Citation Nr: 1328470 Decision Date: 09/06/13 Archive Date: 09/16/13 DOCKET NO. 09-32 691 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to service connection for a left hip total arthroplasty, to include as secondary to service-connected right knee disability. 2. Entitlement to service connection for a breathing condition, to include as due to exposure to asbestos. 3. Entitlement to an initial compensable disability rating for hemorrhoids prior to November 14, 2011, and in excess of 20 percent since. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD A. Spector, Associate Counsel INTRODUCTION The Veteran served on active duty from October 1979 to September 1984. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a March 2009 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California, which denied service connection for a right knee disability, a respiratory condition, and a left hip disability, and granted service connection for hemorrhoids and assigned a noncompensable disability rating, effective July 23, 2008. The Veteran filed a notice of disagreement (NOD) with these determinations in April 2009, and timely perfected his appeal in August 2009. Additionally, in a June 2012 rating decision, the RO increased the Veteran's disability rating for hemorrhoids to 20 percent, effective November 14, 2011. Additionally, in a March 2013 rating decision, the RO granted service connection for status post total right knee arthroplasty of the right knee and meniscus tear with medial collateral ligament strain and effusion, and degenerative arthritis of the right knee. This decision constitutes a full grant of benefits. Therefore, the claim of a service connection for a right knee disability is no longer on appeal. On the August 2009 Substantive Appeal, the Veteran noted that he would like a hearing, but that he would have no reliable transportation to or from Los Angeles. A clarification letter was sent to the Veteran's representative. An August 2013 letter from the Veteran's representative noted that he contacted the Veteran and that he did not wish to have a hearing. Therefore, the Board can proceed with review of the issues on appeal. The Board recognizes that the RO characterized the Veteran's breathing condition on appeal as entitlement to service connection for a respiratory condition. However, a review of the record reflects that the Veteran made a claim for a breathing disability and subsequently discussed treatment for sinus/throat conditions. Additionally, VA treatment records show a diagnosis of allergic rhinitis. The Board observes that VA has an obligation to liberally construe the pleadings of a claimant to discern all issues raised in the record. See Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009); Clemons v. Shinseki, 23 Vet. App. 1 (2009). Thus, in light of the Veteran's assertions, the Board will consider whether service connection is warranted for any current breathing condition. For this reason, the Board finds that the Veteran's breathing claim is more appropriately framed as the broader issue indicated on the title page of this decision, rather than as a specific condition. The Board notes that, in addition to the paper claims file, there is a Virtual VA paperless claims file associated with the above claims. A review of the documents in such file reveals that there are additional VA treatment records related to the Veteran's claims on appeal. These records have been reviewed and considered by the Board. The issues of entitlement to service connection for a left hip disability and a breathing condition 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. Throughout the pendency of the appeal , the Veteran's hemorrhoids were manifested by chronic problems with bleeding, excessive redundant tissue, frequent pain, and fissures. 2. The evidence of record does not demonstrate that the Veteran's service-connected hemorrhoids are so exceptional or unusual that referral for extraschedular consideration by designated authority is required. CONCLUSIONS OF LAW 1. Prior to November 14, 2011, the criteria for a higher 20 percent disability rating for service-connected hemorrhoids have been met. 38 U.S.C.A. §§ 1155, 5102, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.321, 4.114, Diagnostic Code 7336 (2012). 2. Throughout the pendency of the appeal, the criteria for a disability rating in excess of 20 percent for hemorrhoids have not been met. 38 U.S.C.A. §§ 1155, 5102, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.321, 4.114, Diagnostic Code 7336 (2012). 3. Application of the extraschedular rating provisions is not warranted in this case. 38 C.F.R. § 3.321(b) (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Notify and Assist The VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 U.S.C.A. §§ 3.102, 3.156(a), 3.159 and 3.326(a). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide in accordance with 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The Veteran's claim arises from his disagreement with the initial evaluation assigned following the grant of service connection. 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), Goodwin v. Peake, 22 Vet. App. 128, 134 (2008), Dunlap v. Nicholson, 21 Vet. App. 112 (2007). Therefore, no further notice is required for this claim. VA must also make reasonable efforts to assist the Veteran in obtaining evidence necessary to substantiate the claim for the benefit sought unless no reasonable possibility exists that such assistance would aid in substantiating the claim. This duty includes assisting with the procurement of relevant records, including pertinent treatment records, and providing an examination when necessary. See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The VA has also done everything reasonably possible to assist the Veteran with respect to his claim for benefits, such as obtaining VA treatment records and providing the Veteran with VA examinations in February 2009 and November 2011. The Board thus concludes that there are no additional records outstanding with respect to his increased rating claim for service-connected hemorrhoids. Consequently, the duty to notify and assist has been satisfied as to the claim now being finally decided on appeal. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001). II. Initial Increased Ratings Disability ratings are determined by the application of the VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2012). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate diagnostic codes identify the various disabilities. 38 C.F.R. § Part 4 (2012). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). In Fenderson v. West, 12 Vet. App 119 (1999), the Court emphasized the distinction between a new claim for an increased evaluation of a service-connected disability and a case (such as this one) in which the Veteran expresses dissatisfaction with the assignment of an initial disability evaluation where the disability in question has just been recognized as service-connected. VA must assess the level of disability from the date of initial application for service connection and determine whether the level of disability warrants the assignment of different disability ratings at different times over the life of the claim-a practice known as "staged rating." The Veteran bears the burden of presenting and supporting his claim for benefits. 38 U.S.C.A. § 5107(a) (West 2002). In its evaluation, the Board considers all information and lay and medical evidence of record. 38 U.S.C.A. § 5107(b) (West 2002). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board gives the benefit of the doubt to the claimant. Id. The Veteran was initially granted entitlement to service connection for hemorrhoids and assigned a noncompensable disability rating, effective July 23, 2008. Subsequently, the Veteran's disability rating for hemorrhoids was increased to 20 percent, effective November 14, 2011. The Veteran's hemorrhoids have been evaluated under DC 7336. DC 7336 pertains to external and internal hemorrhoids. Under DC 7336, mild or moderate hemorrhoids are rated noncompensably (0 percent) disabling. A 10 percent rating is warranted when the hemorrhoids are large or thrombotic, irreducible, with excessive redundant tissue, or evidencing frequent recurrences. A 20 percent rating is warranted when the hemorrhoids have persistent bleeding and secondary anemia, or fissures. 38 C.F.R. § 4.114, Diagnostic Code 7336 (2012). Turning to the evidence of record, a June 2007 VA treatment record notes that the Veteran had a history of rectal fissure with intermittent history of bright red blood with wiping since he was in the military. Additionally, an October 2008 VA record noted that the Veteran stated that his anal fissure problem was flaring up with loose stools and blood with wiping. A January 2009 VA gastroenterology consult noted that the Veteran had a history of anal fissure flaring up with hematochezia. VA treatment records also show that the Veteran underwent a colonoscopy in February 2009, with removal of a tubular adenoma polyp. The Veteran was afforded a VA examination in February 2009. The Veteran reported that he had blood on the tissue when he wiped, and some in the toilet. Symptoms occurred two to three times out of the month. He felt that stress could be triggering his symptoms. The Veteran reported a history of frequent bleeding, and anal itching and burning. The examiner noted that the Veteran had an external hemorrhoid with excessive redundant tissue. The examiner noted that there were no fissures present. On the April 2009 NOD, the Veteran reported that the VA examiner incorrectly stated the amount of bleeding he experienced from hemorrhoids. He usually bled three to four times a week, two to three times a month. Often, the bleeding was heavy. The Veteran was afforded another VA examination in November 2011 to assess his hemorrhoids. The Veteran reported bleeding on a daily basis, noting there were five days out of the month that he did not. He reported that increased fiber intake and stress increased the anal bleeding. He did not take any medications for this condition. The examiner noted a diagnosis of internal or external hemorrhoids that were mild or moderate, with persistent bleeding, and fissures. In a June 2012 statement, the Veteran reported that not a month goes by without at least one to two occurrences of heavy bleeding many times. He additionally stated that just because he didn't complain about them did not mean there were not a problem. After a review of the evidence of record, the Board finds that the Veteran's hemorrhoids have been found to display the criteria contemplated by a 20 percent rating prior to November 14, 2011: persistent bleeding and secondary anemia or fissures. C.F.R. § 4.119 , Diagnostic Code 7336 (2012). While the February 2009 VA examiner diagnosed the Veteran with an external hemorrhoid with excessive redundant tissue and no fissures, VA treatment records dating back to June 2007 noted history of rectal fissure with intermittent history of bright red blood with wiping. Additionally, an October 2008 VA record noted that the Veteran stated that his anal fissure problem was flaring up with loose stools and blood with wiping. A January 2009 VA gastroenterology consult noted that the Veteran had a history of anal fissure flaring up with hematochezia. Furthermore, the Veteran reported that he experienced heavy bleeding three to four times a week, two to three times a month. All reasonable doubt has been resolved in favor of the Veteran in making this decision. The preponderance of the evidence is for the assignment of a higher 20 percent disability rating for the Veteran's hemorrhoids, prior to November 14, 2011. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Additionally, the Board has considered whether the Veteran is entitled to a disability rating in excess of 20 percent for hemorrhoids throughout the entire period of appeal. However, the Board notes that a 20 percent rating is the maximum schedular evaluation available for hemorrhoids under Diagnostic Code 7336. Consideration has been given to application of additional Diagnostic Codes. The evidence of record has not shown impairment of the rectum or anus (Codes 7333 and 7334). Additionally, the Veteran's condition has not be show to cause fecal leakage required for an evaluation in excess of 20 percent under Code 7332, for impaired sphincter control. There was no evidence that pads were required, and bowel movements were not shown to be involuntary. See 38 C.F.R. § 4.114 (2012). The Board concludes that the preponderance of the evidence is against the claim for a disability rating in excess of 20 percent for hemorrhoids, and the benefit of the doubt rule enunciated in 38 U.S.C.A. § 5107(b) is not for application. III. Extraschedular Consideration The rating schedule represents, as far as is practicable, the average impairment of earning capacity. Ratings will generally be based on average impairment. 38 C.F.R. § 3.321(a), (b). To afford justice in exceptional situations, an extraschedular rating can be provided. 38 C.F.R. § 3.321(b). In a recent case, the Court clarified the analytical steps necessary to determine whether referral for extraschedular consideration is warranted. See Thun v. Peake, 22 Vet. App. 111 (2008). First, the RO or the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Second, if the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a Veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the C&P Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extraschedular rating. The symptoms associated with the Veteran's hemorrhoids, to include bleeding, fissures, and excessive redundant tissue, are not shown to cause any impairment that is not already contemplated by the rating criteria, and the Board finds that the rating criteria reasonably describe his disability. For this reason, referral for consideration of an extraschedular rating is not warranted for this claim. ORDER Entitlement to an initial 20 percent disability rating, but no higher, for service-connected hemorrhoids, prior to November 14, 2011, is granted, subject to the law and regulations governing the payment of monetary benefits. Entitlement to an initial disability rating in excess of 20 percent for service-connected hemorrhoids, is denied. REMAND After a thorough review of the Veteran's claims file, the Board has determined that additional evidentiary development is necessary prior to the adjudication of his claims of service connection for a left hip disability and a breathing condition. A. Left Hip The Veteran contends that his left hip disability is caused by his service-connected right knee disability. VA outpatient treatment records noted a diagnosis of left hip degenerative joint disease (DJD), which resulted in a left hip arthroplasty. The Veteran was afforded a VA examination in November 2012. The examiner noted a diagnosis of total left hip arthroplasty, status post avascular necrosis. The VA examiner concluded that the Veteran's left hip condition was less likely than not due to his right knee condition because treatment records reviewed showed that he injured his left hip during sexual intercourse. There was no mention or indication of an associated knee condition contributing to the injury. Additionally, the left hip condition was diagnosed as avascular necrosis in the head of the femur, which was often associated with heavy alcohol use (confirmed in the Veteran's medical history), but is not a condition brought on by a sudden dislocation. It is a condition that has an insidious onset that can result in poor articulation of the hip joint due to the necrotic femoral head. However, while rendering an opinion, the VA examiner failed to state whether the Veteran's service-connected right knee disability aggravated his left hip disability beyond the normal state of progression. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (stating that once VA undertakes the effort to provide an examination when developing a service- connection claim, even if not statutorily obligated to do so, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided); Robinson v. Shinseki, 557 F.3d 1355 (2009); Combee v. Brown, 34 F.3d 1039 (1994). Therefore, the Veteran should be scheduled for a new VA examination to address whether his left hip disability is aggravated by his service-connected right knee disability. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). B. Respiratory Condition The Veteran contends that his breathing condition is a result of in-service asbestos exposure. Specifically, the Veteran stated that his sinus and breathing problems started after performing ship rehab aboard the USS Okinawa. He was part of the asbestos tile removal team on the ship and dust conditions were quite severe. He stated that breathing problems started then and continued to this day. Service personnel records indicated that the Veteran served as an electronic warfare specialist in November 1980 on the USS Okinawa, and in October 1982 on the USS Wabash. A September 1980 chest x-ray noted that the Veteran had a productive cough for 8 months, chest congestion, and pain upon inhalation. The results showed that the Veteran had a normal chest. A May 1982 service treatment record indicated that the Veteran complained of shortness of breath and that it was hard to breathe for two weeks. He reported that he was concerned with working in a dust filled environment. A finding of pulmonary irritation, secondary to dust and cigarettes was found. At separation, the Veteran reported ear, nose, or throat trouble, shortness of breath, and pain or pressure in chest. VA treatment records show a diagnosis of chronic rhinitis. Additionally, the record notes that an ENT consult in 2009 recommended adenoidectomy/turbinectomy, however, the Veteran did not wish to have surgery at that time. Initially, the Board notes that there is no specific statutory guidance with regard to asbestos-related claims, nor has the Secretary of VA promulgated any specific regulations. However, in 1988, VA issued a circular on asbestos-related diseases that provided guidelines for considering asbestos compensation claims. See Department of Veterans Benefits, Veterans' Administration, DVB Circular 21-88-8, Asbestos- Related Diseases (May 11, 1988). The information and instructions contained in the DVB Circular have since been included in VA Adjudication Procedure Manual, M21-1MR, part IV, subpart ii, chapter 2, section C, paragraph 9 (Jan. 7, 2007) ("VA Manual"). The date of this amended material is December 13, 2005. Also, an opinion by VA's Office of General Counsel (OGC) discussed the proper way of developing asbestos claims. See VAOPGCPREC 4-2000 (Apr. 13, 2000). The Manual defines asbestos as a fibrous form of silicate mineral of varied chemical composition and physical configuration, derived from serpentine and amphibole ore bodies. M21-1MR, Part IV, Subpart ii, Chapter 2, Section C, Subsection (a). Common materials that may contain asbestos are steam pipes for heating units and boilers, ceiling tiles, roofing shingles, wallboard, fire-proofing materials, and thermal insulation. Id., at Subsection (a). The Manual also lists some of the major occupations involving exposure to asbestos include mining, milling, shipyard work, insulation work, demolition of old buildings, carpentry and construction, manufacture and servicing of friction products (such as clutch facings and brake linings), and manufacture and installation of products such as roofing and flooring materials, asbestos cement sheet and pipe products, and military equipment. Id., at Subsection (f). Asbestos fiber masses have a tendency to break easily into tiny dust particles that can float in the air, stick to clothes, and may be inhaled or swallowed. Id., at Subsection (b). Inhalation of asbestos fibers can lead to a non-exclusive list of asbestos related diseases/abnormalities: fibrosis (the most commonly occurring of which is interstitial pulmonary fibrosis, or asbestosis), tumors, pleural effusions and fibrosis, pleural plaques, mesotheliomas of pleura and peritoneum, and cancers of the lung, bronchus, gastrointestinal tract, larynx, pharynx, and urogenital system (except the prostate). Id., at Subsection (b). The guidelines provide that the latency period for asbestos- related diseases varies from 10-45 years or more between first exposure and development of disease. VA Manual, paragraph 9(d). The extent and duration of exposure to asbestos is not a factor for consideration. Id., at Subsection (d). Thus, an asbestos-related disease can develop from brief exposure to asbestos or as a bystander. The guidelines further provide, in part, that the clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal disease. VA Manual, paragraph 9(e). Rating specialists must develop any evidence of asbestos exposure before, during, and after service. A determination must be made as to whether there is a relationship between asbestos exposure and the claimed disease, keeping in mind the latency period and exposure information. The adjudication of a claim for service connection for a disability resulting from asbestos exposure should include a determination as to whether: (1) service records demonstrate the Veteran was exposed to asbestos during service; (2) development has been accomplished sufficient to determine whether the Veteran was exposed to asbestos either before or after service; and (3) a relationship exists between exposure to asbestos and the claimed disease in light of the latency and exposure factors. Id. at Subsection (h). The Court has held that VA must analyze an appellant's claim for service connection for asbestosis or asbestos-related disabilities under the appropriate administrative guidelines. Ennis v. Brown, 4 Vet. App. 523 (1993); McGinty v. Brown, 4 Vet. App. 428 (1993). If the evidence supports a conclusion that the Veteran's current disability, while caused by asbestos exposure, is due to intervening post-service exposure, the opinion must be very specific explaining the basis for this finding. See McGinty, supra. As previously mentioned, the Veteran contends that he was exposed to asbestos while on active duty in the Navy. The Board notes that the RO has not performed the appropriate development to determine if the Veteran was exposed to asbestos while on active duty. Therefore, a remand is necessary for the AMC/RO to perform the necessary development. A specific determination needs to be made as to whether his MOS placed him in an area of possible exposure to asbestos. Additionally, the Veteran was afforded a VA examination in November 2012. The VA examiner concluded that the Veteran did not suffer from any respiratory conditions. The VA examiner opined that it was less likely than not that a respiratory condition (which includes his complaints of shortness of breath with exertion only) was due to service and that it was most likely related to thirty years of tobacco use. However, in a claim for service connection, the requirement of a "current disability" is satisfied if a disorder is diagnosed at the time a claim is filed or at any time during the pendency of the appeal. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Additionally, a significant disability is not required for service connection. Only a "current disability" is required. The Board notes that the Veteran's VA treatment records note a diagnosis of allergic rhinitis. Thus, notwithstanding the November 2012 VA examiner's finding of no respiratory condition, the Board finds that sufficient evidence exists to indicate that the Veteran has a "breathing" condition that may be associated with in-service incidents, thus, triggering the duty to assist. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Further, the VA examiner failed to review and discuss a pertinent May 1982 service treatment record that indicated a finding of pulmonary irritation, secondary to dust and cigarettes. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (stating that when the Secretary undertakes to provide a medical examination or obtain a medical opinion, he must ensure that the examiner providing the report or opinion is fully cognizant of the claimant's past medical history). The Board is without medical expertise to determine if the Veteran's breathing/sinus condition, to include allergic rhinitis, is related to his active duty service. Godfrey v. Brown, 7 Vet. App. 398 (1995); Traut v. Brown, 6 Vet. App. 495 (1994); Colvin v. Derwinski, 1 Vet. App. 171 (1991). Therefore, a VA examination is necessary in order to address the Veteran's contentions and reconcile all diagnoses stated in reference to the Veteran's claim of service connection for a breathing condition. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). A remand is also necessary to obtain outstanding VA and private medical records. In a July 2008 statement, the Veteran reported that he was seen by a few different doctors after leaving the Navy in Mesa, Arizona and Yucca Valley, California. Additionally, in the April 2009 NOD, the Veteran reported throat and sinus surgery by a doctor in Grotto of Palm Springs in 1991-92. However, it does not appear that these private treatment records have been obtained and associated with the claims file. Further, the evidence of record shows that the Veteran was receiving ongoing treatment at the VA through January 2012. Because it appears that there may be outstanding VA and private medical records that may contain information pertinent to his claims, those records are relevant and should be obtained. 38 C.F.R. § 3.159(c)(2) (2012); Bell v. Derwinski, 2 Vet. App. 611 (1992). Accordingly, the case is REMANDED for the following action: 1) The AMC should take appropriate action to develop any evidence of the Veteran's exposure to asbestos before, during, and after his active military service. Contact the National Personnel Records Center (NPRC) to determine whether there are any outstanding military personnel records concerning the Veteran's service in the U.S. Navy. A specific determination needs to be made as to whether his MOS placed him in an area of possible exposure to asbestos. If these requested personnel records are unavailable, or the search for them otherwise yields negative results and further attempts to obtain these records would be futile, this must be documented in the claims file and the Veteran notified in accordance with 38 C.F.R. § 3.159(c)(2), (c)(3). 2) The AMC should obtain any of the Veteran's outstanding VA treatment records dated from January 2012 to the present. Any attempts to obtain these records and responses received thereafter should be associated with the Veteran's claims file. The RO should contact the Veteran and request that he provide a completed release form (VA Form 21-4142) authorizing VA to request copies of any treatment records from any private medical providers, who have treated him for left hip or respiratory/breathing disabilities, to include 1991-92 records from a doctor in Grotto of Palm Springs documenting throat/sinus surgery, and private records for treatment in Mesa, Arizona and Yucca Valley, California. After the Veteran has signed the appropriate releases, those records not already associated with the claims file, should be obtained and associated therewith. All attempts to procure any outstanding treatment records should be documented in the claims file. If the RO cannot obtain records identified by the Veteran, a notation to that effect should be included in the claims file and the Veteran and his representative should be notified of unsuccessful efforts in this regard, in order to allow him the opportunity to obtain and submit those records for VA review. 3) After the foregoing, schedule the Veteran for a VA examination to determine whether the Veteran's left hip condition is related to the Veteran's service-connected right knee disability. The claims file and a copy of this remand must be made available to and reviewed by the examiner in conjunction with the examination. All necessary studies should be performed, and all findings should be reported in detail. The VA examiner should provide an opinion as to whether it is at least as likely as not that the Veteran's currently diagnosed left hip condition is aggravated (i.e., permanently worsened beyond the natural progress of the disease) by his service- connected right knee disabilities. Please specifically address whether there was any increase in severity of the Veteran's left hip disability that was proximately due to or the result of the Veteran's service-connected right knee disabilities, and not due to the natural progress of the Veteran's left hip disability. In rendering these opinions, the examiner should acknowledge and discuss the VA outpatient treatment records, the November 2012 VA examination report, and any other relevant information. Furthermore, the examiner should discuss the Veteran's lay statements regarding the onset and duration of symptoms when discussing the offered opinion. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. 4) Additionally, schedule the Veteran for a VA examination to determine whether any of his current sinus/nasal/respiratory condition(s), to include allergic rhinitis, is related to the Veteran's service. The claims file and a copy of this remand must be made available to and reviewed by the examiner in conjunction with the examination. All necessary studies should be performed, and all findings should be reported in detail. The examiner should address the following: A. Diagnose the Veteran's current sinus/nasal/respiratory conditions. B. For each diagnosis, provide an opinion as to whether it is at least as likely as not that the disorder is related to his active military service, to include an in-service exposure to dust or asbestos if exposure is found by the AMC/RO. In rendering these opinions, the examiner must review the Veteran's service treatment records (September 1980 and May 1982 records), VA treatment records, the November 2012 VA examination report, and any other relevant information. Furthermore, the examiner should discuss the Veteran's lay statements regarding the onset and duration of symptoms when discussing the offered opinion. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. 5) Thereafter, the AMC/RO must review the claims file to ensure that the foregoing requested development has been completed. In particular, review the requested medical opinions to ensure that it is responsive to and in compliance with the directives of this remand and if not, implement corrective procedures. See Stegall v. West, 11 Vet. App. 268 (1998). 6) Following the completion of the foregoing, and after undertaking any other development it deems necessary, the AMC should readjudicate the Veteran's claims. The AMC should then provide the Veteran and his representative with a supplemental statement of the case and allow an appropriate period of time for response. Thereafter, the claims folder should be returned to the Board for further appellate review, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims 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