy more nearly approximates greater than slight impairment, warranting no more than a 10 percent ratings under DC 8520. While the Veteran has been shown to exhibit some neurological impairment of his lower extremities, this has not been supported by even sensory impairment at the time of his examination. Accordingly, a preponderance of the evidence is found to be against a finding of a rating in excess of 10 percent for either lower extremity. Increased Ratings for Right and Left Hand Psoriatic Arthritis These disabilities were initially granted service connection by a January 2005 rating decision and assigned 10 percent ratings under DC 5228, effective from January 12, 2004. In a May 2006 rating decision, the RO assigned an earlier effective date of August 8, 1998 (the day after the Veteran's separation from service) for a noncompensable rating for these disorders, and 10 percent ratings from November 15, 2002. He has continued his appeal. VA examination in February 1999 revealed complaints of pain to various joints. Examination of range of motion of various joints, including the wrists, revealed full motion and X-rays were negative for arthritis. On the other hand, November 2002 VA outpatient records note some reduced range of motion in the wrist and that the Veteran was unable to make a fist totally. Further examination in December 2002 revealed mild discomfort in the hands mild tenderness in the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints bilaterally in scattered distribution. There was also trace swelling at scattered PIP joints on the right. VA examination in June 2004 included a review of the Veteran's claims file. It was felt at this time that his diagnosis of psoriasis was associated with his current diagnosis of psoriatic arthritis and that the two were related and had their onset in active service. A VA rheumatology note from March 2005 noted grip strength as 5/5 bilaterally, swollen DIP and PIP joints, and no swelling of other peripheral joints. A May 2006 rating decision assigned a noncompensable rating prior to November 15, 2002, as records from service discharge to that date did not show functional impairment with painful, limited motion under DC 5003, which requires X-ray evidence of painful or limited motion of a major joint or group of minor joints. Parenthetically, the Board further notes that it has also considered whether any limitation of the fingers or thumbs of the hands would entitle the Veteran to a higher rating prior to November 15, 2002, but there is insufficient evidence of any compensable limitation. For example, under DC 5228, a 10 percent rating would be available for limitation of the thumb evidenced by a gap of one to two inches (2.5 to 5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers, but no such limitation was demonstrated prior to November 12, 2002. Finally, as will be shown more fully below, the Board does not find that the criteria for rheumatoid arthritis are for consideration since the most competent medical evidence of record reveals that psoriatic arthritis is a different disease process that merely involves some of the same treatments as rheumatoid arthritis. The Board therefore finds that a preponderance of the evidence is against entitlement to a compensable rating for either hand disability prior to November 12, 2002. Turning to the evidence after November 12, 2002, the record reflects that the RO increased the Veteran's left and right hand evaluations to 10 percent effective from this date on the basis that the November 12, 2002, treatment records documented functional impairment from limited movement. A VA treatment record from May 2006 notes that the Veteran had been seen at the VA rheumatology clinic in December 2002, January 2003, and August 2004. He had been treated with sulfasalazine therapy since December 2002 with good relief of peripheral joint symptoms. X-rays of the hands on July 2004 was noted to reveal normal findings. DIP and PIP joints were noted to be tender and limited in motion. A VA treatment record from August 2006 again reflects that DIP and PIP joints were tender and limited in motion. A January 2007 VA rheumatology record reflects that grip strength was 4-5/5 bilaterally. DIP and PIP were tender and limited in motion. VA hand, thumb, and fingers examination in October 2009 revealed that the Veteran had a loss of the tip of the left ring finger by trauma and dropped a piece of steel on the right ring finger, causing some traumatic problems in that area. Problems with the arthritis in the hand did reportedly affect his occupational functioning in that it was difficult to grasp things with the hand and daily activities affected including the ability to get dressed. He also noted that pain would preclude almost anything involving the hands. Physical examination revealed that the thumb, index finger, long, ring, and little fingers did not show any significant abnormalities. There was perhaps some slight fusiform swelling over the distal and proximal interphalangeal joints. However, the Veteran could oppose the thumb to all the fingers of both the right and left hand. He could also close the hand and make a fist, although very slowly. On active range of motion, he had pain at rest and with all movements of the right and left hand. There was no evidence of ankylosis of any of the fingers. There was tenderness and he seemed to have problems with grasping objects. It was noticed that the Veteran's movements were very slow, but there was no gap between the tip of the thumb and the fingers between the thumb pad and the fingers when opposing the fingers. The diagnosis included psoriatic arthritis of the hands bilaterally. The examiner noted that it had been reported on a previous VA examination that psoriatic arthritis was similar to rheumatoid in lots of its phases, but it was this examiner's opinion that it was a separate entity in and of itself and was associated with psoriatic skin disease. The examiner further commented that examination of the hands "did no[t] show significant degenerative and/or arthritic changes," and that the physical findings did not match the degree of pain described by the Veteran at the current time. VA bones examination in May 2010 revealed that the Veteran reported a chronic numb sensation to both hands, worse in the morning that affected the thumb, index, and long finger since 1995. He treated this discomfort by taking hyrocodone, which decreased his discomfort. He also complained of chronic hand pain with numbness that was greater in the morning. He denied any precipitating or aggravating factors nor did he have any specific alleviating factors. Physical examination revealed no apparent sensory or motor impairment. The medial nerve test was negative. There was no atrophy of the intrinsic muscles of the hands. The finger joints were not affected. There was no evidence of paralysis and the disabilities were not additionally limited by pain, fatigue, weakness, or lack of endurance on repetitive movement. The previous examination electromyography was noted to be negative for carpal tunnel syndrome as was current examination. It was the examiner's opinion that the Veteran's complaint of carpal tunnel syndrome was not caused by service or secondary to psoriasis or psoriatic arthritis. At the time of the Board's remand in June 2011, the Board determined that further examination was warranted with respect to the Veteran's hand disability as a result of the lack of adequate specificity and promised information regarding his limitation of hand motion at the time of the October 2009 VA examination. VA hand and finger examination in January 2012 revealed that the Veteran reported stiffness and pain in all of the joints in his hands. He further stated that his knuckles would get red and that he had also been treated for carpal tunnel syndrome. He indicated that his hands would prevent him from typing. He also noted that he experienced flare-ups with respect to hand function. Physical examination revealed that there was limitation of motion or pain associated with motion of the fingers or thumbs. There was also no gap between the thumb pad and fingers when the fingers opposed the thumb, and the examiner noted that there was no objective evidence of painful motion. Similarly, there was no gap between any fingertips and the proximal transverse crease of the palm, and no evidence of painful motion. Additionally, there was no tenderness or pain to palpation of the joints or soft tissue or either hand and grip strength was 5/5. There was no anklyosis of the thumb and/or fingers. The examiner found that the Veteran's hand, thumb, or finger conditions impacted on his ability to work, noting that certain activities such as "picking up letters at the conveyor belt at the post office," and turning a wrench, would be more difficult to do. Finally, it was noted that the Veteran did not report for an appointment with physical therapy for further evaluation of the range of motion of his hands. In summary, as was the case with the symptoms demonstrated at the time of the Veteran's VA evaluation in November 15, 2002, at no point in time thereafter has his hand disability been manifested by symptoms that more nearly approximate functional impairment with painful, limited motion under DC 5003, which warrants the assignment of a 10 percent rating with X-ray evidence of painful or limited motion of a major joint or group of minor joints. In fact, January 2012 VA examination revealed improved findings, with the examiner noting no evidence of limited or painful motion. Moreover, while the Board has also again considered whether any limitation of the fingers or thumb of the hand would entitle the Veteran to a higher rating, there is clearly insufficient evidence of any limitation that would entitle him to a rating in excess of 10 percent. For example, under DC 5228, a 20 percent rating would be available for limitation of the thumb evidenced by a gap of more than two inches (5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers, but no such limitation has been demonstrated at any point during the relevant time frame on appeal. Finally, the Board would again note that it does not find that the criteria for rheumatoid arthritis are for consideration since the most competent medical evidence of record reveals that psoriatic arthritis is a different disease process that simply involves some of the same treatment regimens as rheumatoid arthritis. The Board therefore also finds that a preponderance of the evidence is against entitlement to a rating in excess of 10 percent for either service-connected hand disability at any time since the Veteran's discharge from active service in August 1998. With respect to all claims for an increased rating, the Board has also considered whether referral for extraschedular consideration is warranted. An extraschedular disability rating is warranted based upon a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b); see Fanning v. Brown, 4 Vet. App. 225, 229 (1993). Under Thun v. Peake, 22 Vet. App. 111 (2008), there is a three-step inquiry for determining whether a veteran is entitled to an extraschedular rating. First, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Second, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is, thus, found inadequate, the Board must determine whether the claimant's disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedular is inadequate to evaluate a veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether the veteran's disability picture requires the assignment of an extraschedular rating. Here, comparing the manifestations of the Veteran's service-connected lower extremity radiculopathy and his bilateral hand disabilities and the associated impairment to the rating schedule, the Board finds that the degree of disability shown throughout the appeal period under consideration is wholly encompassed by the schedular criteria (for the rating that has been assigned), and consequently those criteria are not inadequate. Referral of either claim for extraschedular consideration is therefore not warranted. Finally, as the record does not reveal that the Veteran is claiming that he is rendered unemployable by virtue of his lower extremity radiculopathy or hand disabilities, the Board finds that the record has not raised an implied claim for a TDIU pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). As he has also been granted TDIU effective from February 5, 2005, an implied claim for TDIU arising out of disabilities granted effective from January 9, 2012, would not provide a basis for any greater benefit. Service Connection Claims Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110 (West 2002). If a chronic disease is shown in service, subsequent manifestations of the same chronic disease at any later date, however remote, may be service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b) (2012). However, continuity of symptoms is required where a condition in service is noted but is not, in fact, chronic or where a diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b) (2012). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances lay evidence of a nexus between the present disorder and the post-service symptomatology. Clyburn v. West, 12 Vet. App. 296, 302 (1999). "Competent medical evidence" means that which is provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. 38 C.F.R. § 3.159(a)(1). "Competent lay evidence" is any evidence not requiring that the proponent have specialized education, training or experience, but is provided by a person who has the knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2) (2012); Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Further, service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b) (West 2002); 38 C.F.R. § 3.303(d) (2012). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran's separation examination in May 1998 was negative for psoriatic arthritis of the bilateral hips, chronic costochondritis/Tietze disease of the thoracic rib cage, or CTS of either wrist. VA post-service treatment records reflect that in October 2007, the Veteran complained of pain in the left hip and headaches, but that previous X-rays of the hips revealed negative findings. The treatment records were also negative for a diagnosis of CTS. VA treatment records from April 2010 noted that he had a diagnosis of Tietze disease listed on his problem list of February 2004 and that he had been seen in the pain management clinic for follow-up visits. VA examination in May 2010 revealed reports of bilateral hips tenderness and flare-ups, physical examination showed no objective evidence of pain in the hip joints at rest or during active range of motion. X-rays of the hips also were interpreted to reveal normal findings. The examiner opined that the complaint of hip pain was not caused by or secondary to active service, noting that there were no positive physical findings or any pain, tenderness, weakness, or decreased range of motion relating to the hips and that X-rays were not supportive of a diagnosis of inflammatory or degenerative arthritis. Therefore, the examiner concluded that the Veteran did not have degenerative joint disease, osteoarthritis, or psoriatic arthritis of either hip. Similarly, although the Veteran reported experiencing chest discomfort on the lateral and entire right side of his chest, with sharp pain, especially at night when turning on his right side, physical examination in May 2010 did not reveal any objective evidence of deformity of the ribs of the chest, angulation, shortening, false motion, or intra-articular involvement. Chest and right rib X-rays in May 2010 revealed normal findings and the examiner stated that the examination was negative for fracture or broken ribs and costochondritis. Consequently, the examiner opined that the Veteran's complaint of right-sided chest pain was not caused by or secondary to service and was not caused by or secondary to psoriasis or psoriatic arthritis. The rationale given was that costochondritis was a transient condition usually seen after a minor viral infection, and that findings were not consistent with that condition, nor was there a transient sharp pain that was reproducible. Therefore, the examiner opined that the Veteran did not have costochondritis at this time. Additionally, as was noted previously with respect to the Veteran's claims for increased ratings for psoriatic arthritis of the hands, VA bones examination in May 2010 revealed that he reported a chronic numb sensation to both hands, worse in the morning that affected the thumb, index, and long finger since 1995. He treated this discomfort by taking hyrocodone, which decreased his discomfort. He also complained of chronic had pain with numbness that was greater in the morning. He denied any precipitating or aggravating factors nor did he have any specific alleviating factors. Physical examination revealed no apparent sensory or motor impairment. The medial nerve test was negative. There was no atrophy of the intrinsic muscles of the hands. The finger joints were not affected. There was no evidence of paralysis and the disabilities were not additionally limited by pain, fatigue, weakness, or lack of endurance on repetitive movement. The previous examination electromyography was noted to be negative for carpal tunnel syndrome as was current examination. It was the examiner's opinion that the Veteran's complaint of carpal tunnel syndrome was not caused by service or secondary to psoriasis or psoriatic arthritis. With respect to the Veteran's bilateral hip symptoms, chest complaints, and claimed bilateral CTS, the Board acknowledges his assertions that he experiences hip, chest, and wrist. Indeed, he is already service-connected for bilateral wrist and hand disability secondary to his psoriatic arthritis; however, without a recognized injury or disease entity separate from already service-connected disability, VA is not authorized to award compensation for reported symptomatology. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(a) (service connection is awarded for "a particular injury or disease resulting in disability..."); see also Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999); aff'd in part sub nom. Sanchez-Benitez v. Principi, 259 F.3d 1356, 1363 (Fed. Cir. 2001) (pain alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection may be granted.) On physical examination in May 2010, the Veteran demonstrated normal clinical and X-ray findings with respect to his hips, chest, and wrists. In the absence of competent evidence which suggests that his bilateral hip, chest, and wrist symptoms not otherwise service connected constitute a chronic disability, the Board has no basis on which to consider the complaints in these areas as more probative than the May 2010 medical findings. The Board finds that the Veteran's own assertions to the contrary do not constitute competent medical evidence in support of his claim. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Absent a showing of a current chronic hip disability, chest disability, or CTS which could be related to service, entitlement to service connection for a bilateral hip disability, chest disability, and CTS must be denied. Service connection may also be established for a current disability on the basis of a presumption under the law that certain chronic diseases manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307 and 3.309(a). Arthritis and diseases of the nervous system can be service-connected on such a basis. However, there is no showing of bilateral hip arthritis or CTS at any time that can be linked to service presumptively, based on continuity of symptoms, or based on a link by medical evidence to the Veteran's active service. Although the Veteran contends that he has a bilateral hip disability, a chest disability, and CTS which are related to his service, as a layman he is not competent to offer opinions on medical causation and, moreover, the Board may not accept unsupported lay speculation with regard to medical issues. Accordingly, the Board concludes that the preponderance of the evidence is against the claims for service connection for bilateral hip psoriatic arthritis, chronic costochondritis/Tietze disease of the thoracic rib cage, or CTS, and the benefit of the doubt rule is not for application. New and Material Evidence Claim Prior unappealed rating decisions may not be reopened absent the submission of new and material evidence warranting revision of the previous decision. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2012). "New" evidence means evidence "not previously submitted to agency decisionmakers." 38 C.F.R. § 3.156(a) (2011). "Material" evidence means "evidence that, by itself or when considered with previous evidence of record, related to an unestablished fact necessary to substantiate the claim." Id. In order to be "new and material" evidence, the evidence must not be cumulative or redundant, and "must raise a reasonable possibility of substantiating the claim." Id. In this regard, in Shade v. Shinseki, 24 Vet. App. 110 (2010), the Veterans Claims Court clarified that the phrase "raise a reasonable possibility of substantiating the claim" is meant to create a low threshold that enables, rather than precludes, reopening. Specifically, the Court stated that reopening is required when the newly submitted evidence, combined with VA assistance and considered with the other evidence of record, raises a reasonable possibility of substantiating the claim. When determining whether the claim should be reopened, the credibility of the newly submitted evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1991). The Court has clarified that, with respect to the issue of materiality, the newly presented evidence need not be probative of all the elements required to award the claim as in this case dealing with a claim for service connection. Evans v. Brown, 9 Vet. App. 273 (1996). However, it is the specified bases for the final disallowance that must be considered in determining whether the newly submitted evidence is probative. Such evidence must tend to prove the merits of the claim as to each essential element that was a specified basis for that last final disallowance of the claim. If new and material evidence is submitted, the claim will be reopened and adjudicated on the merits. 38 U.S.C.A. § 5108 (West 2002). "The Board does not have jurisdiction to consider [the previously adjudicated claim] unless new and material evidence is presented, and before the Board may reopen such a claim, it must so find." Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996). The Board is neither required nor permitted to analyze the merits of a previously disallowed claim if new and material evidence has not been submitted. Butler v. Brown, 9 Vet. App. 167, 171 (1996). No other standard than that articulated in the regulation applies to the determination whether evidence is new and material. See Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). A claim for service connection for PTSD due to sexual trauma was denied by a rating decision in July 2000 that was not appealed. That rating decision denied the claim in part on the basis that the record did not reflect a confirmed diagnosis of PTSD. Treatment records received subsequent to the July 2000 rating decision reflect diagnoses that include PTSD. Therefore, the Board finds that the evidence submitted since the July 2000 rating decision pertinent to the claim for service connection for PTSD due to sexual assault is new and relates to an unestablished fact necessary to substantiate the claim for service connection for PTSD due to sexual assault, is neither cumulative nor redundant of the evidence of record in July 2000, and otherwise raises a reasonable possibility of substantiating the claim. The appeal is granted to this extent. Duty to Notify and Assist Finally, as provided for by the Veterans Claims Assistance Act of 2000 (VCAA), VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Proper notice from VA must inform the claimant of any information and medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. Quartuccio v. Principi, 16 Vet. App. 183 (2002). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). When VCAA notice is delinquent or erroneous, the "rule of prejudicial error" applies. See 38 U.S.C.A. § 7261(b)(2) (West 2002). In addition, the notice requirements of the VCAA apply to all five elements of a service-connection claim, including: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. Regarding the claims for an earlier effective date, the Board notes that the earliest possible date permitted by the effective date regulations has been granted, so that an earlier effective date is not legally possible. In cases such as this, in which a claim cannot be substantiated because there is no legal basis for the claim, or because undisputed facts render the claimant ineligible for the claimed benefit, VA is not required to meet the duty to assist a claimant. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994); Dela Cruz v. Principi, 15 Vet. App. 143, 149 (2001); Mason v. Principi, 16 Vet. App. 129 (2002); see also VAOPGCPREC 5-2004. With respect to the claims for increased ratings, in all instances, the Board finds that it has jurisdiction over the rating assigned since service connection was granted for the disabilities in question. In Dingess, it was held that in cases where service connection has been granted and an initial disability and effective date have been assigned, the typical service-connection claim has been more than substantiated, it has been proven, thereby rendering § 5103(a) notice no longer required because the purpose that the notice is intended to service has been fulfilled. Id. at 490-91. Thus, because the VA notice that was provided before service connection was granted was legally sufficient as to the claims for service connection for bilateral hand psoriatic arthritis and bilateral lower extremity radiculopathy, VA's duty to notify as to the claims for increased initial ratings for these disorders has been satisfied. Moreover, prior to the May 2006 rating decision's assignment of an August 8, 1998, effective date for the grant of service connection for right and left hand psoriatic arthritis, letters satisfying the notice requirements under 38 C.F.R. § 3.159(b)(1) were sent to the Veteran in January 2004, May 2004, and August 2004, prior to the initial RO decision that is the subject of the appeal as to these claims. The letters informed him of what evidence was required to substantiate the claims and of his and VA's respective duties for obtaining evidence. Moreover, with respect to the Dingess requirements, the Veteran was given notice of what type of information and evidence he needed to substantiate his claims for an increased rating as this is the premise of the claims. It is therefore apparent that he had actual knowledge of the rating element of the claim. In addition, he was provided with notice of the type of evidence necessary to establish an effective date for disabilities that are not the subject of this decision by correspondence dated in May 2006. Any questions as to the appropriate effective dates to be assigned are also moot as the claims have been denied. With respect to the issues of entitlement to service connection for bilateral hip psoriatic arthritis, chronic costochondritis/Tietze disease of the thoracic rib cage, and bilateral CTS, the VCAA duty to notify was satisfied by way of letters sent to the Veteran in January and March 2010 that fully addressed all notice elements and was sent prior to the initial RO decision that denied these claims. Under these circumstances, the Board finds that the notification requirements of the VCAA have been satisfied as to both timing and content. Based on the above, the notice deficiencies do not affect the essential fairness of the adjudication. Therefore, the presumption of prejudice is rebutted. For this reason, no further development is required regarding the duty to notify. Next, VA has a duty to assist a veteran in the development of the claim. This duty includes assisting him or her in the procurement of service treatment records and other pertinent records, and providing an examination when necessary. See 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2012). VA has obtained service treatment records, assisted the Veteran in obtaining evidence, afforded him physical examinations, and obtained medical opinions as to the etiology and severity of disabilities. All known and available records relevant to the issues on appeal have been obtained and associated with the claims file and he has not contended otherwise. Therefore, the available records and medical evidence have been obtained in order to make adequate determinations as to these claims. Significantly, neither the Veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claims that has not been obtained. Hence, no further notice or assistance is required to fulfill VA's duty to assist in the development of the claims. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd, 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). ORDER An effective date earlier than February 5, 2005, for an award of TDIU is denied. An effective date earlier than February 5, 2005, for eligibility to DEA benefits is denied. An effective date earlier than January 9, 2012, for the grant of service connection for left lower extremity radiculopathy is denied. An effective date earlier than January 9, 2012, for the grant of service connection for right lower extremity radiculopathy is denied. A rating in excess of 10 percent for left lower extremity radiculopathy is denied. A rating in excess of 10 percent for right lower extremity radiculopathy is denied. A rating in excess of 10 percent for psoriatic arthritis of the right hand, to include a compensable rating prior to November 15, 2002, is denied. A rating in excess of 10 percent for psoriatic arthritis of the left hand, to include a compensable rating prior to November 15, 2002, is denied. Service connection for psoriatic arthritis of the bilateral hips is denied. Service connection for chronic costochondritis/Tietze disease of the thoracic rib cage is denied. Service connection for bilateral CTS is denied. New and material evidence has been submitted to reopen the claim for service connection for PTSD due to sexual trauma, and the claim is reopened. The appeal is granted to this extent. REMAND With respect the claim for service connection for cicatricial neuromacutis (also claimed as headaches), the Veteran contends that he has the disorder secondary to an in-service cranial blunt force trauma with associated headaches. A May 1997 service treatment record entry does note a small laceration on the forehead sustained in the process of opening a trunk without complaints of loss of consciousness or pain, although separation examination in May 1998 did not document any residuals relating to the incident. The Veteran has also reported post-service complaints of chronic headaches and jaw pain. Consequently, since he has reported continuing relevant symptoms and there is some evidence of head trauma in service, the Board finds that he should be afforded a VA examination and opinion as to whether any current cicatricial neuromacutis, headache or other disorder is related to the blunt force trauma in service. With respect to the claim for entitlement to service connection for PTSD, while the Veteran's claim for PTSD clearly includes a claim for service connection for this disorder based on claimed in-service sexual assaults, the Board is unable to locate appropriate notice to him of the types of evidence that may constitute evidence of such assaults. Consequently, the remand of this issue is warranted so that he can be provided with appropriate notice in this regard. Accordingly, the case is REMANDED for the following action: 1. Obtain VA clinical records from the Shreveport VAMC since April 2010. Any relevant treatment records contained in the Virtual VA file that are not available on CAPRI or AMIE must be printed and associated with the paper claims file so they can be available to the examiner for review. 2. The RO should provide the Veteran with a personal assault letter that fully complies with 38 C.F.R. § 3.304(f) and M21-1MR, Part IV, ii, 1, D, 17, regarding evidence he can provide VA to help support his allegations regarding a personal assault causing his current PTSD. 3. Schedule the Veteran for an examination to determine the nature and etiology of any cicatrical neuromacutis, headaches, or any other residual of traumatic brain injury. The claims file and a copy of this remand should be made available to and reviewed by the examiner in conjunction with the examination. All indicated studies should be conducted, and all findings reported in detail. The examiner should provide an opinion as to whether it is at least as likely as not that any cicatrical neuromacutis, headaches, or other current residual of traumatic brain injury is related to the Veteran's blunt force trauma during service. The examiner must provide a comprehensive report including complete rationales for all conclusions reached. 4. The RO should read all medical opinions obtained to ensure that the remand directives have been accomplished, and should return the case to the examiner if all questions posed are not answered. 5. Finally, after the completion of the above action and any additional development deemed appropriate as a result thereof, readjudicate the issues remaining on appeal. If the benefits sought on appeal are not granted, issue a supplemental statement of the case, and given the Veteran and his representative an appropriate amount of time to respond. The Veteran has the right to submit additional evidence and argument on the 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). ______________________________________________ L. HOWELL Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs