Citation Nr: 1324137 Decision Date: 07/30/13 Archive Date: 08/07/13 DOCKET NO. 07-32 558 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Juan, the Commonwealth of Puerto Rico THE ISSUES 1. Entitlement to an earlier effective date than May 9, 2005, for a grant of service connection for a right wrist disability. 2. Whether new and material evidence has been received to reopen a claim of service connection for a cervical spine disability. 3. Whether new and material evidence has been received to reopen a claim of service connection for a lumbosacral spine disability. 4. Entitlement to an initial rating greater than 30 percent for major depressive disorder. 5. Entitlement to a disability rating greater than 30 percent for residuals of a right elbow injury. 6. Entitlement to a disability rating greater than 30 percent for residuals of a right shoulder injury. 7. Entitlement to a compensable disability rating prior to April 5, 2008, and to a disability rating greater than 10 percent thereafter, for residuals of a fourth metacarpal fracture of the right hand. 8. Entitlement to a disability rating greater than 10 percent for a right wrist disability. 9. Entitlement to an earlier effective date than October 16, 2006, for a 10 percent rating for a right wrist disability. ATTORNEY FOR THE BOARD Michael T. Osborne, Counsel INTRODUCTION The Veteran had active service from May 1976 to May 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, the Commonwealth of Puerto Rico. In April 2011, the Veteran revoked the power of attorney in favor of his former service representative and currently is before VA pro se. Although he initially requested an RO hearing on his currently appealed claims, the Veteran also withdrew his RO hearing request in April 2011. Having reviewed the voluminous evidence of record, the Board finds that the issues on appeal are characterized more appropriately as stated on the title page of this decision. The Board notes that, in May 2004, it denied the Veteran's requests to reopen previously denied claims of service connection for a cervical spine disability and for a lumbosacral spine disability, each to include as secondary to service-connected right elbow and right shoulder injuries. This decision was not appealed to the United States Court of Appeals for Veterans Claims (Court) and became final. See 38 U.S.C.A. § 7266 (West 2002 & Supp. 2012). In statements on a VA Form 21-4138 date-stamped as received by VA in April 2008, the Veteran requested that these claims be reopened. He also limited consideration of these reopened claims to the issues of whether he was entitled to service connection for a cervical spine disability and for a lumbosacral spine disability on a direct service connection basis. See 38 C.F.R. §§ 3.303, 3.304 (2012). Although the Board recognizes that normally it must consider all potential theories of entitlement reasonably raised by the evidence, having reviewed the evidence of record, and especially in light of the Veteran's own April 2008 statements, these issues are as stated on the title page of this decision. See also Szemraj v. Principi, 357 F.3d 1370, 1371 (Fed. Cir. 2004), and Roberson v. Principi, 251 F.3d 1378, 1384 (Fed. Cir. 2001) (explaining that the Board must consider all potential theories of entitlement raised by the evidence). The Board also notes that, in March 2007, it adjudicated a claim of entitlement to a disability rating greater than 20 percent for a right shoulder disability. A review of the Veteran's voluminous claims file shows that this was error as the Veteran already was in receipt of a 30 percent rating for his service-connected right shoulder disability in March 2007. A review of the claims file also shows that the RO correctly adjudicated the currently appealed claim as a claim of entitlement to a disability rating greater than 30 percent for a right shoulder disability. The Veteran has perfected a timely appeal on this claim. Thus, the Board finds that its March 2007 decision was not prejudicial to the Veteran. The Board finally notes that, in Rice v. Shinseki, the Court held that a TDIU claim cannot be considered separate and apart from an increased rating claim. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Instead, the Court held that a TDIU claim is an attempt to obtain an appropriate rating for a service-connected disability. The Court also found in Rice that, when entitlement to a TDIU is raised during the adjudicatory process of the underlying disability, it is part of the claim for benefits for the underlying disability. The record in this case indicates that the Veteran has asserted that he is not employable by reason of his service-connected disabilities. His TDIU claim already has been adjudicated by the RO. And the Veteran did not initiate an appeal of the denial of his TDIU claim. Accordingly, the Board finds that a TDIU claim is not part of the Veteran's currently appealed claims. The Board recognizes that this appeal has been ongoing for many years and regrets the delay caused by the need for appropriate development of these claims. The Board notes in this regard that the most recent delay was caused by the need to obtain translation of multiple documents submitted to VA that were in Spanish. With the exception of the Veteran's claim of entitlement to an earlier effective date than May 9, 2005, for the grant of service connection for a right wrist disability, the other currently appealed claims 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. VA will notify the Veteran if further action is required on his part. FINDINGS OF FACT 1. The record evidence demonstrates that the Veteran's claim of service connection for a right wrist disability was dated on June 5, 2002, and date-stamped as received by VA on June 6, 2002. 2. The record evidence shows that the Veteran has prosecuted his service connection claim for a right wrist disability continuously since June 6, 2002. CONCLUSION OF LAW The criteria for an effective date of June 6, 2002, for a grant of service connection for a right wrist disability have been met. 38 U.S.C.A. §§ 5110, 5111 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.4(b)(1), 3.31, 3.151, 3.155, 3.400 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Before assessing the merits of the appeal, VA's duties under the Veterans Claims Assistance Act of 2000 (VCAA) must be examined. The VCAA provides that VA shall apprise a claimant of the evidence necessary to substantiate his claim for benefits and that VA shall make reasonable efforts to assist a claimant in obtaining evidence unless no reasonable possibility exists that such assistance will aid in substantiating the claim. The Veteran's earlier effective date claim for a right wrist disability is a "downstream" element of the RO's grant of service connection for this disability in the currently appealed rating decision. For such downstream issues, notice under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159 is not required in cases where such notice was afforded for the originating issue of service connection. See VAOPGCPREC 8-2003 (Dec. 22, 2003). Courts have held that once service connection is granted, the claim is substantiated, additional notice is not required, and any defect in the notice is not prejudicial. Hartman v. Nicholson, 483 F.3d. 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). In August 2001, June 2002, April 2004, April and November 2006, March 2008, November 2009, and in April 2010, VA notified the Veteran of the information and evidence needed to substantiate and complete his claim, including what part of that evidence he was to provide and what part VA would attempt to obtain for him. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio, 16 Vet. App. at 187. These letters also noted other types of evidence the Veteran could submit in support of his claim. The Veteran further was informed of when and where to send the evidence. After consideration of the contents of these letters, the Board finds that VA has satisfied substantially the requirement that the Veteran be advised to submit any additional information in support of his claim. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). As will be explained below in greater detail, the evidence supports assigning an earlier effective date of June 6, 2002, for the grant of service connection for a right wrist disability. Thus, any failure by the RO to provide notice as to the disability rating under the VCAA cannot be considered prejudicial to the Veteran. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). The Veteran also has had the opportunity to submit additional argument and evidence and to participate meaningfully in the adjudication process. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). With respect to the timing of the notice, the Board points out that the Court held that a VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction decision on a claim for VA benefits. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). Here, notice as to what is required to substantiate the Veteran's claim was issued prior to the currently appealed rating decision. Because the Veteran was fully informed of the evidence needed to substantiate his claim, any failure of the RO to notify the Veteran under the VCAA cannot be considered prejudicial. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). The Board also finds that VA has complied with the VCAA's duty to assist by aiding the Veteran in obtaining evidence and affording him the opportunity to give testimony before the RO and the Board, although he declined to do so. It appears that all known and available records relevant to the issue on appeal have been obtained and associated with the Veteran's claims file; the Veteran has not contended otherwise. The Veteran also does not contend, and the evidence does not show, that he is in receipt of Social Security Administration (SSA) disability benefits such that a remand to obtain his SSA records is required. In response to a request for the Veteran's SSA records, SSA notified VA in June 2013 that no records were available because the Veteran had not filed for SSA disability benefits. As to any duty to provide an examination and/or seek a medical opinion, the Board notes that in the case of a claim for disability compensation, the assistance provided to the claimant shall include providing a medical examination or obtaining a medical opinion when such examination or opinion is necessary to make a decision on the claim. An examination or opinion shall be treated as being necessary to make a decision on the claim if the evidence of record, taking into consideration all information and lay or medical evidence (including statements of the Veteran) contains competent evidence that the claimant has a current disability, or persistent or recurring symptoms of disability; and indicates that the disability or symptoms may be associated with the Veteran's active service; but does not contain sufficient medical evidence for VA to make a decision on the claim. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4). There is no duty to provide an examination or a medical opinion in this case because such evidence would not be relevant to the earlier effective date claim on appeal. In summary, VA has done everything reasonably possible to notify and to assist the Veteran and no further action is necessary to meet the requirements of the VCAA. Law and Regulations The Veteran contends that he is entitled to an effective date earlier than May 9, 2005, for a grant of service connection for a right wrist disability. He specifically contends that June 6, 2002, is the appropriate effective date for the grant of service connection for a right wrist disability because that was the date that his original claim was date-stamped as received by VA. In general, except as otherwise provided, the effective date of an evaluation an award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C.A. § 5110(a); 38 C.F.R. § 3.400. For claims of entitlement to service connection, the effective date will be the day following separation from active service or date entitlement arose if the claim is filed within one year of discharge from service, otherwise the effective date is the date of receipt of claim or date entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2)(i) (2012). A "claim" is defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p); Brannon v. West, 12 Vet. App. 32, 34-35 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). Any communication indicating an intent to apply for a benefit under the laws administered by the VA may be considered an informal claim provided it identifies, but not necessarily with specificity, the benefit sought. See 38 C.F.R. § 3.155(a). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). Upon receipt of an informal claim, if a formal claim has not been filed, the RO will forward an application form to the claimant for execution. If the RO receives a complete application from the claimant within one year from the date it was sent, the RO will consider it filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155 (2012). Factual Background The record evidence demonstrates that the Veteran's original claim of service connection for a right wrist disability was included on a VA Form 21-4138 dated on June 5, 2002, and date-stamped as received by VA on June 6, 2002. The Veteran stated on this form that, while on active service in Panama, he had fallen and fractured his right wrist. Following this injury, he had been taken to a hospital "and my wrist was put into a cast" which he wore for approximately 3 months. The Veteran also stated that this was the first time that he had filed for service connection for a right wrist disability "and the evidence to sustain my claim should be found in my service medical records." In a letter dated on June 28, 2002, and mailed to the Veteran, he was advised by VA that he recently had filed a claim of service connection for a right wrist condition and of his rights, and VA's duties to notify and assist him, in the claims adjudication process. In a letter dated on July 2, 2002, and date-stamped as received by the RO on July 8, 2002, the Veteran provided evidence in support of his service connection claim for a right wrist disability and asked VA to advise him of any additional information or evidence needed to process this claim. He included copies of certain service treatment records and provided a detailed listing of when and where he injured his right wrist and/or received treatment for this disability. In a letter dated on November 16, 2002, and mailed to the Veteran, he was informed that VA records showed that he had filed a claim on June 6, 2002, but the paperwork for this claim had been misplaced. He also was advised that, until the requested evidence was received, no further action would be taken on his claim. In a letter dated on May 3, 2004, the Veteran submitted copies of his prior claim of service connection for a right wrist disability that had been date-stamped as received by VA on June 6, 2002. Several of these pages were stamped "DUPLICATE" by RO personnel. In a letter dated on September 29, 2004, and mailed to the Veteran, he was informed that VA was working on his claim for benefits and had requested medical evidence from several private providers that he had identified. In statements on a VA Form 21-4138 dated on May 2, 2005, and date-stamped as received by the RO on May 9, 2005, the Veteran's service representative requested a status update on the claim of service connection for a right wrist which had been filed on June 6, 2002. In a rating decision dated on September 15, 2006, and issued to the Veteran and his service representative that same day, the RO granted the Veteran's claim of service connection for a right wrist disability (which was characterized as residuals of a fracture of the right wrist) and assigned a zero percent rating effective May 9, 2005. The RO concluded that May 9, 2005, was the appropriate effective date for a grant of service connection for a right wrist disability because that was the date that VA had received the Veteran's claim. In statements on a VA Form 21-4138 dated on October 2, 2006, and date-stamped as received by the RO on October 16, 2006, the Veteran asserted, " I also have proof that I sent my claim [in] on 06/05/02. I have a document that proof [sic] that you received the claim on 06/06/2002." In statements on a VA Form 9 dated on October 5, 2007, and date-stamped as received by the RO on October 15, 2007, the Veteran requested an earlier effective date of June 6, 2002, for the grant of service connection for a right wrist disability. He specifically contended that this claim had been received by VA on June 10, 2002. Analysis The Board finds that the evidence supports assigning an earlier effective date of June 6, 2002, for a grant of service connection for a right wrist disability. The Veteran has contended that his original service connection claim for this disability was filed at the RO on June 6, 2002. He also essentially contends that, but for RO error in losing his original claim paperwork between June 6, 2002, and November 16, 2002, when he was notified by VA that this paperwork had been lost, the appropriate effective date for the grant of service connection for a right wrist disability is June 6, 2002. The evidence of record clearly supports these assertions and demonstrates that the Veteran is entitled to an earlier effective date of June 6, 2002, for a grant of service connection for a right wrist disability. It is clear that the Veteran's original service connection claim for a right wrist disability was date-stamped as received at the RO on June 6, 2002. It is unclear why or how RO personnel lost or misplaced the Veteran's original claim paperwork, especially in light of the "DUPLICATE" stamp marked on this paperwork when the Veteran resubmitted it in May 2004. It is not clear from a review of the record evidence why the evidence received in May 2004 was considered duplicate of evidence previously submitted if the originals had been lost by the RO and needed to be resubmitted by the Veteran. The Board also finds it especially significant that the original paperwork for the Veteran's service connection claim for a right wrist disability was included in appropriate chronological order in his voluminous claims file when it was certified for appellate review by the RO in September 2011. This persuasively suggests that the Veteran filed his original service connection claim for a right wrist disability on June 6, 2002. It also is clear from a review of the record evidence that VA received this claim from the Veteran on June 6, 2002, because the RO promulgated the November 16, 2002, letter notifying him that his claim had been received on that date but the paperwork apparently had been lost. The Board notes further that the Court has held that "[t]he presumption of regularity supports the official acts of public officers and, in the absence of clear evidence to the contrary, courts presume that they have properly discharged their official duties." Clear evidence to the contrary is required to rebut the presumption of regularity. See Ashley v. Derwinski, 2 Vet. App. 307 (1992) (quoting United States v. Chemical Foundation, 272 U.S. 1, 14-15 (1926)). While Ashley dealt with the regularity of Board procedures, in Mindenhall v. Brown, 7 Vet. App. 271 (1994), the Court applied the presumption of regularity to procedures at the RO level. In this case, there is no clear evidence demonstrating that the RO either did not receive the Veteran's claim of service connection for a right wrist disability on June 6, 2002, or that it did not issue the November 16, 2002, letter which notified him that the paperwork for this claim had been lost. Applying the presumption of regularity to the facts of this case, the Board finds that the date-stamp indicating that a claim of service connection for a right wrist disability was filed by the Veteran on June 6, 2002, and the November 16, 2002, letter issued to the Veteran (indicating the loss of his original claim paperwork) were promulgated by the RO as part of its regular claims processing work. In summary, the Board concludes that the Veteran has prosecuted a claim of service connection for a right wrist disability continuously since he filed his original claim on June 6, 2002, the date that it was received by VA. For claims of entitlement to service connection, the effective date will be the day following separation from active service or date entitlement arose if the claim is filed within one year of discharge from service; otherwise, the effective date is the date of receipt of claim or date entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2)(i) (2012). In this case, the date of the Veteran's claim is June 6, 2002. A VA examination report dated in December 2006 also indicates that the Veteran related right wrist symptoms which existed at the time that his original claim was filed. See Gilpin v. West, 135 F.3d 1353, 1355-1356 (Fed. Cir. 1998) (finding requirement of current symptomatology at time application filed to be permissible interpretation of statutes governing compensation benefits). Hence, and after resolving any reasonable doubt in the Veteran's favor, the Board finds that the criteria for an effective date of June 6, 2002, for a grant of service connection for a right wrist disability have been met. See 38 U.S.C.A. § 5110(a); 38 C.F.R. § 3.400(b)(2). ORDER Entitlement to an effective date of June 6, 2002, for a grant of service connection for a right wrist disability is granted. REMAND The Veteran has contended that new and material evidence has been received sufficient to reopen his previously denied claims of service connection for a cervical spine disability and for a lumbosacral spine disability. He also has contended that his service-connected major depressive disorder, residuals of a right elbow injury, residuals of a right shoulder injury, residuals of a fourth metacarpal fracture of the right hand, and right wrist disability all are more disabling than currently evaluated. He has contended further that he is entitled to an earlier effective date than October 16, 2006, for a 10 percent rating for his service-connected right wrist disability. Having reviewed the evidence of record, the Board finds that additional development is necessary before these claims can be adjudicated on the merits. With respect to the Veteran's requests to reopen his previously denied service connection claims for disabilities of the cervical spine and lumbosacral spine, the Board notes that, on several occasions, he has submitted evidence from the U.S. Department of Labor Office of Worker's Compensation Programs (OWCP) indicating that he filed a claim for worker's compensation based on injuries to his cervical spine and lumbosacral spine. To date, the RO has not attempted to obtain this evidence. The Board notes in this regard that VA's duty to assist includes making "as many requests as are necessary to obtain relevant records from a Federal department or agency." See 38 C.F.R. § 3.159(c)(2) (2012). Thus, the Board finds that on remand, the RO/AMC should contact OWCP and attempt to obtain any records for the Veteran's worker's compensation claim. With respect to the Veteran's increased rating claims for his service-connected major depressive disorder, residuals of a right elbow injury, residuals of a right shoulder injury, residuals of a fourth metacarpal fracture of the right hand, and right wrist disability, he asserted in May 2011 correspondence that all of these disabilities are more disabling than currently (or initially) evaluated. A review of the claims file shows that the Veteran's most recent VA psychiatric examination occurred in December 2009 and his most recent VA joints examination occurred in April 2010. The Board notes that VA's duty to assist under the VCAA includes obtaining an examination or medical opinion when necessary. The Court has held that when a Veteran alleges that his service-connected disability has worsened since he was examined previously, a new examination may be required to evaluate the current degree of impairment. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Given the Veteran's contentions, and given the length of time which has elapsed since his most recent VA examinations in December 2009 and in April 2010, the Board finds that, on remand, he should be scheduled for updated VA examinations to determine the current nature and severity of his service-connected residuals of a right elbow injury, residuals of a right shoulder injury, residuals of a fourth metacarpal fracture of the right hand, and right wrist disability. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159. With respect to the Veteran's claim for an earlier effective date than October 16, 2006, for a 10 percent rating for a right wrist disability, the Board notes that adjudication of his increased rating claim for a right wrist disability likely will impact adjudication of this earlier effective date claim. Thus, the Board finds that these claims are inextricably intertwined and adjudication of the Veteran's earlier effective date claim for a 10 percent rating for a right wrist disability must be deferred. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that two issues are inextricably intertwined when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). The RO/AMC also should attempt to obtain the Veteran's up-to-date VA and private outpatient treatment records. The Board notes in this regard that, if any documents obtained are in Spanish, then the RO/AMC should translate them and include the translations in the Veteran's claims file before recertifying this appeal. Accordingly, the case is REMANDED for the following action: 1. Contact the Veteran and ask him to identify all VA and non-VA clinicians who have treated him for major depressive disorder since his service separation and/or for residuals of a right elbow injury, residuals of a right shoulder injury, residuals of a fourth metacarpal fracture of the right hand, and/or for a right wrist disability in recent years. Ask the Veteran to provide copies of all documents related to his application for worker's compensation benefits from the U.S. Department of Labor, Office of Worker's Compensation Programs (OWCP), that are in his possession. Advise the Veteran not to resubmit any records already provided to VA. Obtain all VA treatment records which have not been obtained already. Once signed releases are received from the Veteran, obtain all private treatment records which have not been obtained already. A copy of any records obtained, to include a negative reply, should be included in the claims file. If any documents obtained are in Spanish, please translate them and include the translations in the Veteran's claims file before recertifying this appeal to the Board. 2. Contact the U.S. Department of Labor, Office of Worker's Compensation Programs (OWCP), and request a complete copy of all records pertaining to the Veteran's claim for worker's compensation benefits. A copy of any records obtained, to include a negative reply, should be included in the claims file. 3. Schedule the Veteran for appropriate examination to determine the nature and extent of his service-connected major depressive disorder. The claims file and a copy of this remand must be provided to the examiner for review. All appropriate testing should be conducted. The Veteran should be asked to provide a complete medical history, if possible. The examiner is asked to state whether the Veteran's service-connected major depressive disorder is manifested by occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks more than once a week, difficulty in understanding complex commands, impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks), impaired judgment, impaired abstract thinking, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The examiner also is asked to state whether the Veteran's service-connected major depressive disorder is manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood due to such symptoms as suicidal ideation, obsessional rituals which interfere with routine activities, speech intermittently illogical, obscure, or irrelevant, near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively, impaired impulse control (such as unprovoked irritability with periods of violence), spatial disorientation, neglect of personal appearance and hygiene, difficulty in adapting to stressful circumstances (including work or a work-like setting), or an inability to establish and maintain effective relationships. The examiner finally is asked to state whether the Veteran's service-connected major depressive disorder is manifested by total occupational and social impairment due to such symptoms as gross impairment in thought process or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place, and memory loss for names of close relatives, own occupation, or own name. 4. Schedule the Veteran for appropriate examination to determine the nature and extent of his service-connected residuals of a right elbow injury. The claims file and a copy of this remand must be provided to the examiner for review. All appropriate testing should be conducted. The Veteran should be asked to provide a complete medical history, if possible. The examiner is asked to state whether the Veteran's service-connected residuals of a right elbow injury are manifested by forearm flexion limited to 55 degrees or forearm flexion limited to 45 degrees. 5. Schedule the Veteran for appropriate examination to determine the nature and extent of his service-connected residuals of a right shoulder injury. The claims file and a copy of this remand must be provided to the examiner for review. All appropriate testing should be conducted. The Veteran should be asked to provide a complete medical history, if possible. The examiner is asked to state whether the Veteran's service-connected residuals of a right shoulder injury are manifested by limitation of motion of the arm to 25 degrees from the side. 6. Schedule the Veteran for appropriate examination to determine the nature and extent of his service-connected residuals of a fourth metacarpal fracture of the right hand. The claims file and a copy of this remand must be provided to the examiner for review. All appropriate testing should be conducted. The Veteran should be asked to provide a complete medical history, if possible. The examiner is asked to state whether the Veteran's service-connected residuals of a fourth metacarpal fracture of the right hand are manifested by favorable ankylosis of the index and long fingers, index and ring fingers, or index and little fingers. The examiner also is asked to state whether the Veteran's service-connected residuals of a fourth metacarpal fracture of the right hand are manifested by favorable ankylosis of the thumb and any finger. 7. Schedule the Veteran for appropriate examination to determine the nature and extent of his service-connected right wrist disability. The claims file and a copy of this remand must be provided to the examiner for review. All appropriate testing should be conducted. The Veteran should be asked to provide a complete medical history, if possible. The examiner is asked to state whether the Veteran's service-connected right wrist disability is manifested by wrist ankylosis. If right wrist ankylosis is present, then the examiner is asked to state whether it is favorable in 20 to 30 degrees of dorsiflexion, in any other position except favorable, or is unfavorable, in any degree of palmar flexion, or with ulnar or radial deviation. 8. The Veteran should be given adequate notice of the requested examinations which includes advising him of the consequences of his failure to report to the examinations. If he fails to report to the examinations, then this fact should be noted in the claims file and a copy of the scheduling of examination notification or refusal to report notice, whichever is applicable, should be obtained by the RO and associated with the claims file. 9. Review all evidence received since the last prior adjudication and readjudicate the Veteran's claims. If the determination remains unfavorable to the Veteran, then the RO should issue a supplemental statement of the case that contains notice of all relevant actions taken, including a summary of the evidence and applicable law and regulations considered pertinent to the issues. An appropriate period of time should be allowed for response by the Veteran. Thereafter, the case should be returned to the Board for further appellate consideration, if in order. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ WAYNE M. BRAEUER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs