Citation Nr: 1320176	
Decision Date: 06/21/13    Archive Date: 07/02/13

DOCKET NO.  09-23 306A	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Houston, Texas


THE ISSUES

1.  Entitlement to service connection for a left knee disability.

2.  Entitlement to an initial compensable rating for bilateral hearing loss.

3.  Entitlement to an initial compensable rating for a right lower leg scar.  


ATTORNEY FOR THE BOARD

S. Lipstein


INTRODUCTION

The Veteran served on active duty from February 1986 to February 1990. 

This matter came before the Board of Veterans' Appeals (Board) on appeal from an October 2008 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). 

This case was previously before the Board in October 2012.  At that time, the Board remanded the case for further development.  

The Board also notes that, in addition to the paper claims file, there is a paperless, electronic claims file associated with the Veteran's claim.  Such file includes VA treatment records.  Thus, any future consideration of this appellant's case should take into account the existence of this electronic record.

In a March 2012 statement, the Veteran appears to be claiming to be unemployable due to multiple disabilities, stating he has been unable to work since June 2011 due to his knees and right ankle.  This issue has not been addressed by the Agency of Original Jurisdiction (AOJ).  Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action.  

For reasons explained below, the issue of entitlement to service connection for a left knee disability is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC.  VA will notify the Veteran if further action is required on his part.


FINDINGS OF FACT

1.  Throughout the appeal, the Veteran's bilateral hearing loss is manifested by no worse than a Level II impairment of auditory acuity in the right ear and a Level II impairment of auditory acuity in the left ear.

2.  Throughout the appeal, the Veteran's right lower leg scar has been linear, less than 39 square inches in area, and has not been unstable, painful upon examination, or productive of limited function or muscle impairment .


CONCLUSIONS OF LAW

1.  The criteria for an initial compensable evaluation for bilateral hearing loss have not been met.  38 U.S.C.A. §§ 1155, 5107 (West 2002 and Supp. 2012); 38 C.F.R. § 4.85, Diagnostic Code (DC) 6100 (2012).

2.  The criteria for an initial compensable disability rating for right lower leg scar have not been met.  38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. § 4.118, DC 7801, 7802, 7803, 7804, 7805 (2007).
	

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

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)) redefined VA's duty to assist a claimant in the development of a claim.  VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012).

The notice requirements of the VCAA require VA to notify a claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain.  38 C.F.R. § 3.159(b) (2012).  The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between a 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 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).  Id; see also Pelegrini v. Principi, 18 Vet. App. 112 (2004).  However, insufficiency in the timing or content of VCAA notice is harmless if the errors are not prejudicial to the claimant.  Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004) (VCAA notice errors are reviewed under a prejudicial error rule).

However, the appeal concerning the evaluations for hearing loss and the right lower leg scar arises from the initial awards of service connection.  In Dingess, the Court held that in cases in which service connection has been granted and an initial disability rating and effective date have been assigned, the typical service connection claim has been more than substantiated, it has been proven, thereby rendering section 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled.  Dingess, 19 Vet. App. at 490-91; see also Dunlap v. Nicholson, 21 Vet. App. 112 (2007) (section 5103(a) notice is no longer required after service-connection is awarded); Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007).  

The record also reflects that VA has made reasonable efforts to obtain relevant records adequately identified by the Veteran including service treatment records, VA treatment records, private treatment records, and VA examination reports. 

The Board also notes that actions requested in the prior remand have been undertaken.  VA treatment records were obtained and VA examinations were conducted.  An October 2012 letter asked the Veteran to provide information concerning treatment for the claimed conditions.  No additional treatment records were identified by the Veteran.  Accordingly, the Board finds that there has been substantial compliance with the prior remand instructions and no further action is necessary.  See D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict, compliance with the terms of a Board remand is required pursuant to Stegall v. West, 11 Vet. App. 268 (1998)).  
	
In sum, VA has fulfilled its duty to assist the claimant by obtaining identified and available evidence needed to substantiate the claim.  Significantly, the Veteran has not identified, and the record does not otherwise indicate, that any additional evidence exists that has not been obtained and would be necessary for a fair adjudication of the claim.  Hence, no further notice or assistance is required to fulfill VA's duty to assist the Veteran in the development of the claims.  Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002).

Analysis

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability.  38 U.S.C.A. § 1155; 38 C.F.R. § 4.1.  Disabilities must be reviewed in relation to their history.  38 C.F.R. § 4.1.  Other applicable, general policy considerations are:  interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a question as to which of two evaluations apply, assigning a higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disabilities upon the person's ordinary activity, 38 C.F.R. § 4.10.  See Schafrath v. Derwinski, 1 Vet. App. 589 (1991).

Where the appellant has expressed dissatisfaction with the assignment of an initial rating following an initial award of service connection for that disability, separate ratings can be assigned for separate periods of time based on the facts found - a practice known as "staged" ratings.  Fenderson v. West, 12 Vet. App. 119 (1999).

The Board has reviewed all the evidence in the record.  Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail.  Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim.  See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000).

Bilateral Hearing Loss

Service connection for bilateral hearing loss was established by the October 2008 rating decision on appeal.  A noncompensable evaluation was assigned for this disability effective May 13, 2008.  The Veteran contends that a higher evaluation for this disability is warranted. 

Evaluations of bilateral defective hearing range from non-compensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests together with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz).  To evaluate the degree of disability from bilateral service-connected defective hearing, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness.  38 C.F.R. §§ 4.85, Tables VI and VII, Diagnostic Code 6100 (2012).  Disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing.  See Lendenmann v. Principi, 3 Vet. App. 345 (1992).

An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more.  In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral.  38 C.F.R. § 4.86(a) (2012).  Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral.  That numeral will then be elevated to the next higher Roman numeral.  Each ear will be considered separately.  38 C.F.R. § 4.86(b). 

The Veteran underwent a VA QTC examination in September 2008.  He reported difficulty hearing the television.  He denied receiving any treatment for his condition.  He reported that he worked following service as a helicopter and aircraft mechanic, and as a metal worker, with hearing protection at all jobs.  Audiometric testing showed pure tone thresholds, in decibels, as follows:


HERTZ

1000
2000
3000
4000
AVG.
RIGHT
30
25
35
40
33
LEFT
30
30
30
45
34

Speech recognition testing showed scores of 84 percent for both ears.  The examiner diagnosed mild high frequency sensorineural hearing loss bilaterally.  The examiner stated that the subjective factors are difficulty hearing the television and the objective factors are audiometric data.  

The Veteran underwent another VA examination in February 2013.  Audiometric testing showed pure tone thresholds, in decibels, as follows:


HERTZ

1000
2000
3000
4000
AVG.
RIGHT
15
10
25
35
21
LEFT
30
20
30
45
31

Speech recognition testing showed a score of 96 percent for the right ear and a score of 94 percent for the left ear.  The examiner diagnosed sensorineural hearing loss bilaterally.  The examiner stated that the Veteran's hearing loss impacted ordinary conditions of daily life by causing difficulty hearing on the telephone and difficulty understanding conversation in background noise.  The examiner noted, correctly, that hearing loss in the right ear did not meet the definition of hearing loss disability pursuant to 38 C.F.R. § 3.385 (hearing loss will be considered to be a disability for VA purposes when the threshold level in any of the frequencies 500, 1000, 2000, 3000 and 4000 Hertz is 40 decibels or greater; or the thresholds for at least three of these frequencies are 26 decibels or greater; or speech recognition scores are less than 94 percent).  

In this case, in addition to reporting the results of audiometric and speech discrimination testing, the VA examiners also addressed the Veteran's functional impact of the Veteran's hearing loss.  In the September 2008 VA examination, the Veteran noted he had difficulty hearing the television.  In the February 2013 VA audiological examination, the Veteran reported functional impairments including difficulty hearing on the telephone and difficulty understanding conversation in background noise.  Thus, these examinations are adequate for rating purposes.  See Martinak v. Nicholson, 21 Vet. App. 447 (2007) (VA audiometric evaluations must describe the functional effects caused by a hearing disability, but the veteran bears the burden of demonstrating any prejudice caused by a deficiency in the examination).  

Applying the findings of the September 2008 VA examination to 38 C.F.R. § 4.85, Table VI, yields a Level II impairment of auditory acuity in the right and left ears.  When hearing acuity in both ears is Level II, a 0 percent evaluation is assigned under 38 C.F.R. § 4.85, Table VII.  Similarly, applying the findings of the February 2013 VA examination to Table VI yields a Level I impairment of auditory acuity in the right and left ears.  When hearing acuity in both ears is Level I, a 0 percent evaluation is assigned under Table VII.  38 C.F.R. § 4.85.  The Board notes that an exceptional pattern of hearing impairment consistent with 38 C.F.R. § 4.86 was not reflected on the VA examinations, as the puretone thresholds in the relevant frequencies were all less than 55 decibels.  Thus, the provisions of 38 C.F.R. § 4.86 are not for application.

Disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing.  See Lendenmann, supra.  Here, the objective testing results fall squarely within the non-compensable (0 percent) rating criteria under 38 C.F.R. § 4.85.  The Board concludes that the medical findings on examination are of greater probative value than the Veteran's allegations regarding the severity of his bilateral hearing loss.  The Board also notes that the record includes VA treatment records.  While these treatment records note he is service connected for hearing loss, they do not provide evidence sufficient for evaluating his hearing loss pursuant to the rating criteria.  Accordingly, the Board finds that the preponderance of the evidence is against the assignment of a compensable rating for hearing loss. 

Right Lower Leg Scar

Service connection for a right leg scar was established by the October 2008 rating decision on appeal.  A noncompensable evaluation was assigned for this disability effective May 13, 2008.  The Veteran contends that a higher evaluation is warranted for this disability.  The Board notes that the Veteran is in receipt of a separate rating of 20 percent for degenerative arthritis of the right ankle joint.  Therefore, symptomatology associated with that disability cannot be considered in evaluating his right leg scar.  38 C.F.R. § 4.14 (the evaluation of the same manifestation or disability under different diagnoses is to be avoided).

The Board notes that the regulations related to the rating of scars were revised effective October 23, 2008.  However, these changes apply only to applications for benefits received by VA on or after the effective date of October 23, 2008 unless the claimant specifically requests otherwise, which he did not in this case.  See 73 Fed. Reg. 54,710 (Sept. 23, 2008).  Accordingly, because the Veteran's claim was received prior to October 23, 2008 and he did not specifically request consideration under the revised criteria, the revised criteria are not for application in this case. 

Under Diagnostic Code 7801, to receive a compensable disability rating for scars, the scars must be deep or cause limitation of motion and cover an area exceeding 6 square inches (39 square (sq.) centimeters (cm.)).  38 C.F.R. § 4.118 (2007).  If the scars are superficial, a 10 percent rating is warranted if the scars cover an area of at least 144 square inches (929 sq. cm.), are unstable, or are painful on examination.  38 C.F.R. § 4.118, Diagnostic Codes 7802, 7803, 7804 (2007).  Scars that cause limitation of function are rated based on the impairment of function of the affected part.  38 C.F.R. § 4.118, Diagnostic Code 7805 (2007).

In July 2008, the Veteran reported that he could not put all his weight on his right leg and could not balance himself because of a scar on his right leg.  

The Veteran underwent a VA examination in September 2008.  He reported that he suffered a laceration on the lower right leg.  He described symptoms of constant pain, throbbing and swelling.  He reported he had difficulty with walking for prolonged periods.  For his right ankle injury he noted symptoms of weakness, stiffness, swelling, giving way, lack of endurance and fatigability.  He stated the pain in the right ankle travels up to the leg and knee.  He reported the pain is crushing, aching, sharp and cramping.  He again stated that he had difficulty with walking for prolonged periods.  

Upon physical examination, there was a level scar at the right lateral lower 
leg measuring about 13 centimeters by 0.5 centimeters.  The scar had hyper-pigmentation of less than six square inches.  There was no tenderness, disfigurement, ulceration, adherence, instability, tissue loss, inflammation, edema, keloid formation, hypopigmentation or abnormal texture.  The examiner diagnosed status post laceration right lower leg with scar.  The subjective factor was history of laceration right lower leg.  The objective factors were scar on examination and evidence of previous laceration.  The examiner also diagnosed a right ankle injury with subjective factors of pain and swelling of the right ankle along with objective factors of edema, soft tissue swelling, arthritis, tenderness, guarding of movement and decreased range of motion with limping gait. 

The Veteran underwent another VA examination in February 2013.  He reported pain that comes and goes.  He stated that the scar was treated once and there was no tissue loss.  Upon physical examination of the ankle, the examiner noted there were no scars that were painful or unstable, and the total area of the scar was not greater than 39 square centimeters.  The examiner also noted the Veteran did not have any scars that resulted in limitation of function.  On the scar examination, the examiner diagnosed a linear right lateral leg scar 10 centimeters in length that was non-tender, without pain, non-keloid, and flat.  The examiner noted the scar was not painful or unstable.  The examiner indicated the Veteran's scar did not impact his ability to work.

The Veteran also underwent a VA muscle examination in February 2013, to determine whether the scar impacted muscle functioning due to the nature of the laceration injury.  In this regard, the service treatment records reveal that the Veteran received a laceration on his right lower leg while working with a metal grinding machine.  The findings at that time revealed a 17 cm long cut on the distal right lower leg reaching down to the fibula with moderate bleeding.  X-ray revealed no bone injury.  He was treated with excision of the wound edge, suturing of the fascia and musculature, and suturing of the skin.  

On VA muscle examination, the examiner noted the Veteran had a minimal scar associated with the muscle injury and that in the past there was a fascial defect.  However, he noted that suturing and excising under local anesthesia while in service was sufficient and that there was no defect now.  The examiner further indicated that the injury did not affect muscle substance or function.  Muscle strength was full throughout the right leg and there was no atrophy, weakness, or loss of power as a result of the laceration injury or residual scar. 

Upon consideration of the record, the Board finds that the preponderance of the evidence is against the claim.  The findings on VA examination reveal a linear scar which is less than 39 sq. cm. in area.  Indeed, the 2008 examiner noted the scar was 13 cm. long and .5 cm wide, while the 2013 examiner noted a linear scar of 10 cm. in length.  Thus, to the extent the scar is considered deep, the scar does not cover 39 sq. cm, and a compensable rating is not warranted under Diagnostic Code 7801.  It therefore follows, then, that the area of the scar is less than 929 sq. cm. for a compensable evaluation under Diagnostic Code 7802 for a superficial scar.  

Additionally, the evidence does not reveal the scar has been unstable, and a compensable evaluation under Diagnostic Code 7803 is not warranted.  Additionally, although the Veteran has reported leg pain and cramping, the scar itself has been shown on VA examinations to be nontender.  The Board notes the Veteran's complaints of pain radiating from the ankle up the leg, cramping, and functional impairment have been attributed by the 2008 VA examiner to his right ankle disability, which is separately compensated.  See 38 C.F.R. § 4.14 (the evaluation of the same manifestation or disability under different diagnoses is to be avoided).  Moreover, the 2013 VA examiner found no residual muscle impairment or functional impairment resulting from the scar.  For this reason, a compensable evaluation for the Veteran's right leg scar pursuant to Diagnostic Code 7805 based on functional impairment, to include under 38 C.F.R. § 4.73 for muscle impairment, is not warranted.  

The Board also notes that the record includes VA treatment records.  While these records note he is service connected for a right lower leg scar, they do not provide evidence sufficient to evaluate his scar under applicable rating criteria.  

The Board concludes that the medical findings on examination are of greater probative value than the Veteran's allegations regarding the severity of his right lower leg scar.  Accordingly, the Board finds that the preponderance of the evidence is against the claim for a compensable evaluation for the right lower leg scar. 

Other Considerations

In exceptional cases an extraschedular rating may be provided.  38 C.F.R. § 3.321.  The Court has set out a three-part test, based on the language of 38 C.F.R. § 3.321(b)(1), for determining whether a Veteran is entitled to an extraschedular rating: (1) the established schedular criteria must be inadequate to describe the severity and symptoms of the claimant's disability; (2) the case must present other indicia of an exceptional or unusual disability picture, such as marked interference with employment or frequent periods of hospitalization; and (3) the award of an extraschedular disability rating must be in the interest of justice.  Thun v. Peake, 22 Vet. App. 111 (2008), aff'd, Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). 

The Board finds that the rating criteria contemplate the Veteran's disabilities.  With regard to the Veteran's bilateral hearing loss, although he has reported it causes difficulty with employment examinations, the rating criteria contemplate a level of impaired hearing as shown by objective testing, and the Veteran does not experience any symptomatology not contemplated by the rating schedule.  The Veteran's right lower leg scar is linear, stable, not painful on observation, and smaller than 39 square inches.  These manifestations are contemplated in the applicable rating criteria.  He is already separately compensated for the functional impairment in his right ankle, and the medical evidence indicates there is no functional impairment attributed to his right leg scar.  Thus, the rating criteria are therefore adequate to evaluate the Veteran's disabilities and referral for consideration of an extraschedular rating is not warranted. 

As a final matter, the Board notes the Veteran has provided statements regarding getting fired from jobs, being out of work since June 2011 and being unsure whether he will ever work again.  However, these statements reference his knee and ankle disabilities, and some also mention headaches, hand, and back disabilities.  He has not alleged, and the evidence does not indicate that he is unemployable due to his hearing loss and/or his right leg scar.  Indeed, following his last statement concerning his employability, made in March 2012, he was noted to have been employed in a production line building aircraft for 90 days and was permitted to sit due to ankle and knee flare-ups.  The job ended in October 2012.  Thus, as the evidence does not indicate the Veteran is unemployable as a result of the disabilities presently being decided, remand pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009) is not warranted.  As noted in the Introduction, however, to the extent he claims he is unemployable due to other disabilities, to include his service-connected right ankle, such matter is referred to the RO.

In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine.  However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal.  See 38 U.S.C.A. § 5107(b) (West 2002); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990).


ORDER

Entitlement to an initial compensable evaluation for bilateral hearing loss is denied.

Entitlement to an initial compensable evaluation for right lower leg scar is denied.  

REMAND

With regard to the left knee disability, the Veteran underwent a VA examination in February 2013.  The examiner concluded that the left knee disability is less likely than not incurred in or caused by service, and that the left knee disability is not related to or aggravated by service-connected right ankle disability.  As part of the rationale for these opinions, the examiner stated that the nexus of the left knee disability was post-service.  In completing the Disability Benefits Questionnaire, however, he later checked off the box indicating that the left knee disability clearly and unmistakably existed prior to service, and was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event or illness.  The Board is unable to reconcile the statement that the nexus of the left knee disability was post-service with the later statement that the left knee disability clearly and unmistakably existed prior to service.  Thus, clarification of the opinion is necessary.  

Relevant ongoing medical records should also be requested.  38 U.S.C.A. § 5103A(c) (West 2002); see also Bell v. Derwinski, 2 Vet. App. 611 (1992) (VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim).

Accordingly, the case is REMANDED for the following actions:

1.  Obtain relevant records for the Veteran from the San Antonio VA Medical Center dated since March 2013.  If the requested records are not available the Veteran should be notified of such.  

2.  Return the claims file and the February 2013 VA examination report to that examiner, if available.  Following review of the claims file, the examiner should clarify his conflicting statements that the left knee disability is related to a post-service event versus his statement that it clearly and unmistakably existed prior to service.  The examiner should set forth a rationale for all opinions expressed and conclusions reached. 

If this examiner is not available, arrange for the opinion to be provided by another examiner of similar qualifications.  If a new examination is deemed necessary by the examiner, one should be scheduled.

3.  Following the completion of the above, the RO/AMC should review the evidence and determine whether the appellant's claims may be granted.  If not, he should be furnished an appropriate supplemental statement of the case and be provided an opportunity to respond.  Thereafter, the case should be returned to the Board for further appellate consideration, if in order.  

The appellant has the right to submit additional evidence and argument on the matters the Board has remanded.  Kutscherousky v. West, 12 Vet. App. 369 (1999).

This claim must be afforded expeditious treatment.  The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner.  See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012).



______________________________________________
K.A. BANFIELD
Veterans Law Judge, Board of Veterans' Appeals


Department of Veterans Affairs