Citation Nr: 1305908 Decision Date: 02/21/13 Archive Date: 02/27/13 DOCKET NO. 08-15 733 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to a rating in excess of 30 percent for residuals of a total replacement of the left knee. 2. Entitlement to a rating in excess of 10 percent for chondromalacia patella of the right knee, with traumatic arthritis. 3. Entitlement to a total rating by reason of individual unemployability due to service connected disabilities (TDIU). (The issue of entitlement to a clothing allowance will be addressed in a separate decision by the Board.) REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant (the Veteran) and his spouse ATTORNEY FOR THE BOARD Joseph P. Gervasio, Counsel INTRODUCTION The Veteran, who is the appellant, served on active duty from July 1979 to May 1983. This case comes to the Board of Veterans' Appeals (Board) on appeal of a March 2007 rating decision of the Montgomery, Alabama, Regional Office (RO) of the Department of Veterans Affairs (VA). In June 2012, a videoconference board hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran's claims file. In correspondence dated in December 2010, the Veteran claimed entitlement to service connection for a low back disability. In correspondence dated in November 2010, the Veteran claimed an effective date earlier than April 4, 2010 for an award of service connection for tinea pedis and onychomycosis. In correspondence dated in May 2011, the Veteran claimed service connection for chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), and gastroesophageal reflux disease (GERD) as a result of exposure to contaminated water while he was stationed at Camp Lejeune, North Carolina. In correspondence dated in July 2011, the Veteran requested consideration for specially adapted housing or a special home adaptation grant. During the June 2012 Board hearing, the matter of a separate compensable rating for a painful scar of the left knee was raised. These matters have been raised by the record, but have not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over them, and they are referred to the AOJ for appropriate action. The issue of entitlement to a rating in excess of 10 percent for chondromalacia patella of the right knee, with traumatic arthritis and TDIU 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. VA will notify the appellant if additional action is required on his part. FINDING OF FACT Residuals of total left knee arthroplasty are manifested by prosthetic replacement of the knee joint with minimal weakness, pain, or limitation of motion. CONCLUSION OF LAW From May 1, 2007, the criteria for a rating in excess of 30 percent for residuals of total left knee arthroplasty have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.7, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5055 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). In a claim for increase, the VCAA requirement is generic notice, that is, the type of evidence needed to substantiate the claim, namely, evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on employment, as well as general notice regarding how disability ratings and effective dates are assigned. Vazquez-Flores v. Shinseki, 580 F.3d 1270 (Fed. Cir. 2009). The Veteran was advised of VA's duties to notify and assist in the development of the claim decided herein prior to the initial adjudication of the claim. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). An October 2006 letter explained the evidence necessary to substantiate the claim, the evidence VA was responsible for providing, and the evidence the Veteran was responsible for providing. The Veteran has had ample opportunity to respond or supplement the record. With regard to the duty to assist, the Veteran's service treatment records (STRs) and pertinent post-service treatment records, including records utilized by the Social Security Administration (SSA) in a disability determination, have been secured. The Veteran has also been afforded VA medical examinations in connection with the claim, most recently in April 2011. 38 C.F.R. § 3.159(c) (4) (2012). The Board finds that the opinion obtained is adequate. The opinion was provided by a qualified medical professional and was predicated on a full reading of all available records. The examiner also provided a detailed rationale for the opinion rendered. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Neither the Veteran nor the Veteran's representative has challenged the adequacy of the examination obtained. Sickels v. Shinseki, 643 F.3d 1362 (Fed. Cir. 2011) (holding that the Board is entitled to presume the competence of a VA examiner and the adequacy of his opinion). Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion has been met. 38 C.F.R. § 3.159(c)(4) (2012). Increased Rating Laws and Regulations Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C.A. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21 (2012). Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3 (2012). The United States Court of Appeals for Veterans Claims (Court) has held that "staged" ratings are appropriate for an increased rating claim where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board notes that it has reviewed all of the evidence in the Veteran's claims file, with an emphasis on the evidence relevant to the appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, 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 claim. The Board is required to render a finding with respect to the competency and credibility of the lay evidence of record. See Coburn v. Nicholson, 19 Vet. App. 427, 433 (2006). Competent, credible lay evidence could be, in and of itself, sufficient to establish an elemental fact necessary to support a finding of service connection. Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). As a fact finder, the Board is obligated to determine whether lay evidence is credible in and of itself. The Board cannot determine that lay evidence lacks credibility solely because it is unaccompanied by contemporaneous medical evidence, but it may consider a lack of contemporaneous medical evidence as one factor in determining the credibility of lay evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Credibility is a factual determination going to the probative value of the evidence, to be made after the evidence has been admitted or deemed competent. Cartwright v. Derwinski, 2 Vet. App. 24 (1991). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994). A veteran is competent to describe symptoms that he experienced in service or at any time after service when the symptoms he perceived, that is, experienced, were directly through the senses. 38 C.F.R. § 3.159 (competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience; lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person.); Layno, 6 Vet. App. at 469-71 (lay testimony is competent as to symptoms of an injury or illness, which are within the realm of one's personal knowledge; personal knowledge is that which comes to the witness through the use of the senses; lay testimony is competent only so long as it is within the knowledge and personal observations of the witness, but lay testimony is not competent to prove a particular injury or illness); see Barr 21 Vet. App. at 303 (lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d at 1377. Also, a veteran as a layperson is competent to offer an opinion on a simple medical condition. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (citing Jandreau). VA must consider the competency of the lay evidence and cannot outright reject such evidence on the basis that such evidence can never establish a medical diagnosis or nexus; however, this does not mean that lay evidence is necessarily always sufficient to identify a medical diagnosis, but rather only that it is sufficient in those cases where the layman is competent and does not otherwise require specialized medical training and expertise to do so, i.e., the Board must determine whether the claimed disability is a type of disability for which a layperson is competent to provide etiology or nexus evidence. See Davidson, 581 F.3d at 1316 (recognizing that, under 38 U.S.C.A. § 1154(a), lay evidence can be competent and sufficient to establish a diagnosis of a condition when a layperson is competent to identify the medical condition; the person is reporting a contemporaneous medical diagnosis; or lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). Rating Left Knee Disability Service connection for chondromalacia patella of the left knee, with traumatic arthritis was granted by the RO in a November 1983 rating decision. A noncompensable (0 percent) initial disability rating was awarded at that time. The rating was increased to 10 percent in December 2004 and increased to 30 percent by rating decision in March 2006. The Veteran underwent a total replacement of the left knee in March 2006 and, after an award of a 100 percent convalescent rating, a 100 percent schedular rating was awarded for 12 months under the provisions of Code 5055. After the expiration of the 100 percent rating a 30 percent rating was established as of May 1, 2007. The Veteran appealed the 30 percent rating. The Veteran contends that his left knee disability is more disabling than currently evaluated. During the Board hearing in June 2012, the Veteran testified that he had significant pain and limitation of motion of the knee joint, stating that he could not completely straighten his knee. He also stated that he had significant pain and tenderness as a result of the surgery, including pain of the surgical scar, which measured approximately 12 to 14 inches. He stated that he took several medications for the knee pain and that he experienced stiffness in the morning to the point where he needed his spouse's help to put on his socks. Pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5055, the Schedule provides the rating criteria for the prosthetic replacement of a knee joint. Under this code, for one year following implantation, the knee joint warrants an evaluation of 100 percent. Thereafter, where there are chronic residuals consisting of severe painful motion or weakness in the affected extremity, a 60 percent evaluation is warranted. Where there are intermediate degrees of residual weakness, pain or limitation of motion, the disability is rated by analogy to Diagnostic Codes 5256, 5261, or 5262. The minimum assigned evaluation under this code is 30 percent. Id. Under Diagnostic Code 5256, a 30 percent disability evaluation is assigned for ankylosis of the knee, favorable angle in full extension, or in slight flexion between 0 and 10 degrees. A 40 percent rating is assigned when there is extremely unfavorable ankylosis in flexion between 10 and 20 degrees. A 50 percent rating is warranted when there is extremely unfavorable ankylosis in flexion between 20 and 45 degrees. A 60 percent rating is warranted when there is extremely unfavorable ankylosis in flexion at an angle of 45 degrees or more. 38 C.F.R. § 4.71a , Diagnostic Code 5256 (2012). Under Diagnostic Code 5261, a 30 percent disability evaluation is warranted when extension is limited to 20 degrees. A 40 percent disability evaluation is warranted when extension is limited to 30 degrees. A 50 percent disability evaluation is warranted when extension is limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261 (2012). Under Diagnostic Code 5262, a 30 percent disability evaluation is warranted for malunion of the tibia and fibula with marked knee or ankle disability. A 40 percent evaluation is assigned for nonunion of the tibia and fibula with loose motion, requiring brace. 38 C.F.R. § 4.71a, Diagnostic Code 5262 (2012). Standard range of knee motion is from 0 degrees (extension) to 140 degrees (flexion). 38 C.F.R. § 4.71, Plate II (2012). Additionally, under Diagnostic Code 5257, a 10 percent disability evaluation is contemplated when other impairment of the knee, recurrent subluxation or lateral instability, is mild. A 20 percent disability evaluation is contemplated when such impairment is moderate. A 30 percent disability evaluation is assigned when such impairment is severe. 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2012). The evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14 (2012). Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition was not "duplicative of or overlapping with the symptomatology" of the other condition. Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examinations on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective enervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10 , 4.40, 4.45 (2012). The Court has held that the RO must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40, which requires the VA to regard as "seriously disabled" any part of the musculoskeletal system that becomes painful on use. DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. § 4.14 (avoidance of pyramiding) do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including during flare-ups. The Board notes that the guidance provided by the Court in DeLuca must be followed in adjudicating claims where a rating under the diagnostic codes governing limitation of motion should be considered. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Actually painful, unstable, or malaligned joints, due to healed injury, are as entitled to at least the minimum compensable rating for the joint. The joints should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59 (2012). An examination was conducted by VA in October 2006. At that time, it was reported that the Veteran had undergone five surgical procedures on the left knee before undergoing a total arthroplasty in March 2006. During the examination, it was related that the residuals of the total replacement of the left knee had a significant effect on the Veteran's usual occupation. He complained of a lack of stamina, decreased strength, and pain of the lower extremity. He needed to take medication every six hours for pain, which made him dizzy. His disability was considered to have a moderate effect on many of his daily activities. Examination showed no deformity, giving way, or instability. The Veteran had complaints of pain and stiffness, but not weakness or episodes of dislocation, subluxation or locking. There was no effusion. The Veteran complained of flare-ups of moderate severity that occurred weekly. The Veteran stated that the flare-ups lasted hours. Active range of motion was to 102 degrees flexion, with pain beginning at 100 degrees flexion. Passive range of motion was the same, with pain beginning at 95 degrees flexion. There was additional limitation of motion after repetitive use, with flexion being further limited to 98 degrees, with the major factor being pain with stiffness. Regarding extension, the Veteran's lacked 4 degrees from full extension actively and lacked 2 degrees from full extension passively. After repetitive use, the Veteran lacked 9 degrees from full extension, with the major factor being pain with stiffness. There was no joint ankylosis. There was tenderness, painful movement, weakness and guarding of movement. There was no crepitation, masses behind the knees, clicks or snaps, grinding, instability, patellar abnormality, meniscus abnormality, or other knee abnormality. An examination was conducted by VA in April 2011. At that time, the Veteran complained that he had continued pain of the left knee associated with stiffness, limited standing, and limited walking. He was only able to stand for 15 to 20 minutes before he was forced to sit down. He stated that he could walk only one to two blocks before his left knee swelled and became too painful to bear weight. He took hydrocodone and etodolac for pain and inflammation. Examination showed no deformity, giving way, instability, or incoordination. There was pain, stiffness, weakness, and decreased speed of joint motion. There were no episodes of dislocation, subluxation, or locking. He had flare-ups occurring on a weekly basis that were described as moderate in severity. These lasted one to two days in duration and were precipitated by prolonged standing and walking, relieved by rest and pain medication. He used a knee brace intermittently, but frequently. There was no crepitation, masses, clicks, snaps, grinding, instability, patellar abnormality, meniscus abnormality, or abnormal tendons or bursae. On active range of motion, the Veteran lacked 4 degrees from full extension and was able to flex to 80 degrees. Pain began at 80 degrees. On passive range of motion, the Veteran lacked 4 degrees of extension and flexed to 75 degrees, with pain beginning at 75 degrees. There was no additional limitation of motion on repetitive use. X-ray studies showed status post left knee arthroplasty without evidence of loosening of the prosthetic components and with normal relationship between the prosthetic components. There was a .4 cm tiny ossific density adjacent to the fabella that could represent a loose body and a questionable vague oval .8 cm ossific density overlapping the region of the left suprapatellar pouch/quadriceps tendon, which could represent a small loose body within the suprapatellar pouch or dystrophic ossification of the adjacent soft tissues. The diagnosis was moderately severe chronic left knee pain, residuals of a left knee arthroplasty. The examiner indicated that the Veteran's disabilities had moderate effects on many of his usual daily activities and a severe effect on sports. In considering the evidence of record under the laws and regulations set forth above, the Board concludes that the Veteran is not entitled to an evaluation in excess of 30 percent for service-connected residuals of total left knee arthroplasty. As an initial matter, the Board has considered entitlement to a higher rating under Diagnostic Codes 5256, 5261, and 5262, as directed by Diagnostic Code 5055. The Board notes that while the record reflects that the Veteran wears a knee brace at times, his residuals of a total left knee arthroplasty are not characterized by nonunion of the tibia and fibula with loose motion requiring a brace. Nonunion of the tibia and fibula is simply neither shown nor contended. Indeed, the April 2011 X-ray study showed that the prosthesis was in satisfactory position, with possible small loose bodies. The Veteran is therefore not entitled to a rating in excess of 30 percent pursuant to Diagnostic Code 5262. In addition, the evidence of record establishes that the left knee is not ankylosed, and as a result a higher rating under Diagnostic Code 5256 is also not warranted. Ankylosis is "immobility and consolidation of a joint due to disease, injury, surgical procedure." See Lewis v. Derwinski, 3 Vet. App. 259 (1992) (citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)). The examination reports specifically indicated that there was no ankylosis of the knee joint. The Veteran's limitation of motion of the right knee also does not equate to limitation of extension of the leg to 30 degrees. The VA examination reports show that the Veteran lacks up to 4 degrees of extension, which is far greater than that required for a rating in excess of 30 percent. While additional disability as a result of repetitive motion is noted, this is not shown to meet the criteria for an increased rating under Code 5261, even with consideration of functional impairment. 38 C.F.R. §§ 4.40 , 4.45; DeLuca, 8 Vet. App. at 202. Moreover, flexion of the knee joint is to, at least, 75 degrees, which is noncompensable under the rating schedule. See 38 C.F.R. § 4.71a, Diagnostic Code 5260 (2012). As a higher rating is not warranted under Diagnostic Codes 5256, 5261, and 5262, the assignment of a rating in excess of 30 percent under Diagnostic Code 5055 is not warranted for the time period from May 1, 2007, the effective date of the award of the 30 percent rating. The Board also finds that the assignment of a higher (60 percent) rating is not warranted under Diagnostic Code 5055 for severe, chronic residuals of his total knee replacement. The Board finds that the criteria for a 60 percent rating have not been met. The VA examination reports do not demonstrate that he has chronic residuals consisting of severe painful motion or weakness in his left lower extremity. The assessments are that the knee disability is not shown to result in severe functional impairment or adversely affect his overall activities of daily living to more than a moderate degree. Indeed, as discussed above, the Veteran is not shown to meet the threshold for establishing disability at the intermediate level. As such, a rating in excess of the 30 percent rating is not warranted under the provisions of Code 5055. The Board has considered whether the Veteran is entitled to a separate evaluation under Diagnostic Code 5257 for left knee instability. See Esteban 6 Vet. App. at 259 (separate ratings are appropriate where none of the symptomatology for any one condition duplicates, or overlaps, others). In this regard, it is noted that the VA examinations in 2006 and 2011 showed no instability, subluxation, or complaints of giving way. As such, the Board determines that the assignment of a separate 10 percent rating for other disability of the left knee is not warranted. For all the foregoing reasons, the Veteran's claim for entitlement to an evaluation in excess of 30 percent for residuals of total left knee arthroplasty, for the time period from May 1, 2007, to the present, must be denied. The Board has considered staged ratings, under Hart v. Mansfield, 21 Vet. App. 505 (2007), but concludes that they are not warranted. Since the preponderance of the evidence is against this claim, the benefit of the doubt doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board also has 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)(1) (2012); 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 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 schedule 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 VA 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. In this case, comparing the Veteran's disability level and symptomatology to the rating schedule, the degree of disability throughout the appeal period under consideration is contemplated by the rating schedule. The Veteran's left knee arthroplasty residuals directly correspond to the minimal schedular criteria for the 30 percent evaluation for a total knee replacement (Code 5055), which also incorporates various orthopedic factors that limit motion or function of the knee. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca. There is no objective evidence of other disability that would warrant a separate compensable evaluation as the result of instability (Code 5257). As such, the 30 percent rating specifically contemplates the Veteran's symptomatology. For this reason, the Board finds that the assigned schedular rating is adequate to rate the Veteran's left knee disability, and no referral for an extraschedular rating is required. ORDER A rating in excess of 30 percent for residuals of a total replacement of the left knee is denied. REMAND The remaining issues before the Board are entitlement to a rating in excess of 10 percent for chondromalacia patella of the right knee, with traumatic arthritis, and TDIU. During testimony before the Board in June 2012, the Veteran testified that he had undergone additional surgery on the knee at the VA medical centers in Birmingham and Tuscaloosa (VAMC). In a June 2012 physical therapy note, it is noted that the Veteran was being treated for bilateral total knee arthroplasties. Records of this treatment, and records of treatment leading up to the surgery, are believed to have significant probative value. As such, they must be obtained prior to appellate consideration. The matter of TDIU must be held in abeyance pending this development. Accordingly, the case is REMANDED for the following action: 1. The RO/AMC should contact the (VAMC) and request copies, for association with the claims folder, of any and all records of treatment that the Veteran received since August 2011. 2. Thereafter and following any additional development deemed warranted, the RO/AMC should readjudicate the remaining issues on appeal. If the determinations remain unfavorable to the Veteran, he and his representative should be provided with a supplemental statement of the case (SSOC) that addresses all relevant actions taken on the claims for benefits. The Veteran should be given an opportunity to respond to the SSOC prior to returning the case to the Board for further review. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ BARBARA B. COPELAND Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs