Citation Nr: 1321440 Decision Date: 07/03/13 Archive Date: 07/12/13 DOCKET NO. 06-29 479 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUES 1. Entitlement to service connection for a skin disorder, to include as due to undiagnosed illness. 2. Entitlement to service connection for a gastrointestinal disorder, to include as due to undiagnosed illness. 3. Entitlement to service connection for a respiratory disorder, to include as due to undiagnosed illness. 4. Entitlement to an initial evaluation in excess of 50 percent for posttraumatic stress disorder (PTSD), prior to June 29, 2011. REPRESENTATION Appellant represented by: Virginia A. Girard-Brady, Attorney WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD James R. Siegel, Counsel INTRODUCTION The Veteran served on active duty from August 1984 to May 1987 and from December 1990 to September 1991. He also had service from January 2000 to January 2008. A May 2009 Administrative Decision of the Department of Veterans Affairs (VA) Regional Office (RO) concluded the Veteran's final period of service was characterized as dishonorable. Thus, the Veteran is not eligible for VA benefits based on this period of service. See 38 C.F.R. § 3.12 (2012). This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2005 rating decision of the RO that denied the Veteran's claim for service connection for skin, gastrointestinal and respiratory disorders, each to include as due to undiagnosed illness. When this case was previously before the Board in August 2009, it was remanded for additional development of the record. By decision dated April 2011, the Board denied service connection for chronic skin and gastrointestinal disorders, both to include as due to undiagnosed illness. The claim for service connection for a respiratory disorder, to include as due to undiagnosed illness, was remanded for additional development of the record. The Veteran appealed the claims that were denied to the United States Court of Appeals for Veterans Claims (Court) which, by Order dated July 2012, granted a Joint Motion for Partial Remand. The case is again before the Board for appellate consideration. The issues of service connection for loss of vision of both eyes and a spinal cord disability have been raised by the record, but have not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over them, and they are] referred to the AOJ for appropriate action. The issue of entitlement to an initial evaluation in excess of 50 percent for PTSD 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. 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). FINDINGS OF FACT 1. The Veteran had service in the Southwest Asia Theater of operations during the Persian Gulf War. 2. Tinea pedis and folliculitis are known clinical disorders, and there is no competent and probative evidence linking any skin disability to service, to include service in the Persian Gulf. 3. Gastroesophageal reflux disease is a known clinical disorder, and there is no competent and probative evidence linking any gastrointestinal disability to service, to include service in the Persian Gulf. 4. Allergic rhinitis is a known clinical disorder, and there is no competent and probative evidence linking any respiratory disability to service, to include service in the Persian Gulf. CONCLUSIONS OF LAW 1. A skin disability was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5107 (West 2002); 38 C.F.R. § 3.317 (2012). 2. A gastrointestinal disability was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5107 (West 2002); 38 C.F.R. § 3.317 (2012). 3. A respiratory disability was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5107 (West 2002); 38 C.F.R. § 3.317 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Notice and Assistance VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). See also Pelegrini v. Principi, 18 Vet. App. 112 (2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Dingess v. Nicholson, 19 Vet. App. 473 (2006). Notice was provided to the Veteran in September 2005 and December 2009 letters. The record also reflects that VA has made reasonable efforts to obtain relevant records adequately identified by the appellant. Specifically, the information and evidence that have been associated with the claims file include the service treatment records, Social Security Administration records, private and VA medical records, reports of VA examinations, and the Veteran's testimony at a hearing before the undersigned. Several VA examinations have been conducted, and opinions regarding the etiology of the Veteran's skin, gastrointestinal and respiratory disabilities were obtained. 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 the VA examinations obtained in this case are adequate, as they are based on an examination of the record and a review of the claims folder. The opinion considered the pertinent evidence of record, to include statements of the Veteran regarding the etiology of his skin, gastrointestinal and respiratory disorders. Based on the foregoing, the Board finds that all relevant facts have been properly and sufficiently developed in this appeal and no further development is required to comply with the duty to assist the Veteran in developing the facts pertinent to the claim. Essentially, all available evidence that could substantiate the claim has been obtained. Analysis The Board has reviewed all the evidence in the appellant's claims file. 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 each 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). Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires evidence of: (1) a current disability (for which service connection is sought); (2) evidence of incurrence or aggravation of a disease or injury in service; and (3) evidence of a nexus between the claimed disability and the disease or injury in service. See Shedden v, Principi, 381 F.3d 1153, 1166-1167 (Fed. Cir. 2004). Under 38 C.F.R. § 3.317, a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability may be service connected, provided that such disability became manifest either during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2011, and by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. A "qualifying chronic disability" has been defined to mean a chronic disability resulting from any of the following (or any combination of the following): (1) an undiagnosed illness; or (2) medically unexplained chronic multisymptom illnesses that are defined by a cluster of signs or symptoms (specifically chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, or any other illness the Secretary determines meets the criteria of a medically unexplained chronic multisymptom illnesses). 38 C.F.R. § 3.317(a)(2). The term "medically unexplained chronic multisymptom illness" means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. 38 C.F.R. § 3.317(a)(2)(ii). Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. Id. "Objective indications of chronic disability" include both "signs" in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Disabilities that have existed for 6 months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. 38 C.F.R. § 3.317(a)(4). The 6-month period of chronicity is measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. Id. Signs or symptoms that may be a manifestation of an undiagnosed illness or a medically unexplained chronic multisymptom illness include, but are not limited to the following: fatigue; signs or symptoms involving the skin; headache; muscle pain; joint pain; neurologic signs or symptoms; neuropsychological signs or symptoms; signs or symptoms involving the respiratory system (upper or lower); sleep disturbances; gastrointestinal signs or symptoms; cardiovascular signs or symptoms; abnormal weight loss; and menstrual disorders. 38 C.F.R. § 3.317(b). Compensation shall not be paid under 38 C.F.R. § 3.317: (1) if there is affirmative evidence that an undiagnosed illness was not incurred during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; or (2) if there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between a veteran's most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or (3) if there is affirmative evidence that the illness is the result of a veteran's own willful misconduct or the abuse of alcohol or drugs. 38 C.F.R. § 3.317(a)(7) (as re-designated September 29, 2010); see 75 Fed. Reg. 59968 (2009). Establishing service connection generally requires medical evidence or, in certain circumstances, lay evidence of the following: (1) A current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) nexus between the claimed in-service disease and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed.Cir.2007); Hickson v. West, 12 Vet. App. 247 (1999); Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd per curiam, 78 F.3d 604 (Fed.Cir.1996) (table). The evidence establishes that the Veteran served in the Persian Gulf during the requisite time period under 38 C.F.R. § 3.317. The Veteran primarily asserts he has a skin disability, a gastrointestinal disorder and a respiratory disorder due to his service in the Persian Gulf. On a report of medical history in May 1991, the Veteran denied skin disease, frequent indigestion and intestinal trouble. He also denied shortness of breath, chest pain and a chronic cough. He completed a Southwest Asia demobilization/redeployment medical evaluation in May 1991 and denied having any diseases or injuries while in that region. He also denied a rash or skin infection, as well as stomach or belly pain, nausea and diarrhea. A redeployment examination in May 1991 demonstrated the skin, abdomen and viscera and lungs and chest were evaluated as normal. It was reported the Veteran had a pruritic rash that was not responding to topical steroids, and it was recommended that he should go to the VA if his skin problem persisted. The Veteran submitted an initial claim for service connection for back, shoulder and vision problems in August 1991. Private medical records show the Veteran was seen for unrelated complaints following a motor vehicle accident in September 1994. He also reported a cough with green sputum of two days duration. It was noted he had an upper respiratory tract infection. VA outpatient treatment records disclose the Veteran was seen in May 1998 and reported stomach problems and loose stools for five years. The pertinent assessment was possible irritable bowel syndrome. He was treated for allergic rhinitis in November 1998. A report of medical history for enlistment in the National Guard in April 1999 reveals the Veteran denied hay fever, asthma, shortness of breath, chest pain and a chronic cough. A physical examination showed the skin, abdomen and viscera and lungs and chest were evaluated as normal. Service treatment records from the period of service from which the Veteran's discharge was dishonorable show he was seen in September 2000 for pain and swelling of the toes. The assessment was tinea pedis. He complained of sinus problems in February 2001. He stated his symptoms had been present for five days. The assessment was bronchitis. A November 2003 report of medical history shows the Veteran reported frequent indigestion and stomach trouble. He denied skin disease. He reported stool urgency with associated abdominal pain since the Gulf War. He indicated he had dyspepsia with certain foods. Additional service department records show the Veteran was seen in November 2003 with a 14-year history of a widespread rash on the inner thighs, arms, abdomen and back. The diagnosis was hidradenitis. On examination in November 2003, the abdomen and viscera were evaluated as normal. The skin was abnormal. It was noted he had erythematous, scaly and macerated lesions between the web spaces of both feet. Tinea pedis, possible irritable bowel syndrome and gastroesophageal reflux disease were noted under the summary of defects. He was seen for mild seborrheic dermatitis on the scalp in March 2004. It was also noted that month that he was seen for seasonal allergies and an upper respiratory infection. A VA general medical examination was conducted in November 2004. There were no complaints concerning a respiratory disorder. An examination demonstrated the chest was clear to auscultation and percussion. The Veteran had no respiratory restrictions. He claimed he had difficulty breathing through a respiratory mask. A chest X-ray was normal. When seen in a VA outpatient treatment clinic in August 2005, the Veteran reported he developed pain in the left chest when he tried to do some running. A VA Persian Gulf examination was conducted in October 2005. The Veteran asserted he had a skin condition at least since 1998. He also described postprandial fullness with nausea and vomiting, dating back years. He related he deferred going to bed on many occasions because he felt short of breath. The examiner was unable to elicit a history of a chronic deep cough, wheezing, sputum production, hemoptysis, unexplained fevers, chills or night sweats. Following an examination, the impression was there was no evidence of a respiratory illness accounting for the Veteran's dyspnea at rest. The examiner indicated the Veteran's problem related to anxiety. It was noted a pulmonary function test was normal, and the examiner concluded the Veteran had subjective dyspnea, of unknown cause and without any objective abnormality. It was also concluded he had tinea versicolor based upon signs of some residuals of his latest episode. It was stated his gastrointestinal condition was not clearly gastroesophageal reflux disease, and there was no immediate other diagnosis apparent. It was reported an upper gastrointestinal series was normal, as was an abdominal ultrasound. The Veteran was afforded a VA examination of the skin in December 2005. He reported his initial problem with pimples on his face while in Kuwait in 1984. He said he had not seen a medical provider in service for this. It was noted there was no documentation of past acne or urticaria. The diagnosis was no acne or urticaria. A VA examination was conducted in January 2010. The examiner noted she reviewed the claims folder. The Veteran reported the onset of his skin condition was immediately following service in 1991. He described a recurrent rash, with itching all over his body. He indicated he received no treatment for this until 1991. He also reported blisters on his feet in 1991. The diagnoses were mild tinea pedis and folliculitis of the trunk. The examiner stated tinea pedis was intermittent and not a chronic condition, and that it was not related to or diagnosed in the Southwest Asia theater of operations. She further noted that folliculitis of the trunk was not a chronic condition as many examinations and the clinical records do not all document the condition. She observed that while the Veteran had a rash during service, he had differing complaints regarding his skin condition since that time, including hives, acne, insect bites and tinea. She related there was no evidence of chronicity as the condition did not persist as no skin lesions were noted on examination of the skin in 2005. There was no undiagnosed illness, as in each case a diagnosis was made. Thus, it was unlikely that the Veteran's current skin symptoms and findings are related to or the same as the one noted in service. With respect to tinea pedis, the examiner pointed out that it was a diagnosed illness that had not been chronic in nature. She added it was not present on examination in 2005 and was not present or diagnosed during the period of service from 1990 to 1991. On the January 2010 VA examination, the Veteran also stated he had difficulty breathing due to shortness of breath. He recalled breathing toxins from Persian Gulf War related burning in which he was exposed to fumes and not provided appropriate breathing equipment. He asserted the onset of his condition was 1995. The diagnosis was there was no evidence of obstructive or restrictive disease based on normal spirometry. Therefore, there was no diagnosis and no undiagnosed illness. There was no evidence of chronic symptomatology. A VA examination of the nose and sinuses in January 2010 resulted in a diagnosis of allergic rhinitis. The examiner indicated the condition was present prior to service, and was chronic in nature. There was no evidence of chronic sinusitis. The examiner noted the Veteran's respiratory symptoms were not caused by or a result of active duty in the Southwest Asia theater of operations. She stated the Veteran had evidence of seasonal/botanical related allergic symptoms prior to service and there was no evidence of aggravation or treatment of such in the service treatment records. The condition of allergic rhinitis was chronic. She added there was no undiagnosed illness related to this condition. With respect to subjective dyspnea, there was no evidence of a lung condition for the Veteran's service from 1990 to 1991. There was no evidence of a chronic lung/respiratory condition other than allergic rhinitis in the VA outpatient treatment records. There was no undiagnosed illness as the pulmonary function test, chest X-ray and physical examination showed no evidence of any illness. There was no diagnosis associated with the Veteran's symptoms and no undiagnosed illness associated with the symptoms. The Veteran was also examined by the VA for his gastrointestinal disability in January 2010. The examiner reviewed the claims folder. The Veteran maintained his gastrointestinal problems began in 1991, and that he had experienced problems with gas since the Gulf War. He recalled no treatment in service for gastrointestinal symptoms. The diagnosis was subjective reflux symptoms without objective evidence. The examiner stated it was likely related to the diagnosis of gastroesophageal reflux disease which appeared to be chronic in nature, but was not present during service from 1990 to 1991. She added there was no undiagnosed illness of the gastrointestinal system. She concluded gastroesophageal reflux disease was not caused by or a result of active duty in the Southwest Asia theater of operations. She explained there was no evidence of a chronic condition of the gastrointestinal tract while in Southwest Asia, and there were no reported symptoms until 2005. She observed diagnostic imaging in 2005 was negative for reflux. She added the symptoms corroborated with gastroesophageal reflux disease and, therefore, there was no undiagnosed condition, and there was no objective evidence of rectal incontinence. Finally, she noted that while gastroesophageal reflux disease symptoms and hemorrhoids were chronic in nature, they were not present until 2005 or later and, therefore, not related to service from 1990 to 1991. The Veteran was again afforded a VA examination in May 2011. The examiner reviewed the claims folder. The Veteran indicated his symptoms associated with allergic rhinitis had their onset in 1991 and were related to oil burning exposure in service. He denied any problems with allergies prior to this, but stated he had problems with his sinuses in 1987 when doing field training exercises and he was exposed to various pesticides. The diagnosis was allergic rhinitis. The examiner opined it was less likely as not that allergic rhinitis was caused by or a result of active service. She observed the Veteran had evidence of seasonal/botanical elated allergic symptoms prior to service, and there was no evidence of aggravation or treatment of such in the service treatment records. She pointed out the Veteran at times denied having hay fever on questionnaires. She explained that the actual etiology of allergic rhinitis is multifold. She noted it is a common disorder. The record reflects the Veteran has been diagnosed with tinea pedis, folliculitis, allergic rhinitis and gastroesophageal reflux disease. As these are known clinical diagnoses, service connection for these conditions is precluded under 38 C.F.R. § 3.317. The Board acknowledges the assertions of the Veteran that he has skin, gastrointestinal and respiratory disabilities that are related to service, to include his service in the Persian Gulf. He is competent to report that he has experienced skin, respiratory and gastrointestinal problems since service. Lay persons are competent to provide opinions on some medical issues; however, the specific issue in this case, the etiology of a skin, gastrointestinal and respiratory disorders, falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). There is no medical evidence linking any current skin, gastrointestinal or respiratory disorder to service. The JMR directed the Board to assess the credibility of the Veteran's allegations regarding his claims for service connection for skin and gastrointestinal disorders. In essence, the Veteran argues he developed skin and gastrointestinal problems during service and that they have persisted since service. The Board notes that when the Veteran filed his initial claim for service connection in August 1991, he made no mention of gastrointestinal or skin disorders. It is also significant to point out that on an April 1999 report of medical history for a National Guard examination, the Veteran denied skin disease and indigestion. Clinical evaluations of the skin and abdomen and viscera showed no abnormality. The Veteran has provided various accounts regarding the onset of his skin and gastrointestinal disabilities. The Board notes that on VA examination in October 2005, he asserted his skin condition had been present since at least 1998, and he reported a 14 year history of a rash in 2003. He stated on VA examination in December 2005 he first had problems with pimples in 1984. In January 2010, he claimed his skin condition began right after his separation from service in 1991. Similarly, the Board notes that when the Veteran was seen in May 1998, he claimed his stomach problems had been present for five years. This would date the onset of his gastrointestinal disorder to 1993, about two years after his discharge from service. In November 2003, he claimed he had experienced abdominal pain since the Gulf War. The Board notes the Veteran has also provided various accounts regarding the onset of his respiratory disorder. The Board further observes that while he alleged his symptoms began in 1991 when he was examined by the VA in 2011, he previously claimed his symptoms began in 1995. In this regard, the Board observes the Veteran denied any pertinent symptoms in May 1991 and the initial indication of allergic rhinitis was in November 1998, approximately seven years after his separation from service. Because of the inconsistency of the history of the symptoms reported by the Veteran the Board concludes that his statements regarding the onset and existence of skin, gastrointestinal and respiratory symptoms are not credible and will be accorded no probative weight. Thus, the evidence demonstrates that skin, gastrointestinal and respiratory disorders were first manifested many years after service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed.Cir.2000) ("evidence of a prolonged period without medical complaint can be considered, along with other factors concerning the veteran's health and medical treatment during and after military service, as evidence of whether a pre-existing condition was aggravated by military service). There is no indication in the record by credible probative evidence that the Veteran has skin, gastrointestinal or respiratory disabilities that are associated with service, to include his service in the Persian Gulf. In the absence of any indication of chronic skin, gastrointestinal or respiratory disabilities for years after service, the Board finds that the objective medical evidence of record outweighs his reported onset and continuity of symptomatology, which have been found to be not credible. Such records are more reliable, in the Board's view, than the Veteran's unsupported and contradictory assertions of the onset of his symptomatology. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) [VA cannot ignore a veteran's testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence]; see also Curry v. Brown, 7 Vet. App. 59, 68 (1994) [contemporaneous evidence has greater probative value than history as reported by the veteran]. In view of the conflicting statements he has made with respect to when his skin, gastrointestinal and respiratory conditions began, the Board finds the Veteran is not credible. The Board concludes the medical findings and opinions of record to have greater probative value than the Veteran's contradictory claims. The Board finds, therefore, that the preponderance of the evidence is against the claims for service connection for skin, gastrointestinal and respiratory disabilities, to include as due to undiagnosed illness. 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); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). ORDER Service connection for a skin disability, to include as due to undiagnosed illness, is denied. Service connection for a gastrointestinal disorder, to include as due to undiagnosed illness, is denied. Service connection for a respiratory disorder, to include as due to undiagnosed illness, is denied. REMAND By rating action dated January 2011, the RO granted service connection for PTSD, and assigned a 50 percent evaluation for it, effective January 26, 2008. The Veteran submitted a notice of disagreement with the evaluation assigned for PTSD, but a statement of the case has not been issued. Where a statement of the case has not been provided following the timely filing of a notice of disagreement, a remand, not a referral is required by the Board. Manlincon v. West, 12 Vet. App. 238 (1999). This matter must, accordingly, be remanded for issuance of a statement of the case. By rating action dated April 2013, a 100 percent evaluation was assigned for PTSD, effective June 29, 2011. 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.) The RO should issue a statement of the case addressing the issue of entitlement to an initial evaluation in excess of 50 percent for PTSD, prior to June 29, 2011. The appellant and his representative should be afforded the appropriate period of time to respond. This issue should be returned to the Board only if the Veteran or his representative submits a timely substantive appeal. The appellant has the right to submit additional evidence and argument on the matter or 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). ______________________________________________ MILO H. HAWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs