Citation Nr: 1322265 Decision Date: 07/11/13 Archive Date: 07/18/13 DOCKET NO. 95-38 797 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New York, New York THE ISSUES 1. Entitlement to service connection for a respiratory disability. 2. Entitlement to service connection for body strain of the chest and abdomen. 3. Entitlement to an extraschedular rating for hemorrhoids. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD S.J. Janec, Counsel INTRODUCTION The Veteran served on active duty from February 1964 to April 1967. This appeal comes before the Board of Veterans' Appeals (Board) from a March 1995 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in New York, New York, that determined that new and material evidence had not been submitted sufficient to reopen a claim for service connection for bronchitis and denied a claim for a rating in excess of 10 percent for hemorrhoids. This matter also arises from an August 2003 rating decision that denied service connection for a body strain of the abdomen, back, and chest, claimed as secondary to a left knee disability. The Veteran testified before the Board at a hearing held at the RO in August 2004. At the hearing, the Veteran submitted a substantive appeal regarding the body strain issues. On July 13, 2005, the Board issued a decision that denied service connection for body strain; determined that new and material evidence had not been received to reopen a claim for service connection for chronic bronchitis; and denied a schedular rating in excess of 10 percent for service-connected hemorrhoids. The Veteran appealed the July 2005 Board decision to the United States Court of Appeals for Veterans Claims. In an August 2007 Memorandum Decision, the Court affirmed the Board's decision to the extent that it denied a schedular rating greater than 10 percent for hemorrhoids. The remainder of the Board's decision was vacated and the matters, to include the issue of whether an extraschedular rating was warranted for hemorrhoids, were remanded to the Board for further development and readjudication consistent with the opinion. In May 2009, the Board remanded these matters for additional notice and development. In May 2009, the Board also remanded claims for service connection for posttraumatic stress disorder (PTSD), body strain, and a left knee disability for additional development. An August 2011 rating decision granted service connection for PTSD, a left knee disability, and a lumbar spine disability, claimed as back strain. As that is considered a full grant of the benefits sought pertaining to each of those issues, they are no longer on appeal. In August 2012, the Board found that new and material evidence had been submitted and reopened the claim for service connection for a respiratory disability. The issues were then remanded for further evidentiary development. A January 2013 rating decision granted service connection for radiculopathy of the right and left lower extremities and assigned a 20 percent rating for each, effective November30, 2009; and granted an increased 20 percent rating for the lumbar spine disability. A January 2013 supplemental statement of the case addressed the issues of entitlement to service connection for a respiratory disability and an extraschedular rating for hemorrhoids. The issue of entitlement to service connection for body strain of the chest and abdomen is REMANDED to the RO via the Appeals Management Center in Washington, D.C. FINDINGS OF FACT 1. A chronic respiratory disability is not shown in service, and the preponderance of the evidence fails to shows that the Veteran's diagnosed chronic obstructive pulmonary disease, or any other respiratory disability, had its onset in service or is otherwise related to his period of active duty, including in-service cold exposure. 2. The evidence does not show that the Veteran's hemorrhoids are not adequately compensated by the schedular rating and the evidence shows that they do not cause frequent hospitalization or marked interference with employment. CONCLUSIONS OF LAW 1. A chronic respiratory disability, to include asthma, bronchitis, and chronic obstructive pulmonary disease, was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 101, 1110, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309(a) (2012). 2. Referral for consideration of an extraschedular rating for hemorrhoids is not warranted. 38 U.S.C.A. §§ 1155, 5103A (West 2002); 38 C.F.R. §§ 3.102, 3.321, 4.3, 4.114, Diagnostic Code 7336 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist Upon receipt of a substantially complete application, VA must notify the claimant and any representative of any information, medical evidence, or lay evidence not previously provided to VA that is necessary to substantiate the claim. The notice must: (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. 38 U.S.C.A. §§ 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 3.159 (2012); Pelegrini v. Principi, 18 Vet. App. 112 (2004). If VA does not provide adequate notice of any of element necessary to substantiate the claim, or there is any deficiency in the timing of the notice, the burden is on the claimant to show that prejudice resulted from a notice error, rather than on VA to rebut presumed prejudice. Shinseki v. Sanders, 129 S. Ct. 1696 (2009). The Veteran's claim was filed and initially adjudicated prior to the enactment of the law regarding issuance of notice. The Board finds that any defect with regard to the timing or content of the notice to the appellant is harmless because of the thorough and informative notices provided subsequently, and because the appellant had a meaningful opportunity to participate effectively in the processing of the claim with an adjudication of the claim by the RO subsequent to receipt of the required notice. The record does not show prejudice to the appellant, and the Board finds that any defect in the timing or content of the notices has not affected the fairness of the adjudication. Mayfield v. Nicholson, 19 Vet. App. 103 (2005); Dingess v. Nicholson, 19 Vet. App. 473 (2006). Specifically, the Veteran was provided appropriate notice in letters dated in June 2009 and August 2009 subsequent to the rating decision on appeal. The Veteran has neither alleged nor demonstrated any prejudice with regard to the content or timing of the notices provided. Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (burden of showing that an error is harmful or prejudicial falls upon the party attacking the agency determination); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The Board considers it significant that the subsequent statements made by the Veteran and his representative suggest actual knowledge of the elements necessary to substantiate the claims. Dalton v. Nicholson, 21 Vet. App. 23 (2007) (actual knowledge is established by statements or actions by the claimant or the claimant's representative that demonstrate an awareness of what is necessary to substantiate a claim). Thus, VA has satisfied its duty to notify the appellant and had satisfied that duty prior to the adjudication in the most recent January 2013 supplemental statement of the case. Overton v. Nicholson, 20 Vet. App. 427 (2006) (Veteran afforded a meaningful opportunity to participate effectively in adjudication of claim, and therefore notice error was harmless). The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained. The appellant has not referred to any additional, unobtained, relevant, available evidence since the Board's August 2012 remand. VA has obtained examinations with respect to the claims on appeal and the examinations and opinions are adequate for rating purposes. Nieves-Rodriguez v. Peake, 22 Vet App 295 (2008); Barr v. Nicholson, 21 Vet. App. 303 (2007) (when VA undertakes to provide an examination, it must ensure that the examination or opinion is adequate). Thus, the Board finds that there has been substantial compliance with the August 2012 remand and VA has satisfied the duty to assist. Stegall v. West, 11 Vet. App. 268 (1998). Consequently, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Service Connection Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty in active service or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2012). Evidence of continuity of symptomatology of a disability identified in 38 C.F.R. § 3.309(a) from the time of service until the present is required where the chronicity of a condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b) (2012); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d) (2012). Service connection generally requires evidence of a current disability with a relationship or connection to an injury or disease or some other manifestation of the disability during service. Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000); Mercado-Martinez v. West, 11 Vet. App. 415 (1998); Cuevas v. Principi, 3 Vet. App. 542 (1992). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In adjudicating a claim, the Board must assess the competence and credibility of the claimant. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362 (2005). The Board also has a duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997); Wensch v. Principi, 15 Vet. App. 362 (2001). The competency of evidence must be distinguished from weight and credibility, which are factual determinations going to the probative value of the evidence. Rucker v. Brown, 10 Vet. App. 67 (1997); Cartright v. Derwinski, 2 Vet. App. 24 (1991) (although interest may affect credibility of testimony, it does not affect competency to testify). If all the evidence is in relative equipoise, reasonable doubt shall be resolved in the claimant's favor, and the claim granted. 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R. § 3.102 (2012). However, if the preponderance of the evidence is against the claim, the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran's service medical records show that he was treated for a sore throat of bacterial nature with tonsillitis in December 1964. In March 1966, he was treated for tonsillitis. He did not have any respiratory abnormalities according to a January 1967 separation examination. On the accompanying medical history report, the Veteran noted chest pain or pressure. On examination in June 1976, in connection with enlistment in the reserves, the Veteran denied any respiratory abnormalities. He specifically denied having asthma or frequent colds. The examination identified no pertinent abnormalities of any system at issue. At an April 1982 hearing, the Veteran testified that he served with a unit in Korea and that he was sick for a period and that he had bronchitis. He indicated that he was treated in 1967, immediately after service, for bronchitis. A February 1984 VA progress note refers to a history of asthma for 20 years that had developed in service. In November 1984, the Veteran reprised the same 20-year history of asthma. He also stated that he had never been hospitalized for asthma. A January 1989 VA X-ray revealed no acute disease in the Veteran's lungs. A medical history prepared in connection with March 1989 VA treatment noted that the Veteran had had asthma for 25 years, which would be since 1964. In connection with VA treatment in January 1992, the Veteran's past medical history included a history of asthma for the past 20 years, which would be since 1972. An X-ray showed no pulmonary abnormality. In May 1994, the Veteran asserted that bronchitis was first present during his period of service, and that his current respiratory disability was a result of exposure to cold weather in service. The Veteran testified before the RO in November 1995 that he was treated for an upper respiratory infection and tonsillitis during the winter of 1964, while stationed at the Demilitarized Zone (DMZ) in Korea. He stated that was eventually upgraded to chronic bronchitis. A June 1998 progress note from a non-VA clinic in Astoria, New York, relates to treatment for an upper respiratory infection and bronchitis. Similar records also refer to colds and flu, such as in May 1997 and November 1997. A family internist, Dr. Batra, with the Astoria Center of the Queens-Long Island Medical Group, P.C., wrote in November 1998 that the clinic had treated the Veteran since 1989 for chronic bronchitis. A treating, VA doctor, Deborah Shapiro, M.D., wrote in December 2003 on a form provided by the representative that the Veteran had a diagnosis of moderate asthma, but did not discuss any relationship to the Veteran's active service. However, Dr. Shapiro had not reviewed the Veteran's treatment records. At the August 2004 Board hearing, the Veteran testified about the sub-zero temperatures he encountered while stationed in Korea and the resulting frostbite, pneumonia, and chronic bronchitis. VA medical records and private medical records dated from May 2003 to February 2012 show ongoing treatment for a history of asthma and chronic obstructive pulmonary disability. In March 2010, the Veteran was seen for bronchitis/asthma exacerbation. In April 2010, he was treated for a respiratory tract infection. At an April 2010 pulmonary consult, childhood asthma was questioned. A past history of smoking was noted. He quit more than seven years prior to that note. The clinician concluded that the Veteran most likely had an asthma/chronic obstructive pulmonary disease diagnosis. A chest X-ray was normal. A July 2011 VA treatment note indicated that the Veteran had stopped using tobacco products more than seven years ago. In February 2012, he was seen for asthma/chronic obstructive pulmonary disease. The Veteran and his representative have submitted numerous statements asserting that the Veteran was subjected to freezing temperatures during service and that he received treatment for upper respiratory infections in service. In addition, the Veteran has continued to assert that he has experienced the same symptoms from service to the present, resulting in various diagnoses of asthma, chronic obstructive pulmonary disease, and allergic rhinitis. Upon VA respiratory examination in September 2012, the clinician concluded that the Veteran had chronic obstructive pulmonary disease. The examiner reviewed the Veteran's claims file and electronic medical records, and provided a thorough clinical evaluation. It was noted that the Veteran had a history of smoking three packs of cigarettes per day for more than 20 years. The Veteran provided a history of chronic bronchitis, but was subsequently told that he had chronic obstructive pulmonary disease. Pulmonary function tests in June 2009 showed a mild obstructive defect. The clinician opined that it was more likely that the Veteran's chronic obstructive pulmonary disease was due to his smoking and not due to any illness/injury/event that occurred while he was on active duty. It was explained that a review of the medical literature revealed that cigarette smoking was overwhelmingly the most important risk factor for chronic obstructive pulmonary disease. The examiner stated that acute viral respiratory tract infections more than 40 years ago do not cause chronic obstructive pulmonary disease. The record shows that the Veteran was treated for a sore throat of bacterial nature with tonsillitis, and tonsillitis on another occasion. His assertions of exposure to cold and bouts of bronchitis have been conceded. However, upon separation examination in January 1967, no chronic respiratory conditions were found. Additionally, upon examination for enlistment in the reserves in June 1976, the Veteran denied any respiratory abnormalities. He also specifically denied having asthma or frequent colds. The examination identified no pertinent abnormalities of the respiratory system. Asthma, bronchitis, and chronic obstructive pulmonary disease are not chronic diseases listed in the presumptive disorders in 38 C.F.R. § 3.309(a). Moreover, there are virtually no medical records documenting complaints of asthma, bronchitis, and/or chronic obstructive pulmonary disease until more than 15 years after discharge. A February 1984 VA progress note referred to a history of asthma for 20 years that had developed in service. However, the Veteran's service treatment records do not comport with that history. Again, the Board observes that notably, upon separation examination in January 1967, no respiratory diseases were found; and in 1976, the Veteran specifically denied having asthma or frequent colds. The Board finds that the objective contemporary clinical evidence pertaining to the Veteran's medical history is more probative and credible than later statements made in conjunction with claims for VA compensation benefits. Cartright v. Derwinski, 2 Vet. App. 24 (1991) (although interest may affect credibility of testimony, it does not affect competency to testify). An x-ray in 1992 showed no pulmonary abnormality. A prolonged period without documented medical complaint can be considered, along with other factors concerning a claimant's health and medical treatment during and after military service, as evidence of whether an injury or disease was incurred in service, which resulted in any chronic or persistent disability. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Here, the lack of clinical evidence reflecting treatment pertaining to the respiratory system until more than 15 years after discharge from active service is against the Veteran's claim for service connection. To the extent that the Veteran and others have alleged continuity of symptomatology since discharge, the Board finds that they are competent to report about chest pain or witnessing complaints of chest pain during service and after discharge. Charles v. Principi, 16 Vet. App. 370 (2002); Layno v. Brown, 6 Vet. App. 465 (1994) (Veteran is competent to report symptoms because that requires only personal knowledge, not medical expertise, as it comes to him through his senses). Although lay persons are competent to provide opinions on some medical issues, the specific disabilities in this case asthma, chronic bronchitis, and chronic obstructive pulmonary disease clearly fall outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). Those diseases are complex and require specialized training and medical diagnostic testing for a determination as to diagnosis and causation, and are therefore not susceptible of lay opinions on diagnosis and etiology. Upon VA examination in September 2012, the examiner concluded that it was less likely that the Veteran's currently manifested respiratory disease, chronic obstructive pulmonary disease, was due to military service, including the reported respiratory infections in service. The Veteran has not presented a competent medical opinion to the contrary. The Board has accorded that examiner's statement significant probative value because it was based on a full review of the record, consideration of the Veteran's statements, and a thorough clinical evaluation. Winsett v. West, 11 Vet. App. 420 (1998); Bloom v. West, 12. Vet. App. 185 (1999). Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for a respiratory disability, and the appeal must therefore be denied. 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R. § 3.102 (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Extraschedular Rating for Hemorrhoids The record shows that the Veteran developed persistent pain after a hemorrhoidectomy in March 1989. In August 1989, he underwent an anal fistulotomy because of redundant skin closing over an earlier operation. Post-operative progress notes from 1989 indicate that the Veteran did not report any further complaints at that time. In October 1992 and March 1993, the Veteran was diagnosed with gastroenteritis. The Veteran testified before the RO in November 1995 that he was not experiencing any bleeding from his hemorrhoids. He discussed earlier surgeries, apparently referring to VA treatment in 1989, but he also said that he had healed properly. A family internist, Dr. Batra, M.D., with the Astoria Center of the Queens-Long Island Medical Group, P.C., wrote in November 1998 that the clinic had treated the Veteran since 1989 for surgery for hemorrhoids. In 1999, the Veteran presented with several episodes of melena in the recent past. Testing revealed gastritis. He also had anemia symptoms at that time. The assessment indicated that the gastritis was induced by non-steroidal anti-inflammatory medication. Colonoscopy was normal to the cecum. The Veteran underwent VA examination in October 2002. He denied any relevant bleeding. He also denied abdominal pain. Degree of sphincter control was normal. He reported fecal staining of underwear after bowel movement. There were no episodes of bright red blood per rectum. There was no tenderness or distention of his abdomen on examination. The bowel sounded normal. There were no masses or organomegaly. Rectal examination confirmed external hemorrhoids, but no masses; he was heme negative. There was no evidence of fecal leakage, bleeding, or anemia. No fissures were visible. The examiner noted a normal colonoscopy from 1999. The diagnosis was hemorrhoids, status post hemorrhoidectomy in March 1989 and status post anal fistulotomy in August 1989. On primary care follow-up by VA in December 2003, the Veteran complained of chronic irritation and pruritic ani. At an August 2004 hearing before the Board, the Veteran testified that he was having difficulties with hemorrhoids. He feared that he would have to wear special underwear because of daily leakage. He stated that he had had internal bleeding two years earlier. Prior to that, he had had an additional bleeding episode about a year earlier. He also watched his diet, avoiding spicy foods. He said that absent the lifestyle modifications, he would have anemia. He remarked that his hemorrhoid disability caused him to miss or leave early from work, and limited the jobs that he was able to take. He further stated that he had used all of his allotted sick time and had "lost a lot of days working." He testified that he was working eight hour shifts in a tower at the transit authority routing the trains. Upon VA examination in November 2009, no internal or external hemorrhoids were identified upon clinical evaluation, including during a colonoscopy in May 2008. The physician concluded that the Veteran's hemorrhoid disability had no significant impact on his ability to work. Upon VA examination in September 2012, the Veteran reported that he continued to use suppositories two to three times per month and sitz baths for irritation. Clinical evaluation was normal. There were no external hemorrhoids, anal fissures, or other abnormalities. There were no large or thrombotic hemorrhoids, and no irreducible hemorrhoids. The physician concluded that the hemorrhoids were mild and required no hospitalization or chronic medication. They did not affect his physical or sedentary activities, and they did not prevent him from engaging in substantially gainful employment. In a February 2013 statement, the Veteran asserted that he experienced episodes of bleeding and leakage on a daily basis that was embarrassing at work. His absence was more than 30 percent of the time and he required light duty assignments because of his ongoing medical condition. The Board has been directed to consider whether extraschedular consideration is warranted for the Veteran's service-connected hemorrhoids. 38 C.F.R. § 3.321(b) (2012); Barringer v. Peake, 22 Vet. App. 242 (2008). The threshold factor for extraschedular consideration is a finding that the evidence presents such an exceptional disability picture that the available schedular rating for the service-connected disability is inadequate. There must be a comparison between the level of severity and symptomatology of the service-connected disability with the established criteria. If the criteria reasonably describe the Veteran's disability level and symptomatology, then the Veteran's disability picture is contemplated by the Rating Schedule, and the assigned schedular rating is adequate, and no referral is required. Thun v. Peake, 22 Vet. App. 111 (2008). The criteria for rating hemorrhoids provide that a 10 percent rating is warranted for hemorrhoids that are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. The next higher rating, a 20 percent rating, requires evidence of persistent bleeding and with secondary anemia or with fissures; the 20 percent rating is the maximum rating available under the diagnostic code for rating hemorrhoids. 38 C.F.R. § 4.114, Diagnostic Code 7336 (2012). In considering the evidence, the Board finds that the record does not establish that the rating criteria are inadequate for rating the Veteran's service-connected hemorrhoid disability. The competent medical evidence of record shows that his hemorrhoids are mild to moderate in nature and require suppositories two to three times per month with sitz baths. Those symptoms and level of severity are contemplated by the established criteria. The Veteran has asserted that he has anal leakage on a daily basis as a result of his hemorrhoids. However, that symptom has not been attributed to his service-connected hemorrhoids. Additionally, although the Veteran has asserted that he has missed 30 percent of his work due to hemorrhoids, he has not submitted any medical or employment records that support that assertion. A VA examiner found that the disability should not interfere with employment. Furthermore, the criteria specifically include persistent bleeding for the criteria for the 20 percent rating, but require fissures or anemia to also be present to warrant that higher rating. Therefore, persistent bleeding is contemplated by the schedule and not found to be enough to warrant a higher rating in the absence of anemia or fissures. Accordingly, the Board finds that the evidence does not show marked interference with employment or frequent hospitalization due to hemorrhoids. Therefore, the Board concludes that the symptoms and the effects of the Veteran's disability have been fully considered and contemplated in the 10 percent rating currently assigned, and referral for an extraschedular rating is not warranted. Thun v. Peake, 22 Vet. App. 111 (2008); 38 C.F.R. § 3.321(b) (2012). ORDER Service connection for a respiratory disability, to include asthma, chronic bronchitis, and chronic obstructive pulmonary disease, is denied. An extraschedular rating for hemorrhoids is denied. REMAND In the August 2012 Board decision, the claim for service connection for body strain, including of the chest and abdomen, was remanded to the RO for further development and readjudication. However, after the requested development was accomplished, the issue was not re-adjudicated on the merits, and was not included in the January 2013 supplemental statement of the case. It was noted in the supplemental statement of the case that separate action was being taken on the remaining issues on appeal, and a January 2013 rating decision granted service connection for radiculopathy of the right and left lower extremities. However, that does not appear to satisfy a claim for service connection for a chest and abdominal disability. Therefore, the claim must be remanded so that the it may be readjudicated. Accordingly, the case is REMANDED for the following action: Readjudicate the claim of entitlement to service connection for body strain of the chest and abdomen. If the decision is adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the claim to the Board. The appellant 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 or the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ Harvey P. Roberts Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs