Citation Nr: 1319771 Decision Date: 06/19/13 Archive Date: 06/27/13 DOCKET NO. 05-16 712 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi THE ISSUES 1. Entitlement to service connection for a bilateral eye disability. 2. Entitlement to service connection for a bilateral ear disability. 3. Entitlement to service connection for an acquired psychiatric disorder, claimed as depression. ATTORNEY FOR THE BOARD A.M. Ivory, Counsel INTRODUCTION The Veteran served on active duty from October 1977 to July 1983. This appeal to the Board of Veterans' Appeals (Board) arose from a November 2004 rating decision in which the RO in Columbia, South Carolina denied the Veteran's claims for service connection for arthritis in the knees, hands, and wrists, a bilateral eye condition, a bilateral ear condition, depression, back pain, chest pain, and benign fibro-osseous lesion (claimed as dental condition). In November 2004, the Veteran filed a notice of disagreement (NOD). A statement of the case (SOC) was issued in March 2005, and the Veteran filed a substantive appeal (via a VA Form 9, Appeal to the Board of Veterans' Appeals) in April 2005. In February 2009, the Board remanded the claims on appeal to the RO, via the Appeals Management Center (AMC) in Washington, D.C., for further action, to include additional development of the evidence. After completing the requested development, the AMC continued to deny the claims (as reflected in a February 2010 supplemental SOC (SSOC)) and returned the matters to the Board for further consideration. In June 2011 the Board remanded the issues of entitlement to service connection for a bilateral eye disability and a bilateral ear disability for further action, to include additional development of the evidence. After completing the requested development, the AMC continued to deny the claims (as reflected in a September 2012 supplemental SOC (SSOC)) and returned the matters to the Board for further consideration. In June 2011, the Board also denied service connection for an acquired psychiatric disorder, claimed as depression, as well as service connection for arthritis in the knees, hands, and wrists; back pain; chest pain; and benign fibro-osseous lesion (claimed as dental condition). The Veteran appealed only the Board's denial of entitlement to service connection for an acquired psychiatric disorder, claimed as depression to the United States Court of Appeals for Veterans Claims (Court). In February 2012 the Court granted the joint motion for remand filed by representatives for both parties, vacating the Board's decision, and remanding the claim to the Board for further proceedings consistent with the joint motion. During the pendency of the appeal, the Veteran's claims file was transferred to the jurisdiction of the RO in Jackson, Mississippi, which has certified the matters for appellate review. The Board notes that the claims file reflects that the Veteran was previously represented by the American Legion. In July 2008, the Veteran filed a VA Form 21-22, Appointment of Veterans Service Organization as Claimant's Representative, appointing the Disabled American Veterans (DAV) as her representative. When the Veteran appealed her claim to the Court she was represented by Robert V. Chisholm, Esquire. However, in November 2012 the Veteran submitted a form that she was electing to be pro se and wanted to represent herself. Thus, the Veteran currently does not have a representative for any issue on appeal. The Board recognizes the change in representation. A review of the Virtual VA paperless claims processing system does not reveal any additional documents pertinent to the present appeal. The Board's decision addressing the claim of entitlement to service connection for a bilateral eye disability is set forth below. The claims for entitlement to service connection for a bilateral ear disability and an acquired psychiatric condition are addressed in the remand following the order; those matters are being remanded to the RO, via the Appeals Management Center (AMC), in Washington, D.C. VA will notify the appellant when further action, on her part, is required. FINDINGS OF FACT 1. All notification and development actions needed to fairly adjudicate the claim herein decided has been accomplished. 2. While service treatment records reflect that the Veteran complained red, dry, itchy eyes during service and was diagnosed with conjunctivitis during service her current diagnosis is refractive error of the eye (and therefore not a disability for VA compensation purposes), and there is no competent evidence of a current eye disability due to aggravation by superimposed in-serve injury or disease. CONCLUSION OF LAW The criteria for service connection for disability claimed as a bilateral eye disability are not met. 38 U.S.C.A. §§ 1131 , 5103, 5103A, 5107(b) (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102 , 3.159, 3.303, 4.9 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION 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). Notice requirements under the VCAA essentially require VA to notify a claimant of any evidence that is necessary to substantiate the claims, as well as the evidence that VA will attempt to obtain and which evidence he or she is responsible for providing. See, e.g., Quartuccio v. Principi, 16 Vet. App. 183 (2002) (addressing the duties imposed by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) ). As delineated in Pelegrini v. Principi, 18 Vet. App. 112 (2004), after a substantially complete application for benefits is received, proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claims; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claims, in accordance with 38 C.F.R. § 3.159(b)(1) . The Board notes that, effective May 30, 2008, 38 C.F.R. § 3.159 has been revised, in part. See 73 Fed. Reg. 23,353 -23,356 (April 30, 2008). Notably, the final rule removes the third sentence of 38 C.F.R. § 3.159(b)(1) , which had stated that VA will request that a claimant provide any pertinent evidence in his or her possession. VA's notice requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between the 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-compliant 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.; Pelegrini, 18 Vet. App. at 112. See also Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). However, the VCAA notice requirements may, nonetheless, be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Id. In this appeal, in a July 2004 pre-rating letter, the RO provided notice to the Veteran explaining what information and evidence was needed to substantiate the claims for service connection, what information and evidence must be submitted by the appellant, and what information and evidence would be obtained by VA. Post rating, a March 2009 letter provided information pertaining to the assignment of disability ratings and effective dates, as well as the type of evidence that impacts those determinations, consistent with Dingess/Hartman. After issuance of the above-described notice, and opportunity for the appellant to respond, the RO readjudicated the claims on appeal, as reflected in the February 2010 SSOCs. Hence, the appellant is not shown to be prejudiced by the timing of the latter notice. See Mayfield v. Nicholson, 20 Vet. App. 537, 543 (2006); see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as in an SOC or SSOC, is sufficient to cure a timing defect). The record also reflects that VA has made reasonable efforts to obtain or to assist in obtaining all relevant records pertinent to the matter on appeal. Pertinent medical evidence associated with the claims file consists of service treatment records, various private medical records, VA treatment records, and the report of the July 2012 VA examination. Also of record and considered in connection with the appeal are various written statements provided by the Veteran and by her representative, on her behalf. The Board also finds that no additional RO action to further develop the record in connection with the claim herein decided is warranted. The Board also finds that the June 2011 remand was complied with since the Veteran was afforded the July 2012 VA examination and additional treatment records were obtained. As the requested development has been completed, no further action to ensure compliance with the remand directive is required. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). In summary, the duties imposed by the VCAA have been considered and satisfied. Through various notices of the RO, the Veteran has been notified and made aware of the evidence needed to substantiate the claim, the avenues through which she might obtain such evidence, and the allocation of responsibilities between herself and VA in obtaining such evidence. There is no additional notice that should be provided, nor is there any indication that there is additional existing evidence to obtain or development required to create any additional evidence to be considered in connection with the claim herein decided. Consequently, any error in the sequence of events or content of the notice is not shown to prejudice the Veteran or to have any effect on the appeal. Any such error is deemed harmless and does not preclude appellate consideration of any of the matter herein decided, at this juncture. See Mayfield, 20 Vet. App. at 543 (rejecting the argument that the Board lacks authority to consider harmless error). See also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. Analysis Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110 , 1131; 38 C.F.R. § 3.303. Such a determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Service connection may be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). When such chronic diseases are at issue, the second and third elements for service connection may be established by showing continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a). Id. In adjudicating a claim for VA benefits, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Refractive error is not a disease or injury within the meaning of applicable legislation (i.e., not a compensable disability). 38 C.F.R. §§ 3.303(c), 4.9. Considering the pertinent evidence in light of the governing legal authority, the Board finds that the claim for service connection must be denied. The Veteran's service treatment records reflect that the Veteran complained of recurring itching of the eyes. In November 1977 the Veteran was seen for eye problems and it was noted " ? impaired vis acuity." In May 1978 she reported moderate eye pain and was diagnosed with a viral syndrome. In October 1978 she was seen for dry skin around her left eye and was diagnosed with itching of the left eye and was given hydrocortisone. In January 1979 the Veteran was diagnosed with recurrent left acute conjunctivitis. At a February 1979 Optometry Examination it was noted that the Veteran left eye gets very red and that it started last year and occurred three times and occurred once this year. The Veteran reported that she wanted a reading prescription. On examination it was noted that she had mild chronic blepharitis, clear corneas and lenses, and macular reflex with dense pigment. She was advised about her blepharitis and told to keep her eyes clean and to come in next time she had red eye. In June 1979 it was noted that the Veteran's eyes were fine and there was no distance blur. In September 1979 the Veteran was seen at the emergency room with complaints of severe headaches, transient dim vision, and nervousness. In October 1979 the Veteran was seen at the outpatient clinic and she reported redness and irritation of the right eye and was diagnosed with conjunctivitis of the right eye. In February 1980 the Veteran was seen for an injury to the right eye but there was no foreign body or abrasion to the cornea and her vision was normal and not blurred. In June 1980 the Veteran was seen for problems with her left eye, she complained of recurrent itching for the past two years. It was noted that she had conjunctiva of the cornea and a possible corneal abrasion. There were no complaints of blurred vision or diplopia. It was then noted that she woke up with itching of the left eye and a swollen upper lid; she was diagnosed with traumatic conjunctivitis. In August 1980 she reported itching eyes; it was noted that she had red eyes for the last two to three years off and on. Her vision was 20/20 for both the right and left eye and her lids and cornea were noted to be clear. A May 1981 Record of Optometric Examination it was noted that the Veteran had allergic conjunctivitis. The Board notes that there was no notation of any eye problems in her June 1977 Report of Medical Examination, the undated Report of Medical Examination, or the April 1982 Report of Medical Examination. The Veteran's post-service treatment records include an October 2004 VA optometry consult. She reported red, itchy eyes going on for more than 20 years and since she left the service. The Veteran was diagnosed with dry eye syndrome of both eyes, but the Veteran refused dilation because she had to return to work. At a private medical appointment in June 2009, the Veteran noted that she had dryness in her eyes, particularly ever since her pterygium resection. The Veteran was afforded a VA examination in July 2012; she reported symptoms of red, itchy eyes and lid swelling occasionally. She also reported a history of pterygium excision but she was unsure of when; the VA examiner stated that the Veteran was a poor historian and was vague in her answers. She was diagnosed with uncorrected distance and uncorrected near of 20/200 in both eyes, corrected distance of 20/70 in the right eye and 20/40 or better in the left eye, and corrected bear if 20/40 or better in both eyes. On examination there was no evidence of dry eye, the tear production test was normal at one minute compared to the usual five minutes, there was no evidence of pterygim, and there was no explanation of difference in uncorrected distance vision and corrected near vision in the right eye. The VA examiner also noted that in addition to there being no evidence of pterygium it was not in service. The Board finds that though the Veteran had red and itchy eyes in service and a diagnosis of conjunctivitis in service there is no evidence of a post-service diagnosed eye disability. On examination the only diagnosed eye disability was visual acuity for the right eye corrected distance. Thus, the only current diagnosis is a refractive error of the eye, and therefore not a disability for VA compensation purposes. 38 C.F.R. §§ 3.303(c), 4.9. While the Board notes that service connection may be granted, in limited circumstances, for disability due to aggravation of a constitutional or developmental abnormality by superimposed disease or injury (see VAOPGCPREC 82-90, 55 Fed. Reg. 45,711 (1990); Carpenter v. Brown , 8 Vet. App. 240, 245 (1995); and Monroe v. Brown, 4 Vet. App. 513, 514-15 (1993)), there is no competent evidence that such has occurred in this case. In this case, the Veteran has not reported either during service or since service that she had an in-service eye injury. However, in this case it does not matter since the fact remains that service connection for her only diagnosed eye condition is legally precluded. Significantly, neither the Veteran nor any of her representative has presented or identified any contrary, competent evidence or opinion-medical evidence or opinion which indicates that the Veteran has injury-related eye disability upon which to predicate an award of service connection. Furthermore, without appropriate training and expertise, the Veteran is not competent to render a diagnosis of eye disability. See Bostain v. West , 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). As lay assertions in this regard have no probative value, the Veteran clearly cannot support her claim on the basis of lay assertions, alone. The Board emphasizes that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C.A. § 1131; see also 38 C.F.R. § 3.310. Thus, where, as here, the only available medical evidence indicates that the Veteran does not have a disability for VA compensation purposes, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In the instant case, the claim for service connection an eye disability must be denied, because the first essential criterion for a grant of service connection-evidence of a current disability upon which to predicate a grant of service connection-has not been met. For all the foregoing reasons, the Board finds that the claim for service connection for an eye disability must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b) ; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER Service connection for an eye disability is denied. REMAND Unfortunately the Board finds that further RO action on the claims remaining on appeal is warranted, even though such will, regrettably, further delay an appellate decision on the matters. In June 2011 the Board remanded in part for the Veteran to undergo a ear, nose, and throat (ENT) examination by an appropriate physician, at a VA medical facility. In the June 2011 remand the Board noted the Veteran alleged that she has a current bilateral ear disability that is related to service. It was noted that service treatment records reflected that the Veteran complained, on several occasions, of prolonged bilateral ear pain, and had diagnosed ear infections in service. It was additionally noted that recently-obtained medical evidence reveals that the Veteran has bilateral hearing loss to the extent recognized as a disability for VA purposes. See 38 C.F.R. § 3.385 (2012 ). The Board stated that since there was evidence of the Veteran's prolonged bilateral ear pain in service, and the recent findings of bilateral hearing loss, collectively suggest that Veteran may have a current disability related to service. Since there was no actual opinion addressing the medical relationship, if any, between her current disability and service the Board found that a medical examination and opinion-based on full consideration of the Veteran's documented medical history and assertions, and supported by clearly-stated rationale-would be helpful in resolving the claim for service connection. See 38 U.S.C.A. § 5103A ; 38 C.F.R. § 3.159; McLendon, 20 Vet. App. at 83. Thus, the Board remanded in order for to be afforded a VA examination. The VA examiner was directed to identify all current disability/ies affecting the ears, to include previously diagnosed bilateral hearing loss. Then, with respect to each such diagnosed disability, the physician should offer an opinion, consistent with sound medical judgment, as to whether it is at least as likely as not (i.e., there is a 50 percent or greater probability), that the disability had its onset in or is otherwise medically related to service (to include the assessment of prolonged bilateral ear pain, otitis media, and otitis externa noted therein). The Veteran was afforded two VA examinations in July 2012; the first was a VA ear conditions examination. The VA examiner stated that on examination the Veteran had no abnormal finding of acute or chronic middle ear disease, Eustachian tube dysfunction, tympanic membrane abnormalities, or inflammatory disease. He opined that each of the episodes of ear complaint with positive findings and documented by record during the Veteran's military service were or acute nature that responded to medical management. He further stated that there is no evidence of progression of disease to a chronic state in either ear. The Veteran was then afforded a VA audiological examination in July 2012; however, on examination the Veteran could not be tested because though her responses were obtained they were elevated and not representative of her best effort. It was further stated that the test results were invalid because the Veteran exaggerated her responses such that there was very poor agreement between the speech reception thresholds and pure tone. It was also stated that the use of speech discrimination score was not appropriate for this Veteran because of language difficulties, cognitive problems, inconsistent speech discrimination score, etc., that makes the combined use of puretone average and speech discrimination scores inappropriate. No diagnosis was given but the VA examiner stated that it was less likely as not that the Veteran's hearing loss was caused by or a result of an event in the military service. The rationale was that the Veteran had normal hearing for VA purposes on April 12, 1982. While the July 2012 VA audiologist could not administer an audiological examination there is evidence in the Veteran's claims file that she meets the standards for VA hearing loss under 38 C.F.R. § 3.385. The Board finds that a remand is warranted in order for an additional VA nexus opinion to be rendered. There is no separation examination of record; however, there is a June 1976 Report of Medical Examination for Enlistment, a July 1977 Report of Medical Examination for Flying, an undated Report of Medical Examination, and an April 1982 Report of Medical Examination for Periodical Reasons. While the Veteran did not meet the standards for hearing loss under 38 C.F.R. § 3.385 during her military service there is evidence that the Veteran's audiometric readings decreased in severity during service. Thus, the Board finds that the Veteran should be afforded a new VA examination to determine her current audiometric results and for an opinion, detailed with rationale, whether her current bilateral hearing loss is related to any aspect of her military service, including any noise exposure and her in-service diagnoses. In light of points raised in the parties' Joint Motion, and the Board's review of the claims file, further RO action on the matter of the Veteran's claim of entitlement of service connection for an acquired psychiatric disorder is warranted. As pointed out in the Joint Motion, in February 2009 the Board remanded the issue of entitlement to service connection for an acquired psychiatric disorder, claimed as depression, for further development. The February 2009 remand directed the RO to obtain outstanding private and VA treatment records. It was also stated that: As such, if, on remand, any evidence reflecting current signs and symptoms of any of these disabilities is associated with the claims file, the Veteran should be afforded appropriate VA examination(s) to obtain a medical nexus opinion pertinent to each diagnosed disability. February 2009 Board Remand The Veteran was not afforded a VA examination and in June 2011 the Board denied the Veteran's claim of entitlement to service connection for an acquired psychiatric disorder, claimed as depression. The Board stated while the Veteran has been diagnosed with anxiety disorder NOS and depression, the claims file lacks any probative evidence that either of the Veteran's current disorders is related to her service; thus, the current record does not reflect even a prima facie claim for service connection for her claimed disability, VA has no obligation to obtain further medical examination or opinion in connection with her claim. See 38 U.S.C.A. § 5103A(d); Wells v. Principi, 326 F. 3d. 1381, 1384 (Fed. Cir. 2003). See also Duenas v. Principi, 18 Vet. App. 512 (2004) (per curium). In the Joint Motion, it was pointed out records indicating that the Veteran was diagnosed with, or showed positive signs of, depression in 2004 were subsequently associated with the Veteran's claims filed after the Board's remand. It was noted that the Veteran was afforded a VA examination in January 2005, where no nexus opinion was given, and there is no evidence that the Veteran underwent a VA examination following the February 2009 Board remand. The Joint Motion then stated that: Given that the evidence regarding the diagnosis of [the Veteran] with depression was produced during the pendency of the current appeal, such evidence should be considered to be evidence of a current disability. Thus, pursuant to its February 2009 decision, the Board, in decision on appeal, should have remanded [the Veteran's] claim of entitlement to an acquired psychiatric disorder, claimed as depression, in order to provide a VA medical examination to obtain a medical nexus compliant with the remand order, but did not. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that when "the remand order of the Board or this Court are not complied with, the Board itself errs in failing to insure compliance."). Therefore, [the Veteran's] claim of entitlement to service connection for an acquired psychiatric disorder, claimed as depression is warranted in order for the Board to comply with the February 2009 remand order. February 2012 Joint Motion for Remand Thus, the Board finds that the Veteran should be afforded a VA examination in order to determine the current nature and etiology of the Veteran's acquired psychiatric disorder. The VA examiner should determine if the Veteran has a current psychiatric diagnosis and whether it is at least likely as not related to the Veteran's military service. The Board notes that according to the Veteran's service treatment records the Veteran was seen in April 1980 for personal problems at home and was diagnosed with mild depression. In September 1982 she reported depression and in October 1982 she reported a heaviness in her chest due to personal problems which she was working out and starting to feel better. In January 1983 it was noted she had multiple stresses and personal problems and that she needed ongoing counseling/stress management. It was noted that it was related to multiple marital and personal problems, fear of having another miscarriage, and having no support system in Germany. The Veteran is hereby advised that, failure to report to the examinations scheduled in connection her bilateral hearing loss and her acquired psychiatric disorder, without good cause, may result in denial of the claims for service connection. See 38 C.F.R. § 3.655 (2012). Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant and death of an immediate family member. If the Veteran fails to report to the scheduled examinations, the RO should obtain and associate with the claims file a copy of the notice of the date and time of the examination sent to him by the pertinent VA medical facility. Prior to arranging for the Veteran to undergo further examination, the RO should obtain and associate with the claims file all outstanding VA medical records. The Board emphasizes that records generated by VA facilities that may have an impact on the adjudication of a claim are considered constructively in the possession of VA adjudicators during the consideration of a claim, regardless of whether those records are physically on file. See Dunn v. West, 11 Vet. App. 462, 466-67 (1998); Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). Hence, the RO should obtain from the above-noted facility all outstanding records of VA treatment and/or evaluation of the Veteran. The RO should follow the current procedures prescribed in 38 C.F.R. § 3.159(c) as regards requests for records from Federal facilities. Further, to ensure that all due process requirements are met, and that the record before the physician is complete, the RO should also give the appellant another opportunity to present information and/or evidence pertinent to the claim remaining on appeal. The RO's letter to the Veteran should explain that he has a full one-year period for response. See 38 U.S.C.A § 5103(b)(1) (West 2002); but see 38 U.S.C.A. § 5103(b)(3) (West Supp. 2012) (amending the relevant statute to clarify that VA may make a decision on a claim before the expiration of the one-year notice period). Thereafter, the RO should obtain any additional evidence for which the appellant provides sufficient information and, if necessary, authorization, following the procedures prescribed in 38 C.F.R. § 3.159 (2012). The actions identified herein are consistent with the duties imposed by the Veterans Claims Assistance Act of 2000 (VCAA). See 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2012). However, identification of specific actions requested on remand does not relieve the RO of the responsibility to ensure full compliance with the VCAA and its implementing regulations. Hence, in addition to the actions requested above, the RO should also undertake any other development or notification action deemed warranted by the VCAA prior to adjudicating the claims on appeal. Accordingly, the matters are REMANDED for the following action: 1. Obtain any all outstanding, pertinent records of evaluation and/or treatment of the Veteran. Follow the procedures set forth in 38 C.F.R. § 3.159(c) with respect to requesting records from Federal facilities. All records and/or responses received should be associated with the claims file. 2. Send to the Veteran and her representative a letter requesting that the Veteran provide sufficient information, and if necessary, authorization to enable it to obtain any additional evidence pertinent to the claims on appeal that is not currently of record. Clearly explain to the Veteran that she has a full one-year period to respond (although VA may decide the claim within the one-year period). 3. If the Veteran responds, assist her in obtaining any additional evidence identified by following the current procedures set forth in 38 C.F.R. § 3.159. All records and responses received should be associated with the claims file. If any records sought are not obtained, notify the Veteran and her representative of the records that were not obtained, explain the efforts taken to obtain them, and describe further action to be taken. 4. After all records and/or responses received from each contacted entity have been associated with the claims file, or a reasonable time period for the Veteran's response has expired, the RO should arrange for the Veteran to undergo a VA audiology examination, at a VA medical facility. The entire claims file, to include a complete copy of the REMAND, must be made available to the physician designated to examine the Veteran, and the report of examination should include discussion of the Veteran's documented medical history and assertions. All appropriate tests and studies should be accomplished (with all results made available to the examining physician prior to the completion of his or her report), and all clinical findings should be reported in detail. The VA audiologist should determine if the Veteran has current hearing loss. The VA examiner should also opined whether it is at least as likely as not (i.e., there is a 50 percent or greater probability), that the disability had its onset in or is otherwise medically related to service (to include the assessment of prolonged bilateral ear pain, otitis media, and otitis externa noted therein). In rendering each requested opinion, the physician should specifically consider the in- and post-service treatment records, as well as the Veteran's assertions (to include assertions of continuity bilateral ear pain since service). The physician should set forth all examination findings, along with complete rationale for the conclusions reached, in a printed (typewritten) report. 5. The RO should arrange for the Veteran to undergo a VA examination, by an appropriate physician, at a VA medical facility. The entire claims file, to include a complete copy of this REMAND, must be made available to the physician designated to examine the Veteran, and a report of the examination should include discussion of the Veteran's medical history and assertions. All appropriate tests and studies should be accomplished (with all findings made available to the requesting physician prior to the completion of his or her report), and all clinical findings should be reported in detail. The VA examiner should clearly indicate all current psychiatric disabilities. Then, with respect to each such diagnosed disability, the examiner should render an opinion, consistent with sound medical principles as to whether it is at least likely as not (there is a 50 percent or greater probability) that the disability had its onset in, or is otherwise medically-related to service. In rendering the requested opinion, the examiner should consider and discuss all pertinent lay and medical evidence of record, to include the Veteran's assertions of symptoms since service. The physician should set forth all examination findings, along with the complete rationale for all conclusions reached, in a printed (typewritten) report. 6. If the Veteran fails to report to the scheduled examinations, obtain and associate with the claims file a copy of any notice(s) of the date and time of the examination sent to the Veteran by the pertinent VA medical facility. 7. To help avoid future remand, ensure that all requested actions have been accomplished (to the extent possible) in compliance with this REMAND. If any action is not undertaken, or is taken in a deficient manner, appropriate corrective action should be undertaken. Stegall v. West, 11 Vet. App. 268 (1998). 8. After completing the requested actions, and any additional notification and/or development action deemed warranted, readjudicate the claim on appeal in light of all pertinent evidence and legal authority. 9. If any benefit sought on appeal remains denied, furnish to the Veteran and her representative an appropriate SSOC that includes clear reasons and bases for all determinations, and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. The purpose of this REMAND is to afford due process, and to accomplish additional development and adjudication; it is not the Board's intent to imply whether the benefits requested should be granted or denied. The Veteran need take no action until otherwise notified, but she may furnish additional evidence and/or argument during the appropriate time frame. See Kutscherousky v. West, 12 Vet. App. 369 (1999); Colon v. Brown, 9 Vet. App. 104, 108 (1996); Booth v. Brown, 8 Vet. App. 109 (1995); Quarles v. Derwinski, 3 Vet. App. 129, 141 (1992). 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). ______________________________________________ JACQUELINE E. MONROE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs