Citation Nr: 1319674 Decision Date: 06/18/13 Archive Date: 06/27/13 DOCKET NO. 08-34 280 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota THE ISSUES 1. Entitlement to service connection for a claimed seizure disorder. 2. Entitlement to service connection for claimed dystonia. 3. Entitlement to service connection for a claimed eye disorder, as secondary to dystonia. 4. Entitlement to service connection for a claimed ear disorder, as secondary to dystonia. 5. Entitlement to service connection for a claimed cardiovascular disorder, as secondary to dystonia. REPRESENTATION Veteran represented by: Vietnam Veterans of America ATTORNEY FOR THE BOARD M. Donohue, Counsel INTRODUCTION The Veteran served on active duty from April 1972 to April 1974. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a July 2008 decision of the RO. In a February 2011 decision, the Board found that new and material evidence had been received to reopen the claims of service connection for dystonia and a seizure disorder. The reopened claims, along with the claims of service connection for eye, ear and cardiovascular disorders, were remanded for additional development. The appeal was again remanded by the Board in November 2012. The issues of service connection for a dental condition, claimed as secondary to dystonia, and service connection for an innocently acquired psychiatric disorder, a low back condition, a knee disorder and an ankle condition, have been raised by the record, but have not been addressed by the RO. Therefore, the Board does not have jurisdiction and refers these matters to the AOJ for appropriate action. The issues of service connection for dystonia and for eye, ear and cardiovascular disorders, as secondary to dystonia, are being remanded to the RO via the Appeals Management Center (AMC) in Washington, DC. Please note this appeal has been advanced on the Board's docket pursuant to 38 U.S.C.A. § 7107(a)(2) (West 2002); 38 C.F.R. § 20.900(c) (2012). FINDING OF FACT The competent and credible evidence of record does not establish that the Veteran suffers from a chronic seizure disorder. CONCLUSION OF LAW The Veteran does not have a disability manifested by a chronic seizure disorder due to disease or injury that was incurred in or aggravated by active service, nor may any be presumed to have been incurred therein. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION After the evidence has been assembled, the Board is responsible for evaluating the entire record. 38 U.S.C.A. § 7104(a) (West 2002). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. See 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R. § 3.102 (2012). Indeed, in Gilbert v. Derwinski, 1 Vet.App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet.App. at 54. Furthermore, the Board notes that it has reviewed all of the evidence in the claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis will focus specifically on what evidence is needed to substantiate the issue adjudicated herein and what the evidence in the claims file shows, or fails to show, with respect to this claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). I. The Veterans Claims Assistance Act of 2000 (VCAA) The Veterans Claims Assistance Act of 2000 (VCAA), codified in pertinent part at 38 U.S.C.A. §§ 5103, 5103A (West 2002), and the pertinent implementing regulation, codified at 38 C.F.R. § 3.159 (2012), provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. The law and regulations also require VA to notify the claimant and the claimant's representative, if any, of any information and any medical or lay evidence not previously provided to VA that is necessary to substantiate the claim. As part of the notice, VA is to specifically inform the claimant and the claimant's representative, if any, of which portion, if any, of the evidence is to be provided by the claimant and which part, if any, VA will attempt to obtain on behalf of the claimant. In March 2006, the Court issued its decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006) and held that the notice requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a "service connection" claim. As previously defined by the courts, those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. Upon receipt of an application for "service connection," therefore, VA is required to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. This includes notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. The Board also notes that the Court has held that the plain language of 38 U.S.C.A. § 5103(a) requires that notice to a claimant pursuant to VCAA be provided "at the time" that, or "immediately after," VA receives a complete or substantially complete application for VA-administered benefits. Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). The timing requirement enunciated in Pelegrini applies equally to the initial-disability-rating and effective-date elements of a service-connection claim. Dingess, supra. In the present case, VA issued a VCAA notice letter to the Veteran in May 2008, prior to the initial adjudication of his claim. This letter informed the Veteran of what evidence was required to substantiate his service connection claim and of his and VA's respective duties for obtaining evidence. The May 2008 letter also informed the Veteran as to the law pertaining to the assignment of a disability rating and effective date as the Court required in Dingess. In short, the record indicates that the Veteran received appropriate notice pursuant to VCAA. VCAA also provides that VA shall make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate a claim for VA benefits, unless no reasonable possibility exists that such assistance would aid in substantiating the claim. In this capacity, as noted in the Introduction, the Board remanded the Veteran's claim in February 2011 and November 2012. Specifically in February 2011, the Board requested that the RO provide the Veteran with a corrective VCAA notification letter which clarified the bases of his prior denial for a seizure disorder. The Board also requested the RO assist the Veteran in obtaining any additional medical records he identified, and readjudicate his claim. Upon review, the record indicates that the Veteran was provided with a corrective VCAA notice letter which informed him of the basis of his previous denial of service connection in February 2011. This letter also informed the Veteran that VA would make reasonable efforts to obtain any evidence he identified. Upon review, however, the Veteran did not identify any additional treatment records. The Veteran's claim was then readjudicated in the May 2012 Supplemental Statement of the Case. In the November 2012 remand, the Board again requested that the RO contact the Veteran and request he identify any outstanding medical treatment records. The Board also requested that the Veteran be afforded a VA examination to determine the nature and etiology of his claimed seizure disorder. In a December 2012 letter, the AMC requested the Veteran identify "each health care provider who has treated [his] claimed . . . dystonia," however, no additional records were identified. The record also reflects that the Veteran was provided with the requested VA examination in January 2013. His claim was then readjudicated in the March 2013 SSOC. Thus, the Board's remand instructions have been complied with. See Stegall v. West, 11 Vet. App. 268, 271 (1998) [where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance]; see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) [although under Stegall VA is required to comply with remand orders, substantial compliance, not absolute compliance, is required]. Further, the Board finds that reasonable efforts have been made to assist the Veteran in obtaining evidence necessary to substantiate his claim and that there is no reasonable possibility that further assistance would aid in substantiating it. In particular, the record contains the Veteran's service treatment records, VA and private medical records, records from the Social Security Administration and a VA examination report. The Board has carefully reviewed the Veteran's statements and concludes that he has not identified further evidence not already of record. The Board has also reviewed the medical records for references to additional treatment reports not of record, but has found nothing to suggest that there is any outstanding evidence with respect to the Veteran's claim. As noted, the Veteran was provided with a VA examination in January 2013. The report of this examination reflects that the examiner reviewed the Veteran's past medical history, recorded his current complaints, conducted an appropriate physical examination and rendered an appropriate diagnosis consistent with the remainder of the evidence of record. See Barr v. Nicholson, 21 Vet. App. 303 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board therefore concludes that the examination is adequate for adjudication purposes. See 38 C.F.R. § 4.2 (2012). The Board additionally observes that all appropriate due process concerns have been satisfied. See 38 C.F.R. § 3.103 (2012). The Veteran has been accorded the opportunity to present evidence and argument in support of his claim. He has declined to exercise his option of a personal hearing. Based on the foregoing, the Board finds that all relevant facts have been properly and sufficiently developed in this appeal and that no further development is required to comply with the duty to assist the Veteran in developing the facts pertinent to his claim. Essentially, all available evidence that could substantiate the claim has been obtained. There is no indication in the file that there are additional relevant records that have not yet been obtained. II. Law and Regulations In general, service connection may be granted for disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2012). 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 or injury was incurred in service. See 38 C.F.R. § 3.303(d) (2012). In order to establish service connection for the claimed disorder, there must be (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See 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); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). Certain chronic disabilities, to include epilepsies, are presumed to have been incurred in or aggravated by service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1110, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). With 'chronic disease' shown as such in service (or within the presumptive period under § 3.307), so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). For the showing of a '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. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Id. The term 'chronic disease,' whether as manifest during service or manifest to a compensable degree within a presumptive window following service, applies only to those disabilities listed in 38 U.S.C.A. § 1101 and 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). III. Analysis The existence of a current disability is the cornerstone of a claim for VA disability compensation. See 38 U.S.C.A. §§ 1110, 1131; Degmetich v. Brown, 104 F. 3d 1328 (1997). Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability due to disease or injury, there can be no valid claim. Brammer v. Derwinski, 3 Vet.App. 223, 225 (1992). Likewise, the Federal Circuit has noted that in order for a veteran to qualify for compensation under the relevant statutes, the veteran must prove existence of a disability, and one that has resulted from a disease or injury that occurred in the line of duty. See Sanchez- Benitez v. Principi, 259 F.3d 1356 (2001). In the present case, the Board finds that the preponderance of the evidence reflects a lack of a current seizure disability. As noted, the Veteran was afforded a VA examination to determine the nature and etiology of his claimed seizure disorder in January 2013. After reviewing the Veteran's claims file and conducting a physical examination, the VA examiner stated that the Veteran does not have, and has never been diagnosed with a seizure disorder. Upon review of the record, at no time during the current appeal has the Veteran been diagnosed with a seizure disorder. There is also no evidence that a chronic seizure disorder became manifest to a degree of 10 percent or more within a year of his separation from service. In finding that there is no current disability, the Board has considered the Veteran's reports of spasms that caused him to fall to the floor. See a June 2010 VA treatment record. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet.App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet.App. 49, 57 (1990). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet.App. 67, 74 (1997); Layno v. Brown, 6 Vet.App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet.App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). In this case, there is no dispute that Veteran is competent to report symptoms such as spasms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet.App. 465, 470 (1994). However, the January 2013 VA examiner's finding that there was no seizure disorder outweighs the more general and conclusory descriptions of the Veteran and his opinion that these symptoms constitute a seizure disability. Cf. Nieves-Rodriguez v. Peake, 22 Vet.App. 295, 304 (2008) (threshold considerations in weighing the probative value of medical opinions include the qualifications of the person opining, and most of the probative value from such opinions come from their reasoning). Here, the medical evidence disclosing no current disability is far more probative and credible than the appellant's own unsupported lay statements. Moreover, the Veteran's complaints of spasms have been diagnosed as dystonia and not a seizure disorder. See, e.g., a March 1982 VA treatment record. The Veteran has been accorded ample opportunity to present evidence in support of his claim, i.e., a competent evidence of a current disability. He has failed to do so. See 38 U.S.C.A. § 5107(a) (it is the claimant's responsibility to support a claim for VA benefits). The Court has held that "[t]he duty to assist is not always a one-way street. If a Veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence." See Wood v. Derwinski, 1 Vet.App. 190, 193 (1991). In the absence of a competent medical to establish a diagnosis of a chronic seizure disorder at any time during the appeal period, service connection may not be granted. See Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997) & Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) [service connection cannot be granted if the claimed disability does not exist]. See also McClain v. Nicholson, 21 Vet.App. 319 (2007). Accordingly, the first Shedden element has not been met, and the Veteran's claim fails on this basis alone. In the absence of a claimed disability, there is no need to discuss the remaining two Shedden elements. In conclusion, for the reasons and bases expressed above, the Board finds that the preponderance of the evidence is against the Veteran's claims of service connection for a seizure disorder. The benefit sought on appeal is accordingly denied. ORDER Service connection for a claimed seizure disorder is denied. REMAND The Veteran is seeking service connection for dystonia on the basis that it had its onset during service or was aggravated therein. He is also seeking service connection for separate eye, ear and cardiovascular disorders as secondary to dystonia. For the following reasons, the Board finds that these issues must be remanded to ensure that the Veteran is accorded full compliance with the statutory duty to assist. The Veteran contends that his dystonia had its onset while he was on active duty. See an October 2011 statement. In the alternative, he asserts that this disability existed prior to his enlistment and was aggravated while on active duty. See a November 2008 VA Form 9. With regards to his aggravation theory, the Veteran has alleged that his preexisting dystonia was aggravated during a two week period of active duty for training while in the Army Reserve. See the November 2008 VA Form 9. He indicated that he was put on light duty for the remainder of the training period. Id. While the Veteran's service treatment records have been obtained and associated with his claims folder, there is no indication that efforts were made to obtain the Veteran's Army Reserve treatment records. See Hayre v. West, 188 F.3d 1327 (Fed. Cir. 1999) [VA's efforts to obtain service department records shall continue until the records are obtained or unless it is reasonably certain that such records do not exist or that further efforts to obtain those records would be futile.] In this capacity the Board notes that the record is unclear as to whether the Veteran actually served in the Army Reserve as he appears to have denied having any such service in a July 1981 VA Form 21-526. Accordingly, under these circumstances, additional development is required. Further, a veteran will be considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto. See 38 U.S.C.A. §§ 1111, 1132 (West 2002); 38 C.F.R. § 3.304(b) (2012). Upon review, the Veteran's service treatment records include a March 1972 self report of medical history wherein the Veteran denied having any preexisting diseases or disabilities. He stated that he had never been a patient in a hospital and reported that he was in "good" medical condition. A physical examination conducted at this time revealed no abnormalities and a neurologic examination was normal. As alluded to above, the Veteran has made conflicting reports of when his dystonia had its onset. For example, in October 2011, the Veteran reported that his dystonia had its onset while he was on active duty. In contrast, the Veteran has reported to medical professionals that he had spasms of the neck, face, arm and hand that had occurred for "most of his life" and that his dystonia was aggravated while he was on active duty. See a February 1982 VA treatment records; see also a November 2008 VA Form 9. In March 1984, the Veteran reported that he did not have dystonia prior to service, but had had polio as an infant with involvement of his face and left cheek. He reported that this disability had completely resolved prior to his enlistment. Following the Board's November 2012 remand, the Veteran was afforded a VA examination in January 2013. After conducting a physical examination and reviewing the Veteran's claims folder, the examiner noted that the Veteran had been diagnosed with polio as a child and subsequently diagnosed him with post-polio syndrome. It was noted that the Veteran had been experiencing the natural recurrence and worsening of his polio symptoms that came with age. As a result, the examiner concluded that the Veteran's pre-service episodes of dystonia were not aggravated during his active duty. The Court has held that lay statements by a veteran concerning a preexisting condition, alone, are not sufficient to rebut the presumption of soundness. See Paulson v. Brown, 7 Vet.App. 466, 470 (1995) (a lay person's account of what a physician may or may not have diagnosed is insufficient to support a conclusion that a disability preexisted service); Crowe v. Brown, 7 Vet.App. 238 (1994) (supporting medical evidence is needed to establish the presence of a preexisting condition). In determining whether a condition pre-existed service, however, lay evidence must still be considered. That is, the Veteran's medical history, accepted medical principles, evidence regarding the basic character, origin and development of the condition, and lay and medical evidence concerning the inception, development and manifestations of the condition must all be considered. 38 C.F.R. § 3.304(b). See Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009). Moreover, while contemporaneous clinical evidence or recorded history may often be necessary to satisfy the heavy burden of rebutting the statutory presumption of soundness, there is no absolute rule in the statute, the regulation, or the case law requiring such evidence before the presumption can be rebutted. Harris v. West, 203 F. 3d. 1347, 1351 (Fed. Cir. 2000). Where a later medical opinion is based on statements made by the veteran about the pre-service history of his condition, contemporaneous clinical evidence and recorded history may not be necessary. Id. Such an opinion exists in this case. However, it is predicated solely upon the Veteran's statements regarding the diagnosis of polio prior to service. These statements are inconsistent with the statements he made at the time of his enlistment. Specifically, that he had not been hospitalized and that he was in good health at the time of his enlistment. Therefore, this evidence does not represent the clear and unmistakable evidence necessary to rebut the presumption of soundness. Upon review, it is clear that the medical treatment records which note that the Veteran had a prior history of polio are based on his own inconsistent statements. See LeShore v. Brown, 8 Vet.App. 406, 409 (1995) ['a bare transcription of a lay history is not transformed into 'competent medical evidence' merely because the transcriber happens to be a medical professional']. Consequently, this issue contains certain questions which cannot be answered by the Board. See Colvin v. Derwinski, 1 Vet.App. 171, 175 (1991) (the Board is prohibited from exercising its own independent judgment to resolve medical questions). These questions concern whether it can be established by clear and unmistakable evidence that the Veteran had dystonia or polio prior to service. (As noted above, the Veteran's statements, to include those recorded by his treating physicians, are insufficient to rebut the presumption of soundness.) If so, was this preexisting disability aggravated beyond the normal progression of the disease during service? If it cannot be established that the Veteran had a preexisting disability prior to service, a VA examiner must opine on whether the Veteran's dystonia had its onset during, or is otherwise related to his active duty service. See Charles v. Principi, 16 Vet.App. 370 (2002); see also 38 C.F.R. § 3.159(c)(4) (2012) (a medical examination or opinion is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim). Finally, the Board notes that the Veteran's eye, ear and cardiovascular disorder claims are inextricably intertwined with his claim for service connection for dystonia, as the resolution of that claim might have bearing upon the secondary service connection claims. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to remand the claim on appeal pending the adjudication of the inextricably intertwined claim. Accordingly, the remaining issues are 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. The RO should take all indicated action to contact the National Personnel Records Center (NPRC) and/or any other appropriate repository of records, and attempt to determine if the Veteran served in the Army Reserves. If so, the RO should request a copy of the Veteran's reserve treatment and hospitalization records. All efforts to obtain such records should be documented in the claims folder. 2. The RO should take appropriate steps to contact the Veteran and request that he provide information referable to all VA and non-VA treatment he has received for the claimed disabilities remaining on appeal. After securing any necessary authorization for release of information, the RO should obtain copies of any outstanding records from any identified health care provider. A specific request should be made for any outstanding VA medical records dated since June 2011. All efforts to obtain such records should be documented in the claims folder, and all available records should be associated with the Veteran's VA claims folder. 3. Then, the RO should have the Veteran scheduled for an appropriate VA examination to determine the nature and likely etiology of the diagnosed dystonia. The claims folder, including a copy of this remand, must be made available to the examiner. All diagnostic testing deemed to be necessary by the examiner should be accomplished, and the results should be annotated in the evaluation report. Following examination and review of the claims folder, the examiner is requested to provide an opinion as to: 1) Notwithstanding the Veteran's statements, to include those statements that have been recorded by health care providers as the Veteran's medical history, can it be established that the Veteran had dystonia or polio prior to his active duty service? 2) If it can be medically established that the Veteran had dystonia and/or polio prior to his active duty service, were these disabilities aggravated (permanently worsened beyond normal progression) during his active duty service? 3) If it cannot be established that the Veteran had dystonia and/or polio prior to his active duty service, did the currently diagnosed dystonia have its clinical onset in active service, or is otherwise related to active service? Complete rationale should be provided for all opinions expressed. 4. After completing all indicated development, the RO should readjudicate the issues remaining on appeal in light of all the evidence of record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a fully responsive SSOC and afforded a reasonable opportunity for response. Thereafter, if indicated, the case should be returned to the Board for the purpose of appellate disposition. The Veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or by the Court 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). ______________________________________________ STEPHEN L. WILKINS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs