Citation Nr: 1318250 Decision Date: 06/05/13 Archive Date: 06/11/13 DOCKET NO. 11-12 775 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to a compensable initial rating for bilateral hearing loss. 2. Entitlement to service connection for a bilateral elbow disability. 3. Entitlement to service connection for hypertension. 4. Entitlement to service connection for a lung disability, to include as due to asbestos exposure. 5. Entitlement to service connection for a back disability. 6. Entitlement to service connection for a bilateral eye disability. 7. Entitlement to service connection for an enlarged prostate, to include as due to herbicide exposure. REPRESENTATION Appellant represented by: Vietnam Veterans of America ATTORNEY FOR THE BOARD M. Riley, Counsel INTRODUCTION The Veteran served on active duty from May 1958 to May 1960 and from October 1961 to June 1982. This case comes before the Board of Veterans' Appeals (Board) on appeal from a July 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In a December 2010 notice of disagreement, the Veteran initiated an appeal with respect to a claim for entitlement to service connection for a heart disability. A statement of the case (SOC) was issued in March 2011, but in May 2011 the Veteran responded with a statement withdrawing the claim from appeal status. The claim for entitlement to service connection for a heart disability is therefore not before the Board. 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 issues of entitlement to service connection for back, eye and prostate disabilities are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. In April 2013, prior to the promulgation of a decision in the appeal, the Board received notification from the appellant that a withdrawal of the appeal for entitlement to an initial compensable rating for bilateral hearing loss is requested. 2. A chronic bilateral elbow disability, currently diagnosed as degenerative joint disease and spurring with calcified tendonitis, was not present during service, was not manifested within one year from the Veteran's discharge from service, and is not the result of a disease or injury in service. 3. Hypertension was not present during service, was not manifested within one year from the Veteran's discharge from service, and is not the result of a disease or injury in service. 4. A lung disability, currently diagnosed as a nodule of the left lower lobe, was first demonstrated many years after service and is not etiologically related to exposure to asbestos or other disease or injury during active duty service. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal for entitlement to an initial compensable rating for bilateral hearing loss have been met. 38 U.S.C.A. § 7105(b)(2), (d)(5) (West 2002); 38 C.F.R. § 20.204 (2012). 2. A chronic bilateral elbow disability, currently diagnosed as degenerative joint disease and spurring with calcified tendonitis, was not incurred in or aggravated by active service, nor may it be presumed to have been incurred therein. 38 U.S.C.A. §§ 1110, 1112, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. Hypertension was not incurred in or aggravated by active service, nor may it be presumed to have been incurred therein. 38 U.S.C.A. §§ 1110, 1112, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 4. A lung disability, currently diagnosed as a nodule of the left lower lobe, was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1112, 1131, 1137; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Withdrawn Claim The Board may dismiss any appeal which fails to allege a specific error of fact or law in the determination being appealed. 38 U.S.C.A. § 7105 (West 2002). An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204 (2012). Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.204. In the present case, the appellant (through his representative) withdrew the appeal for entitlement to an initial compensable rating for bilateral hearing loss in an April 2013 statement. Hence, there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the Board does not have jurisdiction to review the appeal with respect to this claim and it is dismissed. Service Connection Claims Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"-the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). See also Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed.Cir.2007). When a chronic disease is shown in service sufficient to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). 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. Id. When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Id. For this purpose, a chronic disease is one listed at 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (holding that the term "chronic disease in 38 C.F.R. § 3.309(b) is limited to a chronic disease listed at 38 C.F.R. § 3.309(a)). Service connection may 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). Additionally, for veteran's who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases, such as arthritis and hypertension, are presumed to have been incurred in service if such manifested to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a), 3.309(a). Bilateral Elbow Disability The Veteran contends that service connection is warranted for a bilateral elbow disability as it was incurred during active duty service. The record clearly shows a current bilateral elbow condition. Upon VA examination in April 2010, the Veteran was diagnosed with bilateral elbow degenerative joint disease (spurring) with calcified tendonitis. Service records document two instances of complaints related to the elbows. In April 1975, the Veteran complained of localized tenderness in his left elbow and was diagnosed with tennis elbow at an orthopedic consultation. Five months later, in September 1975, he reported swelling in the right elbow and an effusion and bursitis were diagnosed. Although the Veteran's upper extremities were normal upon examination for retirement in May 1982, the Board finds that two of the three elements necessary for service connection-a current disability and an in-service injury-are demonstrated. Regarding the third element of service connection, a nexus between the Veteran's current disability and the in-service injury, the Board notes that service records do not indicate such a link. No chronic conditions were noted on the May 1982 retirement examination and the Veteran specifically denied experiencing a painful or "trick" elbow on the accompanying report of medical history. There is also no medical evidence of elbow arthritis within a year from the Veteran's retirement from active duty service to allow for service connection on a presumptive basis. See 38 C.F.R. § 3.307, 3.309. In fact, the earliest post-service medical evidence related to the claimed elbow disability dates from the April 2010 VA examination, almost 20 years after service, when a chronic disability was identified by a VA examiner. The absence of any clinical evidence for years after service weighs the evidence against a finding that the Veteran's degenerative joint disease was present in service or in the year immediately after service. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). There is also no competent medical evidence of a nexus in support of the claim. The Veteran's treating physician has not provided a medical opinion linking an elbow disability to service, and the Veteran does not appear to have undergone any post-service treatment for the condition or reported symptoms of the disability to his private doctor. The only medical opinion of record, that of the April 2010 VA examiner, weighs against the claim. After physically examining the Veteran and reviewing the claims file, the VA examiner concluded it was less likely as not that the Veteran's current disability was due to service. The examiner's opinion was based on the contents of the service records (which did not document any treatment or complaints for either elbow after 1975) and the post-service records which were entirely negative for evidence of chronicity of a bilateral elbow condition. The VA examiner's opinion was well-reasoned and supported with reference to specific evidence in the claims file. It is therefore entitled to significant probative weight. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from when it is the factually accurate, fully articulated, and sound reasoning for the conclusion, not the mere fact that the claims file was reviewed). The Board has also considered the Veteran's statements connecting his elbow disability to active duty service. The Board notes that lay persons are competent to provide opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). The specific issue in this case, however, falls outside the realm of common knowledge of a lay person. Jandreau, 429 F.3d at 1377 (lay persons not competent to diagnosis cancer). The Veteran is competent to report observable symptoms, such as elbow pain, but his opinion as to the cause of the symptoms simply cannot be accepted as competent evidence. Id. Furthermore, the Board notes that the Veteran has not reported a history of a continuity of symptomatology since service to allow for an award of service connection under 38 C.F.R. § 3.309(b). During the April 2010 VA examination, the Veteran specifically stated that he did not experience any problems with his elbows after his discharge from service aside from vague reports of minimal pain, and he did not seek any treatment for the claimed disability. Although the Veteran's representative stated in the April 2013 informal hearing presentation that the Veteran had complained of continuous symptoms since service, the Veteran's own statements during the VA examination contradict this assertion. Thus, the Veteran has not reported a clear history of continuous elbow pain since active duty service. In sum, the post-service medical evidence of record shows that the first evidence of the Veteran's current disability was almost two decades after his separation from active duty service. In addition, there is no competent evidence that the Veteran's bilateral elbow degenerative joint disease and spurring with calcified tendonitis is related to his military service. The Board therefore concludes that the evidence is against a nexus between the Veteran's claimed disability and his active duty service. Accordingly, the Board must conclude that the preponderance of the evidence is against the claim and it is denied. 38 U.S.C.A. § 5107(b) (West 2002). Hypertension The Veteran contends that service connection is warranted for hypertension as the disability developed during active duty service. A current disability is demonstrated by the evidence of record as hypertension was diagnosed upon VA examination in April 2010. Thus, the first element of service connection is established. Although the Veteran has been diagnosed with chronic hypertension, the Board finds that the record does not establish an in-service injury. Service treatment records are negative for complaints or treatment related to hypertension or high blood pressure. Additionally, in September and November 1981, two military physicians specifically found that the Veteran did not have a history or current findings of hypertension. The Veteran also denied any problems with high blood pressure on medical history forms completed in September 1981 and May 1982. The Veteran's blood pressure at the May 1982 examination for retirement was 142/80 and was characterized as normal by an April 2010 VA examiner who reviewed the claims file. The Veteran has also not reported any incidents or injuries that occurred during service in connection with his current claim for compensation. In the April 2013 informal hearing presentation, his representative argued that service records demonstrated a steady increase in blood pressure readings throughout the Veteran's more than 20 year period of active service; however, such an increase is not documented in the service records. During cardiology consultations in September and November 1981, less than a year before his separation from active duty, the Veteran's blood pressure was measured as 120/80. While systolic pressure was slightly higher during the May 1982 retirement examination when it measured to 142, this single finding does not represent a steady increase in blood pressure and was described as normal by a VA examiner in April 2010. The Board therefore finds that the contents of the service records and the opinion of the April 2010 VA examiner regarding the interpretation of the Veteran's blood pressure readings outweighs the statements of the Veteran's representative. The record also does not establish a link between the Veteran's hypertension and any incident of active duty service. As discussed above, service records are negative for findings indicative of hypertension and the Veteran's blood pressure was normal at the May 1982 retirement examination. He also specifically denied a history of high blood pressure on the accompanying report of medical history. The Veteran has not submitted any medical evidence in support of his claim and the only medical opinion of record, that of the April 2010 VA examiner, weighs against the claim. The VA examiner's opinion was based on a review of the claims file and the Veteran's statements, including his contention that he was diagnosed with hypertension in 1983 soon after his discharge from service. Although service connection is possible for hypertension on a presumptive basis if manifested to a compensable degree within one year of separation from service, the record before the Board is entirely negative for medical findings of hypertension until August 2006, almost 25 years after service, when it was identified by the Veteran's private doctor. The Veteran has not identified the physician or facility that reportedly diagnosed hypertension in 1983 and the Board finds that service connection for hypertension as a chronic disease under 38 C.F.R. §§ 3.307 and 3.309 is not possible. As for the Veteran's statements connecting his hypertension to service, the Board notes that lay persons are competent to provide opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). The specific issue in this case, i.e. the etiology of the Veteran's current hypertension, falls outside the realm of common knowledge of a lay person. Jandreau, 429 F.3d at 1377. The Veteran is competent to testify as to observable symptoms, but his opinion as to the cause of the symptoms simply cannot be accepted as competent evidence. Id. The Board also notes that the Veteran has not reported a clear history of a continuity of symptomatology since service to allow for an award of service connection under 38 C.F.R. § 3.309(b). During the April 2010 VA examination, he stated that hypertension was initially diagnosed in 1983, but the record contains no medical evidence (or specific statements from the Veteran) to allow the Board to determine that hypertension as chronic disease manifested to a compensable level in the year after his separation from active service. As the evidence does not establish an in-service injury or a nexus between the Veteran's current hypertension and any incident of active duty, Board must conclude that the preponderance of the evidence is against the claim and it is denied. 38 U.S.C.A. § 5107(b) (West 2002). Lung Disability The Veteran also contends that service connection is warranted for a chronic lung disability as it was incurred due to asbestos exposure during active duty service. In an April 2013 informal hearing presentation, the Veteran's representative reported that the Veteran had been diagnosed with an acute respiratory disorder during active service and had experienced cold symptoms with changes of weather since service. Initially, the Board finds that the record establishes the presence of a current disability. While the Veteran did not complain of any respiratory symptoms during an April 2010 VA examination, a chest CT performed in connection with the examination demonstrated a tiny lung nodule in the left lower lobe. No other lung disorders were identified, but the Board finds that the lung nodule arguably constitutes a current disability. The Veteran contends that his disability is the result of asbestos exposure during active service with the Army. There is no specific statutory guidance concerning asbestos claims, nor has the VA Secretary promulgated any regulations in regard to such claims. However, the VA Adjudication Procedure Manual, M21-1MR, Part IV, Subpart ii, Chapter 2, Section C (Manual), provides information concerning claims for service connection for disabilities resulting asbestos exposure. The United States Court of Appeals for Veterans Claims (Court) has also held that VA must analyze an appellant's claim for service connection for asbestosis or asbestos-related disabilities under the appropriate administrative guidelines. Ennis v. Brown, 4 Vet. App. 523 (1993); McGinty v. Brown, 4 Vet. App. 428 (1993). The adjudication of a claim for service connection for a disability resulting from asbestos exposure should include a determination as to whether or not: (1) service records demonstrate the Veteran was exposed to asbestos during service; (2) development has been accomplished sufficient to determine whether or not the Veteran was exposed to asbestos either before or after service; and (3) a relationship exists between exposure to asbestos and the claimed disease in light of the latency and exposure factors. Manual at Subsection (h). The relevant factors discussed in the manual must be considered and addressed by the Board in assessing the evidence regarding an asbestos related claim. See VAOPGCPREC 4-2000. The Board finds that the Veteran likely had some exposure to asbestos during service. His DD-214 and service personnel records demonstrate that he served as a wheeled vehicle mechanic and engineer equipment repairman. Although the records do not specifically confirm asbestos exposure, the VA Manual notes that the servicing of friction products, such as clutch facings and brake linings, involves exposure to asbestos. Manual at subsection (f). The Board will therefore resolve all doubt in favor of the Veteran and find that he was exposed to asbestos during active duty service based on his military occupational specialty (MOS). The presence of an in-service injury is demonstrated. The Board must now determine whether the Veteran's claimed disabilities are etiologically related to his in-service exposure to asbestos. Service treatment records do not indicate such a relationship; they are negative for evidence of a chronic lung disability. The Veteran's representative reported in April 2013 that the Veteran was treated for an acute respiratory disorder in service, but treatment records are negative for treatment or complaints related to the lungs. A chest X-ray performed in March 1979 was suggestive of some localized fibrotic changes in the right lower lobe, but no diagnosis was rendered and later chest X-rays performed throughout active service were negative for abnormalities. Similarly, the Veteran's lungs and chest were normal upon physical examination at the May 1982 retirement examination. At that time, the Veteran also specifically denied experiencing shortness of breath, dyspnea, cough, asthma, or lung infections on the accompanying report of medical history. There is also no objective post-service evidence of lung problems or complaints until August 2007, 25 years after the Veteran's retirement from military service, when he reported experiencing dyspnea to his private physician. No diagnosis was made at that time and a respiratory examination was normal. The earliest diagnosis of a lung disability dates from the April 2010 VA examination when a chest CT demonstrated a left lower lobe nodule. There is also no competent medical evidence in support of the claim. The Veteran has not submitted any medical opinions in support of his claim and private treatment records are devoid of any findings of a chronic lung disability. Dyspnea was noted by a private physician in August 2007, but the accompanying respiratory examination was normal and no diagnosis was rendered. The only medical opinion of record, that of the April 2010 VA examiner, weighs against the claim. After reviewing the claims file and physically examining the Veteran, the VA examiner concluded that there was no evidence of current lung disease or an asbestos-related injury. The Veteran's chest CT, while indicating a lung nodule, was negative for interstitial lung disease, pleural plaques, or other findings associated with asbestos exposure. A pulmonary function test (PFT) was also normal and the Veteran denied any symptoms or history of shortness of breath, dyspnea, cough, asthma, or lung infections. Based on review of the claims file and the contemporaneous examination and tests, the VA examiner concluded that the Veteran had no active lung disease or asbestos-related injury. The Board has considered the Veteran's statements connecting his current lung disability to active duty service and asbestos exposure. The Board notes that lay persons are competent to provide opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). The specific issue in this case, however, falls outside the realm of common knowledge of a lay person. Jandreau, 429 F.3d at 1377. The Veteran is competent to testify as to observable symptoms, but his opinion as to the cause of the symptoms simply cannot be accepted as competent evidence. Id. Furthermore, the Board notes that the Veteran has not reported a history of continuing symptoms since service. In the April 2013 informal hearing presentation, his representative stated that the Veteran had experienced cold symptoms with changes of the weather since service, but such statements only indicate vague intermittent symptoms rather than continuous lung problems. The Veteran himself has not provided any specific statements in support of his claim and has not provided any information regarding current symptoms. It is therefore clear that the Veteran has not reported a history of continuous lung problems since service. The Board notes that its discussion of the Veteran's symptoms is in the context of using lay evidence to prove the nexus element of a service connection claim under 38 C.F.R. § 3.303(a) and (d), but not 38 C.F.R. § 3.303(b). See Davidson, 581 F.3d 1313; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In sum, the competent evidence of record is clearly against a nexus between the Veteran's only diagnosed lung condition-a nodule in the lower left lobe-and his active duty service and asbestos exposure. Accordingly, the Board must conclude that the preponderance of the evidence is against the claim and it is denied. 38 U.S.C.A. § 5107(b) (West 2002). 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, 5126 (West 2002)) defined VA's duties to notify and assist a veteran in the substantiation of a claim. VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) and that the claimant is expected to provide. Pelegrini v. Principi (Pelegrini II), 18 Vet. App. 112, 120-21 (2004), see 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). In this case, notice fulfilling the requirements of 38 C.F.R. § 3.159(b) was furnished to the Veteran in a September 2009 letter. The Veteran also received notice regarding the disability-rating and effective-date elements of the claims in the September 2009 letter. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VA is also required to make reasonable efforts to help a claimant obtain evidence necessary to substantiate a claim. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c), (d). This "duty to assist" contemplates that VA will help a claimant obtain records relevant to a claim, whether or not the records are in Federal custody, and that VA will provide a medical examination or obtain an opinion when necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4). VA has obtained records of treatment reported by the Veteran, including service treatment records and private medical records. During the April 2010 VA examination, the Veteran reported that he was diagnosed with hypertension in 1983, a year after his retirement from active duty service. However, he has never identified the physician or facility that diagnosed hypertension in 1983, despite VA's requests for the Veteran to submit and/or identify all records of treatment for the claimed disabilities. In the May 2011 substantive appeal, the Veteran stated that he would submit records of private treatment that were not currently in VA's possession. Records were received from his private physician in June 2011, but they date only from June 2006. The Veteran has not indicated that any additional records are available for procurement and the Board therefore finds that all available private treatment records have been associated with the claims file. The Veteran has also not reported undergoing any VA treatment for the disabilities on appeal. Additionally, the Veteran was provided proper VA examinations in response to his claims. In the April 2013 informal hearing presentation, the Veteran's representative argued that the April 2010 VA examination pertaining to the claimed lung disability was not adequate. The representative noted that the VA examiner did not discuss the Veteran's past report of dyspnea to a private physician in August 2007 or the Veteran's current contention that he was diagnosed with an acute respiratory disorder during active service. The Board finds that the April 2010 VA examination is adequate and notes that the history provided by the Veteran's representative in April 2013 is at odds with statements made by the Veteran during the VA examination and throughout the claims period. Although the Veteran complained of dyspnea to a private doctor in August 2007, the accompanying respiratory examination was wholly negative and there were no other complaints related to the Veteran's lungs in the post-service record. At the time of the April 2010 VA examination, the Veteran also specifically denied a past history of dyspnea. He did not report the diagnosis of any lung conditions during service, either acute or chronic, and instead denied a history of lung infections. Service treatment records are also negative for complaints or findings related to any lung infections. As noted above, a March 1979 chest X-ray suggested localized fibrotic changes, but later X-rays were entirely negative for any lung abnormalities and the record contains no evidence of treatment for a lung infection. As the Veteran's newly reported history of a lung infection during service is inconsistent with (and outweighed by) the contents of the service records and the Veteran's own reports at the April 2010 VA examination, the Board finds that the VA examiner's failure to address it does not render the examination report inadequate. For the reasons set forth above, the Board finds that VA has complied with the VCAA's notification and assistance requirements. ORDER The appeal for entitlement to an initial compensable rating for bilateral hearing loss is dismissed. Entitlement to service connection for a bilateral elbow disability is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for a lung disability, diagnosed as a nodule of the left lower lobe, to include as due to asbestos exposure, is denied. REMAND The Board finds that additional development is necessary with respect to the claims for entitlement to service connection for back, eye, and prostate disabilities. Specifically, VA examinations and medical opinions are necessary to determine the nature and etiology of the claimed conditions. VA is obliged to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service; and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C.A. § 5103A(d) (West 2002). The evidence of a link between current disability and service must be competent. Wells v. Principi, 326 F.3d 1381 (Fed. Cir. 2003). The threshold for getting an examination under the VCAA is low. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The Veteran contends that chronic back, eye, and prostate disabilities were incurred during active duty service. Post-service treatment records demonstrate the presence of current disabilities as the Veteran's private physician diagnosed arthritis of the thoracic spine and bilateral arcus senilis of the eyes in August 2006. The Veteran's prostate was also enlarged upon examination in August 2006 and laboratory test results have shown a gradual increase in his prostate-specific antigen (PSA) test results since that date. Additionally, service treatment records document that the Veteran complained of recurrent back pain and spasms during the May 1982 retirement examination. He also received treatment for eye complaints several times during active service, and the Board finds that medical interpretation of the reported findings is required. Thus, VA examinations and medical opinions are required by the duty to assist. 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. Afford the Veteran an appropriate VA examination to determine the nature and etiology of the claimed back disability. The Veteran's claims file must be made available to the examiner for review in connection with the examination. After physically examining the Veteran and reviewing the complete claim file, the examiner should determine whether it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent), that any present back disability (to include arthritis) was incurred due to any event during active duty service. The rationale for all opinions expressed should also be provided. The examiner should specifically discuss the Veteran's complaints of back pain and spasms noted at the May 1982 retirement examination. 2. Afford the Veteran an appropriate VA examination to determine the nature and etiology of the claimed eye disability. The Veteran's claims file must be made available to the examiner for review in connection with the examination. After physically examining the Veteran and reviewing the complete claim file, the examiner should determine whether it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent), that any present eye conditions (to include arcus senilis) were incurred due to any event during active duty service. The rationale for all opinions expressed should also be provided. The examiner's opinion should address whether the Veteran's eye examinations performed during active duty service document the presence of a chronic eye disability. 3. Afford the Veteran an appropriate VA examination to determine the nature and etiology of the claimed prostate disability. The Veteran's claims file must be made available to the examiner for review in connection with the examination. After physically examining the Veteran and reviewing the complete claim file, the examiner should determine whether the Veteran has a chronic prostate disability. If a disability is demonstrated, the examiner should determine whether it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent), that any present prostate disability was incurred due to any event during active duty service, to include the Veteran's presumed exposure to herbicides. The rationale for all opinions expressed should also be provided. The examiner's opinion should address the private doctor's finding of an enlarged prostate in August 2006 and the Veteran's gradually increasing PSA levels since that date. 4. Readjudicate the claims on appeal. If the benefits sought are not fully granted, issue a supplemental statement of the case before returning the case to the Board, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ MICHAEL MARTIN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs