Citation Nr: 1306307 Decision Date: 02/22/13 Archive Date: 02/27/13 DOCKET NO. 11-19 340 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Entitlement to service connection for diabetes mellitus, type II. 2. Entitlement to service connection for hypertension. 3. Entitlement to service connection for sinusitis. REPRESENTATION Appellant represented by: Mississippi Veterans Affairs Commission ATTORNEY FOR THE BOARD L. Kirscher Strauss, Counsel INTRODUCTION Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The Veteran had active service from February 1954 to October 1957. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. In November 2011 and again in December 2012, the Board remanded the case for additional development. The development with respect to the claims for service connection for diabetes mellitus and hypertension has been completed. The issue of entitlement to service connection for sinusitis is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. Competent and probative evidence of record fails to establish that type II diabetes mellitus was initially manifested during service or within one year after separation from service, or that diabetes mellitus is related to active service. 2. Competent and probative evidence of record fails to establish that hypertension was initially manifested during service or within one year after separation from service, or that hypertension is related to active service. CONCLUSIONS OF LAW 1. The criteria for establishing service connection for type II diabetes mellitus have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 1137, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 2. The criteria for establishing service connection for hypertension have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 1137, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2012)) includes enhanced duties to notify and assist claimants for VA benefits. VA regulations implementing the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). The notice requirements of the VCAA require VA to notify the claimant of any evidence that is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, VA will attempt to obtain. 38 C.F.R. § 3.159(b) (2012). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between a veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VCAA notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO, to include the AMC). Id.; see also Pelegrini v. Principi, 18 Vet. App. 112 (2004). However, insufficiency in the timing or content of VCAA notice is harmless if the errors are not prejudicial to the claimant. Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004) (VCAA notice errors are reviewed under a prejudicial error rule). In this case, in a January 2010 letter issued prior to the decision on appeal, the Veteran was provided notice regarding what information and evidence is needed to substantiate his claims for service connection as well as what information and evidence must be submitted by the Veteran and what information and evidence will be obtained by VA. The letter also advised him of how disability evaluations and effective dates are assigned, and the type of evidence that impacts those determinations. The case was last adjudicated in January 2013. The record also reflects that VA has made reasonable efforts to obtain relevant records adequately identified by the Veteran including available service treatment records, post-service private and VA treatment records, and VA examination reports and medical opinions. The Board also notes that actions requested in the prior remands have been undertaken. Here, the AMC requested additional medical evidence in support of the claims, including from Dr. B.; additional treatment records from the Jackson VA Medical Center dated from March 2010 through September 2012 were obtained and associated with the electronic, Virtual VA claims file; the Veteran was afforded an additional VA examination to determine whether any sinusitis or rhinitis disorder was related to service; and the AMC addressed the Board's request to attempt to locate additional service treatment records, which the Board discusses in further detail below. The AMC later issued a supplemental statement of the case (SSOC). Based on the foregoing, the Board finds that the AMC substantially complied with the mandates of the remands, and a decision on the merits can proceed. See D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict, compliance with the terms of a Board remand is required pursuant to Stegall v. West, 11 Vet. App. 268 (1998)). In summary, VA has considered and complied with the VCAA provisions discussed above. The Veteran was notified and aware of the evidence needed to substantiate the claims, the avenues through which he might obtain such evidence, and the allocation of responsibilities between the Veteran and VA in obtaining such evidence. The Veteran was an active participant in the claims process by submitting evidence and argument. Therefore, he was provided with a meaningful opportunity to participate in the claims process and has done so. Any error in the sequence of events or content of the notice is not shown to have affected the essential fairness of the adjudication or to cause injury to the Veteran. See Pelegrini, 18 Vet. App. at 121. Therefore, any such error is harmless and does not prohibit consideration of this matter on the merits. See Conway, 353 F.3d at 1374; Dingess, 19 Vet. App. 473; see also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. General Relevant Laws and Regulations for Service Connection Service connection will be granted if it is shown that the Veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. In addition, certain chronic diseases, including diabetes mellitus and hypertension, may be presumed to have been incurred during service if the disorder becomes manifest to a compensable degree within one year of separation from active duty. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2012). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service. Watson v. Brown, 4 Vet. App. 309, 314 (1993); see also Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). To establish service connection, there must be: (1) a medical diagnosis of a current disability; (2) medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 252 (1999) (citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996)). The Board notes that the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1 (2012). As a preliminary matter, the Board notes that after the Veteran January 2010 claims for service connection were received, the RO contacted the National Personnel Records Center (NPRC) and requested the Veteran's service treatment records (STRs). That same month, the NPRC responded that it was sending all the records that it had, but that the Veteran's STRs were fire-related. The STRs received include the Veteran's service entrance and discharge examinations, but do not include treatment records. In June 2010, the Veteran's representative submitted argument that according to the NPRC's website, the Veteran's records were not involved in the fire and that an additional attempt to obtain his records should be made. In 1973 a fire at the NPRC destroyed the STRs of many veterans. The website for the NPRC notes that for Air Force veterans, the records affected were for personnel discharged between September 25, 1947 and January 1, 1964, with names alphabetically after Hubbard. See The 1973 Fire, National Personnel Records Center, located at http://www.archives.gov/st-louis/military-personnel/fire-1973.html (last visited November 1, 2011). The Veteran served in the Air Force, was discharged in October 1957, and his last name is alphabetically prior to Hubbard. According to the NPRC's own website, therefore, the Veteran's STRs are not fire-related. Accordingly, the Board remanded the claim in November 2011, in part, to attempt to obtain the STRs. Following the remand, the AMC put a November 2011 document in the claims file documenting that all of the evidence was already in the claims file and that the Board had improperly directed development. With the exception of sending letters to the Veteran in February and March 2010 and in December 2012, the RO/AMC did not take further action to obtain any outstanding service treatment records. However, upon careful review of the service treatment records, the Board concludes that the November 2011 AMC memorandum regarding improperly directed development because the evidence (service treatment records) was already in the claims file appears to be accurate. Service treatment records received in January 2010 included February 1954 enlistment reports of medical history and examination, January 1957 reports of medical history and examination, and September 1957 discharge reports of medical history and examination. Inspection of the January 1957 medical history report reveals that the Veteran described the purpose of that examination as "records lost," and the examination report lists the purpose of the examination to "est[ablish] current physical." Therefore, it appears that medical records dated prior to January 1957 were lost during service. No further information was provided as to how or where treatment records dated prior to January 1957 were lost. Accordingly, because the January 1957 reports themselves indicate that the records were lost during service, the Board finds that no further action is required to attempt to locate them. Turning to the evidence, service treatment records were silent for complaints, findings, or diagnosis of diabetes mellitus or hypertension. In reports of medical history dated in February 1954 at enlistment, in January 1957, and in September 1957 at service discharge, the Veteran denied currently or ever having high blood pressure. Examination reports dated in February 1954, January 1957, and September 1957 indicated that clinical evaluation of the endocrine system was normal; laboratory findings were reported as negative. Blood pressure was recorded as 112/70 in February 1954, 138/84 in January 1957, and 120/80 at separation in September 1957. A post-service private treatment record dated in July 2002 reflects that the Veteran presented for a blood pressure follow-up. Current medications for hypertension included Hytrin and Lotrel. The assessment was hypertension. During follow-up treatment for blood pressure in March 2005 with a private family nurse practitioner, M. J., F.N.P., the assessment was hypertension. The nurse practitioner ordered a basic metabolic profile (BMP) on the Veteran. During a follow-up visit four days later in March 2005, a private physician noted that the Veteran's blood sugar was 392, and he was started on Glucotrol (Glipizide). A May 2006 private treatment record indicated that the Veteran presented for a diabetic eye examination. The physician noted that the Veteran had been borderline diabetic for a few years and had just been put on Glipizide about six months previously. Following the examination, the impression included type 2 diabetes without retinopathy. Subsequent private treatment records reflected ongoing evaluation and treatment for type II diabetes mellitus and hypertension. During March 2009 private follow-up treatment for diabetes, the Veteran indicated that it had been under good control. In February 2010, the Veteran presented to the Jackson VA Medical Center for initial evaluation to establish care. He reported a medical history that included hypertension and type 2 diabetes. Subsequent VA treatment records documented ongoing evaluation and treatment for hypertension and diabetes. The Veteran's claim for service connection was received in January 2010. On his application, he indicated that his high blood pressure began in 1994 and his diabetes disability began in 2005. In his June 2010 notice of disagreement with the denial of his claim, the Veteran asserted that his claimed disabilities started in the military. The Veteran presented for a routine VA primary care follow-up visit in February 2011. A history of the present illness (HPI) indicated that the Veteran was followed for hypertension and diabetes. The impression included hypertension, at goal and non-insulin dependent diabetes mellitus, at goal. In his July 2011 substantive appeal, he claimed that his military medical record supports his claimed disabilities. In August 2011 correspondence, the Veteran's representative related the Veteran's contention that he was diagnosed and treated for diabetes mellitus and hypertension while on active duty. On a VA Form 21-4142, Authorization and Consent to Release Information, dated in November 2011, the Veteran indicated that nurse practitioner, M. J., had treated him for diabetes since December 2005 and that M. J. discovered his diabetes. The Veteran was afforded VA diabetes and hypertension examinations in September 2012. In each examination report, the examining physician indicated that he had reviewed the claims file. During the diabetes examination, the Veteran stated that he was treated for diabetes mellitus in service, and he described his current symptoms and treatment. The diagnosis was type II diabetes mellitus diagnosed in 2005. The examiner opined that the Veteran's diabetes mellitus was not incurred in or the result of military duty or deployment, and it had not been permanently aggravated by any other service-connected condition. Supporting his conclusion, the examiner noted that the 1957 separation examination did not indicate that the Veteran was being treated for an endocrine condition, such as diabetes. In addition, private treatment records unequivocally indicated that the Veteran was initially diagnosed with type II diabetes in March 2005 after routine blood work. The examiner also noted that treatment records from 2002 to 2003 indicated that the Veteran was being treated for hypertension without concurrent diabetes, and as the hypertension proceeded his diabetes and his diabetes had been under excellent glycemic control, his hypertension had not been aggravated by diabetes. During the VA hypertension examination, the Veteran stated that his hypertension was addressed in service. Following a review of the claims file and physical examination, the examiner opined that the current hypertension was not incurred in or the result of military service, nor was it secondary to, or aggravated by any other service-connected condition. In support of his conclusion, the examiner noted that service treatment records did not document treatment for hypertension or document elevated blood pressure. He also observed that the Veteran's weight was approximately 160-165 pounds during service and 208 pounds in 2002 when hypertension was first documented in private treatment records. The Board has considered the medical and lay evidence of record, but finds that entitlement to service connection for diabetes mellitus or hypertension is not warranted. Considering the claim for service connection for diabetes mellitus on a direct basis, the Board notes that none of the service medical records reflects complaints, findings, or diagnosis of an endocrine disorder, to include diabetes. Rather examination reports during service consistently documented a normal endocrine system. Considering the claim for service connection for hypertension on a direct basis, the Board observes that none of the blood pressure readings among the service examination reports reflected "hypertension" as defined by 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1 for VA compensation purposes, and the Veteran denied a history of high blood pressure on discharge examination in October 1957. In addition, in his January 2010 claim for service connection, the Veteran reported that his high blood pressure began in 1994, and the earliest available medical evidence of diagnosed hypertension is in 2002, more than 44 years after separation from service. Similarly, on his application, he stated that his diabetes began in 2005, more than 47 years after separation from service, and his original statement about when his diabetes began is consistent with the objective medical evidence of record. Moreover, the Board also points out that the passage of many years between discharge from active service and the objective documentation of a claimed disability is a factor that tends to weigh against a claim for service connection for the disability. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). As a result, service connection for diabetes mellitus or hypertension on a direct or presumptive basis is not warranted. To the extent the Veteran contends that his current diabetes mellitus and hypertension disabilities were diagnosed and treated during military service, the Board notes that the January and September 1957 examination reports do not reflect diagnosis or treatment for either disability. The Board is skeptical that if the Veteran was diagnosed and receiving treatment for diabetes and hypertension during service that he would not have mentioned these disabilities or medications taken for these disabilities at his separation examination. Also, the Veteran has not shown that he has specialized training sufficient to render an opinion as to the diagnosis or etiology of diabetes mellitus or hypertension, as such requires medical expertise and testing to determine. Accordingly, his opinion that his current diabetes and hypertension began during military service is not competent medical evidence, particularly because diagnosis of these disabilities is not noted on his September 1957 separation examination. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In summary, the Board finds the objective medical records and the opinions of the September 2012 VA examiner are of greater probative value than the Veteran's lay assertions. The Board also finds that these assertions are contradicted by the January and September 1957 examination reports, which do not reflect diagnosis or treatment during service for either disability. Furthermore, the assertion that these disabilities were diagnosed and treated during service is inconsistent with the Veteran's prior statement on his January 2010 claim for service connection that hypertension began in 1994 and diabetes began in 2005. Because the Veteran's statements regarding the onset of his claimed disabilities are inconsistent, the Board does not find the Veteran to be a credible historian with respect to the onset of these disabilities. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995) ("The credibility of a witness can be impeached by a showing of interest, bias, inconsistent statements, or, to a certain extent, bad character."). Finally, the Board finds the opinions of the September 2012 VA examiner to be persuasive evidence against the claims because each opinion was based on a review of the claims file, subjective history from the Veteran, and physical examination, and each was supported by an articulated medical rationale that was consistent with the evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). In conclusion, the Board finds there is no basis upon which to conclude that diabetes mellitus or hypertension is related to military service. See 38 C.F.R. §§ 3.303, 3.307, 3.309. Therefore, service connection for diabetes mellitus or hypertension is not warranted. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claims for service connection for diabetes and hypertension, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b) (West 2002); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). ORDER Service connection for diabetes mellitus is denied. Service connection for hypertension is denied. REMAND The Veteran has a right to substantial compliance with the Board's remand orders. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Moreover, if the Board proceeds with final disposition of an appeal, and the remand orders have not been complied with, the Board itself errs in failing to ensure compliance. Stegall, 11 Vet. App. at 271. Thus, while the Board regrets the additional delay in this case, for the reasons discussed below, the case must be returned to the RO/AMC. In December 2012, the Board remanded the claim remaining on appeal, in part, because it did not appear that the November 2012 VA respiratory examiner examined the Veteran for his claimed sinusitis. The Board also found the November 2012 examination report inadequate because the examiner did not render a medical opinion regarding any relationship between the seasonal rhinitis noted in post-service treatment records and military service. The Veteran was afforded a VA examination for sinusitis, rhinitis, and other conditions of the nose, throat, larynx, and pharynx using a disability benefits questionnaire (DBQ) in January 2013. Unfortunately, the report contains some ambiguity as to whether the Veteran currently has sinusitis. In response to the question of whether the Veteran now has or had ever been diagnosed with a sinus, nose, throat, larynx, or pharynx condition, the examiner answered "yes" and indicated that chronic sinusitis was diagnosed in 1957. In response to whether the Veteran had sinusitis, rhinitis, a larynx or pharynx condition, deviated nasal septum, tumors or neoplasms, or other conditions, the examiner check "no." The DBQ instructions direct the examiner to proceed to the next section if the answer is "no" or to check all that apply if the answer is "yes." Although the examiner checked, "no," he responded to the specific questions regarding rhinitis and traumatic deviated nasal septum. The examiner indicated that x-rays of the sinuses were normal; however, the x-ray report was not associated with the examination report. In a remarks section of the report, the examiner stated that he found no clinical or radiologic evidence of acute or chronic sinusitis. However, the Veteran did have severe non-traumatic nasal septal deformity with obstruction, left worse than right, as seen on x-rays. The examiner reiterated that he could not find any sinus-nasal disease that could be related to service activities or treatment, reasoning that there was currently no sinus disease. He opined that it was as likely as not that the current symptoms of nasal congestion were all secondary to nasal obstruction by the severe septal deviation. The examiner did not render a medical opinion as to whether rhinitis was incurred in or medically related to military service. For these reasons, the claim must be remanded to arrange for an additional examination and medical opinion and to associate the x-rays from the January 2013 examination with the claims file. By way of history, the Board observes that service treatment records were silent for complaints, findings, or diagnosis of sinus problems. In reports of medical history dated in February 1954 at enlistment, in January 1957, and in September 1957 at service discharge, the Veteran denied currently or ever having sinusitis or hay fever. Examination reports dated in February 1954, January 1957, and September 1957 indicated that clinical evaluation of the nose and sinuses was normal. During February 2003 follow-up treatment for hypertension, the Veteran requested medication refills, including for Allegra. A diagnosis regarding the sinuses or nose was not rendered. During follow-up treatment for blood pressure in March 2005 with a private family nurse practitioner, M. J., F.N.P., objective medical findings included clear nasal drainage with head, ears, eyes, nose, and throat essentially within normal limits. The assessment included rhinitis. The nurse practitioner prescribed Alle[gra] 180 [mg] every day. Private treatment records dated in October 2006 and September 2008 reflect that Allegra was refilled. The assessment in September 2008 was rhinitis. During March 2009 private follow-up treatment for diabetes, the Veteran stated that his Allegra had not been working well lately. Objective examination of the head, eyes, ears, nose, and throat was reported as "look okay." The assessment included rhinitis, and the nurse practitioner gave the Veteran some Ala-Hist that he could take "a couple of times a day for his sinuses." In February 2010, the Veteran presented to the Jackson VA Medical Center for initial evaluation to establish care. He reported a history of sinusitis, for which he was taking Loratadine (Claritin). During a review of systems, he did not endorse headaches, earache or discharge, or nasal stuffiness. The Veteran's claim for service connection was received in January 2010. On his application, he indicated that severe sinusitis began in 2000. In his June 2010 notice of disagreement with the denial of his claim, the Veteran asserted that his claimed disabilities started in the military. The Veteran presented for a routine VA primary care follow-up visit in February 2011. A history of the present illness (HPI) indicated that the Veteran was followed for sinusitis for which he was taking Loratadine daily. Reported physical examination findings did not pertain to the sinuses. The impression included sinusitis. An August 2011 primary care follow-up note listed "sinusitis - Loratadine daily" in the past medical history. Active medications included Loratadine "for allergies." Physical examination findings did not reference the sinuses. In his July 2011 substantive appeal, he claimed that his military medical record supported his claimed disabilities. In August 2011 correspondence, the Veteran's representative related the Veteran's contention that he was diagnosed and treated for sinusitis while on active duty. During a September 2012 VA respiratory examination, the Veteran stated that he began smoking a pack of cigarettes per day after service from age 22 through approximately age 62. He reported currently smoking two packs of five cigars per week. Following a review of the claims file and pulmonary function testing (PFT), the examiner concluded that the Veteran did not have the respiratory condition he was claiming. He elaborated that the service treatment records did not indicate that the Veteran was treated for a chronic respiratory condition and neither his VA nor private treatment records revealed care for a chronic respiratory condition. The examiner acknowledged that the post-service treatment records did, however, reflect care for seasonal rhinitis, particularly complaints of rhinorrhea, with aggravation during the spring and summer months. The examiner also indicated that the current PFT was consistent with chronic obstructive pulmonary disease (COPD) parameters; however, he did not meet the criteria for chronic bronchitis. The examiner summarized that the Veteran did not claim a respiratory condition was incurred in or the result of service, and service treatment records did not indicate care for such a condition, "yet PFTs were indicative of COPD, WITHOUT a clinical diagnosis of such, or care for same, which is MORE than likely due to tobacco abuse, that is, LESS likely than not due to, or the result of military service." (Emphasis in original). Before arranging for an additional VA examination, relevant ongoing VA medical records should also be requested from the VA medical center in Jackson, Mississippi and related clinics dating since September 2012. See 38 U.S.C.A. § 5103A(c) (West 2002); see also Bell v. Derwinski, 2 Vet. App. 611 (1992) (VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim). Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. Relevant ongoing VA treatment records dating since September 2012 to the present from the Jackson, Mississippi VA medical center and related clinics should be obtained. Also, the x-ray report from the January 2013 VA examination must be obtained and associated with the claims file. 2. After completion of the above development to the extent possible, the Veteran should be afforded a VA sinusitis, rhinitis, and other conditions of the nose, throat, larynx, and pharynx examination. The purpose of the examination is to determine whether the Veteran has a current sinusitis or rhinitis disorder that arose during service or is otherwise related to service. The claims file and a copy of this Remand must be provided to and be reviewed by the examiner in conjunction with the examination. Any tests or studies deemed necessary should be conducted, and the results should be reported in detail, and the reports of any tests or studies must be associated with the examination report. Following review of the claims file and examination of the Veteran, the examiner should clearly identify all disorders found. With respect to each diagnosed disability, the examiner should opine as to whether it is at least as likely as not (50 percent probability or greater) that the current sinusitis, rhinitis, or other disability arose during service or is otherwise related to any incident of service. A medical analysis and rationale are to be included with all opinions expressed. 3. Thereafter, the RO/AMC must review the claims file to ensure that the foregoing requested development has been completed. In particular, review the requested medical opinion to ensure that it is responsive to and in compliance with the directives of this remand and if not, implement corrective procedures. See Stegall v. West, 11 Vet. App. 268 (1998). 4. After completing the above action and any other development as may be indicated by any response received as a consequence of the actions taken in the paragraphs above, the claim should be readjudicated. If the claim remains denied, a supplemental statement of the case should be provided to the Veteran and his representative. After they have had an adequate opportunity to respond, this issue should be returned to the Board for further appellate 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). ______________________________________________ J. A. MARKEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs