Citation Nr: 1323106	
Decision Date: 07/19/13    Archive Date: 07/24/13

DOCKET NO.  10-01 165	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Hartford, Connecticut


THE ISSUES

1. Entitlement to service connection for hearing loss.

2. Entitlement to service connection for tinnitus.

3. Entitlement to service connection for back disability.

4. Entitlement to service connection for bilateral knee disability.

5. Entitlement to service connection for acquired psychiatric disability, to include post-traumatic stress disorder (PTSD), anxiety, and depression.

6. Entitlement to service connection for migraine headaches, to include as secondary to an acquired psychiatric disability.


REPRESENTATION

Appellant represented by:	Disabled American Veterans


ATTORNEY FOR THE BOARD

Amanda Christensen, Associate Counsel


INTRODUCTION

The Veteran had active military service from November 1983 to November 1987.

This appeal comes to the Board of Veterans' Appeals (Board) from a June 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Newington, Connecticut.

The Board has not only reviewed the Veteran's physical claims file but also the Veteran's file on the "Virtual VA" system to insure a total review of the evidence.  

The issue of service connection for an acquired psychiatric disorder and headaches, to include as secondary to an acquired psychiatric disorder, 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.


FINDINGS OF FACT

1.  The Veteran does not have a current bilateral hearing loss disability.

2.  The Veteran does not have tinnitus.

3.  The Veteran does not have a back disability.

4.  The Veteran does not have a knee disability.

CONCLUSIONS OF LAW

1.  The criteria for entitlement to service connection for bilateral hearing loss have not been met.  38 U.S.C.A. §§ 1112, 1131, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2012).

2.  The criteria for entitlement to service connection for tinnitus have not been met.  38 U.S.C.A. §§ 1131, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303 (2012).

3.  The criteria for entitlement to service connection for a back disability have not been met.  38 U.S.C.A. §§ 1131, 5107 (West 2002 & Supp. 2012); 38 C.F.R.  §§ 3.102, 3.303 (2012).

4.  The criteria for entitlement to service connection for a bilateral knee disability have not been met.  38 U.S.C.A. §§ 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012).


REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service.  38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303.  Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). 

Additionally, service connection may be granted, on a secondary basis, for a disability which is proximately due to or the result of an established service-connected disorder.  38 C.F.R. § 3.310 (2012).  

To establish service connection, there must be a competent diagnosis of a current disability; medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability.  Hickson v. West, 12 Vet. App. 247, 252 (1999); see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  
 
Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions.  Competent medical evidence may also include statements conveying sound medical principles found in medical treatises.  It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses.  38 C.F.R. § 3.159(a)(1).  Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience.  Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person.  38 C.F.R. § 3.159(a)(2).  This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis.  Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).   

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied.  38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant.  
	
A. Hearing Loss

Impaired hearing is considered a disability for VA purposes when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 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 Veteran's June 1983 audiogram on his entrance into service showed pure tone thresholds, in decibels, as follows:




HERTZ



500
1000
2000
3000
4000
RIGHT
5
5
5
15
20
LEFT
5
5
5
10
10

The Veteran's November 1987 audiogram on his discharge from service showed pure tone thresholds, in decibels, as follows:




HERTZ



500
1000
2000
3000
4000
RIGHT
5
0
10
15
10
LEFT
0
10
10
15
10

The Veteran's service treatment records show no complaints of hearing loss during service.

In a January 2009 statement the Veteran stated that while firing weapons in the military it caused him to ask people to repeat themselves.  At his May 2010 DRO hearing the Veteran said he worked as an aviation boatswain's mate launching aircraft.  He stated that he wore hearing protection but the plane engines were still loud.  He said he had not been exposed to any noise as loud either prior to or after service.  He testified that he sometimes turns the television up loud so he can hear it.

The Veteran testified he sought treatment for hearing loss and tinnitus at the West Haven VA in 2009.  However, a review of the Veteran's VA treatment records shows he requested a hearing examination in 2010 as part of his application for a commercial driver's license, but no complaint of, treatment for, or diagnosis of hearing loss is in the record, providing evidence against this claim.

Based on the foregoing, the Board finds that the preponderance of the evidence shows that the Veteran does not have a current bilateral hearing loss disability in accordance with VA standards.  See 38 C.F.R. § 3.385.  The Board notes that the Veteran is competent to report hearing loss, but that his testimony, while clear that he was exposed to loud noise in service, is vague as to whether he experiences current hearing loss.  

It is important for the Veteran to understand that the fact that the Veteran was exposed to loud noise during service (which is not at issue) and the fact that his hearing may not be as good as it once was does not necessarily support a finding that the Veteran does not have hearing within a range of "normal" for VA purposes at this time.  The Veteran's hearing, while perhaps not as good as it once was, was still within a range of normal when he left service.

Although the Veteran said he has sought treatment for hearing loss, VA records reflect no such treatment.  The evidence further does not support a continuity of symptomatology since service indicating hearing loss.  As a preponderance of the evidence is against the Veteran's claim for service connection for hearing loss, his claim must be denied.  38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

B. Tinnitus

In a January 2009 statement the Veteran reported that some mornings he experiences the room spinning and a ringing noise in his ears.  At his May 2010 DRO hearing the Veteran testified he sometimes hears ringing in his ears.  He said ringing in his right ear causes pain and he sticks cotton in his ear for the pain in the winter.

The Veteran's service treatment records show no complaints of tinnitus during service.  Further, VA treatment records show no complaint of, treatment for, or diagnosis of tinnitus after service despite the Veteran's assertion he sought treatment in 2009 for the condition.

Based on the foregoing, the Board finds that the preponderance of the evidence suggests that the Veteran does not have tinnitus.  The Board notes that the Veteran is competent to report tinnitus, and that he has reported hearing ringing in his ears at times.  However, he also reported seeking treatment for the condition, and a review of the records shows no such treatment.  A chronic condition (ringing in the ears since noise exposure in service) is simply not indicated, even based on the Veteran's own statements.  Thus, even if the Board were to find that the Veteran has this problem at this time, the Veteran's own statement do not clearly support a finding in support of this claim.    

The Board find's the Veteran's description of experiencing tinnitus is not accurate.  As a preponderance of the evidence is against the Veteran's claim for service connection for hearing loss, the benefit of the doubt doctrine does not apply, and his claim must be denied.  38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49.

C. Back Disability

On the Veteran's June 1983 report of medical history on his entrance into service he denied recurrent back pain.  His spine was found normal on examination.  

The Veteran testified at his May 2010 DRO hearing that on various occasions during service he hurt his lower back while on the flight deck.  He also testified he slipped and fell going through portholes.  He referenced picking up the metal catapult that launches aircraft.  He said his back pain started in boot camp, but he was afraid to go to the medic.  

The Veteran's service treatment records contain no complaint of or treatment for any back condition, although he sought treatment for a variety of other conditions in service, including an eye injury, shoulder contusion, ankle sprain, abdominal muscle strain, upper respiratory infections, foot pain, pseudofolliculitis barbae, and a rash.  

The fact that the Veteran sought treatment for other minor conditions in service calls into doubt his statement that he was afraid to go to the medic for treatment of back pain.

The Veteran's spine was found normal at his November 1987 discharge examination, further weighing against his claim (there would be no reason for the Veteran at discharge to not indicate he had a back problem if, in fact, he had back problems since boot camp, as he appears to indicate).

The Veteran testified that during a 1989 physical when he went to work for the United States Postal Service he reported chronic back pain.  He said he also sought treatment in the 1990s for back pain but was not currently receiving treatment.  The Veteran reported he currently has weakness, fatigue, and pain that have prevented him from picking his child up and sometimes causes him difficulty tying his shoes.

VA treatment records show no complaints of back pain with the exception of pleuritic back pain during a May 2010 visit for wheezing and chest tightness.  The lack of complaints of back pain in the Veteran's records and lack of a current diagnosis of a back disability is strong evidence against the Veteran's claim.

As the evidence shows no current diagnosis of a back disability and the Veteran's service treatment records contain no evidence of a back injury or complaints of back pain in service, the Board finds the Veteran's claim must be denied.  As the preponderance of the evidence is against this claim, the benefit of the doubt doctrine does not apply.  38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49.

In this regard, it is important for the Veteran to understand that even if the Board assumes, notwithstanding the above, that the Veteran currently has a back problem, the evidence above clearly suggest the Veteran did not have a back problem in service or for many years after service, providing highly probative evidence against this claim that any current back problem has any connection to service. 
D. Bilateral Knee Disability

The Veteran's lower extremities were found normal at his June 1983 entrance examination.

At his May 2010 DRO hearing the Veteran testified he banged his knees on the ship.  He said he dealt with the pain because he was afraid to tell anyone.  

Service treatment records show the Veteran was treated for an abrasion on his left knee in June 1987.  The injury was cleaned and bandaged.  The Veteran was noted to have good range of motion.  He returned approximately a week later stating that he had noticed swelling recently but it had gone down.  X-rays showed the knee to be within normal limits.  There are no service treatment records regarding the Veteran's right knee.

The Veteran's lower extremities were found normal at his November 1987 discharge examination.

The Veteran testified that after service he first sought treatment for his knees in the early 1990s.  The Veteran testified that both of his knees swell and lock up.

The Veteran's VA treatment records contain no complaints of or treatment for any knee condition.

Although the Veteran testified to some subjective current complaints regarding his knees, the medical evidence contains no diagnosis of a knee disability.  Further, the Veteran's VA records contain no current complaints regarding the Veteran's knees, both factors against finding the Veteran has a current knee disability.  In addition, although the Veteran's service treatment records show treatment for a left knee abrasion, the records suggest the injury healed, and no knee disability was noted on the Veteran's discharge examination.  Further, the record contains no evidence of a right knee injury.

Based on the forging, the Board finds the Veteran's claim must be denied.  As the preponderance of the evidence is against this claim, the benefit of the doubt doctrine does not apply.  38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49.

Once again, it is important for the Veteran to understand that even if the Board assumes, notwithstanding the above, that the Veteran currently has this problem, the evidence above clearly suggest the Veteran did not have this problem (a "chronic" knee problem - not simply the residuals of a knee injury that resolved within several days) in service or for many years after service, providing highly probative evidence against this claim that any current problem has any connection to service. 

Duties to Notify and Assist

As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), VA has a duty to notify and assist claimants in substantiating a claim for VA benefits.  38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). 

Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim.  38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002).  Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide.  38 C.F.R. § 3.159(b)(1).  Such notice should also address VA's practices in assigning disability evaluations and effective dates for those evaluations.  See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006).  While the required notice should be furnished prior to the issuance of the appealed rating decision, any initial errors of notice will not be prejudicial if: 1) corrective actions (e.g., issuance of a post-adjudication notice letter containing the required information) are taken, and 2) the appeal is readjudicated (e.g., in a  Supplemental Statement of the Case).  See Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007).

Here, the VCAA duty to notify was satisfied by way of a letter sent to the Veteran in December 2008.  In the letter, the RO informed the Veteran of what evidence was required to substantiate his claims for service connection and of the Veteran's and VA's respective duties for obtaining evidence.  In the letter the RO also provided notice with regard to how VA assigns disability ratings and effective dates in the event that service connection is established.  

VA also has a duty to assist the Veteran with the development of facts pertinent to the appeal.  38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c).  This duty includes the obtaining of "relevant" records in the custody of a federal department or agency under 38 C.F.R. § 3.159(c)(2), as well as records not in federal custody (e.g., private medical records) under 38 C.F.R. § 3.159(c)(1).  VA will also provide a medical examination if such examination is determined to be "necessary" to decide the claim.  38 C.F.R. § 3.159(c)(4).

The Board finds that all necessary development has been accomplished.  The RO has obtained the Veteran's service treatment records and VA treatment records.  The RO attempted to obtain private treatment records identified by the Veteran, but was unable to do so.  In a December 2008 letter the RO properly notified the Veteran that the records could not be obtained due to the Veteran not providing a correct address.  See 38 C.F.R. § 3.159(e).  The Veteran did not provide additional information.  Also, the Veteran did not submit any private treatment records from his family doctor although he said at his May 2010 DRO hearing he would provide the information.  While VA has a statutory duty to assist the Veteran in developing evidence pertinent to a claim, the Veteran also has a duty to assist and cooperate with VA in developing evidence; the duty to assist is not a one-way street.  See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991); see also Hayes v. Brown, 5 Vet. App. 60, 68 (1993).  

The Veteran did submit personal statements.  Neither the Veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained.  

The Veteran was not afforded a VA examination for his hearing loss, tinnitus, back, or knee disabilities, but none is required.  

In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration.  These four factors are:  (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim.  38 U.S.C. § 5103A(d) and 38 C.F.R. § 3.159(c)(4).  

With respect to the third factor above, the Court of Appeals for Veterans Claims has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service.  The types of evidence that "indicate" that a current disability "may be associated" with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation.  McLendon v. Nicholson, 20 Vet. App. 79 (2006).  

The Federal Circuit has addressed the appropriate standard to be applied in determining whether an examination is warranted.  In Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) and Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010), the Federal Circuit held that while there must be "medically competent" evidence of a current disability, "medically competent" evidence is not required to indicate that the current disability may be associated with service.  Colantonio, 606 F.3d at 1382; Waters, 601 F.3d at 1277.  On the other hand, a conclusory generalized lay statement suggesting a nexus between a current disability and service, as in this case, would not suffice to meet the standard as this would, contrary to the intent of Congress, result in medical examinations being "routinely and virtually automatically" provided to all veterans claiming service connection.  Waters, 601 F.3d at 1278-1279.  Here, as the only evidence that the Veteran's claimed disabilities are related to his military service is his own conclusory generalized lay statements, which are unsupported by even speculative medical evidence, there is no basis for a medical opinion.  Further, the medical evidence does not reflect that the Veteran has currently diagnosed hearing loss, tinnitus, back disability, or bilateral knee disabilities, providing highly probative evidence against such a claim even if a medical opinion were obtained.  Accordingly, the Board finds that referral for a VA medical examination is not warranted.  

Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist in the development of the claim.  Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio, 16 Vet. App. 183.

ORDER

Service connection for hearing loss is denied.

Service connection for tinnitus is denied.

Service connection for back disability is denied.

Service connection for bilateral knee disability is denied.


REMAND

Unfortunately, a remand is required in this case. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. 

The Veteran contends that he currently suffers from an acquired psychiatric disorder that began during basic training after he was harassed and teased by fellow service members and supervisors and witnessed a suicide attempt by a fellow service member.

At his May 2010 DRO hearing the Veteran testified that being from Panama he had a heavy accent when he entered boot camp and for that the non-commissioned officers harassed him.  He said he was called names, told he was a piece of garbage, and asked why he came to America.

Also at boot camp in November 1983 the Veteran said he was sleeping when he heard a scream and ran into the bathroom to find a fellow service member had slit his wrists.  The Veteran said he grabbed a towel to wrap the man's wrists.  He did not know if the man later died.

In January 2009, the Veteran sought mental health treatment at the VA, reporting depression with anhedonia, insomnia, fatigue, and poor self-esteem since 1984 when he witnessed a fellow service member slit his wrists in boot camp and had a verbally abusive sergeant.  The Veteran was diagnosed with PTSD and depression by a VA psychiatrist.

In June 2009 the Veteran said that during basic training other soldiers made fun of his accent and told him he would never amount to anything.  He said superiors also threatened to use objects to sexually molest him.

The Veteran testified that he continues to have anxiety attacks as a result of his experiences in boot camp and over the years took it out on his wife and kids but did not seek treatment until going to the VA in December 2008.

In a January 2009 statement in support of his PTSD claim, the Veteran related walking in and seeing a fellow service member who had slit his wrists.  However, the Veteran did not provide the man's name.  

In February 2009 the RO sent the Veteran a letter asking for more information about his stressors.  The Veteran did not provide additional information and the Joint Services Records Research Center determined there was not sufficient information to corroborate the Veteran's claims.

The Veteran should provide the name of the service member who attempted suicide. 

Although the Veteran's service treatment records are negative for any complaints of or treatment for a psychiatric disorder, his post-service VA treatment records document diagnoses of PTSD and depression.  In VA records and statements to the VA the Veteran has consistently reported two stressors in service that he believes caused his psychological problems, specifically his treatment during boot camp and his seeing a fellow service member attempt suicide by slitting his wrists.  Although the Veteran has not provided sufficient information to verify the suicide attempt, his description of his treatment during basic training is possibly plausible, though this is not clear.

Therefore, the Board concludes that a VA examination and medical opinion are necessary to determine whether the Veteran has a current psychiatric disorder, to include PTSD and a depressive disorder, and if so, whether such disorders are related to his military service.  Such an examination should be provided on remand as the Veteran has not yet been afforded a VA examination with the opportunity to obtain an etiological opinion.  38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006).

The Veteran's claim service connection for migraine headaches, to include as secondary to an acquired psychiatric disability, is inextricably intertwined with the claim of service connection for an acquired psychiatric disability as the outcome of that claim could materially affect the result of the Veteran's headaches claim.  See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated).  Thus, the Veteran's headache claim must be readjudicated after AOJ readjudicates the acquired psychiatric disability claim on appeal following the completion of the development requested on remand.

Accordingly, the case is REMANDED for the following action:

1. Ask the Veteran to submit all records regarding any workers compensation claim he has ever filed with either the United States Postal Service or any other organization (or a waiver in order for the RO/AMC to obtain these records itself), even if the claim was unsuccessful.  A complete records on any claim is required.    

2. Schedule the Veteran for a VA psychiatric examination. The claims file and a copy of this Remand must be made available to and reviewed by the examiner in conjunction with the examination.  The examiner is requested to provide a diagnosis of any acquired psychiatric disorder found to be present (if any).  For each diagnosed psychiatric disorder, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the disorder had its clinical onset during active service from November 1983 to November 1987 or is related to any in-service disease, event, or injury, to include consideration of the Veteran's account of his experiences in basic training (if found to be credible).  The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions.

3. When the development requested has been completed, and the RO has ensured compliance with the requested action, this case should again be reviewed by the RO on the basis of the additional evidence and the claims for service connection for an acquired psychiatric disorder and migraine headaches should be readjudicated.  If the benefit sought is not granted, the Veteran and his representative should be furnished a Supplemental Statement of the Case, and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review.

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

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


______________________________________________
JOHN J. CROWLEY
Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs