Citation Nr: 1320126 Decision Date: 06/21/13 Archive Date: 07/02/13 DOCKET NO. 07-08 589 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California THE ISSUES 1. Whether new and material evidence has been received to reopen the claim of service connection for chronic obstructive pulmonary disease (COPD). 2. Whether new and material evidence has been received to reopen the claim of service connection for residuals of burn injury of the hands. 3. Whether new and material evidence has been received to reopen the claim of service connection for ganglion cyst of the right wrist. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD Christopher Maynard, Counsel INTRODUCTION The Veteran had active service from April 1975 to April 1979. By rating action in July 2002, the RO, in part, denied service connection for COPD, burn scars of the hands, and ganglion cyst of the right wrist. The Veteran and his representative were notified of this decision and did not appeal. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from a January 2005 decision by the RO which declined to reopen the Veteran's claims. In January 2010, a hearing was held at the RO before the undersigned member of the Board. In March 2011, the Board remanded the issues currently on appeal for additional development. The reopen claims of service connection for residual of a burn injury of the hands and COPD will be discussed in the REMAND section below. FINDINGS OF FACT 1. Service connection for COPD, residuals of burn scars of the hands and ganglion cyst of the right wrist was last finally denied by an unappealed rating decision by the RO in July 2002. 2. The additional evidence received since the July 2002 rating decision concerning the issues on appeal relates to an unestablished fact necessary to substantiate the claims, and raises a reasonable possibility of substantiating the claims. 3. The Veteran's ganglion cyst of the right wrist is at least as likely as not related to service. CONCLUSIONS OF LAW 1. The July 2002 RO decision which last denied service connection for COPD, residuals of burn scars of the hands, and ganglion cyst of the right wrist is final. 38 U.S.C.A. § 7104 (West 2002); 38 C.F.R. §§ 3.104, 20.1103 (2012). 2. New and material evidence has been received to reopen the claim of service connection for COPD. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107, 5108 (West 2002); 38 C.F.R. §§ 3.156(a), 3.159, 3.303, 20.1105 (2012). 3. New and material evidence has been received to reopen the claim of service connection for residuals of burn injury to the hands. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107, 5108 (West 2002); 38 C.F.R. §§ 3.156(a), 3.159, 3.303, 20.1105 (2012). 4. New and material evidence has been received to reopen the claim of service connection for ganglion cyst of the right wrist. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107, 5108 (West 2002); 38 C.F.R. §§ 3.156(a), 3.159, 3.303, 20.1105 (2012). 5. A ganglion cyst of the right wrist was incurred in service. 38 U.S.C.A. §§ 1110, 1154(a), 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Before addressing the merits of the Veteran's claim, the Board is required to ensure that the VA's "duty to notify" and "duty to assist" obligations have been satisfied. See 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2012). Under the Veterans Claims Assistance Act (VCAA), when VA receives a complete or substantially complete application for benefits, it must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide. 38 C.F.R. § 3.159. Such notice must indicate that a disability rating and an effective date for the award of benefits will be assigned if there is a favorable disposition of the claim. Id; 38 U.S.C.A. §§ 5100, 5102, 5106, 5107, 5126; 38 C.F.R. § 3.326; see also Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II). The notification obligation in this case was accomplished by way of letters from the RO to the Veteran dated in April and July 2004, and March, April, May and July 2012. Although the proper notification letter was not sent prior to adjudication of the Veteran's claim in January 2005, this was not prejudicial to him as he was subsequently provided proper notice (July 2012), the claims were readjudicated, and a supplement statement of the case (SSOC) was promulgated in October 2012. Thus, the Board finds that the notification requirements of the VCAA have been satisfied. See Quartuccio v. Principi, 16 Vet. App. 183 (2002); Pelegrini, 18 Vet. App. 112 (2004); Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F. 3d 1328 (Fed. Cir. 2006); Kent v. Nicholson, 20 Vet. App. 1 (2006). Furthermore, based on the communications sent to the Veteran and his representatives over the course of this appeal, he has actual knowledge of the evidence he is required to submit in this case. Based on his contentions as well as the communications provided to him by VA, it is reasonable to expect that he understands what is needed to prevail. As to VA's duty to assist, the Board finds that all necessary development has been accomplished and that appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). The Veteran's service treatment records (STRs) and all VA and private medical records have been obtained and associated with the claims file. The Board has also reviewed the Veteran's Virtual VA records. Further, neither the Veteran nor his representative have made the RO or the Board aware of any additional evidence that needs to be obtained in order to fairly decide the merits of the issues on appeal, and neither has argued that any error or deficiency in the accomplishment of the duty to notify and duty to assist has prejudiced the Veteran in the adjudication of his appeal. See Shinseki v. Sanders, 129 S.Ct.1696 (2009). Concerning the January 2010 Travel Board hearing, in Bryant v. Shinseki, 23 Vet. App. 488 (2010), the Court held that 38 C.F.R. § 3.103(c)(2) requires that the individual who chairs a hearing must fully explain the issues and to suggest the submission of evidence that may have been overlooked. In the present case, the undersigned identified the issues on appeal and asked specific questions directed at identifying any pertinent evidence not currently associated with the claims folder that might have been overlooked or was outstanding and might substantiate the claims currently on appeal. The Veteran was advised of the specific type of evidence needed to reopen his claim and was given an additional time to submit the necessary evidence. (See July 2012 AMC letter). Accordingly, the Veteran is not shown to be prejudiced on this basis. Additionally, neither the Veteran nor his representative have asserted that VA failed to comply with 38 C.F.R. § 3.103(c)(2), nor has he identified any prejudice in the conduct of the Board hearing. By contrast, the hearing focused on the elements necessary to substantiate the claim, and the Veteran, through his testimony, demonstrated that he had actual knowledge of the elements necessary to substantiate his claim. As such, the Board finds that, consistent with Bryant, there is compliance with the duties set forth in 38 C.F.R. § 3.103(c)(2). Finally, the issues currently on appeal were remanded in March 2011 for additional development of the record. The remand directives included providing the Veteran with appropriate VCAA notice pertaining to a reopened claim under Kent, 20 Vet. App. 1 (2006). The AMC also provided the Veteran with appropriate VCAA notice under Kent, in July 2012. In light of the foregoing, the Board finds that the AMC has substantially complied with the March 2011 remand orders and no further action is necessary in this regard. See D'Aries v. Peake, 22 Vet. App. 97, 106 (2008); Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998), where the Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (2002). Based on a review of the claims file, the Board finds that there is no indication in the record that any additional evidence relevant to the issues to be decided herein is available and not part of the claims file. See Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007). Accordingly, the Board finds that duty to notify and duty to assist have been satisfied and will proceed to the merits of the Veteran's appeal. Finality 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. However, before reaching the merits of the Veteran's claim for COPD, ganglion cyst of the right wrist, and burn scars of the hands, the Board must first rule on the matter of reopening of the claims. That is, the Board has a jurisdictional responsibility to consider whether it is proper for the claims to be reopened. Jackson v. Principi, 265 F.3d 1366 at 1369 (Fed. Cir. 2001). As noted above, service connection for COPD, residuals of burn injury of the hands, and ganglion cyst of the right wrist was finally denied by the RO in July 2002, and there was no appeal of that rating decision. Therefore, the laws and regulations governing finality and reopening of a previously disallowed claim are pertinent in the consideration of the current issue on appeal. A decision by the RO shall be final and binding on all field offices of the Department of Veterans Affairs as to conclusions based on the evidence on file at the time VA issues written notification of the decision. A final and binding agency decision shall not be subject to revision on the same factual basis except by duly constituted appellate authorities or except where there is clear and unmistakable error in the decision. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. §§ 3.104, 20.1103 (2012). Under pertinent law and VA regulations, the Board may reopen and review a claim which has been previously denied if new and material evidence is submitted by or on behalf of the appellant. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a). The Veteran's request to reopen his claims for service connection was received in February 2004, and the regulation applicable to his appeal defines new and material evidence as evidence not previously submitted to agency decisionmakers which, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim, is neither cumulative nor redundant, and raises a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (2012). In Shade v. Shinseki, 24 Vet. App. 110, 118 (2010), the Court stated that when determining whether the submitted evidence meets the definition of new and material evidence, VA must consider whether the new evidence could, if the claim were reopened, reasonably result in substantiation of the claim. Id. Thus, pursuant to Shade, evidence is new if it has not been previously submitted to agency decisionmakers and is material if, when considered with the evidence of record, it would at least trigger VA's duty to assist by providing a medical opinion, which might raise a reasonable possibility of substantiating the claim. Id. The Court has clarified that, with respect to the issue of materiality, the newly presented evidence need not be probative of all the elements required to grant the claim. However, it is the specified bases for the final disallowance that must be considered in determining whether the newly submitted evidence is probative. Such evidence must tend to prove the merits of the claim as to each essential element that was a specified basis for the last final disallowance of the claim. See Evans v. Brown, 9 Vet. App. 273, 285 (1996). Courts have held that 38 C.F.R. § 3.156(b) requires that VA evaluate submissions received during the year following notice of a rating decision to determine whether they contain new and material evidence, even if the new submission may support a new claim. See Bond v. Shinseki, 659 F.3d 1362, 1367-8 (Fed. Cir. 2011); Buie v. Shinseki, 24 Vet. App. 242, 251-52 (2010). In this regard, the Board notes that no additional evidence was received from the Veteran during the one year period following the July 2002 rating decision. The evidence of record at the time of the July 2002 rating decision included the Veteran's STRs, and numerous VA and private medical records from 1996 to 2001, and a July 2001 VA QTC examination report. The STRs showed that the Veteran had a scar on his left palm at the time he was examined and accepted for military service in April 1975, that he was treated for an upper respiratory infection on a couple of occasions during his first three of months of service in 1975, and that he suffered a laceration to his right wrist that required four sutures in May 1978. The STRs were otherwise negative for any complaints, treatment, abnormalities or diagnosis referable to any burn injury of the hands or a ganglion cyst, and a chest x-ray study in November 1978 was negative. On a Report of Medical History for separation from service in March 1979, the Veteran did not report any problems or history of a burn injury to his hands, a ganglion cyst or any respiratory problems, and specifically denied any history of swollen or painful joints, chronic or frequent colds, skin disease, asthma, shortness of breath, chest pains, chronic cough, tumors, growths or cysts, arthritic pain, or lameness. The Veteran also responded in the negative for any other illness or treatment other than hemorrhoids during service. His separation examination in March 1979 showed no abnormalities of the skin, upper extremities, lungs or chest, and a chest x-ray study was within normal limits. A VA Exchange of Beneficiary Information form, dated in January 1981, showed that the Veteran was hospitalized for a ganglion cyst of the right wrist at VAMC Northport, New York in January 1981. A letter from a private physician, dated in April 2000, noted that the Veteran sustained first, second and third degree burns on the right side of his face, neck, anterior chest and both hands and wrists, and had some upper airway pulmonary distress from a "Fly Ash" burning incident at work in March 1985. The physician indicated that it appeared that his wounds had healed, but advised the Veteran to obtain a pulmonary function test (PFT) to determine if there was any pulmonary insufficiency. A letter from the same private physician dated in December 2000, noted that the Veteran had been exposed to breathing in toxic substances over a period of years causing toxic encephalopathy and a lung and throat disorder. A VA pulmonary function test (PFT) in June 2000, noted that the Veteran was a pack-a-day smoker for 28 years, and included a diagnosis of minimal obstructive airway disease - peripheral airway, and mild neuromuscular disease. The July 2001 VA QTC examination showed that the Veteran reported a history of shortness of breath and coughing due to COPD from long-term smoking, removal of a ganglion cyst from his right wrist in January 1980, and second degree burns on his arms, face, neck and hands from an industrial accident in "1977." The Veteran also reported that his hands were bandaged for a week. On examination, there was a ganglion cyst on the dorsum of the radial aspect of the right wrist and some abnormal discoloration on both hands from a previous burn. A respiratory examination, including a PFT was within normal limits and showed normal spirometry. The diagnoses included residual discoloration of the hands, ganglion cyst of the wrist, and no pathology to render a diagnosis of COPD. The remainder of the VA and private medical records showed treatment for various maladies from 1996 to 2001, including complaints of shortness of breath and dyspnea beginning in 2000. The records do not show treatment for a ganglion cyst or any hand problems. The evidence added to the record since the July 2002 rating decision includes numerous VA and private outpatient records from 1999 to 2010, a transcript of a hearing at the RO before the undersigned in January 2010, and VA hospital records for treatment of a ganglion cyst on the right wrist in January 1981. The January 1981 VA hospital records, which were not previously of record and were associated with the claims file in September 2012, showed that the Veteran was admitted for a mass on his right wrist that had been increasing in size over the two previous months. The Veteran reported that he developed a similar mass on the right wrist about two months after a laceration injury to the wrist in service in May 1978, and said that he was told by doctors that it was either a ganglion cyst or a radial artery aneurysm. He said that the mass resolved about a month later and that he had no further signs or symptoms until "January 1980." The hospital records showed that the ganglion cyst was lacerated and drained, and that the Veteran was discharged on the third day in good health. At the hearing in January 2010, the Veteran testified that he could not recall if he injured his wrist in service, but said that he was treated for a mass on his wrist at Ft. Carson in 1978, and was told that it wasn't a swollen vein and that he should just live with it. He testified that he was treated for the ganglion cyst by VA in January 1980, and that after it was excised, it came back within a year and has since spread up to his elbow. (T p.9-14). The Veteran testified that he suffered a burn injury to his hands when he grabbed a kerosene stove that had caught fire, and threw it out the door of the guard shack while on training in Alberta, Canada in January 1977. He said that he was treated at Ft. Wainwright after the incident, but did not require any further treatment during service. (T p.16-18). Concerning his COPD, the Veteran testified that he had a history of bronchitis since childhood when he entered military service, and that he was given a profile (limited duty restriction) from tear gas training. However, the sergeants made him go into the gas chamber anyway, and he suffered a severe respiratory reaction that hospitalized him for two weeks at Ft Polk during basic training. (T p. 19-20). The Veteran's testimony concerning his history of a ganglion cyst, respiratory problems and burn injury in service is presumed credible for the limited purpose of reopening the previously disallowed claims. Shade v. Shinseki, 24 Vet. App. 110 (2010). That is, the Veteran's testimony is new, in that he had never provided any detailed information concerning his medical history and, therefore, was not previously considered by the RO, and is material since it relates to an unestablished fact necessary to substantiate the claims or raises a reasonable possibility of substantiating the claims. Id. As the Board finds that the additional VA medical records and the Veteran's testimony are new and material, there is no need to discuss whether the other evidence is likewise new and material as the claim will be reopened solely on the basis of this evidence. Having determined that the Veteran's claim is reopened, the Board must next determine if it will be prejudicial to him if the Board addresses the merits of the claims. See Bernard v. Brown, 4 Vet. App. 384 (1993). Concerning the claims for COPD and a burn injury of the hands, the Board finds that further development of the evidence is necessary, and such will be discussed in the Remand section below. As to the claim for ganglion cyst of the right wrist, however, the Board finds that the current evidence of record is sufficient to render a favorable decision on the merits, and that the Veteran will not be prejudiced by the Board proceeding with the adjudication of this issue. Id. Service Connection - In General Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed.Cir.1996) (table); see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303. An alternative method of establishing the second and third Shedden/Caluza elements for a chronic disability listed under 38 C.F.R. § 3.309(a), is through a demonstration of continuity of symptomatology. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir 2013); see also, Barr v. Nicholson, 21 Vet. App. 303 (2007); Clyburn v. West, 12 Vet. App. 296, 302 (1999). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition listed under 38 C.F.R. § 3.309(a) was "noted" during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. See Hickson, 12 Vet. App. at 253 (lay evidence of in-service incurrence sufficient in some circumstances for purposes of establishing service connection); 38 C.F.R. § 3.303(b). In this case, tinnitus is not listed as a specified chronic disease under the provisions of 38 C.F.R. §§ 3.307, 3.309. In relevant part, 38 U.S.C. § 1154(a) requires that the VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim to disability or death benefits. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed.Cir.2007). In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed.Cir.2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept 14, 2009). Medical evidence of a "chronic" disease should set forth the physical findings and symptomatology elicited by examination within the applicable period. 38 C.F.R. § 3.307(b); Oris v. Derwinski, 2 Vet. App. 95, 96 (1992). A chronic disease need not be diagnosed during the presumptive period but characteristic manifestations thereof to the required degree must be shown by acceptable medical and lay evidence followed without unreasonable time lapse by definite diagnosis. 38 C.F.R. § 3.307(c); Caldwell v. Derwinski, 1 Vet. App. 466, 469 (1991). Ganglion Cyst The evidence required to warrant a grant of disability benefits does not have to be conclusive. The question is whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). In this case, the Veteran's testimony before the undersigned regarding his history of a ganglion cyst was essentially consistent with the information he provided to VA doctors when he was diagnosed and treated for a ganglion cyst in 1981, and the Board has found no reason to question the credibility of his description of symptoms since service. Further, the 1981 VA treatment records showed that the ganglion cyst was at the site of the scar from his laceration injury in service. The Veteran's reported history of a mass on his right wrist shortly after his laceration injury in service, and the recurrence of a similar mass, then diagnosed as a ganglion cyst at the same site after service is supportive of his claim of service connection. The Veteran is competent to testify that the mass in service had the same look and symptoms as what was diagnosed as a ganglion cyst after service. Therefore, resolving all reasonable doubt in favor of the Veteran, the Board finds that service connection for a ganglion cyst of the right wrist is warranted. ORDER To the extent that new and material evidence has been submitted to reopen the claim of service connection for COPD, the appeal to reopen is granted. To the extent that new and material evidence has been submitted to reopen the claim of service connection for residuals of burn injury to the hands, the appeal to reopen is granted. Service connection for ganglion cyst of the right wrist is granted. REMAND In view of the favorable decision to reopen the claims of service connection for COPD and residuals of burn injury to the hands, the RO must now consider the issues on a de novo basis. In order to establish service connection, there must be: (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). As noted above, at the hearing in January 2010, the Veteran testified that he was hospitalized for two weeks with respiratory problems after going through tear gas training at Ft. Polk, Louisiana during basic training. He also testified that he was treated for burn injuries to his hands at Ft. Wainwright in Alberta, Canada in January 1977. In this regard, the Board notes that, previously, the Veteran never advised the RO of any specific places where he was treated in service, therefore, no attempt has ever been made to obtain the reported STRs. As these records are potentially pertinent to his claim and are within the constructive possession of VA, an attempt must be made to obtain all available treatment records and associate them with the claims file. In light of the discussion above, and to ensure full compliance with due process requirements, it is the decision of the Board that further development is necessary prior to appellate review. Accordingly, the claim is REMANDED to the AMC for the following action: 1. The AMC should take appropriate steps to obtain all available service clinical (hospital) records for the Veteran's reported hospitalization for respiratory problems at Ft. Polk (May through July 1975), and for treatment of a burn injury of the hands at Ft. Wainwright in Alberta, Canada in January 1977. Follow the procedures set forth in 38 C.F.R. § 3.159. All records and/or responses received should be associated with the claims file. 2. If additional STRs are obtain that show treatment for a burn injury of the hands, the Veteran should be scheduled for an examination to determine, if feasible, the etiology of any identified residuals. The claims folder should be made available to the examiner for review. All indicated tests and studies should be accomplished. The examiner should render an opinion as to whether it is at least as likely as not that any identified residuals of a burn injury of the hands is etiologically related to service. 3. The Veteran should be afforded a VA examination to determine the nature and etiology of any current respiratory disorder. The claims folder should be made available to the examiner for review, and a notation to the effect that this record review took place included in the report. All indicated tests and studies should be accomplished. The examiner should render an opinion as to whether it is at least as likely as not that any identified respiratory disorder, including COPD had its onset in service or is otherwise related to service, including his gas chamber incident or any symptoms he had in service. The examiner(s) above should review the entire record, including the Veteran's service treatment records and post-service medical records prior to formulating an opinion. A fully articulated medical rationale for all opinions expressed must be set forth in the examination report. The examiner(s) should address the particulars of this Veteran's medical history and the relevant medical science as applicable to this claim. If the examiner(s) are unable to render an opinion without resorting to speculation, this should be noted and explained. In so doing, the examiner(s) should identify any evidence required in order to render a non-speculative opinion, (which the AMC should attempt to obtain, and then return the claims file to the examiner(s) for completion of the opinion). Note: The term "at least as likely as not" does not mean merely within the realm of medical possibility, but rather that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of causation as it is to find against it. 4. After the requested development has been completed, the AMC should readjudicate the claims. If the benefits sought on appeal remain denied, the Veteran and his representative should be furnished a Supplemental Statement of the Case and given the opportunity to respond thereto. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The Veteran need take no action unless otherwise notified. 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 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). ____________________________________________ K. OSBORNE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs