Citation Nr: 1306254 Decision Date: 02/22/13 Archive Date: 02/27/13 DOCKET NO. 08-06 812A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for fibroid cyst on right ovary, status post hysterectomy. 2. Entitlement to service connection for pruritus with dermatographism. 3. Entitlement to an initial disability evaluation in excess of 20 percent for degenerative arthritis, thoracolumbar spine. 4. Entitlement to an initial compensable disability evaluation for inferior lattice degeneration, retina, right eye. 5. Entitlement to an initial disability evaluation in excess of 40 percent for neurogenic bladder for the period from August 1, 2006 through June 20, 2010, and entitlement to an initial staged rating in excess of 60 percent from June 21, 2010. REPRESENTATION Appellant represented by: Rochelle E. Richardson, Attorney At Law WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD David S. Nelson, Counsel INTRODUCTION The Veteran had active service from July 1986 to July 2006. These matters are before the Board of Veterans' Appeals (Board) on appeal from September 2006, January 2008, March 2010, and December 2011 decisions by the St. Petersburg, Florida, Regional Office (RO) of the Department of Veterans Affairs (VA). This case was previously before the Board in September 2010 and was remanded for additional development. In June 2010 the Veteran testified during a Video Conference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the record. In correspondence received in November 2012 the Veteran's attorney indicated that no further Board hearings are requested on these matters. A claim for entitlement to a total rating based on individual unemployability due to service-connected disability (TDIU) is part of an increased rating issue when such claim is raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009). In this case, however, TDIU consideration is not warranted. At her December 2010 VA examination the Veteran indicated that she was working full-time. As such, the issue of entitlement to a TDIU is not raised by the record at this time. The issues of entitlement to service connection for a kidney and gastrointestinal disorder secondary to a claimed gynecological disorder have been raised by the record (the Veteran's attorney's May 2012 correspondence) 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 service connection for fibroid cyst on right ovary, status post hysterectomy 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's pruritus first manifested during her active service. 2. Throughout the rating period on appeal, the Veteran's thoracolumbar spine disability has been manifested by complaints of pain with functional impairment comparable to no less than thoracolumbar spine flexion of 90 degrees; degenerative arthritis has been shown, with no neurological complications. 3. The Veteran's service-connected inferior lattice degeneration, retina, right eye is manifested by lattice degeneration with 3 holes inferiorly in the right eye with no irregularities related to the Veteran's right eye, including visual impairment. 4. From August 1, 2006 through June 20, 2010, the Veteran's neurogenic bladder disability required the wearing of absorbent materials which needed to be changed no more than four times per day. 5. From June 21, 2010, the Veteran neurogenic bladder disability required the wearing of absorbent materials which needed to be changed more than four times per day. CONCLUSIONS OF LAW 1. Pruritus with dermatographism was incurred in active service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2012). 2. The criteria for an initial rating in excess of 20 percent for degenerative arthritis, thoracolumbar spine, have not been met at any time during the rating period on appeal. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Codes 5237, 5242 (2012). 3. The criteria for an initial compensable disability rating for inferior lattice degeneration, retina, right eye, have not been met at any time during the rating period on appeal. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. §§ 4.7, 4.79, Diagnostic Code 6011 (prior to December 10, 2008). 4. The criteria for an initial rating in excess of 40 percent for neurogenic bladder for the period from August 1, 2006 through June 20, 2010 have not been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. §§ 4.7, 4.115b, Diagnostic Code 7542 (2012). 5. The criteria for an initial staged rating in excess of 60 percent for neurogenic bladder for the period from June 21, 2010 have not been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. §§ 4.7, 4.115b, Diagnostic Code 7542 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS 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). The VCAA applies in this case. Duty to Notify As the September 2006 rating decision granted service connection for low back disability, right eye disability, and neurogenic bladder disability, those claims are now substantiated. As such, the filing of a notice of disagreement as to the disability ratings assigned does not trigger additional notice obligations under 38 U.S.C.A. § 5103(a). 38 C.F.R. § 3.159(b)(3) (no VCAA notice required because of filing of NOD); Dunlap v. Nicholson, 21 Vet. App. 112, 116-17 (2007) (noting that once an initial VA decision awarding service connection and assigning a disability evaluation and effective date has been made, 38 U.S.C. § 5103(a) notice is no longer required). As for rating the Veteran's disabilities, the relevant disability rating criteria have been provided to the Veteran, including in the April 2010 statement of the case. In a February 2008 VCAA letter the Veteran received notice regarding the assignment of a disability rating and effective date in the event of an award of VA benefits. Dingess/Hartman v. Nicholson,19 Vet. App. 473 (2006). In light of the favorable decision to grant the claim of entitlement to service connection for pruritus with dermatographism, any deficiency as to VA's duties to notify and assist pursuant to the VCAA is rendered moot. During the June 2010 Board hearing, to assist the Veteran, the undersigned asked questions to help direct the Veteran's testimony, and specifically asked the Veteran to state her dates of treatment to ensure that the record was complete. The undersigned also indicated that the record would be held open for 60 days in an effort to enable the Veteran to obtain additional evidence in support of her claims. These actions fulfilled the duties under 38 C.F.R. § 3.103 (2012). See Bryant v. Shinseki, 23 Vet. App. 488 (2010). Duty to Assist The Veteran's service treatment records are of record, as are VA and private treatment records. The Veteran has undergone VA examinations that addressed the rating matters presented by this appeal. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the examinations obtained in this case are adequate, as they considered the pertinent evidence of record, and included an examination of the Veteran and elicited her subjective complaints and clinical measures and observations reported. The examinations described the Veteran's disabilities in sufficient detail so that the Board is able to fully evaluate the claimed disabilities. Accordingly, the Board finds that VA's duty to assist with respect to obtaining VA examinations in this appeal has been met. The Board finds that there has been substantial compliance with its September 2010 remand instructions. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). The Veteran has not referenced any other pertinent, obtainable evidence that remains outstanding. VA's duties to notify and assist are met, and the Board will address the merits of the claims. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). 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 C.F.R. § 3.303(d). I. Pruritus with Dermatographism A June 2006 service treatment record indicates that the Veteran complained of multiple hyperpigmented areas that had bothered her for over 4 years. The assessment was acne and post-inflammatory hyperpigmentation. In a July 2009 VA dermatology record the Veteran indicated that she had experienced itching (of the back, arms, neck, legs, palms, feet, and scalp) since returning from Iraq in 2005. Examination revealed isolated papules, dry patches, and hyperpigmented scars of the arms, legs, and neck. The assessment included pruritus and scars. A March 2010 VA record noted that the Veteran had complained of a generalized itching since 2005. The assessment involved chronic pruritus. A November 2010 VA record noted that the Veteran continued to complain of pruritus related to dermatitis. The Veteran's active medications for her skin problems included Lidocaine and Loratadine (for dermatographism). The Board finds that the Veteran has provided credible statements as to the incurrence of pruritus in service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (2007) (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a layperson is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). She has additionally provided credible and competent testimony as to the continuity of symptoms since hers separation from service, and this testimony is essentially supported by the clinical evidence of record. As the Veteran is competent to report a continuity of symptomatology since the initial inservice manifestation of her skin disorder, she is competent to relate the currently diagnosed skin disabilities to her active service. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). In sum, service connection for pruritus with dermatographism is warranted. Increased Rating Claims Disability evaluations are determined by comparing a veteran's present symptoms with criteria set forth in the VA's Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Because the instant appeal is from the initial ratings assigned with the grant of service connection, the possibility of "staged" ratings for separate periods during the appeal period, based on the facts found, must be considered. See Fenderson v. West, 12 Vet. App. 119 (1999). When a question arises as to which of two ratings applies under a particular code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 U.S.C.A. § 5107; 38 C.F.R. §§ 3.102, 4.3. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all the 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. II. Degenerative arthritis, thoracolumbar spine. The September 2006 rating decision, in pertinent part, granted service connection for degenerative arthritis of the thoracolumbar spine and assigned a noncompensable rating, effective August 1, 2006. A January 2008 RO decision increased the rating for the Veteran's low back disability to 20 percent, also effective August 1, 2006. Under Diagnostic Codes 5237 and 5242, thoracolumbar spine strain and degenerative arthritis warrants a 20 percent evaluation where there is forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees, or the combined range of motion of the thoracolumbar spine is not greater than 120 degrees, or there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis or abnormal kyphosis. A 40 percent evaluation is warranted for forward flexion of the thoracolumbar spine 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. The Veteran has indicated that she is only able to walk two blocks when her back pain is present. She also stated that her back pain would interfere with her ability to lift and carry items at work. X-rays have revealed mild levoscoliosis of the thoracic spine and diagnoses have included degenerative arthritis of the thoracic spine. Records such as an August 2008 VA treatment record reveal that the Veteran has made complaints of and sought treatment for thoracic back pain. At the June 2010 Board hearing the Veteran indicated that she would take Motrin for her back pain. She indicated that her back arthritis made her feel as if her back was burning, especially by the end of a work day. The Board has reviewed the competent evidence and finds no support for assignment of the next-higher 40 percent evaluation under the general rating formula for diseases and injuries of the spine as there is no showing that forward flexion of the thoracolumbar spine is limited to 30 degrees or less (or favorable ankylosis of the entire thoracolumbar spine). In this regard, VA examinations dated in March 2006 and January 2011 have revealed forward flexion of the thoracolumbar spine from 0 to 90 degrees. The Board has considered additional limitation of function of the lumbar spine due to factors such as pain, weakness, incoordination and fatigability. 38 C.F.R. §§ 4.40, 4.45 and 4.59 and DeLuca, 8 Vet. App. at 202. While VA examiners noted that the Veteran's thoracolumbar spine had pain on motion, the examiners have noted that there was no evidence of additional limitations of the low back after repetitive use. The Board finds that even considering additional functional limitation due to pain, the competent findings do not indicate a disability picture comparable to having forward flexion of the thoracolumbar spine limited to 30 degrees or less as is necessary in order to achieve the next-higher evaluation under Diagnostic Code 5237. Any associated objective neurologic abnormalities, such as may affect the extremities, or cause bowel or bladder impairment, are separately evaluated under an appropriate Diagnostic Code. Note (1). The Board observes that there is no objective evidence of any neurological complications as a result of her service-connected low back disability. Indeed, the extent there is any resulting bladder impairment, the Veteran is already service-connected for a neurogenic bladder. Straight leg raising testing has been negative, and the January 2011 VA examiner noted that the Veteran's sensory and motor examinations were normal. In short, the Board finds that the Veteran has no associated objective neurological complications of the service-connected low back disability. The Veteran has not asserted, and the record does not show, that the Veteran has thoracolumbar spine intervertebral disc disease. However, to the extent the Veteran's symptoms may nonetheless mimic the symptoms thereof, and to afford the Veteran every possible consideration, the Board will consider it's application under Diagnostic Code 5243 in the alternative. Under the Formula for rating Intervertebral Disc Syndrome Based on Incapaciting episodes, the next higher rating or 40 percent is assignable for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. Under this formula, and "incapacitating episode" is a period of acute signs or symptoms that requires bed rest prescribed, and treatment provided, by a physician. 38 C.F.R. § , Diagnostic Code 5243, Note (1). The medical evidence does not reveal any incapacitating episodes caused by the service-connected lumbar spine to the extent that the assignment of a 40 percent rating under Intervertebral Disc Syndrome formula. Indeed, the January 2011 VA spine examination specifically stated there was no lost time from work in the past 12 months, and did not make mention of prescribed bedrest by a physician. As such, a rating under the alternative ratings formula for intervertebral disc disease is not warranted While the Veteran is competent to give evidence about what she observes or experiences concerning her low back disability, she is not competent to identify a specific level of disability of her lumbar spine disability according to the appropriate diagnostic code. Such competent evidence concerning the nature and extent of the Veteran's low back disability has been provided by the medical personnel who have examined her during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings directly address the criteria under which the Veteran's spine disability is evaluated, including forward flexion. As such, the Board finds these records to be the most probative evidence with regard to whether a rating in excess of 20 percent is warranted. In conclusion, the evidence of record reveals a disability picture consistent with the 20 percent evaluation assigned throughout the rating period on appeal. III. Inferior lattice degeneration, retina, right eye. The September 2006 rating decision, in pertinent part, granted service connection for inferior lattice degeneration, retina, right eye, and assigned a noncompensable rating under Diagnostic Code 6011, effective August 1, 2006. Diagnostic Code 6011 provides for a 10 percent disability rating for localized scars, atrophy, or irregularities of the retina, unilateral or bilateral, that are centrally located and that result in an irregular, duplicated, enlarged, or diminished image. Diagnostic Code 6011 also provides for an alternate evaluation to be made based on visual impairment due to retinal scars, atrophy, or irregularities, if this would result in a higher evaluation. The Board notes that VA amended the regulations relevant to rating disabilities of the eye during the course of this appeal. See 73 Fed. Reg. 66,543 (November 10, 2008). This amendment is effective December 10, 2008 and applies to all applications for benefits received by VA on or after that date. As the Veteran's increased rating claim was received prior to December 10, 2008, the amendment does not apply in this case. At any rate, Diagnostic Code 6100 was essentially unaffected by the amendment. A March 2006 VA examiner noted that the Veteran's right eye findings were normal. At a November 2007 VA examination the Veteran indicated that her right eye had "flashes of light." The November 2007 VA examiner noted that the Veteran's right eye condition was stable. Right peripheral lattice degeneration was noted, with corrected right eye visual acuity of 20/15 (far) and 20/20 (near). Visual field was normal in the right eye, and the November 2007 VA examiner noted that the Veteran's right eye lattice degeneration was a frequent finding on dilated examinations and was not visually significant. At the June 2010 Board hearing the Veteran indicated that her vision was worsening. At a December 2010 VA eye examination, the Veteran denied flashes, floaters, pain and diplopia. Corrected far and near right eye vision was 20/20. Lattice degeneration with 3 holes was seen inferiorly in the right eye. The impression was stable lattice degeneration of the right eye with no vision loss from the lattice degeneration. A review of the evidence reveals that there are essentially no irregularities related to the Veteran's right eye lattice degeneration, including visual impairment. For those reasons, the Board finds that an initial compensable disability rating is not warranted. While the Veteran is competent to give evidence about what she observes or experiences concerning her right eye, such as light flashes, she is not competent to identify a specific level of disability according to the appropriate diagnostic code. Such competent evidence concerning the nature and extent of the Veteran's right eye disability has been provided by the medical personnel who have examined her during the current appeal. The medical findings directly address the criteria under which the Veteran's disability is evaluated, including visual impairment. As such, the Board finds these records to be the most probative evidence with regard to whether a compensable rating is warranted. IV. Neurogenic bladder The September 2006 rating decision, in pertinent part, granted service connection for neurogenic bladder and assigned a 40 percent disability rating under Diagnostic Code 7542, effective August 1, 2006. A December 2011 RO decision increased the rating to 60 percent, effective June 21, 2010. A neurogenic bladder disability must be rated according to the level of voiding dysfunction. 38 C.F.R. § 4.115b, Diagnostic Code 7542. Voiding dysfunction is to be rated as urine leakage, frequency, or obstructed voiding. 38 C.F.R. § 4.115a. A 20 percent rating is assigned when the wearing of absorbent materials is required and when the absorbent materials must be changed less than two times per day. Urinary incontinence or leakage requiring the wearing of absorbent materials that must be changed two to four times per day is assigned a 40 percent rating. Urinary incontinence or leakage requiring the use of an appliance of the wearing of absorbent materials that must be changed more than four times per day is assigned a 60 percent rating. 38 C.F.R. § 4.115a. A. Initial disability evaluation in excess of 40 percent for neurogenic bladder for the period from August 1, 2006 through June 20, 2010 At a March 2006 VA examination the Veteran indicated that she had to urinate 6 times from 9:00 pm to 6:30 am. She stated that she required three pads a day. At a December 2007 VA examination the Veteran indicated that she was using Depends that she would change 2-3 times every 24 hours. The evidence for this time period does not show the wearing of absorbent materials which must be changed more than four times per day. As such, an evaluation in excess of 40 percent is not warranted for the period from August 1, 2006 through June 20, 2010. B. Initial staged rating in excess of 60 percent for neurogenic bladder from June 21, 2010. At the June 21, 2010 Board hearing the Veteran indicated that she would go to the bathroom at least 15-16 times a day and would change pads about 6 times per day. On and after June 21, 2010, the Veteran's symptoms have included the wearing of absorbent materials that must be changed more than four times per day, thus warranting the currently assigned 60 percent rating. A 60 percent evaluation is the maximum rating provided for under Diagnostic Code 7542. The Board can find no other applicable diagnostic code that would provide a higher rating. Therefore, a rating in excess of 60 percent is denied. C. Conclusion to increased initial rating claims The Board has been mindful of the "benefit-of-the-doubt" rule, but, in this case, there is not such an approximate balance of the positive evidence and the negative evidence to permit more favorable determinations. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). As for extraschedular consideration for the disabilities on appeal, the threshold determination is whether the disability picture presented in the record is adequately contemplated by the rating schedule. Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). The Court clarified the analytical steps necessary to determine whether referral for extra-schedular consideration is warranted. Either the RO or the Board must first determine whether the schedular rating criteria reasonably describe or contemplate the severity and symptomatology of the Veteran's service-connected disability. Thun v. Peake, 22 Vet. App. 111, 115 (2008). If so, then the assigned schedular evaluation is adequate, referral for extra-schedular consideration is not required, and the analysis stops. If the RO or the Board finds that the schedular evaluation fails to reasonably describe or contemplate the severity and symptomatology of the Veteran's service-connected disability, 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 or frequent periods of hospitalization. Id. At 116. If additional factors are found, 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 to determine whether justice requires assignment of an extra-schedular rating. Id. The evidence of record does not reveal that the Veteran's disability picture is so unusual or exceptional in nature as to render the schedular rating inadequate. The Veteran's disabilities on appeal have been evaluated under the applicable Diagnostic Codes that have specifically contemplated the level of occupational and social impairment caused by service-connected spinal, right eye, and voiding disability. The Veteran's symptoms such as pain, limitation of motion, visual acuity, and wearing of absorbent pads are specifically enumerated under the diagnostic codes used the evaluate the disabilities on appeal. Therefore, referral for assignment of an extra-schedular evaluation in this case is not in order. Floyd v. Brown, 9 Vet. App. 88, 95 (1996); Bagwell v. Brown, 9 Vet. App. 337 (1996). ORDER Service connection for pruritus with dermatographism is granted. An initial disability evaluation in excess of 20 percent for degenerative arthritis, thoracolumbar spine is denied. An initial compensable disability evaluation for inferior lattice degeneration, retina, right eye, is denied. An initial disability evaluation in excess of 40 percent for neurogenic bladder for the period from August 1, 2006 through June 20, 2010 is denied. An initial staged rating in excess of 60 percent for neurogenic bladder from June 21, 2010 is denied. REMAND As for the issue of entitlement to service connection for fibroid cyst on right ovary, status post hysterectomy, pertinent evidence (including a May 2012 letter form a private physician) has been added to the record but has not been considered by the AOJ, including in the AOJ's most recent adjudication. In May 2012 correspondence the Veteran's Attorney specifically stated that AOJ initial review of the evidence was not waived. As such, this issue must be remanded to the AOJ for review of the additional evidence and any appropriate associated development. Applicable VA regulations require that pertinent evidence submitted by the appellant must be referred to the agency of original jurisdiction for review and preparation of another SSOC unless this procedural right is waived in writing by the appellant. 38 C.F.R. §§ 19.37, 20.1304 (2012). Based on the correspondence above, the AOJ shall readjudicate the claim with the benefit of consideration of all evidence added to the file. The Board has considered whether the veteran should be scheduled for a VA examination with a medical opinion regarding a possible relationship between the disability on appeal and the Veteran's military service. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Board finds, however, that such an examination is not necessary as such an examination was undertaken in January 2010. Accordingly, the case is REMANDED for the following action: 1. The AOJ should request all VA medical records pertaining to treatment of the Veteran from October 2012 and associate them with the claims file (or Virtual VA file). 2. The AOJ should then, based on all the evidence of record, readjudicate the issue of entitlement to service connection for fibroid cyst on right ovary, status post hysterectomy. If the benefit sought on appeal is not granted, a supplemental statement of the case should be issued, the Veteran and her representative should be afforded the appropriate period to respond, and the case should thereafter be returned to the Board, as appropriate. The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ JONATHAN B. KRAMER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs