Citation Nr: 1321972 Decision Date: 07/10/13 Archive Date: 07/18/13 DOCKET NO. 07-00 209 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUES 1. Entitlement to service connection for bilateral hearing loss. 2. Entitlement to service connection for a right knee disability. 3. Entitlement to service connection for a left knee disability. 4. Entitlement to an initial compensable rating for residuals of laceration of the left hand, third and fourth digits, prior to March 28, 2012 and 10 percent thereafter. 5. Entitlement to service connection for frostbite of the feet. 6. Entitlement to service connection for frostbite of the hands. 7. Entitlement to service connection for a thoracolumbar spine disability. 8. Entitlement to service connection for a mental health disorder. REPRESENTATION Appellant represented by: AMVETS WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD M. Mac, Counsel INTRODUCTION The Veteran served on active duty from March 1982 to February 1984. The issues pertaining to service connection for bilateral hearing loss and the bilateral knee disability are on appeal from an October 2005 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). A review of the claims folder shows that the RO in a rating decision in October 2007 granted service connection for residuals of the left hand laceration, third and fourth digits and assigned a noncompensable rating. In December 2007 the Veteran filed a notice of disagreement with the rating. A Decision Review Officer (DRO) decision in August 2012 increased the rating to 10 percent effective March 28, 2012. Thus the issue has been characterized as reflected on the title page of the decision. In October 2008, the Board denied the Veteran's claims for service connection for bilateral hearing loss and for right and left knee disabilities. The Veteran appealed the denials to The United States Court of Appeals for Veterans Claims (Court). In an Order, dated in November 2009, the Court granted a Joint Motion to Remand of the parties, the VA Secretary and the Veteran, and remanded the case to the Board for readjudication consistent with the Motion. The parties to the Joint Motion agreed that the Board relied on an inadequate examination report for hearing loss and failed to provide an adequate statement of reasons or bases for denying service connection for the bilateral knee disability. A hearing was held on April 17, 2013, by means of video conferencing equipment with the appellant in Lincoln, Nebraska before the undersigned sitting in Washington, DC, who was designated by the Chairman to conduct the hearing pursuant to 38 U.S.C.A. § 7107(c), (e)(2) and who is rendering the determination in this case. A transcript of the hearing testimony is in the claims file. During the hearing the Veteran clarified that he wanted a higher initial rating for his service-connected left hand. The presiding Acting Veterans Law Judge clearly set forth the issue to be discussed and sought to identify pertinent evidence not currently associated with the claims folder. As such, the Board finds that VA fully complied with the duties set forth in 38 C.F.R. 3.103(c)(2) and Bryant v. Shinseki, 23 Vet. App. 488, 492 (2010). Further review of the file shows that the RO in a rating decision in December 2006 denied service connection for frostbite of the hands and feet. In November 2007 the Veteran filed a notice of disagreement, a statement of the case was issued in August 2007 and a Form 9 Appeal was received in September 2007. Thus, the issue has been perfected and is currently in appellate status. In a rating decision in December 2010, the RO denied service connection for a mental health disorder and a thoracolumbar spine disability. In January 2011 the Veteran disagreed with that determination. A Statement of the Case was not issued and the Board is required to remand these issues. See Manlicon v. West, 12 Vet. App. 238 (1999). A review of the Virtual VA paperless claims processing system includes the August 2012 DRO Decision and the April 2013 Board hearing transcript. Other documents in the Virtual VA paperless claims processing system reveal documents that are either duplicative of the evidence of record or are not pertinent to the present appeal. With the exception of the issue of service connection for bilateral hearing loss, the remaining issues are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDING OF FACT A bilateral hearing loss disability was not affirmatively shown to have been present coincident with service and a bilateral hearing loss disability first diagnosed after service is unrelated to an injury, disease, or event in service. CONCLUSION OF LAW A bilateral hearing loss disability was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102 , 3.159, 3.303, 3.385 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, codified in part at 38 U.S.C.A. §§ 5103, 5103A, and implemented in part at 38 C.F.R. § 3.159, amended VA's duties to notify and to assist a claimant in developing information and evidence necessary to substantiate the claim. Duty to Notify Under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), when VA receives a complete or substantially complete application for benefits, it will notify the claimant of (1) any information and medical or lay evidence that is necessary to substantiate the claim, (2) what portion of the information and evidence VA will obtain, and (3) what portion of the information and evidence the claimant is to provide. The VCAA notice requirements apply to all five elements of a service connection claim. The five elements are: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473 (2006). The VCAA notice must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The RO provided pre-adjudication and post-adjudication VCAA notice by letter, dated in June 2005 and in December 2006. The Veteran was notified of the evidence needed to substantiate the claim for service connection, as well as what information and evidence must be submitted by the Veteran, what information and evidence would be obtained by VA, and the provisions for disability ratings and for the effective date of the claims. To the extent that the VCAA notice pertaining to degree of disability and effective date came in December 2006, after the initial adjudication, the timing of the notice did not comply with the requirement that the notice must precede the adjudication. The procedural defect was cured as after the RO provided substantial content-complying VCAA notice, the claim of service connection was readjudicated as evidenced by the supplemental statement of the case, dated in May 2011. Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007) (Timing error cured by adequate VCAA notice and subsequent readjudication without resorting to prejudicial error analysis.) Duty to Assist VA has fulfilled its duty to assist in obtaining identified and available evidence needed to substantiate the claim. Available service treatment records, post-service treatment records, a copy of the hearing transcript, and lay statements have been associated with the record. Most recently, the Veteran was afforded a VA examination in March 2011 and the examiner provided an etiological opinion with a fully adequate rationale. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Thus, with respect to the Veteran's claim, there is no additional evidence which needs to be obtained. Service Connection A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C.A. § 1131. Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting such service, was aggravated by service. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). For the showing of 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." Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b). Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). Analysis As to a bilateral hearing loss disability, there are specific requirements regarding what constitutes a hearing loss disability under VA law. The threshold for normal hearing is from 0 to 20 decibels. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The threshold for normal hearing is from 0 to 20 decibels at the tested frequencies of 500, 1000, 2000, 3000, and 4000 Hertz, and a higher threshold level indicates some degree of hearing impairment, but not necessarily a hearing loss disability under 38 C.F.R. § 3.385. Hensley v. Brown, 5 Vet. App. 155, 157 (1993) (citing as authority Current Medical Diagnosis and Treatment, 110-11 (Stephen A. Schroeder et al. eds. (1988)). For service connection, in-service noise exposure need not be the only source of acoustic trauma; it must only be a contributing source. The absence of in-service evidence of hearing loss during a veteran's period of active duty is not fatal to a claim for service connection. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Competent evidence of a current hearing loss disability (i.e., one meeting the requirements of section 3.385, as noted above) and a medically sound basis for attributing such disability to service may serve as a basis for a grant of service connection for hearing loss. See Hensley, 5 Vet. App. at 159. In this case, the Veteran's DD 214 shows that he was an infantryman during service. During his DRO hearing in March 2012 and Board hearing in April 2013, the Veteran testified he had noise exposure during service from weapons such as M60, M16, M14 and mortars without hearing protection. In March 2012 he testified that he first noticed hearing problems while on active duty. During the April 2013 hearing, he stated that he worked in construction after service but was not exposed to loud noise. In support of his claim, the Veteran submitted an Internet article on "Acceleration of Age-Related Hearing Loss by Early Noise Exposure: Evidence of Misspent Youth". The audiological evaluation on enlistment examination shows puretone thresholds in decibels at 500, 1000, 2000, 3000, and 4000 Hertz were 5, 10, 15, 5, and 0 in the right ear and, 20, 10, 15, 35, and 5 respectively, in the left ear. An audiogram in June 1982 shows puretone thresholds in decibels at 500, 1000, 2000, 3000, and 4000 Hertz were 15, 15, 10, 15, and 15 in the right ear and 5, 10, 10, 5, and 15 in the left ear. An audiogram in February 1984 shows puretone thresholds in decibels at 500, 1000, 2000, 3000, and 4000 Hertz were 20, 10, 15, 5, and 0 in the right ear and 10, 15, 20, 15, and 5 in the left ear. On VA audio examination in September 2005, puretone thresholds in decibels at 500, 1000, 2000, 3000, and 4000 Hertz were 25, 25, 35, 45, and 35 in the right ear and 30, 30, 40, 40, and 40 in the left ear. Speech recognition scores using the Maryland CNC Test was 94 percent in the right ear and 98 percent in the left ear. The examiner was of the opinion that it is not likely that hearing loss is related to service. The examiner noted that the Veteran had significant noise exposure in service and commented that additional noise exposure since separation may be a contributing factor to the Veteran's hearing loss. On VA audio examination in May 2011, the examiner noted that the Veteran had exposure to infantry noise during service and noted that post-service the Veteran worked in construction framing houses with an air gun, but that he had reported the air gun was not loud. Puretone thresholds in decibels at 500, 1000, 2000, 3000, and 4000 Hertz were 25, 25, 35, 45, and 40 in the right ear and 30, 35, 40, 45, and 40 in the left ear. Maryland CNC Test was 94 percent in both ears. After reviewing the claims folder and examining the Veteran, the examiner was of the opinion that it is not at least as likely not that the Veteran's hearing loss is related to military noise exposure. Her rationale was that exposure to either impulse sounds or continuous exposure can cause hearing loss, which usually abates within 16 to 48 hours after exposure. She further explained that impulse noise may result in immediate and permanent hearing loss. Continuous and repeated exposure to loud noise could also cause permanent hearing loss. The examiner concluded that since damage from noise exposure occurs at the time of exposure, a normal audiogram subsequent to the noise exposure would verify that the hearing recovered without permanent hearing loss. In evaluating the foregoing evidence, the Board finds the May 2011 opinion to be significantly probative as the examiner carefully reviewed the Veteran's longitudinal medical history, considered the Veteran's infantry noise exposure, lack of in-service hearing loss as defined by 38 C.F.R. § 3.385, and commented with an appropriate rationale as to why the Veteran's current bilateral hearing loss disability is not related to service. His service treatment records do not show he had hearing loss as defined by 38 C.F.R. § 3.385 and this opinion is consistent with the other evidence of record. Under certain circumstances, a lay person is competent to identify a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). As a general matter, lay witnesses are competent to testify as to their observations as well as opine on questions of diagnosis and etiology in some circumstances. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (lay witnesses are competent to testify as to their observations, but this testimony must be weighed against the other evidence of record); Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation). See also Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (Board's categorical statement that "a valid medical opinion" was required to establish nexus, and that a layperson was "not competent" to provide testimony as to nexus because she was a layperson, conflicts with Jandreau; lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology). The Board has considered the Veteran's lay statements and acknowledges that he is competent to give evidence about what he has experienced or observed. Layno v. Brown, 6 Vet. App. 465 (1994). In this regard the Veteran's statements that he has experienced decreased hearing acuity are credible. The appellant is competent to state that he has decreased hearing acuity. However, the appellant as a lay person is not competent to state that he has hearing loss disability as defined by 38 C.F.R. § 3.385, because such a determination is based on results of audiology testing that meet the standards of a hearing loss disability under 38 C.F.R. § 3.385. For this reason, a hearing loss disability under the criteria of 38 C.F.R. § 3.385 is not a simple medical condition that the Veteran as a lay person is competent to identify. Nor is it a simple medical condition that the Veteran as a lay person is competent to offer an opinion on. To the extent the Veteran asserts that his hearing loss is related to service, the onset and etiology of such disorder is a complex medical matter beyond the ken of a layperson. Jandreau v. Nicholson, 492 F.3d 1372 (2007). Whether the appellant has a hearing loss disability that is related to service requires specialized training for a determination as to causation, and is therefore not susceptible of lay opinion. In view of the foregoing, the Veteran's statements are outweighed by the May 2011 VA examiner's opinion, which the Board finds to be highly probative as it reflected the VA examiner's specialized knowledge, training, and experience as to the diagnosis and etiology of the Veteran's bilateral hearing loss disability as well as consideration of all relevant lay and medical evidence of record. The Board has also considered the Internet article submitted by the Veteran which discusses the relationship between age related hearing loss and early noise exposure. Medical treatise evidence can, in some circumstances, constitute competent medical evidence. See Wallin v. West, 11 Vet. App. 509, 514 (1998); see also 38 C.F.R. § 3.159(a)(1). However, the Internet article submitted by the Veteran does not contain any information or analysis specific to the Veteran's case. As such, the article evidence submitted by the Veteran is of limited probative value. The United States Court of Appeals for the Federal Circuit recently held that if a disorder is not on the list of chronic diseases in 38 C.F.R. § 3.309(a), it is not a chronic disease and service connection therefore could not be established for it on a presumptive basis. In rendering the decision, the Federal Circuit cited the portion of its decision in Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) where it reiterated its holding that bilateral hearing loss, even if medically chronic, is not a presumptive disease because it is not on the list of chronic diseases in either 101(3) or 38 C.F.R. § 3.309(a). As hearing loss is not included among the chronic diseases under 38 U.S.C.A. § 1101 and 38 C.F.R. § 3.309(a), consideration of continuity of symptomatology under 38 C.F.R. § 3.303(b) is not applicable. See Walker. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim of service connection for bilateral hearing loss, that doctrine is not applicable. 38 U.S.C.A. § 5107 (CONTINUED ON NEXT PAGE) ORDER Entitlement to service connection for bilateral hearing loss is denied. REMAND Knees Service treatment records show that the Veteran was in a motor vehicle accident in January 1983 and was treated for right knee pain. In November 1983 he complained of left knee pain from an injury while playing basketball. At separation in February 1984, the Veteran reported a history of swollen or painful joints and having a trick or locked knee. The examiner noted that the Veteran had Osgood-Schlatter 's disease. After service, on VA examination in September 2005 the diagnosis was Osgood Schlatter disease, asymptomatic. Accompanying x-rays show old Osgood Schlatter's disease in the right knee and a bony excrescence off the superior aspect of the medial condyle in the left knee, which may be representative of an old superior bony trauma or MCL injury. VA progress notes in June 2011 show osteoarthritis in both knees. On VA examination in May 2010, the diagnosis was Osgood Schlatter's disease and degenerative disease in both knees. The examiner stated that it would be speculative to relate these to service as the Veteran's entrance examination does not show a knee disability. He stated it therefore would be medically impossible to determine whether Osgood Schlatter's disease preexisted service or whether it was incurred in service as the medical literature shows it is usually an ongoing condition that begins in adolescence. While the examiner provided an explanation that it would be speculative to conclude that Osgood Schlatter's preexisted service and was aggravated by service, he did not address the etiology of the Veteran's degenerative joint disease in the knees. 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). Therefore an addendum opinion is necessary for the VA examiner to address the etiology of the Veteran's bilateral knee arthritis. Prior to requesting such opinion, the RO/AMC should request the Veteran's assistance in obtaining any outstanding medical evidence, to include medical records dated in approximately 1983 pertaining to treatment of the knees at Emanuel Hospital in Omaha, Nebraska. Such records were referenced by the Veteran during his April 2013 Board hearing; no efforts have yet been undertaken to obtain these records. Left Hand Service treatment records in September 1982 show the Veteran had a knife wound in the left hand. During his DRO hearing in March 2012, the Veteran testified that he had 2 scars on his left hand. In April 2013 he testified that his service- connected residuals of laceration of the left hand involving the third and fourth digits increased in severity since his last examination in March 2012. He stated that the tingling and numbness sensation was getting worse and that his in-service injury was a through and through wound that affected two muscle groups. As the evidence suggests a material change in the disability since the Veteran was last examined by VA, a reexamination is necessary under 38 C.F.R. § 3.327. The criteria for rating scars under Diagnostic Codes 7800-7805 were amended effective October 23, 2008 and apply to all claims received by VA on or after October 23, 2008. As to claims filed before October 23, 2008, on January 20, 2012, 38 C.F.R. § 4.118 was revised to clarify that a veteran whose scars were rated by VA under Diagnostic Codes 7800-7805 in effect prior to October 23, 2008, may request review under the revised Diagnostic Codes. 77 Fed. Reg. 2909 (January 20, 2012). In the instant case the Veteran has not requested that his scar be rated under the revised criteria and the criteria prior to October 23, 2008 apply. Cold Residuals In August 2006, the Veteran contended that he has residuals of frostbite of the hands and feet due to service when he was in Grafton, Germany and had to perform field training in extremely cold weather. His personnel records and DD 214 Form show that he was in Germany during winter time as he arrived in Germany in May 1983 and was there for nearly 9 months. Thus the Veteran should be afforded a VA examination to determine if he has residuals of frostbite of the hands and feet that are related to service. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Thoracolumbar Spine, Mental Health Disorder In a rating decision in December 2010, the RO denied service connection for a mental health disorder and a thoracolumbar spine disability. In January 2011 the Veteran disagreed with that determination. A Statement of the Case has not been issued for either issue and under these circumstances, a Statement of the Case must be issued for both issues. See Manlicon v. West, 12 Vet. App. 238 (1999). Accordingly, the case is REMANDED for the following action: 1. Issue a Statement of the Case referable to the following issues: entitlement to service connection for a mental health disorder and a thoracolumbar spine disability. Only if the Veteran perfects an appeal should the claims be certified to the Board and after any necessary development has been completed. 2. Contact the Veteran, and, with his assistance, identify any outstanding records of pertinent medical treatment from VA or private health care providers. Specifically ask for written authorization to obtain the Veteran's 1983 medical records for his knees from the Emanuel Hospital in Omaha, Nebraska, which he referenced during his April 2013 Board hearing. With the Veteran's assistance obtain copies of any other additional pertinent records and add them to the claims file. If VA attempts to obtain any outstanding records which are unavailable, the Veteran should be notified in accordance with 38 C.F.R. § 3.159(e). 3. Following receipt of any outstanding records, obtain an addendum opinion from the VA examiner who conducted the May 2010 VA examination for the knees. If this examiner is unavailable another appropriate examiner should render the opinion. Access to the claims file, Virtual VA, and a copy of this remand must be made available to the examiner for review. Following a review of the claims file, to include any additional evidence added to the record since the May 2010 examination, the examiner must offer an opinion, consistent with sound medical principles and in consideration of the Veteran's specific contentions, as to whether it is at least as likely as not (i.e., there is a 50 percent or greater probability) that any degenerative joint disease of either knee is related to service. In formulating the opinion the examiner is asked to comment on the Veteran's service treatment records which in January 1983 show he was in a motor vehicle accident and was treated for right knee pain and in November 1983 complained of left knee pain due to a basketball injury. The examiner is asked to comment on the effect the Veteran's military occupational specialty as an infantryman had on his current knee disabilities. The examiner should address the Veteran's April 2013 testimony whereby he asserted that he hurt his knees in a motor vehicle accident in service when his car rolled over as well as when he was playing football. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be acknowledged and considered in formulating any opinion. The examiner is asked to provide a rationale for the opinion rendered. If the examiner is not able to provide an opinion, he or she should explain why. 4. Following receipt of any outstanding records, schedule the Veteran for a VA examination to determine the nature, extent, and severity of his service-connected laceration of the left hand, third and fourth digits. Access to the claims file, Virtual VA, and a copy of this remand must be made available to the examiner for review. All indicated studies, including range of motion studies in degrees, should be performed. The claim folders must be made available to the examiner for review. The examiner should address the following: a) The number of scars the Veteran has that are associated with his service-connected laceration of the left hand, their measurement in square inches or centimeters, and whether they are deep; superficial, unstable; painful on examination; or cause limitation of function. b) The neurological impairment associated with the service-connected laceration of the left hand. The examiner should identify the nerve or nerves involved and determine whether there is symptomatology reflective of either complete paralysis; or mild, moderate, moderately severe, or severe incomplete paralysis of the affected nerve or nerves. c) The presence and severity of any signs and symptoms of muscle disability associated with the service-connected residuals of laceration of the left hand involving the third and fourth digits. The examiner must specifically identify the muscle group injury (by muscle group number), if any, that is associated with the residuals of the laceration of the left hand involving the third and fourth digits. d) Whether the Veteran has loss of range of motion as a result of his service-connected residuals of laceration of the left hand involving the third and fourth digits. Range of motion studies in degrees, should be performed. Tests of joint motion against varying resistance should be performed, and the extent of any incoordination, weakened movement, and excess fatigability on use should be described, with a notation of any additional functional impairment. The examiner should identify any objective evidence of pain or functional loss due to pain. The examiner is asked to express an opinion whether there would be additional limits on functional ability on repeated use or during flare-ups (if the Veteran describes flare-ups), and, if feasible, express this in terms of additional degrees of limitation of motion on repeated use or during flare-ups. If this is not feasible, the examiner should so state and provide an explanation why not. 5. Following receipt of any outstanding records, schedule the Veteran for a VA examination to determine the nature and etiology of any residuals of frostbite of the hands and feet. Access to the claims file, Virtual VA, and a copy of this remand must be made available to the examiner for review. After reviewing the claims folder and examining the Veteran, the examiner must offer an opinion, consistent with sound medical principles and in consideration of the Veteran's specific contentions, as to whether it is at least as likely as not (i.e., there is a 50 percent or greater probability) that the Veteran has residuals of frostbite of the hands and feet that are related to service. In formulating the opinion the examiner is asked to comment on the fact that personnel records show the Veteran was in Germany during the winter of 1983 to 1984. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be acknowledged and considered in formulating any opinion. The examiner is asked to provide a rationale for the opinions rendered. If the examiner is not able to provide an opinion, he or she should explain why. 6. After the development requested has been completed, the AMC/RO should review the examination reports to ensure that they are in complete compliance with the directives of this REMAND. The AMC/RO must ensure that the examiners documented his or her consideration of Virtual VA. If any report is deficient in any manner, the AMC/RO must implement corrective procedures at once. 7. The Veteran is hereby notified that it is his responsibility to report for the examinations and to cooperate in the development of his claims. The consequences for failure to report for a VA examination without good cause may include denial of the claims. 38 C.F.R. §§ 3.158, 3.655 (2012). In the event that the Veteran does not report for any of the aforementioned examinations, documentation should be obtained which shows that notice scheduling the examinations was sent to the last known address. It should also be indicated whether any notice that was sent was returned as undeliverable. 8. After the above development has been completed, readjudicate the issues of service connection for a bilateral knee disability, service connection for frostbite of the hands and feet, and entitlement to an initial compensable rating for residuals of laceration of the left hand, third and fourth digits, prior to March 28, 2012 and 10 percent thereafter. If any benefit sought on appeal remains denied, furnish the Veteran and his representative a supplemental statement of the case and return the case to the Board. 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). ______________________________________________ STEPHANIE L. CAUCUTT Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs