Citation Nr: 1319902 Decision Date: 06/20/13 Archive Date: 07/02/13 DOCKET NO. 09-38 885 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for a right knee disability. 2. Entitlement to service connection for a left knee disability. 3. Entitlement to service connection for a right shoulder disability. 4. Entitlement to service connection for asthma. REPRESENTATION Appellant represented by: Kenneth Lavan, Attorney WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Jebby Rasputnis, Associate Counsel INTRODUCTION The Veteran served on active duty from June 1993 to February 1994. This appeal to the Board of Veterans' Appeals (Board) arose from an April 2008 rating decision in which the RO denied service connection for a right shoulder disability, asthma, and bilateral knee disabilities. In April 2009, the Veteran filed a notice of disagreement (NOD). A statement of the case (SOC) was issued in August 2009, and, in October 2009, the Veteran filed a substantive appeal (via a VA Form 9, Appeal to the Board of Veterans' Appeals). The RO issued a supplemental SOC in September 2010. In January 2013, the Veteran testified during a Board video-conference hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. During the hearing, the undersigned granted a 60-day abeyance for submission of additional evidence. Subsequent to the Board hearing, in April 2013, the Veteran submitted additional evidence to the Board. She, through her attorney, waived her procedural right of initial RO consideration of this evidence. See 38 C.F.R. §§ 20.800, 20.1304(c) (2012). The Board's decision on the claim for service connection for right knee disability is set forth below. The claims for service connection for left knee disability, right shoulder disability, and asthma are addressed in the remand following the order; these matters are being remanded to the RO, via the Appeals Management Center (AMC), in Washington, DC. VA will notify the Veteran 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 have been accomplished. 2. Although the Veteran has presented a claim for service connection for a bilateral knee disability, she has not presented any specific allegation of, and the record does not otherwise show, an event, injury, or disease affecting the right knee during her active duty service or for several years thereafter. 3. There is no competent, probative evidence even suggesting that there exists a nexus between the Veteran's current right knee complaints and any incident of her service. CONCLUSION OF LAW The criteria for service connection for a right knee disability are not met. 38 U.S.C.A. §§ 1101, 1110, 1131, 5103, 5103A, 5107(b) (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Due Process Considerations 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) (2010). Notice requirements under the VCAA essentially require VA to notify a claimant of any evidence that is necessary to substantiate the claim, as well as the evidence that VA will attempt to obtain and which evidence she 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 claim; (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 her possession that pertains to the claim, 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 her 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 AOJ (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, a May 2007 pre-rating letter provided notice to the Veteran as to what information and evidence was needed to substantiate a claim for service connection, what information and evidence must be submitted by the appellant, and what information and evidence would be obtained by VA. The letter also provided general information pertaining to VA's assignment of disability ratings and effective dates in accordance with Dingess/Hartman. Specifically as regards the Veteran's January 2013 Board hearing, it is noted that the United States Court of Appeals for Veterans Claims (Court) has held that that provisions of 38 C.F.R. § 3.103(c) (2) impose two distinct duties on VA employees, including Board personnel, in conducting hearings: to explain fully the issues, and to suggest the submission of evidence that may have been overlooked. Bryant v. Shinseki, 23 Vet. App. 488 (2010). During the hearing in this case, the undersigned Veterans Law Judge discussed the evidence necessary to substantiate a claim for service connection. The Veterans Law Judge specifically inquired as to basis of the Veteran's contentions as to why service connection was warranted for a knee disability and indicated that medical evidence supportive of a nexus between a current disability and service would assist her in substantiating her claims. Accordingly, the Bryant duties were met, and the hearing is legally sufficient. The record also reflects that VA has made reasonable efforts to obtain, or to assist in obtaining, all relevant records pertinent to the matter herein decided. Pertinent evidence associated with the claims file consists of service treatment records, service personnel records, and private treatment records. Also of record and considered in connection with the appeal is the transcript of the January 2013 Board hearing, along with written statements provided by the Veteran's attorney on her behalf. The Board notes that, in addition to the paper claims file, there is a paperless, electronic (Virtual VA) claims file associated with the Veteran's appeal. A review of the paperless claims processing system did not reveal any additional evidence pertinent to the appeal that was not already associated with the Veteran's paper file. The Board also finds that no additional RO action to further develop the record in connection with the claim for a right knee disability, prior to appellate consideration, is required. Although the Veteran testified in January 2013 that she received prior surgery for a knee, her testimony indicates that she was referring to the left knee and, as such, any such surgical records would not be pertinent to the claim herein decided. Regardless, she has not presented any such medical records or provided VA with any authorization to obtain them on her behalf so that VA could obtain for her. VA's duty to assist is not a one-way street. See Wood v. Derwinski, 1 Vet.App. 190, 193 (1991). See also Swann v. Brown, 5 Vet.App. 229, 233 (199). In any event, this evidence is not shown to have any bearing on the outcome of the appeal as the claim is herein denied due to lack of competent, credible evidence of an in-service injury. Neither the Veteran nor her attorney has identified any additional existing evidence that is necessary for a fair adjudication of the specific claim herein decided. Under the circumstances, the Board finds that the RO has undertaken sufficient and appropriate development action and that no further action in this regard is warranted. In summary, the duties imposed by the VCAA have been considered and satisfied. The Veteran has been notified and made aware of the evidence needed to substantiate this 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 this claim. 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 the matter herein decided, at this juncture. See Mayfield v. Nicholson, 20 Vet.App. 537, 543 (2006) (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 during service. 38 U.S.C.A. § 1110; 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); Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992). Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). If a chronic disease, such as arthritis, becomes manifest to a degree of 10 percent within one year of separation from active service, then it is presumed to have been incurred during active service, even though there is no evidence of such disease during service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1111, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In some cases, service connection may be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) a chronic disease shown as such in service (or within an applicable presumptive period under 38 C.F.R. § 3.307) and (ii) subsequent manifestations of the same chronic disease; or (b) if the fact of chronicity in service is not adequately supported, by evidence of continuity of symptomatology. The United States Court of Appeals for the Federal Circuit has held that the provisions of 38 C.F.R. § 3.303(b) relating to establishing service connection on the basis of continuity of symptomatology in lieu of a medical nexus opinion is limited to disorders explicitly recognized as chronic under 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Here, as the record does not show, and the Veteran does not contend, that she has been diagnosed with any disorder explicitly recognized as chronic under 38 C.F.R. § 3.309(a), these provisions cannot be favorably applied to her claim. Id. The Board is bound by statute to set forth specifically the issue under appellate consideration and its decision must also include separately stated findings of fact and conclusions of law on all material issues of fact and law presented on the record, and the reasons or bases for those findings and conclusions. 38 U.S.C.A. § 7104(d); see also 38 C.F.R. § 19.7 (implementing the cited statute); see also Vargas-Gonzalez v. West, 12 Vet.App. 321, 328 (1999); Gilbert v. Derwinski, 1 Vet.App. 49, 56-57 (1990) (the Board's statement of reasons and bases for its findings and conclusions on all material facts and law presented on the record must be sufficient to enable the claimant to understand the precise basis for the Board's decision, as well as to facilitate review of the decision by courts of competent appellate jurisdiction. The Board must also consider and discuss all applicable statutory and regulatory law, as well as the controlling decisions of the appellate courts). As is evident, below, the analysis in this decision focuses on the most salient and relevant evidence, and on what the evidence shows or fails to show with respect to the appealed claim. See Timberlake v. Gober, 14 Vet.App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). After a full review of the record, including the medical evidence and statements made by the Veteran and on her behalf, the Board finds that service connection for a right knee disability is not warranted. Although the Veteran timely perfected an appeal of the claim construed as for service connection for bilateral knee disabilities, she has never specifically alleged any in-service event, injury, or disease affecting the right knee. As discussed in further detail below, as, with respect to the right knee, there is no competent, credible and probative evidence of any such in-service occurrence that has resulted in current disability, the claim for service connection must be denied. On the Veteran's claims form, she indicated that she was seeking entitlement to service connection for "knee." In a May 2007 letter, the RO requested clarification of her claim - specifically, the RO inquired if she was seeking service connection for a right knee disability, a left knee disability, or bilateral knee disabilities. The Veteran did not respond to the inquiry and, in April 2008, the RO adjudicated the issue of service connection for bilateral knee disabilities. The Veteran's service treatment records show that, at the time of her pre-enlistment examination, she denied any knee disabilities and her lower extremities were evaluated as normal. During service, she was treated in August 1993 for left knee pain that began approximately two weeks prior while running; she reported no specific trauma and x-rays were negative. At the time of her discharge in 1994, her lower extremities were again evaluated as normal and she again denied having knee disability. In March 2001, more than seven years after service, the Veteran sought private treatment for right knee pain. X-ray revealed normal articulation, but some "bony sclerosis" in the distal right femur - the radiologist noted "question [of] early change of bone infarct versus old injury." However, no corresponding diagnosis was rendered and the radiologist did not specify a timeframe for "old." In April 2001, an MRI revealed a partial tear of the anterior cruciate ligament, sprain of the medial collateral ligament, and evidence of subtle tears of the posterior horns of the medial and lateral menisci. The 'past medical history' section of a private hospital's emergency treatment form completed in January 2005 reflects that the Veteran reported right knee arthroscopy among her prior surgical procedures. Several years later, in April 2010, the Veteran again sought treatment for her right knee. The private treatment note reflects that she reported a sudden onset of pain approximately four days prior as the result of a knee sprain. X-ray revealed no abnormalities other than moderate suprapatellar joint effusion and slight obliteration of the Hoffa's fat pad, which was noted to "suggest[] an effusion." The treating physician diagnosed an acute knee sprain. In January 2013, the Veteran's attorney submitted a statement on her behalf. Her attorney noted that the Veteran was treated for left knee pain in service in 1993, was observed to have ligament and meniscal tears of the right knee after service in 2001, and that she "still has pain in her knees." The Board notes that this statement reflects a contention that the Veteran experienced continuity in only left knee symptoms from service and continuity in right knee symptoms from 2001. During the January 2013 Board hearing, the Veteran testified that she did not have any knee problems before service, but did develop "knee problems" in service. She specified that in-service activities such as running and marching were "wearing on that knee" and, as a result, she sought treatment for her left knee while on active duty. In regard to current disability, the Veteran stated that her right knee presently had "no cartilage" except for a "small amount" in back and that she had been advised that she would need either a partial or full knee replacement "in the next two to three years." The Veteran also testified that, "because of the knee problem [she] had then [in-service]," "the knee" would just "give out." She stated that the problem with that knee caused her to fall at work in either 1998 or 1999 and later required surgery. The Board observes that her testimony in regard to in-service occurrence and post-service continuity is specific to the left knee. Further, the Veteran acknowledged that no doctor had ever informed her that she had any knee disability as the result of her in-service experiences. Significantly, neither the Veteran nor her attorney has identified any in-service event, injury, or disease involving the right knee-even though they have been given multiple opportunities to do so. The record shows no other evidence of any such in-service occurrence. Instead, the record reflects that the Veteran sought in-service treatment only in regard to the left knee and denied knee disability at the time of discharge from service. See Curry v. Brown, 7 Vet.App. 59, 68 (1994) (contemporaneous evidence has greater probative value than subsequently reported history). Further, the record shows that she did not seek treatment for her right knee until 2001, which is approximately seven years after her service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (passage of many years between discharge from service and objective documentation of a claimed disability is a factor that tends to weigh against a claim for service connection). Although the Veteran and her attorney have requested that VA afford her an examination in regard to her claimed bilateral knee disabilities, VA is not, on these facts, required to arrange for VA examination or to otherwise obtain a medical opinion in connection with the specific claim for a right knee disability. Generally, VA has a duty provide a medical examination or obtain a medical opinion if the evidence indicates the existence of a current disability or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease in service -or, as appropriate, service-connected disability- but the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C.A. § 5103A(d)(2) (West 2002 & Supp. 2012); 38 C.F.R. § 3.159(c)(4)(i) (2012); McLendon v. Nicholson, 20 Vet.App. 79 (2006). Here, however, here, as there is, fundamentally, no specific allegation, or other evidence, of any such in-service event, injury, or disease affecting the right knee, or resulting current disability, no examination is required. See Bardwell v. Shinseki, 24 Vet.App. 36, 39-40 (2010) (holding that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service). On these facts, a remand of this claim for an examination or to obtain a medical opinion as to the etiology of any claimed right knee disability would, in essence, improperly place any examining physician in the Board's role of a fact finder. In other words, any medical opinion which provided a nexus between the Veteran's current right knee disability and an undocumented incident of her military service would necessarily be based solely on speculation. See generally Bloom v. West, 12 Vet.App. 185 (1999) (a medical opinion based on speculation... does not provide the required degree of medical certainty). Finally, to whatever extent the Veteran and her attorney have, by merely advancing a claim, attempted to directly establish that there exists a medical nexus between any current right knee symptoms and service, to include on the basis of continuity of symptoms, such attempt must fail. Not only is there no specific allegation of continuity, but, as detailed above, there is no evidence of continuity within the record. See 38 C.F.R. § 3.303(b). Further, the Board emphasizes that the matters of medical diagnosis and etiology of the internal process under consideration are ones within the province of trained professionals. See Jones v. Brown, 7 Vet.App. 134, 137-38 (1994). As neither the Veteran nor her attorney is shown to have any medical training or expertise, neither is competent to render a probative (i.e., persuasive) opinion on the medical matters upon which this claim turn. See, e.g., 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'). Hence, even if the appeal itself could be construed as a lay assertion of medical nexus between current right knee symptoms and service, it would have no probative value in this appeal. For all the foregoing reasons, the claim for service connection for a right knee disability must be denied. In reaching the conclusion to deny the claim, 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 a right knee 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 these matters. To date, the Veteran has not been afforded a VA examination to obtain a medical opinion as to whether she experiences any left knee disability, right shoulder disability, or asthma that is medically-related to her active duty service. Generally, VA has a duty provide a medical examination or obtain a medical opinion if the evidence indicates the existence of a current disability or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease in service -or, as appropriate, service-connected disability- but the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C.A. § 5103A(d)(2) (West 2002 & Supp. 2012); 38 C.F.R. § 3.159(c)(4)(i) (2012); McLendon v. Nicholson, 20 Vet.App. 79 (2006). Here, the evidence reflects in-service treatment for the left knee, the right shoulder, and asthma. As the Veteran has contended that she has experienced symptoms of such disabilities ever since service and has presented some supportive medical evidence, the Board finds that such examinations and opinions would be helpful in resolving the matters remaining on appeal. See 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2012); McLendon, 20 Vet. App. 79 (2006). Accordingly, the RO should arrange for the Veteran to undergo VA joints examination and VA respiratory disorders examination, by appropriate physicians, at a VA medical facility. The Veteran is hereby advised that failure to report for any scheduled examination(s), without good cause, may result in denial of her claim(s) for service connection. 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 any scheduled examination(s), the RO should obtain and associate with the claims file (a) copy(ies) of the notices of the dates and times of the examination(s) sent to her by the pertinent VA medical facility. Prior to arranging for the Veteran to undergo further examination, to ensure that all due process requirements are met, and that the record is complete, the RO should obtain and associate with the claims file all outstanding, pertinent records. The Board observes that the Veteran has reported treatment at Piedmont Hospital and South Fulton Hospital and her service treatment records identify a Dr. Vikram as her family physician. Although she has not yet authorized the release of records from these sources, the RO should give her another opportunity to do so, and to provide other additional information and/or evidence pertinent to the claims on appeal. The RO's letter to the Veteran should explain that she has a full one-year period for response. See 38 U.S.C.A. § 5103(b)(1) (West 2002); but see also 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 attempt to obtain any additional evidence for which the Veteran provides sufficient information, and, if needed, authorization, following the current procedures prescribed in 38 C.F.R. § 3.159. 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 and/or notification action deemed warranted by the VCAA prior to adjudicating the claims remaining on appeal in light of all pertinent evidence and legal authority. Accordingly, these matters are hereby REMANDED for the following action: 1. Send to the Veteran and her attorney a letter requesting that she provide sufficient information, and, if necessary, authorization to enable the RO to obtain any additional evidence pertinent to the claims remaining on appeal that is not currently of record. Specifically request that the Veteran provide, or provide authorization for the RO to obtain, any pertinent records from Piedmont Hospital, South Fulton Hospital, and a Dr. Vikram. Clearly explain to the Veteran that she has a full one-year period to respond (although VA may decide the claims within the one-year period). 2. If the Veteran responds, assist her in obtaining any additional evidence identified, following the current procedures set forth in 38 C.F.R. § 3.159. All records/responses received should be associated with the claims file. If any records sought are not obtained, notify the Veteran and her attorney of the records that were not obtained, explain the efforts taken to obtain them, and describe further action to be taken. 3. After all records and/or responses received from each contacted entity have been associated with the claims file, arrange for the Veteran to undergo a VA joints examination by an appropriate physician. The entire claims file, to include a complete copy of the REMAND, must be made available to the individual designated to examine the Veteran, and the examination report 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 examiner prior to the completion of his or her report), and all clinical findings should be reported in detail. The examiner should clearly identify all current disability(ies) of the right shoulder and left knee. Then, with respect to each such diagnosed disability, the examiner should provide 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. In rendering the requested opinion, the physician should consider and discuss all pertinent in- and post-service evidence and lay assertions. The examiner should set forth all examination findings along with complete rationale for the conclusions reached in a printed (typewritten) report. 4. After all records and/or responses received from each contacted entity have been associated with the claims file, arrange for the Veteran to undergo a VA respiratory disorders examination by an appropriate physician. The entire claims file, to include a complete copy of the REMAND, must be made available to the individual designated to examine the Veteran, and the examination report 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 examiner prior to the completion of his or her report), and all clinical findings should be reported in detail. The examiner should clearly identify any current respiratory disability(ies), to include asthma. Then, with respect to each such diagnosed disability, the examiner should opine whether or not any such disability clearly and unmistakably existed prior to service and, if so, if such disability clearly and unmistakably was NOT aggravated (i.e. permanently worsened beyond a natural progression) by service. With respect to any disability for which the examiner determines did not clearly and unmistakably pre-exist service, the examiner should provide an opinion 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, or was otherwise incurred, during service. The examiner should set forth all examination findings along with complete rationale for the conclusions reached in a printed (typewritten) report. 5. If the Veteran fails to report to any scheduled examination(s), obtain and associate with the claims file copies of any notices of the dates and times of the appointment(s) sent to her by the pertinent VA medical facility. 6. 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. See Stegall v. West, 11 Vet. App. 268 (1998). 7. After completing the requested actions, and any additional notification and/or development deemed warranted, readjudicate the claims remaining on appeal in light of all pertinent evidence and legal authority. 8. If any benefit sought on appeal remains denied, furnish to the Veteran and her attorney an appropriate SSOC that includes clear reasons and bases for the determination, 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 REMAND must be afforded expeditious treatment. The law requires that all claims 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