Citation Nr: 1323454	
Decision Date: 07/23/13    Archive Date: 08/01/13

DOCKET NO.  04-37 687	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Montgomery, Alabama


THE ISSUES

1.  Entitlement to service connection for a bilateral ankle disability (other than Achilles tendonitis).

2.  Entitlement to service connection for a left hand disability.


REPRESENTATION

Appellant represented by:	Disabled American Veterans


WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

J. Juliano, Counsel


INTRODUCTION

The Veteran served on active duty from March 1971 to December 2000, with additional Army Reserve service prior to that time.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2002 rating decision of the Department of Veterans Affairs (VA) regional office (RO) located in St. Petersburg, Florida.  During the course of the appeal, jurisdiction was transferred to Montgomery, Alabama.

In February 2010, the Veteran testified before the undersigned Veterans Law Judge at a Travel Board hearing at the RO located in Montgomery, Alabama.  A transcript of the proceeding has been associated with the claims file.  

In February 2011 and December 2012, the Board remanded the Veteran's claims for further development.  Such development has been completed and associated with the claims file, and these matters are returned to the Board for further review.

The Board notes by way of background with regard to the Veteran's claim for service connection for a bilateral ankle disability that the December 2012 Board decision separately granted service connection for bilateral Achilles tendonitis.  Therefore, the issue remaining on appeal herein is entitlement to service connection for a bilateral ankle disability other than Achilles tendonitis.

The issue of entitlement to service connection for left hand disability 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.


FINDING OF FACT

The preponderance of the most probative evidence of record shows that the Veteran's bilateral ankle disability preexisted service, did not increase in severity during service beyond the natural progression of the condition, and was not otherwise aggravated by service.


CONCLUSION OF LAW

Service connection for a bilateral ankle condition is not warranted.  38 U.S.C.A. §§ 1110, 1111, 1131 , 1132, 1153 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.306 (2012).


REASONS AND BASES FOR FINDING AND CONCLUSION

I.  Veterans Claims Assistance Act of 2000 (VCAA)

With regard to the Veteran's claim for service connection for a bilateral ankle disability, VA has met all statutory and regulatory notice and duty to assist provisions.  See 38 U.S.C.A. §§ 5102, 5103(a), 5103A, 5106 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.326(a) (2012).

Under the VCAA, when VA receives a complete or substantially complete application for benefits, it is generally required to "notify the claimant and the claimant's representative, if any, of any information and any medical or lay evidence not previously provided . . . that is necessary to substantiate the claim."  38 U.S.C.A. § 5103(a)(1) (West Supp. 2012).  As part of that notice, VA must "indicate which portion of that information and evidence, if any, is to be provided by the claimant and which portion, if any, the Secretary . . will attempt to obtain on behalf of the claimant."  38 U.S.C.A. § 5103(a)(1) (West Supp. 2012).  The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability.  See Dingess v. Nicholson, 19 Vet. App. 473 (2006), aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007).

The Board finds that a VCAA letter dated in October 2003 fully satisfied the duty to notify provisions.  See 38 U.S.C.A. § 5103(a) (West Supp. 2012); 38 C.F.R. § 3.159(b)(1) (2012).  The October 2003 VCAA letter informed the Veteran of what information or evidence was needed to support his claim, what types of evidence the Veteran was responsible for obtaining and submitting to VA, and which evidence VA would obtain.

Because the Veteran's claim is denied herein, the Board finds the fact that the October 2003 notice letter did not explain how VA assigns disability ratings and effective dates to be harmless error.  See Dingess, supra.

The Board also concludes that VA's duty to assist has been satisfied.  See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c).  All of the Veteran's service treatment records, VA treatment records, and private treatment records have been associated with the claims file.  The Veteran has not identified any additional relevant treatment records for VA to obtain.  The Board finds that the record contains sufficient evidence to make a decision on the claim.  In that regard, the Board acknowledges that there appears to have been some prior confusion as to whether there were outstanding service treatment records, including inpatient records.  As acknowledged in July 2012 and August 2012 memoranda to the claims file, however, all of the Veteran's service treatment records were already in the claims file (including from Gorgas Army Hospital, Portsmouth Naval Hospital, and Evans Army Hospital).

VA's duty to assist also includes the duty to provide a VA examination when the record lacks evidence to decide a veteran's claim and there is evidence of 
(1) a current disability, (2) an in-service event, injury, or disease, and (3) some indication that the claimed disability may be associated with the established in-service event, injury, or disease, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim.  See 38 C.F.R. § 3.159(c)(4) (2010);  McLendon v. Nicholson, 20 Vet. App. 79 (2006).

The Veteran was provided with VA examinations in June 2004, April 2011 (with a September 2012 addendum opinion), and February 2013 relating to his claim.  The VA examination reports reflect that the examiners had an opportunity to review the claims file, including all of the Veteran's service and VA treatment records, elicit a history from the Veteran, and examine him.  The examiners also provided clear rationales for their conclusions and answered all the questions posed by the Board in its prior remands (as explained in more detail below).  Based thereon, the Board finds these VA examination reports to be thorough and adequate upon which to base a decision with regard to the Veteran's claim.

In February 2011, the Board remanded the Veteran's claim so that he could be provided with a new VA examination address whether the Veteran's preexisting bilateral ankle condition was aggravated by service (a prior June 2004 VA joints examination was provided, albeit brief).  Subsequently, the Veteran was provided with a new April 2011 VA examination, and the VA examiner opined that the Veteran had a preexisting bilateral ankle condition that was not aggravated by service.  A September 2012 addendum opinion was provided, but only relating to the issue of Achilles tendonitis and other unrelated claims (service connection for Achilles tendonitis was ultimately granted by way of the December 2012 Board decision).  See Report at 10.  Because the April 2011 VA examiner did not provide any rationale for her conclusion, in December 2012, the Board again remanded the Veteran's claim to obtain a VA medical opinion or examination for further clarification and explanation as to whether the Veteran's preexisting bilateral ankle condition increased in severity in service, and if so, whether there is clear and unmistakable evidence that the Veteran's preexisting condition was not aggravated by service.  Pursuant to the Board's remand directive, a new February 2013 VA examination was provided (by a different VA examiner than who prepared the April 2011 VA examination report), which examination report addresses all of the questions posed by the Board, including whether the Veteran's preexisting bilateral ankle condition increased in severity during service beyond the natural progression of the disease.  Therefore, the Board finds that there was substantial compliance with the Board's remand directive.  See Stegall v. West, 11 Vet. App. 268 (1998).

As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of this case, the Board finds that any such failure is harmless.  See Mayfield v. Nicholson, 19 Vet. App. 103 (2005), reversed on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006).

II.  Analysis

The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive and providing reasons for rejecting any evidence favorable to the claimant.  Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value.  When all the evidence is assembled, VA is responsible for determining whether the evidence supports a 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.  See Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service.  38 U.S.C.A. § 1110 (West 2002).  That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease.  If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity.  38 C.F.R. § 3.303(b) (2012).  Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service.  38 C.F.R. § 3.303(d) (2012).

To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) 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).

Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, and disorders noted at the time of examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service.  38 U.S.C.A. § 1111 (West 2002).

"When no preexisting condition is noted upon entry into service, the veteran is presumed to have been sound upon entry.  The burden then falls on the government to rebut the presumption of soundness by clear and unmistakable evidence that the veteran's disability was both preexisting and not aggravated by service."  Wagner v. Principi, 370 F.3d 1089, 1096-1097 (Fed. Cir. 2004); VAOPGPREC 3-2003 at 10-11 (July 16, 2003).  The veteran is not required to show that the disease or injury increased in severity during service before VA's duty under the second prong of this rebuttal standard attaches. VAOPGCPREC 3-2003 at 10-11 (July 16, 2003).

When a preexisting disease or injury is noted on the entry, 38 U.S.C.A. § 1153 provides that "[a] preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease."  38 C.F.R. § 3.306(a) (2012).  With regard to veterans who served during a period of war or after December 31, 1946, clear and unmistakable evidence is required to rebut the presumption of aggravation where a pre-service condition underwent an increase in severity during service.  38 C.F.R. § 3.306(b) (2012); Cotant v. Principi, 17 Vet. App. 116, 124, 130 (2003).  Temporary or intermittent flare-ups of symptoms of a preexisting condition alone do not constitute sufficient evidence for a non-combat veteran to show increased disability for section 1153 purposes unless the underlying condition worsened.  Davis v. Principi, 276 F. 3d 1341, 1346- 47 (Fed. Cir. 2002); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991).

The Veteran, a retired Army Colonel, served on active duty from March 1971 to December 2000.  He claims that he has a bilateral ankle disability that was incurred in or aggravated by service.

At the Board hearing, the Veteran testified that eight years prior to service while playing football, he sprained both ankles.  He testified that subsequently, he had no ankle problems until infantry or Adjutant General corps training, particularly due to jumping five to six feet or more off track vehicles.  See Transcript at 5-6.  He has reported that he experienced several sprained ankles in service, and that he was treated with a cast at least twice - once in 1977, and again in 1984 to 1985.  See VA Medical Opinion, February 2013.  He also has reported that on one occasion, while running in formation, somebody stepped on his heels causing him to fall and again sprain his ankles.  See id.  He testified at the Board hearing that he frequently went to sick call in service due to his ankles, and that for nine years of his almost 30 years of active duty, he had a physician who was his direct subordinate who treated his ankles but oftentimes did not make a record of such treatment.  See Transcript at 7.  He testified that his ankles have had problems "collapsing" since training.  See Transcript at 8.  

With regard to the Veteran's service treatment records, a March 1968 Army qualification examination report reflects that both of the Veteran's ankles revealed marked lateral instability bilaterally with partial subluxation with varus stress, and a diagnosis of bilateral lateral ankle instability was noted.  The Veteran's March 1971 report of medical history (for entry into active service) reflects that he reported he had "very weak ankles."  The physician noted the Veteran had a history of fracturing both of his ankles twice between the ages of 16 and 20 and that they tended to sprain, and the Veteran was referred for orthopedic evaluation.  See also Report of Medical History, November 1977.  The March 1971 orthopedic evaluation record reflects that the Veteran had a history of injuring his left ankle eight years prior to service, then both his left and right ankles seven years prior to service, and that the Veteran then complained of weakness bilaterally.  A diagnosis of a talofibular ligament sprain was recorded.  An April 1982 service treatment records reflect that the Veteran sprained his right ankle in a fall.  An October 2000 separation report of medical history reflects that the clinician noted that the Veteran experienced pain in his ankles.  The Board acknowledges May and August 1977 records reflecting the Veteran was placed on profile for months relating to plantar fasciitis, but no notation is reflected regarding any ankle condition.  A later October 1977 record reflects that the Veteran reported ankle difficulty but an examination was negative.  Also, the Board acknowledges that an August 1984 service record (from Gorgas Army Hospital in Panama) reflects that the Veteran was placed in a short-leg cast (left) for six weeks for plantar fasciitis, but again, no notation was made regarding any ankle condition.

As an initial matter, in light of the Veteran's qualification and entrance examination records reflecting his pre-service history of ankle fracture and sprain injuries, as well as diagnosed bilateral ankle instability noted on his qualification examination report, the Board finds that a bilateral ankle condition was noted on entry and, therefore, the presumption of soundness does not apply in this matter.

Post-service, Naval hospital treatment records include an October 2001 record reflecting complaints of plantar fasciitis and Achilles tendonitis, and that his feet and ankles were physically examined by a podiatrist, but no subjective complaints of any history of sprains or instability and no objective findings of such were noted despite a detailed evaluation of the Veteran's feet and ankles.

The June 2004 VA examination report briefly reflects a history of bilateral ankle sprains was noted.  Range of motion testing revealed dorsiflexion to 20 degrees, and plantar flexion to 45 degrees.  The examiner noted there was no painful motion, and repetitive motion did not reveal any additional limitation of motion.  No inflammation, swelling, or lateral instability was found.  Diffuse tenderness over the lateral condyle was noted.  The examiner opined that no significant abnormalities were found.

An April 2011 VA examination report reflects the examiner noted the Veteran's service history.  The Veteran reported experiencing symptoms of instability, and that he falls or twists an ankle about once every two months, with symptoms lasting for five minutes to two days.  Range of motion testing revealed dorsiflexion to 20 degrees, plantar flexion to 45 degrees.  Inversion (medial) and eversion (lateral) testing, and strength to gravity and resistance were all normal.  No deformity, malalignment, tenderness, edema, painful motion, abnormal movement, fatigue, lack of endurance, weakness, atrophy, incoordination, instability, or pertinent abnormal weight bearing was noted.  Also, no loss of function with repetitive use was noted.  X-rays of the Veteran's ankles were normal.  A diagnosis of bilateral ankle instability (lateral subclinical weakness), and opined that it preexisted service and that there was no evidence to support worsening or progression.  The Board acknowledges a September 2012 addendum opinion, which did not address the Veteran's claimed bilateral ankle disability involving instability or a history of strains.

A February 2013 VA examination report reflects that the examiner noted the Veteran's pre-service history.  The Veteran reported to the examiner that his ankles were "fine" prior to service.  See Report at 9.  He reported incurring several severe ankle sprains in service, as well as several instances in which his ankle "collapsed."  He reported also that on one occasion while running in formation, somebody stepped on his heels causing him to again sprain his ankles.  He reported that his ankles were treated with casts at least twice in 1977 and 1984 or 1985.  The Veteran reported to the examiner that he believed that his ankle condition was aggravated by service due to jumping from mechanized vehicles and high trucks.  He also reported that he believed that his ankle condition was aggravated by his service-connected plantar fasciitis and Achilles tendonitis.  The Veteran reported that he was not under orthopedic care.  He reported experiencing symptoms of ankle instability.  

Range of motion testing revealed bilateral plantar flexion to 45 degrees or greater, and dorsiflexion to 20 degrees or greater, including after repetitive testing.  No objective evidence of painful motion was noted, and no additional limitation of motion with repetitive testing was noted.  The examiner opined that the Veteran had no functional loss or functional impairment of the ankle.  No tenderness or pain on palpation was noted.  Ankle strength was 5/5 bilaterally.  Anterior drawer and talar tilt (inversion/eversion) testing for instability was negative.  X-rays revealed no abnormal findings, including no arthritis or ankylosis.  Diagnostic testing also revealed a normal sedimentation rate.  The examiner recorded a diagnosis of bilateral ankle strain, healed without residuals, and opined that it preexisted service and was not aggravated by service beyond the natural progress of the disease.  The examiner cited the lack of objective evidence of aggravation, that x-rays were normal, and his sedimentation rate was normal indicating no inflammatory process.  With regard to the Veteran's newly raised theory of entitlement at the time of the examination for service connection as secondary to his service-connected plantar fasciitis or Achilles tendonitis, the examiner opined that a nexus between the Veteran's ankle condition and his plantar fasciitis or Achilles tendonitis, including any aggravation of his ankle condition, cannot be sustained by medical literature and therefore has no merit ("face value").

In light of the above, the Board finds that a preponderance of the evidence shows that the Veteran had a preexisting bilateral ankle condition that was not aggravated by service.  As explained above, diagnosed bilateral ankle instability as well as a history of sprains and injury were noted on entry into service, and both the April 2011 and February 2013 VA examiners opined that the Veteran's bilateral ankle condition preexisted service.  The April 2011 VA examiner further opined that there was no evidence of any worsening or progression of the Veteran's ankle condition, and the February 2013 examiner likewise opined that it was not aggravated by service beyond the natural progression of the disease.  Therefore, as the medical evidence of record shows no increase in severity during service beyond the natural progress of the condition, the presumption of aggravation does not apply, and there is no medical evidence supporting the Veteran's assertion that his bilateral ankle condition was aggravated by service.  The Board further notes that the June 2004 VA examiner opined that no significant abnormalities were found on examination, and the February 2013 VA examiner likewise recorded a diagnosis of a healed bilateral ankle strain without any residuals.  While the Board acknowledges that the April 2011 VA examiner recorded a diagnosis of bilateral ankle instability, even that was noted by the examiner as subclinical, as all range of motion testing, x-rays, and all other objective findings were all normal.  These normal objective findings do not lend support for any permanent worsening of the Veteran's ankle condition in this case.  Moreover, there is no post-service evidence of complaint or treatment for any ankle condition, despite multiple treatment records in the claims file, including podiatry records, reflecting complaints and treatment for his service-connected plantar fasciitis and Achilles tendonitis (such that there is not a lack of contemporaneous medical evidence, but rather, a mere lack of complaint).  The Board adds that there is no medical evidence of record that contradicts the opinions of the April 2011 and February 2013 VA examiners.

The Board acknowledges that the Veteran asserts that after his pre-service ankle injuries, he did not experience any ankle problems until he was on active duty, that his bilateral ankle condition was aggravated by service, and that he has experienced instability ever since.  The Board finds, however, that the fact that the objective findings on examination in June 2004, April 2011, and February 2013 were normal and there was no objective evidence of instability on testing diminishes the probative value of his subjective account such that there is not sufficient evidence of any in-service incurrence or aggravation of the Veteran's bilateral ankle condition so as to bring the evidence into equipoise in this case.

In summary, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for a bilateral ankle disability, and the benefit of the doubt rule is not for application.  See 38 U.S.C.A. § 5107(b).


ORDER

Entitlement to service connection for a bilateral ankle disability is denied.


REMAND

The Veteran also claims that he has a left hand disability that is related to service.  Specifically, he asserts that he lacerated his left thumb with a fishing knife while stationed in Panama (in 1984), and that he was treated at GAH.  He testified at the Board hearing that, as a result, he has decreased grip strength and painful motion if he squeezes something with his left thumb.  See Transcript at 13-15; see also Statement, March 2011.  He has reported experiencing pain as a result of the injury since service.  See Form 21-4142, March 2011.  He also testified that he has a scar resulting from the injury.

By way of background, a February 1984 service emergency room treatment record from GAH in Panama reflects that the Veteran was treated with sutures for a deep, irregular laceration from a knife to the left thumb and palmer area.  Post-service, an October 2006 Naval hospital record reflects that the Veteran lacerated his left thumb extensor tendon with a utility knife while trying to cut a garden hose.

The Board notes that prior to the 2006 intercurrent injury, the Veteran reported on his July 2002 claim for service connection that he has experienced lost grip strength as a result of the 1984 laceration injury.

The Veteran was initially provided with an April 2011 VA examination relating to his claim, which examiner recorded a diagnosis of left thenar eminence scar and opined that the scar was incurred in service.  Because, however, the April 2011 VA examiner did not address the post-service October 2006 laceration injury, or the Veteran's complaints of hand weakness, in December 2012, the Board remanded the Veteran's claim for a new VA examination.  The February 2013 VA examination report and March 2013 VA medical opinion reflect that a diagnosis of superficial laceration of the left hand (palmar area) at thumb's base - properly healed without residuals, was recorded.  The March 2013 VA examiner opined, among other things, that the in-service 1984 injury was superficial, that the October 2006 orthopedic evaluation was for a possible ligament injury to the PIP joint "on the same location," and that the in-service injury was "distinct" from the October 2006 injury.  

Having carefully reviewed the February and March 2013 VA examination report and opinion, regrettably, the Board finds that a decision cannot be made on the Veteran's claim without a new VA examination.  As noted above, the February 1984 service treatment record reflects that the laceration was "deep" and "irregular," whereas the March 2013 VA examiner noted that the in-service laceration was "superficial" and, therefore, the Veteran's subjective reports (i.e., pain since service and decreased grip strength) cannot be attributed to the 1984 injury.  This means that the examiner based his opinion on an inaccurate factual premise.  

Also, it is not clear whether the March 2013 VA examiner intended to opine that the in-service 1984 injury and post-service 2006 injury were in the same anatomical locations.  Also, the anatomical location of the scar noted on the April 2011 VA examination in relation to the 1984 and 2006 injuries is not clear.  The Board cannot see from the current record whether there is one scar over top of the initial injury site, or if there are two separate scars in different places.  Therefore, unfortunately, the Board finds that a remand is necessary to provide the Veteran with a new VA examination to address whether the Veteran's in-service and post-service injuries are associated with distinct anatomical locations, and to which injury the Veteran's scar relates.  See Barr v. Nicholson, 21 Vet. App. 303 (2007); see also Stegall v. West, 11 Vet. App. 268 (1998).

While the further delay of this case is regrettable, due process considerations require such action.  Accordingly, the case is REMANDED for the following action:

1.  Schedule the Veteran for a new VA examination with an appropriate physician to determine the current nature and the etiology of any scar(s) on the Veteran's left hand or thumb.  Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed.  The complete claims folder must be provided to the examiner for review in conjunction with the examination, and the examiner must note that the claims folder has been reviewed.  The examiner should indicate whether it is at least as likely as not (meaning likelihood of at least 50%) that any of the following conditions is related to the Veteran's documented February 1984 laceration injury:

a) Any left hand disability relating to the Veteran's complaints of pain or painful motion since service, and decreased grip strength.  Please note that the Veteran is a credible historian, and that he reported decreased grip strength on his July 2002 claim prior to the October 2006 post-service laceration;

b) Any current scar(s) on the Veteran's left hand or thumb.

The examiner is also asked to please specify the location of as follows:

a) The in-service February 1984 laceration injury;
b) The post-service October 2006 laceration injury;
c) Each scar on the Veteran's left hand and thumb.

If the 1984 and 2006 laceration injuries are found to be in the same location, and if a scar is present at that location and it is not possible to differentiate as to which laceration caused the scar, the examiner is asked to please explain.

A clear explanation for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board.  

The term "as likely as not" does not mean "within the realm of medical possibility."  Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of that conclusion as it is to find against it.

2.  Then, readjudicate the Veteran's claim.  If the claim remains denied, the Veteran should be provided with a Supplemental Statement of the Case (SSOC).  After the Veteran and his representative have been given the applicable time to submit additional argument, the claim should be 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).



______________________________________________
BETHANY L. BUCK
Veterans Law Judge, Board of Veterans' Appeals


Department of Veterans Affairs