Citation Nr: 1324138 Decision Date: 07/30/13 Archive Date: 08/07/13 DOCKET NO. 07-18 451 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for bilateral hallux valgus and hammertoes to include as secondary to the service-connected bilateral pes planus. 2. Entitlement to an increased disability rating in excess of 30 percent for bilateral pes planus. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD C.L. Krasinski, Counsel INTRODUCTION The Veteran, who is the Appellant in this case, had active service from October 1978 to August 1979. He served from June 1980 to June 1982 under honorable conditions. The Veteran's period of service from June 1982 to June 1984 was dishonorable for VA purposes and is a bar to the receipt of VA benefits during that period. Therefore, the relevant period of active duty for consideration in this case is from October 1978 to August 1979 and from June 1980 to June 1982. This matter comes before the Board of Veterans' Appeals (BVA or Board) from rating decisions dated in February 2006 and February 2008 by the above Department of Veterans Affairs (VA) Regional Office (RO). The February 2006 rating decision denied entitlement to an increased rating for the service-connected foot disability. In the February 2006 rating decision, the RO characterized the service-connected pes planus as severe bilateral hallux valgus with bilateral hammertoes. However, in the June 2007 statement of the case and the October 2009 supplemental statement of the case, the RO properly characterized the service-connected bilateral foot disability as bilateral pes planus and the claim has been properly developed as entitlement to an increased rating for the service-connected pes planus. The February 2008 rating decision denied entitlement to service connection for bilateral hammertoes and hallux valgus to include as secondary to the service-connected bilateral pes planus. In June 2007, the Veteran requested a hearing before the Board for the increased rating claim. However, in June 2012, before a hearing was scheduled, the Veteran withdrew his request. See 38 C.F.R. § 20.704(d) (2012). In a September 2009 rating decision, the RO granted entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) from March 10, 2009. 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 issue of entitlement to an increased disability rating in excess of 30 percent for bilateral pes planus is remanded to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The Veteran did not manifest recurrent symptoms of hallux valgus or hammertoes in active service. 2. The bilateral hallux valgus and hammertoes were not caused by any in-service event, are not related to active service, and are not proximately due to or aggravated by a service-connected disability. 3. The competent, credible, and probative evidence establishes that the bilateral hallux valgus and hammertoes are not proximately due to or aggravated by the service-connected bilateral pes planus. CONCLUSION OF LAW The criteria for service connection for bilateral hallux valgus and hammertoes are not met. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (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), 3.159, 3.326(a) (2012). When VA receives a complete or substantially complete application for benefits, it is required to notify the claimant and the representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). VA must (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. The Board finds that the VCAA notice requirements have been satisfied by letters dated in June 2007 and January 2009. In these letters, VA informed the Veteran of the evidence and information needed to substantiate a claim for secondary service connection and informed the Veteran of which information and evidence he was to provide to VA and which information and evidence VA would attempt to obtain on his behalf. VA informed the Veteran it had to obtain any records held by any federal agency. These letters also informed the Veteran that on his behalf VA would make reasonable efforts to obtain records that were not held by a federal agency, such as records from private doctors and hospitals. Finally, the letters told the Veteran that he could obtain private records himself and submit them to VA. The VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between a veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. The Court held that the VCAA notice must include notice that a disability rating and an effective date of the award of benefits will be assigned if service connection was awarded. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). In the present appeal, the January 2009 letter explained the type of evidence necessary to establish a disability rating and effective date for the claims on appeal. The claim was readjudicated in the January 2010 statement of the case, thus curing any lack of timeliness of notice. Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). VA has a duty to assist a veteran in the development of the claim. This duty includes assisting the veteran in the procurement of service treatment records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Veteran's service treatment records are associated with the claims folder. VA treatment records dated from 2005 to 2010 are associated with the claims folder. VA provided an examination in March 2009 to obtain medical evidence as to the nature and likely etiology of the claimed bilateral hallux valgus and hammertoes. A medical opinion as to etiology was also obtained in January 2008. Each examination is adequate because the examination was performed by a medical professional based on review of claims file, solicitation of history and symptomatology from the Veteran, and an examination of the Veteran. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The VA examiner provided a medical opinion as to whether the claimed disability was caused by the service-connected pes planus. Neither the Veteran nor his representative has challenged the adequacy of the examination obtained for the issue on appeal. Sickels v. Shinseki, 643 F.3d 1362 (Fed. Cir. 2011) (holding that the Board is entitled to presume the competence of a VA examiner and the adequacy of his opinion). Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion has been met. 38 C.F.R. § 3.159(c)(4). For these reasons, the Board finds that the duties to notify and assist the Veteran have been met, so that no further notice or assistance to the Veteran is required to fulfill VA's duty to assist in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001). The Board finds that no reasonable possibility exists that any other assistance would aid in substantiating the claim and VA met its duty to assist the Veteran. Laws and Regulations Service connection will be granted for disability resulting from a disease or injury incurred in or aggravated by military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection requires competent evidence showing, (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002); see also Caluza v. Brown, 7 Vet. App. 498 (1995). In this case, hallux valgus and hammertoes are not listed among the "chronic diseases" under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) does not apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Court has held that service connection can be granted for a disability that is aggravated by a service-connected disability and that compensation can be paid for any additional impairment resulting from the service-connected disorder. Allen v. Brown, 7 Vet. App. 439 (1995). Disabilities that are proximately due to, or aggravated by, service-connected disease or injury, provides that any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. The rating activity will determine the baseline and current levels of severity under the Schedule for Rating Disabilities and determine the extent of aggravation by deducting the baseline level of severity, as well as any increase in severity due to the natural progress of the disease, from the current level. 38 C.F.R. § 3.310. With disability compensation claims, VA adjudicators are directed to assess both medical and lay evidence. As a general matter, a layperson is not capable of opining on matters requiring medical knowledge. See 38 C.F.R. § 3.159(a)(2). In certain circumstances, however, lay evidence may be sufficient to establish a medical diagnosis or nexus. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). In addressing lay evidence and determining its probative value, if any, attention is directed to both competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). See Layno v. Brown, 6 Vet. App. 465, 469 (1994). In terms of competency, lay evidence has been found to be competent with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370, 374 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398, 405 (1995) (flatfoot). That notwithstanding, a veteran is not competent to provide evidence as to more complex medical questions and, specifically, is not competent to provide an opinion as to etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever). 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. See generally Caluza v. Brown, 7 Vet. App. 498 (1995). 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. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006); but see Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000) (evidence of a prolonged period without medical complaint after service can be considered along with other factors in the analysis of a service connection claim). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 7105; 38 C.F.R. §§ 3.102, 4.3, 4.7. Analysis The Veteran served on active duty from October 1978 to August 1979 and received an honorable discharge for that period of service. He served from June 1980 to June 1982 under honorable conditions. The Veteran's period of service from June 1982 to June 1984 was dishonorable for VA purposes and is a bar to the receipt of VA benefits during that period. See the December 1994 VA administrative decision which shows that service for the period from June 1982 to June 1984 was dishonorable and is considered a bar to payment of VA benefits and a disability which may have occurred during this time period is not eligible for VA benefits. See 38 C.F.R. § 3.12 (2012); Cropper v. Brown, 6 Vet. App. 450, 452 (1994). Based upon a review of all the lay and medical evidence, the Board finds the weight of the competent and credible evidence shows that the bilateral hallux valgus and hammertoes did not first manifest during active service, are not caused by any in-service event or injury, are not related to active service, and are not proximately due to or aggravated by the service-connected pes planus. The Veteran contends that he developed bilateral hallux valgus and hammertoes as a result of the service-connected bilateral pes planus. See the Veteran's statement dated in June 2007. Service connection has been granted for bilateral pes planus in 1994 and a 30 percent rating has been assigned from November 14, 1991. Hallux valgus and hammertoes were diagnosed upon VA examination in October 1992. An October 1992 x-ray examination detected bilateral hallux valgus deformities and a persistent hammertoe fixed alignment of the toes. The Veteran submitted statements from his VA podiatrist in support of his claim for secondary service connection. In the July 2007 statement, the VA podiatrist stated that it was his medical opinion that the Veteran's hammertoes were at least as likely as not secondary to his pes planus deformity. In a January 2010 statement, the VA podiatrist stated that the Veteran's hallux valgus condition was at least as likely as not secondary to his pes planus condition and contributed to the hammertoe/claw toe deformity. The Board has the duty to assess the credibility and weight to be given to the evidence. See Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997), and cases cited therein. In evaluating the probative value of medical statements, the Board looks at factors such as the health care provider's knowledge and skill in analyzing the medical data. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993); see also Black v. Brown, 10 Vet. App. 279, 284 (1997). Other factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Prejean v. West, 13 Vet. App. 444, 448-9 (2000). In Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), the Court found that guiding factors in evaluating the probity of a medical opinion are whether the opinion was based on sufficient facts or data, whether the opinion was the product of reliable principles and methods, and whether the medical professional applied the principles and methods reliably to the facts of the case. Id. The Court indicated that the claims file " is not a magical or talismanic set of documents, but rather a tool to assist VA examiners to become familiar with the facts necessary to form an expert opinion to assist the adjudicator in making a decision on a claim." Id. The Board finds the July 2007 and January 2010 medical opinions from the VA podiatrist to have limited probative value. The Board is not questioning the VA podiatrist's skill or expertise. However, the VA podiatrist's medical opinions are too general and conclusory. The VA podiatrist does not provide the rationale for the medical conclusion. Factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion. See Hernandez-Toyens, 11 Vet. App. at 382; see also Prejean, 13 Vet. App. at 448-9. In Nieves-Rodriguez, supra; the Court found that guiding factors in evaluating the probity of a medical opinion are whether the opinion was based on sufficient facts or data, whether the opinion was the product of reliable principles and methods, and whether the medical professional applied the principles and methods reliably to the facts of the case. Id. In the present case, the VA podiatrist did not provide a rationale or basis for the medical opinion and therefore, the medical opinions have limited probative value. The Board finds the weight of the competent and credible evidence shows that the bilateral hallux valgus and hammertoes are not proximately due to or aggravated by the service-connected pes planus. The Veteran was afforded a VA examination of the feet in March 2009 by a podiatrist. The VA examiner reviewed the claims folder and the Veteran's medical history, and examined the Veteran. The VA examiner opined that the Veteran had severe hallux valgus and hammer digits as a result of a hypermobile forefoot and not caused by the pes planus. The VA examiner stated that he did not see any findings consistent with severe pes planus and found quite the contrary by looking at the radiographs and physical examination. The examiner indicated that clearly, radiographically and by examination, the Veteran did not have flatfeet. The examiner indicated that the Veteran had a serious subluxed dislocated hallux valgus of both feet with contracted digits one through five which was the result of a hypermobile atavistic forefoot. The examiner stated that the Veteran had a serious forefoot deformity that was not associated with pes planus. Examination revealed some hypermobility at the tarsometatarsal joint. The examiner indicated that the Veteran's subjective complaints were not matching the objective findings in that the Veteran could not seem to describe pain at the hallux valgus only mid shaft area of both first metatarsals extending up his leg. The Board finds the above-cited VA medical opinion to be highly probative evidence. Nieves-Rodriguez; supra. This examination report has high probative value because the examiner relied on sufficient facts and data and provided a rationale for the respective opinion. The VA examiner reported the detailed examination findings which supported his medical conclusion, which was that the hypermobility of the forefoot caused the hallux valgus and hammertoes, not the pes planus. An independent medical opinion was obtained in January 2008 as to whether the service-connected pes planus caused the bilateral hallux valgus with bilateral hammer toes. The medical doctor reviewed the service treatment records, VA treatment records dated in 2007 and the QTC examination report dated in July 2007. The medical doctor concluded that it was less likely than not that the bilateral hallux valgus and bilateral hammertoes were secondary to the bilateral pes planus because pes planus is not a common casual effect for hallux valgus and hammer toes. The Board finds the January 2008 medical opinion to have great evidentiary weight as the opinion reflects a comprehensive and reasoned review of the pertinent evidence of record and there was a rationale for the medical conclusion. See Hernandez-Toyens; supra. The medical opinion is based on sufficient facts and data. See Nieves-Rodriguez, supra. The Board finds the March 2009 VA medical opinion and the January 2008 independent medical opinion to have great evidentiary weight as the opinions reflect a comprehensive and reasoned review of the evidentiary record, the medical doctors provide a rationale or basis for the opinions, and the medical opinions are based on sufficient facts and data. The July 2007 and January 2010 opinions by the VA podiatrist have less probative value because it is not clear whether the VA podiatrist has access to or reviewed the evidentiary record and the VA podiatrist did not provide a rationale for the opinions. The opinions are general and conclusory. Thus, the Board finds the March 2009 VA medical opinion and the January 2008 independent medical opinion outweigh the July 2007 and January 2010 opinions by the VA podiatrist. The Board finds that the weight of the competent and credible evidence establishes that there is no nexus between the claimed service-connected disability and the current bilateral hallux valgus and bilateral hammertoes. There is no competent evidence that the service-connected pes planus aggravated the bilateral hallux valgus and bilateral hammertoes. As discussed above, the March 2009 VA examiner performed a detailed physical examination of the feet and the examiner did not find findings consistent with severe pes planus. The examiner indicated that radiographically and by examination, the Veteran did not have flat feet. Service connection for bilateral hallux valgus and bilateral hammertoes is not warranted on a secondary basis. Moreover, service connection for bilateral hallux valgus and bilateral hammertoes is not warranted on a direct basis. The service treatment records for the two periods of active service do not document any symptoms, complaints, or findings of bilateral hallux valgus or hammer toes. A November 1977 enlistment examination and an August 1979 separation examination indicate that examination of the feet was normal. The Veteran separated from service in June 1982. The Board notes that the third period of service from June 1982 to June 1984 is dishonorable and will not be considered. Review of the record shows that the Veteran was afforded a VA examination in May 1986 and underwent examination of the feet. Hallux valgus and hammertoes were not detected or diagnosed. Bilateral hallux valgus and bilateral hammertoes were detected upon x-ray examination in October 1992. With regard to post-service symptoms, the weight of the competent and credible evidence shows that the bilateral hallux valgus and bilateral hammertoes were first diagnosed approximately 10 years after service. The evidence of record shows no diagnosis or treatment for the claimed disabilities until 1992, over 10 years after service discharge. The absence of post-service complaints, findings, diagnosis, or treatment after service for many years until 1992 is one factor, considered in addition to the other factors stated in this decision, which tends to weigh against a finding of either bilateral hallux valgus and bilateral hammertoes symptoms in service or recurrent symptoms after service separation. See Buchanan, 451 F.3d at 1337 (holding that the Board may weigh the absence of contemporaneous medical evidence as one factor in determining credibility of lay evidence, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence). The Board has considered the Veteran's contention that he bilateral hallux valgus and hammertoes are related to his service-connected bilateral pes planus. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Barr v. Nicholson, 21 Vet. App. 303 (2007). Although the Veteran is competent to give evidence about what he experiences, however, the question of etiology involves complex medical issues which he, as a layperson, is not competent to address because he does not have the requisite medical knowledge or training. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997). There is no competent evidence of record which relates the current bilateral hallux valgus and bilateral hammer toes to the Veteran's periods of active service. There is no medical evidence of record which medically relates the current bilateral hallux valgus and bilateral hammer toes to active service. Neither the Veteran nor his representative contends that the bilateral hallux valgus and bilateral hammer toes are related to his period of active service. For these reasons, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against the claim for service connection for bilateral hallux valgus and bilateral hammertoes on a direct basis and on a secondary basis. For these reasons, the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. ORDER Service connection for bilateral hallux valgus and bilateral hammertoes on a direct basis and on a secondary basis is denied. REMAND The VCAA specifically provides that the duty to assist includes providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on the claim. 38 U.S.C.A. § 5103A(d) (West 2002). At the time of a January 2008 VA examination, pes planus was noted. On VA podiatry examination in March 2009, the examiner indicted that he did not find evidence of severe pes planus and that that there was no evidence of flatfeet by examination or x-ray examination. In January 2010, a VA treatment record noted that the Veteran returned for evaluation of chronically painful calluses and bunions. The Veteran and his representative maintain that the service-connected pes planus warrants a higher rating. The Board finds that additional examination is necessary to obtain medical evidence as to whether the Veteran the current severity of the service-connected pes planus. VA is required to conduct an accurate and descriptive medical examination based on the complete medical record. 38 C.F.R. §§ 4.1, 4.2; Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA's duty to assist includes "the conduct of a thorough and contemporaneous medical examination, one which takes into account the records of prior medical treatment, so that the evaluation of the claimed disability will be a fully informed one"). The RO should obtain copies of any outstanding treatment records for the service-connected pes planus from the VA Healthcare System since 2010. VA has a duty to seek these records. 38 U.S.C.A. § 5103A(b)(1). The RO should contact the Veteran by letter and request that he provide sufficient information and, if necessary, authorization to enable the RO to obtain any pertinent VA or non-VA treatment records showing treatment of the pes planus. The RO should make an attempt to obtain any treatment records identified by the Veteran that are not associated with the claims file. Accordingly, the case is REMANDED for the following action: 1. Obtain copies of all clinical records from the VA Healthcare System dated since 2010 referable to treatment of the service-connected pes planus and associate the records with the claims file. 2. Contact the Veteran in order to have him identify any source of VA or non-VA medical treatment rendered for the service-connected pes planus. The letter should request sufficient information to identify the health care providers, and if necessary, signed authorizations, to enable VA to obtain any outstanding records. If the Veteran adequately identifies the health care providers and provides the completed authorizations, the RO should request legible copies of all pertinent clinical records that have not been previously obtained, and incorporate them into the Veteran's claims file. The letter should invite the Veteran to submit any pertinent lay and medical evidence to support his claim for increase. 3. Schedule the Veteran for a VA examination to determine the current severity of the service-connected bilateral pes planus. The Veteran's VA claims folder must be made available to the examiner for review in connection with the examination. The examiner should reports all symptom and manifestations due to the bilateral pes planus and report whether each of the bilateral pes planus is mild, moderate, moderately-severe, severe, or pronounced. The examiner should report whether the bilateral pes planus results in marked pronation, extreme tenderness of plantar surfaces, marked inward displacement and severe spasm of the Achilles tendon on manipulation, marked deformity, pain or swelling on use, characteristic callosities, weightbearing line over or medial to the great toe, or inward bowing of the Achilles tendon. The examiner should report whether the symptoms are improved or relieved by orthopedic shoes, appliances and/or built-up shoe or arch support. The examiner should comment on the extent of the functional loss attributable to pain due to the bilateral pes planus. The examiner should provide a rationale for all conclusions. If the VA examiner determines that he or she is unable to provide the requested medical opinion without resorting to speculation, the examiner should indicate this in the report. 4. After completing all indicated development, readjudicate the claim for an increased rating for bilateral pes planus. If any benefit remains denied, a Supplemental Statement of the Case should be furnished to the Veteran and his representative and they should be afforded a reasonable opportunity for response. 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). ____________________________________________ K. J. ALIBRANDO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs