Citation Nr: 1320845 Decision Date: 06/27/13 Archive Date: 07/05/13 DOCKET NO. 06-23 451 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for a heart disability, to include as secondary to service-connected disability. REPRESENTATION Appellant represented by: William K. Thames, II, Attorney at Law ATTORNEY FOR THE BOARD David S. Nelson, Counsel INTRODUCTION The Veteran had active service from April 1957 to January 1977. This case comes before the Board of Veterans' Appeals (BVA or Board) from a November 2004 and May 2005 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. This case was most previously before the Board in February 2011. The February 2011 Board decision found that new and material evidence had been submitted to reopen the Veteran's heart and psychiatric disability claims and then remanded those claims for additional development. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The issue of entitlement to service connection for a heart disability, to include as secondary to service-connected disability, is addressed in the REMAND portion of the decision below and is REMANDED to the Department of Veterans Affairs Regional Office. FINDINGS OF FACT 1. Competent clinical evidence of record establishes a current diagnosis of PTSD due to an inservice stressor that has been verified by the objective evidence of record. 2. The preponderance of the evidence fails to establish that an acquired psychiatric disorder other than PTSD was present in service, that a psychosis was demonstrated to a compensable degree within a year of discharge from service, or that there is a nexus or link between an acquired psychiatric disorder other than PTSD and the Veteran's active service. CONCLUSIONS OF LAW 1. Service connection for PTSD is warranted. 38 U.S.C.A. §§ 1110, 1112, 1113, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2012). 2. Service connection for an acquired psychiatric disorder, other than PTSD, is not warranted. 38 U.S.C.A. §§ 1110, 1112, 1113, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 38 U.S.C.A. §§ 5103, 5103A; 38 C.F.R. §§ 3.159, 3.326(a). Duty to Notify Proper notice from VA must inform the claimant and his representative, if any, prior to the initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ) of any information and any medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). These 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 v. Nicholson, 19 Vet. App. 473 (2006). Information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded must be included. Id. Neither the Veteran nor his representative has alleged prejudice with respect to notice, as is required. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009); Goodwin v. Peake, 22 Vet. App. 128 (2008). None is found by the Board. Indeed, VA's duty to notify has been more than satisfied. The Veteran was notified via letter dated in July 2004 of the criteria for establishing service connection, the evidence required in this regard, and his and VA's respective duties for obtaining evidence. In June 2006 he also was notified of how VA determines disability ratings and effective dates if service connection is awarded. As VCAA notice was not completed prior to the initial AOJ adjudication of the claims, such notice was not compliant with Pelegrini. However, as the case was readjudicated thereafter, there is no prejudice to the Veteran in this regard. Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). Duty to Assist The Veteran's service treatment records and service personnel records are associated with the claims file. Identified VA and private medical records are associated with the Veteran's claims file. There are no outstanding records that have not otherwise been obtained. The Veteran has undergone VA examinations that address the medical matters presented by this appeal. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that a June 2012 VA examination and opinion were not necessarily adequate with respect to addressing the question of whether or not the Veteran meets the requirements for a diagnosis of PTSD. However, as this decision grants the Veteran service connection for PTSD, the inadequacy of the June 2012 VA examination does not necessitate that the Veteran be scheduled for another VA PTSD examination. As for that portion of the Veteran's claim dealing with service connection for psychiatric disability other than PTSD, the Board finds that the VA examinations of record are adequate to decide the Veteran's claim. The opinions of record considered the pertinent evidence and provided a rationale for their conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion has been met. 38 C.F.R. § 3.159(c)(4). The Veteran has not referenced any other pertinent, obtainable evidence that remains outstanding. VA's duties to notify and assist are met, and the Board will address the merits of the Veteran's service connection for psychiatric disability claim. Laws and regulations Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection for a claimed disorder, 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) evidence, generally medical, 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). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (2012); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f) (2012); see Cohen v. Brown, 10 Vet. App. 128 (1997). For VA compensation purposes, 38 C.F.R. § 4.125 requires that all mental disorder diagnoses must conform to the Fourth Edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV). Where there is a chronic disease shown as such in service or within the presumptive period under § 3.307 so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however, remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). This rule does not mean that any manifestations in service will permit service connection. To show chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the disease entity is established, there is no requirement of evidentiary showing of continuity. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). However, the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic. 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection for certain specified chronic diseases, such as a psychosis, may be established on a presumptive basis by showing that such disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. VA is required to evaluate the supporting evidence in light of the places, types, and circumstances of service, as evidenced by service records, the official history of each organization in which the veteran served, the veteran's military records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154(a) (West 2002). Background A November 1969 service treatment record noted that the Veteran complained of chest pain and requested "nerve pills." An April 1970 service treatment record noted that the Veteran complained of continuous substernal pain. The impression was anxiety reaction. Service treatment records dated in October 1971 and November 1971 noted that the Veteran complained of chest pain and was treated with Valium. The Veteran's January 1977 service retirement examination report indicates that the Veteran's psychiatric system was clinically evaluated as normal. The Veteran indicated depression or excessive worry and nervous trouble on the corresponding Medical History Report. It was noted that the Veteran was not taking medication for depression and worry. When he was examined by VA in December 1985, the nervous system portion of that examination indicated that the Veteran was alert, pleasant, and cooperative. There was no diagnosis related to psychiatric disability. At an April 1987 VA examination the Veteran indicated that he had chest pains primarily on the left side. While the examiner essentially stated that the Veteran had no psychiatric diagnosis, due to the Veteran's tension and tendency to worry the Veteran was placed on Xanax. VA records dated from March 2001 to August 2004 noted that the Veteran thought that he might have PTSD or depression as a result of what he went through in Vietnam or because he lost both of his wives to divorce. Impressions included depressive disorder, depression, and generalized anxiety disorder. An August 2004 VA examiner noted that a diagnosis of PTSD could not be offered as the Veteran had not cooperated with the evaluation. In statements received in August 2001 and April 2002 the Veteran stated that he had witnessed multiple incidents during service that had caused problems with his nerves. He stated that while aboard the USS Oriskany in October 1966 there had been a bomb explosion and fire, with quite a few casualties. At a June 2004 VA mental health consultation the Veteran stated that his energy was poor and his memory was fading. He reported flashbacks and nightmares as a result of seeing people being killed and hurt during service. He stated that he did not want any medication for his psychiatric treatment. The diagnosis was depression. A December 2004 VA mental health treatment record indicates that the Veteran complained of sleep problems, flashbacks, social isolation, and nightmares. The diagnoses included a depressive disorder and Rule out PTSD. At a December 2006 VA psychiatric examination the Veteran indicated that he had witnessed a number of accidents aboard ship during service. The Veteran was uncertain of when his psychiatric symptoms had actually started. Current symptoms included poor sleep and occasional nightmares. The diagnosis was anxiety disorder. The examiner stated that the Veteran did not meet the full criteria for a PTSD diagnosis. It was also noted that the Veteran's report of symptoms had been vague and incomplete. The examiner stated, in pertinent part, as follows: The [Veteran] did note some symptoms of anxiety while still on active duty with the Navy, for which he was treated. However, at this time, I cannot conclude that his current symptoms are a further manifestation of what he first experienced in the military, without resorting to mere speculation. An August 2008 VA record indicates that the Veteran reported nightmares and flashbacks associated with incidents he had witnessed while serving on an aircraft carrier during service. Following a review of the Veteran's records and a mental evaluation the August 2008 VA examiner stated that "it is difficult for me to diagnose [the Veteran] with [PTSD] except that there is a strong possibility that it is the case." Treatment records from the Veteran's private psychiatrist dated from April 2008 through April 2011 reflect ongoing psychiatric treatment. Diagnoses included alcoholism and PTSD, Latent. An April 2008 record noted that the Veteran complained of disturbing dreams about events he had witnessed (people dying, including in a fire aboard ship) while serving in the Navy. He said that VA treatment and medications he had tried in the past had not helped him. The records indicate that the Veteran was treated with medications that included Citalopram and Vistaril. At a February 2011 VA PTSD examination the Veteran reported that he had some depression, which the examiner noted was more situational that pervasive, which would "be consistent with his report of not needing the antidepressants over the years." The Veteran indicated that he had witnessed trauma exposure during service, including witnessing incidents aboard ship. The examiner indicated that there was no Axis I diagnosis. It was noted that while some symptoms of depression and PTSD had been noted, the examiner indicated that the Veteran had not met the criteria for a separate depression or PTSD diagnosis. At a June 2012 VA PTSD examination the Veteran was diagnosed with an anxiety disorder. The June 2012 VA examiner noted that the Veteran did not meet the criteria for PTSD, in that the Veteran did not meet criterion E and F. As the June 2012 examiner did not give an etiology of the Veteran's diagnosed anxiety disorder, another examiner was asked to state whether the Veteran's anxiety disorder was related to his military service. In September 2012 the VA examiner stated, however, that the Veteran did not meet the criteria for any Axis I mood disorder. The diagnosis was alcohol dependence. Analysis The Veteran in this case asserts that he has PTSD as a result of witnessing multiple traumatic events aboard ship during service, including explosions that inured several fellow sailors. He also contends that he had bad nerves during service that were evidence of an acquired psychiatric disorder. At the outset, the Board observes that the RO has verified the Veteran's main stressor in this case. The National Personnel Records Center (NRPC) has certified that the Veteran served on the USS Oriskany in October 1966. VA has also acknowledged that a fire erupted on the USS Orisknay in October 1966 that resulted in many causalities. The Veteran has consistently referred to the fact that he witnessed the death and injury of fellow sailors while serving aboard ship during his time in the Navy. He has also consistently maintained that he has had flashbacks and nightmares associated with those events. The Veteran's claimed stressor has been verified. The main matter before the Board is to determine whether the Veteran has a current diagnosis of PTSD. As noted, medical records dated from April 2008 to April 2011 from the Veteran's private psychiatrist reflect a consistent diagnosis of PTSD. The Board finds the PTSD diagnoses rendered by the private psychiatrist to be sufficient in this case. First, the Veteran's private psychiatrist clearly possesses the requisite medical training, expertise, and credentials needed to render a PTSD diagnosis. There is also no indication that the Veteran's private psychiatrist relied on any inaccurate medical history in rendering the Veteran's PTSD diagnosis. The Board also finds it significant that the private psychiatrist treated (to include prescribing medications) the Veteran (albeit sporadically) over a four year time period and continued to indicate during that entire time frame that the Veteran's primary diagnosis was PTSD. The initial treatment record seems to suggest that the Veteran underwent psychological testing at that time, which supported that diagnosis. Reference is also made to the comments from an August 2008 VA examiner who stated that "it is difficult for me to diagnose [the Veteran] with [PTSD] except that there is a strong possibility that it is the case." That said, there is evidence suggesting that the Veteran does not have PTSD. A June 2012 VA examiner concluded that the Veteran did not meet all the DSM-IV criteria for a PTSD diagnosis. Certain inaccuracies in the June 2102 VA examination cause the report to have diminished probative value. The June 2012 VA examiner has stated that the Veteran did not meet Criterion E for PTSD as required in DSM-IV, which is that Criterion B, C, and D be demonstrated for at least a month. However, the claims file (as noted in the background section of this decision) does contain evidence that the Veteran has complained for years of many of the symptoms checked in Criterion B, C, and D (in the PTSD Diagnostic Criteria section of the June 2012 VA PTSD examination). This raises the question as to whether the June 2012 VA examiner had access to or reviewed the Veteran's entire claims file at the time of the examination. The June 2012 VA examiner also made no mention of the fact that the Veteran's private psychiatrist had indicated that the Veteran had been diagnosed and treated for PTSD. The Board finds that the evidence is in at least equipoise as to the question of whether the Veteran has a current diagnosis of PTSD. Resolving doubt in the Veteran's favor, the Board finds that the record establishes a current diagnosis of PTSD due to an inservice stressor that has been verified by the objective evidence of record. As such, service connection for PTSD is warranted. As for psychiatric disability other than PTSD, the Board finds that the Veteran's service treatment records do not reveal that a chronic psychiatric disability was noted in service. The Veteran did complain of having bad nerves during service, and an impression of an anxiety reaction was rendered in 1969 (some 7-8 years prior to his separation from service). However, no psychiatric disability was noted on the Veteran's service separation examination. Further, the post-service records do not show or contain any evidence suggesting a relationship between psychiatric disability (other than PTSD) and the Veteran's service. The findings and opinions of the various psychiatric examiners of record have not linked the Veteran's psychiatric disability such as depression or anxiety to his military service. For example, the December 2006 VA examiner, in noting that the Veteran had symptoms of anxiety during service, went on to state that she could not conclude that the Veteran's current symptoms were a manifestation of what he first experienced in the military. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, psychiatric disability fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). Psychiatric disorders are not the type of condition that are readily amenable to mere lay diagnosis. The evidence shows that specific findings, to include specialized diagnostic testing, are needed to properly assess and diagnose those disorders. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); and Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). That is, although the Board readily acknowledges that the Veteran is competent to report symptoms of feeling depressed or anxious and recall "traumatic" event that he says occurred in service, there is no indication that the Veteran is competent to diagnose a psychiatric disorder. The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a competent opinion as to medical causation. Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating psychiatric disorders. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed.Cir.2012). This lay evidence does not constitute competent medical evidence and lacks probative value. The decision made in Amberman v Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009) is also germane and should be discussed. In that case, the Federal Circuit case agreed with the Veterans Court's holding in Esteban v. Brown, 6 Vet. App. 259 (1994) as to when 38 C.F.R. § 4.14 is and is not for application. Id. at 1381. In Esteban, a facial injury had resulted in that individual suffering disfigurement, painful scars, and muscle damage that made it difficult to chew. Esteban, 6 Vet. App. 261. As summarized in Amberman, "[b]ecause each diagnostic code dealt with different symptoms (cosmetic issues, pain, and difficulty chewing, respectively), the Veterans Court held that they did not constitute the "same disability" or "same manifestation," and therefore section 4.14 was inapplicable." Amberman, 570 F.3d at 1381 (citing Esteban, 6 Vet. App. at 261-62). The Federal Circuit agreed with the Veteran's Court's holding in Esteban that the critical element in assigning separate ratings is that none of the symptomatology of any of the conditions is duplicative or overlapping with the symptomatology of another condition. Id. The statement of interest in Amberman, is "bipolar affective disorder and PTSD could have different symptoms and it could therefore be improper in some circumstances for VA to treat the separately diagnosed conditions as producing only the same disability." Id. at 1381. In the instant case, the Board finds that, even if the Veteran's anxiety and/or depression, were separate and distinct disorder that could be related to service, assigning separate ratings would be pyramiding. Examination of the evidence of record shows that the anxiety and depressive symptoms overlap and are duplicative of the symptoms manifested by the Veteran's now service connected PTSD. There is also no evidence that a psychosis has been demonstrated to a compensable degree within the first year of service discharge. The first documentation of any sort of psychiatric disorder is not shown until many years following service. Notwithstanding that a psychosis has not been diagnosed, the presumption of service connection under 38 C.F.R. § 3.309(a) would fail based on this timing. As for the Veteran's alcoholism, and any other substance abuse problem, it is important to note that pursuant to 38 U.S.C.A. § 1110, "no compensation shall be paid if the disability is a result of the Veteran's own willful misconduct or abuse of alcohol or drugs." VA regulation defines the frequent use of drugs to the point of addiction as willful misconduct, 38 C.F.R. § 3.301(c)(3) (2012). However, "where the use of drugs or addiction thereto results from a service-connected disability, it will not be considered of misconduct origin." Id. A review of the medical records, however, including the records from the Veteran's private psychiatrist, do not indicate that the Veteran's alcoholism was linked to his PTSD. In fact, in those records, the Veteran has indicated that he began drinking prior to service. As for continuity of symptomatology since service, the Board notes that it appears that the Veteran has not been diagnosed with a psychosis. In sum, service connection for PTSD is warranted, and service connection for an acquired psychiatric disorder other than PTSD is not warranted. The Board has considered the applicability of the benefit-of-the-doubt doctrine and in fact has resolved reasonable doubt in the Veteran's favor in this case. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER Entitlement to service connection for PTSD is granted. Entitlement to service connection for an acquired psychiatric disorder other than PTSD is denied. REMAND As for entitlement to service connection for a heart disability, the Veteran asserts that he has heart disability related to his active service. He contends that the complaints of chest pain made during service is evidence that his heart disability had its onset during service. He has also indicated that he developed a psychiatric disorder which in turn has led to the development of a heart disorder. Secondary service connection may also be granted for a disability, which is proximately due to, the result of, or aggravated by, an established service-connected disorder. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). Secondary service connection includes instances in which an established service-connected disorder results in additional disability of another condition by means of aggravation. Allen. The regulation which governs claims for secondary service connection, was amended during the pendency of this appeal, effective October 10, 2006. The current 38 C.F.R. § 3.310(b) sets a standard by which a claim based on aggravation of a non-service-connected disability by a service-connected one is judged. Given what appear to be substantive changes, and because the Veteran's claim was pending before the regulatory change was made, VA must consider the version in effect before the change, which version favors the claimant. As for the Veteran's service treatment records, a November 1969 service treatment record noted that the Veteran complained of chest pain and requested "nerve pills." An April 1970 service treatment record noted that the Veteran complained of continuous substernal pain, and service treatment records dated in October 1971 and November 1971 noted that the Veteran complained of chest pain and was treated with Valium. The Veteran's January 1977 service retirement examination report indicates that the Veteran's heart clinically evaluated as normal; blood pressure was recorded as 130/90. The Veteran indicated pain or pressure in his chest on the corresponding Medical History Report. Records beginning with a May 1986 VA record first noted heart disability. A December 2012 VA heart examination noted a diagnosis of coronary artery disease with ischemic heart disease status post stent placement. In this decision, the Board has found that service connection for PTSD is warranted. While the Veteran has undergone VA examinations that have addressed some of his contentions concerning his heart disability, the record contains insufficient competent medical evidence to decide the matter as to whether the Veteran's heart disability is related to his PTSD. As such, the Veteran should be scheduled for a VA examination with a medical opinion regarding a possible relationship between heart disability and the Veteran's service-connected PTSD. The Veteran's VA records (including those available through the Compensation and Pension Records Interchange (CAPRI) uploaded to the Veteran's electronic Virtual VA folder) reflect treatment through January 24, 2013. The Veteran's updated records, if any, should be obtained. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. Obtain and associate the Veteran's complete outpatient and inpatient VA treatment records from since January 24, 2013. 2. The Veteran should be scheduled for the appropriate VA examination regarding the claimed heart disability. The examiner must be provided the Veteran's claims file for review, and any indicated studies must be completed. Following examination of the Veteran and review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not that the Veteran has any heart disability that is proximately due to service-connected PTSD or that was aggravated (made worse) by service-connected PTSD. Rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. The AOJ should then, based on all the evidence of record, readjudicate the issue of entitlement to service connection for a heart disability, to include as secondary to service-connected disability. If the benefit sought is not granted, a supplemental statement of the case should be issued, and the Veteran and his representative should be afforded the appropriate period to respond. Thereafter, the case should be returned to the Board, as appropriate. The Veteran has the right to submit additional evidence and argument on the matter 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). ______________________________________________ MICHAEL A. HERMAN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs