Citation Nr: 1323933 Decision Date: 07/26/13 Archive Date: 08/06/13 DOCKET NO. 09-13 275 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for a bilateral ankle disability. 3. Entitlement to service connection for a bilateral knee disability. REPRESENTATION Appellant represented by: Vietnam Veterans of America ATTORNEY FOR THE BOARD L.M. Yasui, Counsel INTRODUCTION The Veteran, who is the appellant in this case, served on active duty from July 2005 to April 2006. He had additional service in the United States Naval Reserve. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. Historically, in a June 2011 decision, the Board denied service connection for PTSD and remanded the issues of entitlement to service connection for residuals of a bilateral ankle disorder and residuals of a bilateral knee disorder for further development, specifically for VA examinations and outstanding VA treatment records. The Veteran appealed the June 2011 decision to the United States Court of Appeals for Veterans Claims (Court) insomuch as it denied service connection for PTSD. In March 2012, the Court granted a Joint Motion for Partial Remand, and the part of the Board's decision, only to the extent that it denied the entitlement to service connection for PTSD, was vacated and remanded for action consistent with the terms of the Joint Motion. In April 2013, the Board remanded all the claims listed above to the RO via the Appeals Management Center (AMC) in Washington DC for additional development that included a request to obtain outstanding VA treatment records. The matter has properly been returned to the Board for appellate consideration. See Stegall v. West, 11 Vet. App. 268 (1998). An additional discussion of the RO's compliance with the June 2011 Board Remand is included in the Remand section below. In evaluating this case, the Board has not only reviewed the Veteran's physical claims file, but has also reviewed the Veteran's file on the Virtual VA system to ensure a complete assessment of the evidence. The issues of service connection for a bilateral ankle disability and a bilateral knee disability 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. FINDINGS OF FACT 1. The Veteran engaged in combat during service. 2. The Veteran has a qualifying DSM-IV diagnosis of PTSD. 3. The Veteran's claimed stressors are related to his combat exposure in service. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for PTSD have been met. 38 U.S.C.A. §§ 101, 1101, 1110, 5103(a), 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations imposes obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.326(a) (2012). The claim of service connection for PTSD has been considered with respect to VA's duties to notify and assist. Given the favorable outcome noted above, no conceivable prejudice to the Veteran could result from this decision, and further explanation of how VA has fulfilled the duties to notify and assist is not necessary. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). Service Connection - Laws and Regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). The Court has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f). If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of a veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. See also 38 C.F.R. § 4.125(a) (2012) (stating that the diagnosis of PTSD must comply with the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, of the American Psychiatric Association (DSM-IV). Participation in combat, a determination that is to be made on a case-by-case basis, requires that a veteran personally participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. See VAOPGCPREC 12-99; Moran v. Principi, 17 Vet. App. 149 (2003); see also Sizemore v. Principi, 18 Vet. App. 264, 273-74 (2004). Pursuant to 38 U.S.C.A. § 1154(b), with respect to combat veterans, VA shall accept as sufficient proof of service connection satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions and hardships of such service. Service connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary. See also 38 C.F.R. § 3.304(d). 38 U.S.C.A. § 1154(b), however, can be used only to provide a factual basis upon which a determination could be made that a particular disease or injury was incurred or aggravated in service, not to link the claimed disorder etiologically to the current disorder. See Libertine v. Brown, 9 Vet. App. 521, 522- 23 (1996). 38 U.S.C.A. § 1154(b) does not establish service connection for a combat veteran; it aids him or her by relaxing the adjudicative evidentiary requirements for determining what happened in service. See Wade v. West, 11 Vet. App. 302, 305 (1998) (holding that "a combat veteran who has successfully established the in-service occurrence or aggravation of an injury pursuant to § 1154(b), must still submit sufficient evidence of a causal nexus between that in-service event and his or her current disability"). A veteran (or in this case, the appellant) must still generally establish the claim by competent medical evidence tending to show a current disability and a nexus between that disability and those service events. See Gregory v. Brown, 8 Vet. App. 563, 567 (1996). In rendering a decision on appeal the Board must also analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). The Board is charged with the duty to assess the credibility and weight given to evidence. Wensch v. Principi, 15 Vet. App. 362, 367 (2001); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza, 7 Vet. App. at 498. The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the Veteran's claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). Medical evidence that is speculative, general, or inconclusive in nature cannot support a claim. See Obert v. Brown, 5 Vet. App. 30, 33 (1993); see also Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996); Libertine v. Brown, 9 Vet. App. 521, 523 (1996). A physician's statement framed in terms such as "may" or "could" is not probative. See Warren v. Brown, 6 Vet. App. 4, 6 (1993). A significant factor to be considered for any opinion is the accuracy of the factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment, including by a veteran. See Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner's opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Service Connection for PTSD The Veteran contends that service connection is warranted for his claimed PTSD. In a December 2006 Application for Compensation and/or Pension, the Veteran reported that he was told in a post-deployment health reassessment (PDHRA) that he was suffering from PTSD and mild depression. In an April 2009 substantive appeal, he also reported that he "get[s] angry while driving and just about anything gets [him] angry." The Veteran has also asserted that he came under enemy fire for two weeks while serving in Iraq and witnessed a trailer being ripped apart by an improvised explosive device. In support of his claim of combat exposure, the Veteran's personnel records confirm his reports of having served in Iraq, including receipt of the Iraq Campaign Service Medal with Eagle and Globe Anchor, the Global War on Terrorism Service Medal, and the Seabee Combat Warfare Specialist award. The Board also finds the Veteran's accounts of coming under enemy fire during such service to be credible. As noted in the September 2007 rating action, the RO conceded the inservice stress based on the Veteran's service. As such, his assertions of combat exposure are accepted by the Board. After a review of all the evidence of record, lay and medical, the Board finds that the evidence is in equipoise on the question of whether the Veteran has a current PTSD diagnosis in compliance with the DSM-IV. Evidence favorable to the Veteran's claim is included in a May 2008 traumatic brain injury (TBI) consultation, in which the findings were deemed to be consistent with PTSD and no evidence of TBI was found. That same month, in May 2008, the Veteran underwent a comprehensive screening for PTSD by a VA mental health professional. After an extensive interview and evaluation of the Veteran, the VA mental health professional indicated that the Veteran met the DSM-IV criteria for PTSD noted as due to combat, and provided an Axis I diagnosis of PTSD. Subsequently, November 2008 and March 2009 records further report that findings are consistent, in pertinent part, with a diagnosis of PTSD. See Cohen v. Brown, 10 Vet. App. 128, 144 (1997) (a PTSD diagnosis presumably is in accordance with the DSM-IV criteria, both in terms of the sufficiency and adequacy of the stressor claimed). Evidence against the Veteran's claim is included in January 2007 when the Veteran tested negative for a PTSD screening. Further evidence against the Veteran's claim is included in a January 2008 report. At that time, the Veteran underwent a psychological evaluation documented in a Vet Center intake report. He reported that "since his return of duty in Iraq[,] he has been experiencing an elevated level of anger, especially when in traffic." Following the evaluation, the physician noted the Veteran's neat appearance, appropriate speech and affect, intact memory, and participation in familial and social activities. The physician opined that "the [V]eteran generally functions pretty well both socially and occupational[ly] . . . [and the] reported symptoms do not meet the diagnostic criteria for PTSD." In addition, the Veteran was afforded VA examinations in connection with his claim on appeal in August 2007 and February 2009. At the August 2007 examination, the Veteran reported not being involved in any current mental health treatment, but did take medications in the past for his claimed psychiatric disorder. Upon returning from Iraq in April 2006, the Veteran noted that he began to have mental health symptoms associated with his Iraq War exposure and that his life is "an absolute mess." He currently, but rarely, becomes angry by screaming and yelling, and is verbally abusive to his wife and to other drivers. He drives aggressively at times and does not want cars close to him. He has no motivation, repeatedly watches television, is reclusive, and was previously afraid of bombs on the highway. The Veteran also reported a family history of mental illness and that his anxiety and depression are rare and he sometimes experiences anhedonia. Following the August 2007 examination, the examiner noted the Veteran's denial of nightmares, hallucinations, delusions, and suicidal or homicidal ideations. Based on an interview, mental status evaluation, review of records, and psychological testing consistent with the DSM-IV, the examiner did not diagnose the Veteran with a psychiatric disability. The examiner opined "that while [the Veteran] indicates that he has changed dramatically since coming back from Iraq[,] when questioned more closely, [the Veteran] denies having any real functional impairment. [The Veteran] may have some features of PTSD including stressors as well as anger and irritation. However, the primary symptoms of PTSD according to DSM-IV TR are not met. There is not a clear link between [his] current emotional impairment and his Iraq War experience." The examiner further explained that the "[Veteran] has some mild features of PTSD . . . [h]owever, he fails to meet the criteria for PTSD in terms of frequency and severity of symptoms . . . [and] [h]e does not have any significant functional impairment." Most recently, at the February 2009 examination, the Veteran continued his complaints of getting angry fast and now extreme aggression when driving. He also reported that he does not fall asleep as easily as he used to and that he is more shut off and withdrawn, including from his wife. He has lost interest in prior enjoyable activities and "sometimes [he] just feel[s] like everybody would be better off without [him]." He denied symptoms of nightmares and flashbacks, but noted having memories of old and destroyed equipment in which people might have been injured or killed, such as rocket and mortar attacks. He also reported attending a few counseling sessions at the Vet Center but stopped, and taking prescription medication "a couple of times" which helped him to sleep better. Furthermore, the Veteran's wife, who reported knowing the Veteran very well prior to his service in Iraq, reiterated the Veteran's contentions that he has changed, is more angry, and they do not communicate as well as they used to. Following the February 2009 examination, the examiner noted review of the Veteran's claims file, which included the May 2008 VA outpatient treatment record and the January 2008 Vet Center intake report. He also noted the Veteran's self-report of suicidal ideation and anger, as well as the Veteran's denial of homicidal ideation, delusions, and hallucinations. The examiner opined that although "the Veteran does not fully meet the criteria for PTSD, [the Veteran] does have significant psychiatric symptoms. In fact, the [V]eteran does have significant features of PTSD, though not quite enough in number and severity to meet diagnostic criteria. He experiences subjective outbursts, social withdrawal and isolation and diminished activities. Furthermore, it appears that these symptoms developed in response to traumatic stressors." As a result, the February 2009 VA examiner diagnosed the Veteran with an anxiety disorder not otherwise specified (NOS). "[T]he anxiety disorder NOS is a condition that developed secondary to the [V]eteran's military stressors . . . [and the Veteran] exhibits subjective distress and some social impairment which is mild to moderate, but . . . does not exhibit occupational impairment at this time." The examiner further noted that this opinion is "consistent with the conclusion reached by [the August 2007 VA examiner] and also by the mental health provider who assessed the Veteran at the Dallas Ve[t] Center [in January 2008]." Here, the evidence supportive of the Veteran's claim of record is the May 2008, November 2008, and March 2009 VA treatment records that revealed diagnoses of PTSD. The Board finds these records, as a whole, to be of probative value. Each has diagnosed the Veteran with PTSD after having provided him in-person treatment. In particular, the May 2008 VA mental health professional rendered a PTSD diagnosis which was described as related to "combat trauma." With regard to the weight to assign to these medical opinions, the Court has held that "[t]he probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches . . . As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the [BVA as] adjudicators." Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). The Board notes that each of the examiners who declined to diagnose PTSD saw the Veteran only on a single occasion, whereas the VA mental health providers who diagnosed PTSD afforded continuous treatment and they were therefore privy to a more complete picture of his current psychiatric state. The Board recognizes that the Court has not fully embraced a "treating physician rule" under which a treating physician's opinion would presumptively be given greater weight than that of any other examiner. See Winsett v. West, 11 Vet. App. 420, 424-25 (1998); Guerrieri, 4 Vet. App. at 471-73. Nevertheless, the length of an examiner's opportunity or opportunities to examine a claimant may be considered in assigning probative weight. Guerrieri at 471-73. Based on the above, the Board finds the May 2008, November 2008, and March 2009 VA outpatient treatment records, which reflect current diagnoses of PTSD, are probative and considering all of the evidence, lay and medical, including the VA examinations, the January 2007 PTSD screening, and the Vet Center Intake note, which found a PTSD diagnosis was not warranted, the Board finds that the evidence is in equipoise with regard to whether there is a current diagnosis of PTSD due to conceded combat and service connection is warranted for PTSD. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. ORDER Service connection for PTSD is granted. REMAND A remand is required in this case to ensure that there is a complete record upon which to decide the Veteran's claims of service connection for a bilateral ankle disability and a bilateral knee disability. VA has a duty to make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the claim for the benefits sought, unless no reasonable possibility exists that such assistance would aid in substantiating the claim. 38 U.S.C.A. § 5103A(a) (West 2002); 38 C.F.R.§ 3.159(c), (d) (2012). Pursuant to the June 2011 Board Remand, the Veteran underwent VA examinations of his ankles and knees in December 2012. The VA examiner who conducted both examinations provided medical opinions as to the etiology of the Veteran's bilateral knee and bilateral ankle disabilities. He noted the Veteran's report of injuring his left ankle in service and shortly after, the Veteran noticed right ankle pain. He reported being treated with Motrin and an ace wrap. The Veteran also reported repeated injuries and treatment of the left ankle in service. The examiner next noted the Veteran's report of injuring his right knee in service and shortly after, the Veteran noticed left knee pain. He reported being treated and diagnosed with a contusion. The Veteran also reported having "on and off" knee pain. As to the bilateral ankle disability, the examiner opined that the bilateral ankle condition is less likely than not related to military service. He explained that he did not find any medical documentation of complaints or treatment for an ankle condition in service and that the PDHRA was negative for any ankle complaints. As to the bilateral knee disability, the examiner opined that the bilateral knee condition is less likely than not related to military service. In an identical rationale, the examiner explained that he did not find any medical documentation of complaints or treatment for a knee condition in service and that the PDHRA was negative for any knee complaints. Here, the Board finds the December 2012 VA examinations of the bilateral ankles and knees inadequate for VA compensation purposes. The examiner did not offer adequate rationales as to why the Veteran's current bilateral ankle and knee disabilities are not related to service. Indeed, the VA examiner did not address the significance, if any, of the Veteran's reported history of in-service injuries to his ankles and knees. The Board emphasizes that the Veteran is competent to describe the injury and treatment of his ankles and knees experienced in service as well his in-service symptomatology. See Buchanan v. Nicholson, 451 F.3d 1331, 1336, 1337 (Fed. Cir. 2006); see also Dalton v. Nicholson, 21 Vet. App. 23 (2007) (examination was inadequate where the examiner did not comment on the Veteran's report of in-service injury and instead relied on the absence of evidence in the service treatment records to provide a negative opinion). In fact, a December 2002 service treatment record documented an in-service injury of the left knee and the Veteran was subsequently placed on short-term disability. Also, in the March 2006 PDHRA, the Veteran marked "yes during" for swollen, stiff, or painful joints. As such, the December 2012 VA opinions are also inadequate as they are based on inaccurate facts. See Reonal, 5 Vet. App. at 461 (holding that the Board may reject a medical opinion based on an inaccurate factual basis) Indeed, as explicitly instructed in the June 2011 Board Remand, the December 2012 VA examiner did not comment on or address whether any diagnosed, bilateral ankle or bilateral knee disability is consistent with the Veteran's purported in-service injuries, to include the December 2002 service treatment record. In this regard, a remand by the Board confers on the claimant, as a matter of law, the right to compliance with the remand orders. Stegall at 271. Failure of the Board to ensure compliance with remand instructions constitutes error and warrants the vacating of a subsequent Board decision. Id. Therefore, pursuant to Stegall, the case must again be remanded for compliance with the June 2011 Board Remand and adequate medical opinions must be obtained. Addendum medical opinions are required to determine the etiology of the Veteran's bilateral ankle and bilateral knee disabilities. Accordingly, the issues of service connection for a bilateral ankle disability and service connection for a bilateral knee disability are REMANDED for the following action: 1. If possible, request that the medical professional who conducted the December 2012 VA examinations review the claims file and provide addendum medical opinions. The claims file, including a copy of this Remand, must be made available to, and be reviewed by, the examiner. The examiner should note such review in the examination report (another examination of the Veteran is not required). If the December 2012 examiner is not available, obtain the requested opinions from a medical professional with expertise in orthopedics. If the examiner determines that an additional examination of the Veteran is necessary to provide reliable opinions as to causation, such examination should be scheduled. However, the Veteran should not be required to report for another examination as a matter of course, if it is not found to be necessary. The claims folder must be made available to and reviewed by the examiner. The examiner is requested to provide opinions on the following: a) Is it at least as likely as not (50 percent probability or greater) that any current disability of the bilateral ankles, to include bilateral ankle sprain, began during service or is otherwise etiologically linked to some incident of active duty? b) Is it at least as likely as not (50 percent probability or greater) that any current disability of the bilateral knees, to include bilateral knee sprain, bilateral knee arthralgia, and bilateral knee patellofemoral syndrome, began during service or is otherwise etiologically linked to some incident of active duty? In answering these questions, the examiner should specifically address and comment on the Veteran's reported in-service injuries and treatment of the bilateral ankles and knees, the December 2002 service treatment report indicating an injury of the left knee in service, and the March 2006 PDHRA indicating the Veteran report of swollen, stiff, or painful joints. The term "at least as likely as not" does not mean merely within the realm of medical possibility, but rather 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 causation as it is to find against it. A rationale should be given for all opinions and conclusions rendered. The opinions should address the particulars of this Veteran's medical history and the relevant medical science as applicable to this claim. If an opinion cannot be rendered without resorting to speculation, the examiner should state whether the inability to provide an opinion was due to a need for further information (with said needed information identified) or because the limits of medical knowledge had been exhausted regarding the etiology of the disorder. 2. Then, review the claims folder and ensure that all of the foregoing development actions have been conducted and completed in full. In this regard, ensure that the detailed questions asked by the Board have been addressed by the examiner. If any development is incomplete, appropriate corrective action is to be implemented. Specific attention is directed to the addendum medical opinions. If the requested addendum does not include adequate responses to the specific opinions requested, it must be returned for corrective action. 38 C.F.R. § 4.2 (2012); see also Stegall at 268. 3. When the development requested has been completed, and compliance with the requested actions has been ensured, readjudicate the claims on the basis of the additional evidence. If the benefits sought are 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 Veteran 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). ______________________________________________ K.J. ALIBRANDO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs