Citation Nr: 1329293 Decision Date: 09/12/13 Archive Date: 09/20/13 DOCKET NO. 04-04 619 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Boston, Massachusetts THE ISSUES 1. Entitlement to service connection for a bilateral knee disorder. 2. Entitlement to service connection for a skin disorder (other than actinic keratoses), to include as due to herbicide exposure. 3. Entitlement to service connection for hypertension, to include as due to herbicide exposure and secondary to posttraumatic stress disorder (PTSD). 4. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). 5. Entitlement to service connection for a kidney disorder, to include as due to herbicide exposure and as secondary to hypertension. 6. Entitlement to service connection for an intestinal/digestive disorder, to include as due to herbicide exposure and as secondary to PTSD. 7. Entitlement to service connection for anal irritation, to include as due to herbicide exposure or as secondary to an intestinal digestive disorder. REPRESENTATION Appellant represented by: Michael Kelley, Attorney WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD Paul S. Rubin, Counsel INTRODUCTION The Veteran had active duty service from January 1985 to January 1989 in the United States Army. This matter comes before the Board of Veterans' Appeals (Board) on appeal from March 1989 and September 2002 rating decisions issued by the Department of Veterans Affairs (VA) Regional Offices (ROs) in Honolulu, Hawaii, and Seattle, Washington. During the pendency of the appeal, jurisdiction of the Veteran's claims folder was transferred to the RO in Boston, Massachusetts, as this location is closest to the Veteran's most recent domicile. The Board remanded the appeal in August 2006 and October 2009 for further development. The case has since been returned to the Board for appellate review. In the August 2006 and October 2009 Board decisions, the Board also adjudicated various other service connection issues that were previously on appeal. Thus, these issues are no longer on appeal before the Board. In May 2013, the Veteran presented testimony at a Board videoconference before the undersigned Veterans Law Judge. A transcript of that hearing is associated with the claims folder. At the hearing, the Veteran submitted additional VA and private medical evidence with a waiver of RO's initial consideration. Thus, the Board accepts it for inclusion in the record and consideration by the Board at this time. See 38 C.F.R. §§ 20.800, 20.1304 (2012). After this hearing, the Veteran was given 60 days to submit additional evidence. See 38 C.F.R. § 20.709 (2012). In response, in June 2013, the Veteran's attorney submitted additional private medical evidence for Board consideration. Therefore, the Board will proceed with adjudication of the claims at this time. With regard to the issue of service connection for a bilateral knee disorder, in August 2006 the Board remanded that issue for issuance of a statement of the case (SOC), based on the U.S. Court of Appeals for Veterans Claims (Court's) decision in Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). Subsequently, the RO sent the Veteran a SOC denying the bilateral knee issue in August 2009. The Veteran responded by filing a timely VA Form 9 (substantive appeal), which was received by the RO in September 2009. See 38 U.S.C.A. § 7105(d) (West 2002); 38 C.F.R. §§ 20.200, 20.202, 20.302(b) (2012). The Veteran's VA Form 9 did not specifically identify the issue being appealed (it stated it was appealing "all this issues" listed on the SOC and SSOC), and he did not offer any probative argument as to why the knee issue was decided incorrectly. However, the Federal Circuit has held that 38 U.S.C.A. § 7105(d)(3) does not impose a particular format or degree of specificity for the Veteran's substantive appeal and VA operates under a duty to read the documents that a claimant has submitted liberally and sympathetically. Rivera v. Shinseki, 654 F.3d 1377, 1381 (Fed. Cir. 2011). In Rivera, the Federal Circuit explained that if the RO addresses, for example, multiple claims in the same decision, it may be reasonable to expect the Veteran to specify the particular denied claim that he seeks to appeal. However, less specificity is necessary when the RO's decision addresses only a single issue and the nature of the claimed error with respect to that issue is obvious from the decision itself. 654 F.3d at 1381-82. The Federal Circuit concluded in Rivera that, if the RO decides and references only one issue in the SOC, the Veteran's expression of a desire to appeal the RO's decision effectively identifies the issue to be decided by the Board. Id. As such, the Board has determined that the September 2009 VA Form 9 constitutes a timely filed substantive appeal with regard to the bilateral knee issue. Thus, the issue is considered on appeal before the Board at this time. A review of the Virtual VA paperless claims processing system and the Veterans Benefits Management System (VBMS) does not reveal any additional medical records pertinent to the present appeal. The issues of entitlement to service connection for a kidney disorder, an intestinal/digestive disorder, and anal irritation are addressed in the REMAND portion of the decision below and are REMANDED to the RO in Boston, Massachusetts, for further development and consideration. FINDINGS OF FACT 1. The Veteran has bilateral knee chondromalacia patella with arthritis that is related to his military service. 2. The Veteran has rosacea that is related to his military service. 3. The Veteran has hypertension is related to his military service. 4. The Veteran has a current diagnosis of PTSD that is related to verified in-service stressors. CONCLUSIONS OF LAW 1. Resolving all reasonable doubt in his favor, the Veteran has bilateral knee chondromalacia patella with arthritis that was incurred in active military service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 2. Resolving all reasonable doubt in his favor, the Veteran has rosacea that was incurred in active military service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 3. Resolving all reasonable doubt in his favor, the Veteran has hypertension that was incurred in active military service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 4. Resolving all reasonable doubt in his favor, the Veteran has PTSD that was incurred in active military service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VA's Duty to Notify and Assist With regard to the issues of service connection for bilateral knee chondromalacia patella, a skin disorder (rosacea), hypertension, and PTSD, a review of the claims folder reveals compliance with the Veterans Claims Assistance Act of 2000 (VCAA), 38 U.S.C.A. § 5100 et seq. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). The duty to notify was accomplished by way of VCAA letters from the RO to the Veteran dated in June 2002, July 2002, April 2005, August 2006, August 2008, and November 2010. In any event, if any defect in VCAA notice or assistance is found, such defect is not prejudicial to the Veteran, given the completely favorable disposition of these particular service connection issues. Bernard v. Brown, 4 Vet. App. 384, 392- 94 (1993). To that end, the Board has also considered the Veteran's request for a travel board hearing in the September 2009 substantive appeal for the issue of service connection for bilateral knee chondromalacia. However, given the completely favorable disposition of this particular service connection issue in the present decision, the absence of testimony on that issue is not prejudicial to the Veteran. Bernard, 4 Vet. App. at 392-94. Governing Laws and Regulations for Service Connection Veterans are entitled to compensation from the VA if they develop a disability "resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty." 38 U.S.C.A. § 1110 (wartime service), 1131 (peacetime service); 38 C.F.R. §§ 3.303, 3.306. In the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Under 38 C.F.R. § 3.303(a), 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 - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). See also 38 C.F.R. § 3.303(a). The Federal Circuit Court recently held that diseases that would be considered "chronic" in a medical sense, but which are not listed in 38 C.F.R. § 3.309(a) as an enumerated "chronic disease," may still qualify for service connection under the three-element test for disability compensation described in § 3.303(a). Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013). Under 38 C.F.R. § 3.303(b), with an enumerated "chronic disease" (such as hypertension or arthritis) shown in service (or within the presumptive period under § 3.307), subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. See also Groves v. Peake, 524 F.3d 1306, 1309 (2008). This rule does not mean that any manifestation of joint pain, any abnormality of heart action or heart sounds, any urinary findings of casts, or any cough, in service will permit service connection of arthritis, disease of the heart, nephritis, or pulmonary disease, first shown as a clear cut clinical entity, at some later date. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "Chronic." When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity of symptomatology. 38 C.F.R. § 3.303(b). 38 C.F.R. § 3.303(b) also provides another route by which a Veteran can establish service connection for a "chronic disease" - by way of continuity of symptomatology. Continuity of symptomatology after discharge is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned, i.e., "when the fact of chronicity in service is not adequately supported." When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support a claim for disability compensation for the chronic disease. Proven continuity of symptomatology establishes the link, or nexus, between the current disease and serves as the evidentiary tool to confirm the existence of the chronic disease while in service or a presumptive period during which existence in service is presumed. 38 C.F.R. § 3.303(b). See also Walker, 708 F.3d at 1339-40. The Federal Circuit recently held that the regulation creating a presumption of service connection for "chronic diseases" manifesting during service or within one year of service, and then again at any later date (38 C.F.R. § 3.303(b)), is only available to establish service connection for the "chronic diseases" enumerated in 38 C.F.R. § 3.309(a) (listing named chronic diseases). Walker, 708 F.3d at 1336-37. In the same case, the Federal Circuit clarified that the continuity of symptomatology language in § 3.303(b) also "restricts itself to chronic diseases" found in 38 C.F.R. § 3.309(a). Id. at 1335. With respect to the current appeal, this list includes hypertension and arthritis as an enumerated "chronic disease." See 38 C.F.R. § 3.309(a). Under 38 C.F.R. § 3.303(d), disorders diagnosed after discharge may still be service connected if all the evidence, including pertinent service records, establishes the disorder was incurred in service. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). In essence, lay testimony is competent when it regards the readily observable features or symptoms of injury or illness and "may provide sufficient support for a claim of service connection." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336-37; Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Federal Circuit has held that medical evidence is not always or categorically required in every instance to establish the required nexus or linkage between the claimed disability and the Veteran's military service. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). That is, lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the 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. Davidson, 581 F.3d at 1316. See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In short, when considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent on the issues of diagnosis and medical causation. Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). If the disability is of the type for which lay evidence is competent, the Board must weigh the probative value of that evidence against other evidence of record in making its determination regarding the existence of service connection. See Buchanan v. Nicholson, 451 F.3d 1331, 1334-37 (Fed. Cir. 2006). In determining whether service connection is warranted, the Board shall consider the benefit-of-the-doubt doctrine. 38 U.S.C.A. 5107(b); 38 C.F.R. § 3.102; Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1991). Analysis - Service Connection for a Bilateral Knee Condition The Veteran has contended that he has bilateral knee chondromalacia patella with arthritis that began during his military service. Specifically, he has stated his knee problems are the result of rigorous exercises and training in "jungle school" during his military service, including going up and down hills with heavy equipment on his back. He has indicated that he was treated for and diagnosed with bilateral knee chondromalacia patella during service. He also asserts that this condition precipitated his osteoarthritis of the knees. See Veteran's February 1989 claim; August 2002 Veteran's statement; July 1989 VA examination report. Upon review of the evidence of record, the Board concludes that the Veteran is entitled to service connection for bilateral knee chondromalacia patella with arthritis. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. §§ 1110, 1131; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the present case, there is sufficient evidence that the Veteran meets the threshold criterion for service connection of a current bilateral knee disability. Boyer, 210 F.3d at 1353; Brammer, 3 Vet. App. at 225. Specifically, a July 2009 VA examiner diagnosed the Veteran with "mild" bilateral patellofemoral chondromalacia and arthritis. This diagnosis was based on a review of X-ray reports for the knees. Subsequent private treatment records dated from 2010 to 2013 also confirmed bilateral chondromalacia and osteroarthritis of the knees. The Veteran has undergone physical therapy and takes pain medication to treat his knee pain. Thus, the Veteran clearly has a current bilateral knee disability. Consequently, the determinative issue is whether the Veteran's current bilateral knee disability is somehow attributable to his military service. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service."). See, too, Maggitt v. West, 202 F.3d 1370, 1375 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000); and Collaro v. West, 136 F.3d 1304, 1308 (Fed. Cir. 1998). The Veteran's service treatment records do document complaints of bilateral knee pain and instability in 1985 and 1986 related to training exercises. The Veteran reported that it was difficult to run at that time. Specifically, his service treatment records show treatment of and a diagnosis for bilateral chondromalacia patella with instability in October 1985, December 1985, February 1986, April 1986, and July 1986. The disorder was described as "persistent" in nature, and it was treated by way of Motrin, exercises, and rest. The Veteran was initially put on temporary profile, but he was eventually placed on permanent profile as the result of the bilateral chondromalacia patella. Upon separation in December 1988, the Veteran reported a history of joint pain. Significantly, the Veteran's service personnel records note that he was assigned a numerical designation of 2 under the L category on the Veteran's physical profile, i.e., PULHES (PULHES is the six categories into which a physical profile is divided. The P stands for physical capacity or stamina; the U for upper extremities; the L for lower extremities, including the knees; the H for hearing and ear; the E for eyes; and the S stands for psychiatric). Then, as now, the number 2 indicated that an individual possessed "some limitations" due to a physical defect, and, consequently, limitations were imposed on his duties and assignments. Odiorne v. Principi, 3 Vet. App. 456, 457 (1992). Overall, these service treatment and personnel records provide some evidence in support of the claim. Following his military service, a July 1989 VA examiner diagnosed "possible" chondromalacia patella of both knees, which was only six months after his separation. VA X-rays dated in August 1997 also assessed bilateral degenerative changes in both knees, and a July 2002 VA examiner identified osteoarthritis in both knees. The Veteran has continued to receive treatment and physical therapy for arthritis and bilateral chondromalacia patella of both knees through 2013. In addition, the Veteran has credibly reported bilateral knee pain throughout lay statements, as well as in VA treatment records and at VA examinations dated in the 1990s and 2000s. As a lay person, the Veteran is competent to report symptoms of knee pain during and after his military service. Layno, 6 Vet. App. at 469. See also 38 C.F.R. § 3.159(a)(2). Thus, there is evidence of a nexus or link between his current arthritis and bilateral chondromalacia patella of both knees and his in-service treatment for bilateral chondromalacia patella. Holton, 557 F.3d at 1366. See also 38 C.F.R. § 3.303(a), (d). Notably, the claims folder contains no evidence of any intercurrent knee injury since his separation from service in 1989. See 38 C.F.R. § 3.303(b). Accordingly, resolving doubt in the Veteran's favor, the evidence supports service connection for bilateral chondromalacia patella with arthritis. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Analysis - Service Connection for a Skin Disorder (other than Actinic Keratoses) The Veteran has contended that he developed a skin disorder to the face as a result of direct sun exposure in a tropical environment in Honduras and Panama during active service from 1985 to 1987. He has stated that he did not wear sunscreen during service because it burned and was painful, and he has specifically described the incurrence of red blood vessels on his face. The Veteran has also indicated that he was treated during service in the summer of 1987 for sunburn. In the alternative, he asserts that his skin problems are the result of alleged Agent Orange exposure during service. He had further alleged continuity of rosacea symptoms since service. See May 2013 hearing testimony at pages 22-24; May 2002, July 2002, August 2002, and September 2008 Veteran's statements. At the outset, the Board has already considered and granted service connection for actinic keratosis on the face, forearms, and shoulders in an October 2009 decision. In an earlier August 2006 Board decision, the Board also denied service connection for bilateral foot fungus. Neither issue was appealed. Therefore, neither issue is before the Board at this time. Rather, in the present decision, the Board is only considering service connection for a separate skin disorder. Upon review of the evidence of record, the Board concludes that the Veteran is entitled to service connection for a skin disorder, namely rosacea. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. §§ 1110, 1131; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the present case, there is sufficient evidence that the Veteran meets the threshold criterion for service connection of a disability. Boyer, 210 F.3d at 1353; Brammer, 3 Vet. App. at 225. Specifically, a July 2009 VA skin examiner diagnosed rosacea on the Veteran's face. VA dermatology notes dated in July 2008, August 2008, and November 2008 also assessed rosacea, and the Veteran underwent laser treatment for his rosacea. Thus, the Veteran clearly has a current rosacea disability. Consequently, the determinative issue is whether the Veteran's current rosacea disability is somehow attributable to his military service. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service."). See, too, Maggitt v. West, 202 F.3d 1370, 1375 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000); and Collaro v. West, 136 F.3d 1304, 1308 (Fed. Cir. 1998). The Veteran's service treatment records do not reveal a diagnosis or treatment for rosacea; however, a July 2009 VA skin examiner noted in-service documentation of recurrent sunburn to the face, arms, and neck in July 1987. The Board is not able to find a service record in the claims folder for this treatment. Nonetheless, the Board finds that the Veteran's exposure to sunburn in a tropical environment is consistent with the places, types, and circumstances of his service in Panama and Honduras from 1985 to 1987. The Veteran's service personnel records confirm that he served there from April 1985 to September 1987. VA law provides that each disabling condition the Veteran seeks service connection for must be considered on the basis of the places, types, and circumstances of service as shown by the Veteran's service records, the official history of each organization in which the Veteran served, medical records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154(a); 38 CFR 3.303(a). The Veteran is also competent to report sunburn and symptoms of red blood vessels on the face during and after his military service. Layno, 6 Vet. App. at 469. See also 38 C.F.R. § 3.159(a)(2). There is also medical evidence supporting a nexus or link between his current rosacea and his in-service sun exposure in the tropics. Holton, 557 F.3d at 1366. See also 38 C.F.R. § 3.303 (d). Specifically, a July 2009 VA skin examiner commented that the Veteran had been exposed to sun all during his service in the tropics, such that his actinic keratoses were more likely than not service-connected. Although the July 2009 VA skin examiner did not offer an opinion on the Veteran's rosacea, in August 2009 the Veteran submitted medical treatise evidence suggesting that chronic exposure to sunlight ages the skin, "sometimes" producing telangiectasia (a sign of rosacea). Telangiectasias are defined as permanently dilated small blood vessels that have formed into discolored lesions. DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1901 (31st ed. 2007). Where medical article or treatise evidence, standing alone, discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion, a claimant may use such evidence to meet the requirement for a medical nexus. Wallin v. West, 11 Vet. App. 509 (1998). The medical treatise evidence submitted in the present case adds strength to the Veteran's contentions. Accordingly, resolving doubt in the Veteran's favor, the evidence supports service connection for a skin disorder to the face, characterized as rosacea. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Analysis - Service Connection for Hypertension The Veteran dates the onset of his current hypertension disorder to the time of his service. During service, he exhibited high blood pressure readings for several months. He believes that he developed hypertension during service due to the high stress environment to which he was subject as a Judge Advocate General (JAG) while serving in Honduras and Panama, as well as the hostile military environment against homosexuals. By the time of separation in 1989, the Veteran says his blood pressure went down for a period of time due to less stress. He states that he was not treated again for hypertension until several years after separation from service. He was first placed on medication for hypertension in the mid-1990s and has remained on medication ever since. See August 2002 Veteran's statement; May 2013 hearing testimony at pages 5, 16-20. Upon review of the evidence of record, the Board concludes that the Veteran is entitled to service connection for hypertension. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. §§ 1110, 1131; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the present case, there is sufficient evidence that the Veteran meets the threshold criterion for service connection of a current hypertension disability. Boyer, 210 F.3d at 1353; Brammer, 3 Vet. App. at 225. Specifically, VA examiners in July 2002 and July 2009 diagnosed the Veteran with essential hypertension based on his elevated blood pressure readings. Private treatment records dated from 2010 to 2013 also record a current diagnosis of hypertension. The Veteran has taken lisinopril since the mid-1990s to control his high blood pressure. Thus, the Veteran clearly has a current hypertension disability. Consequently, the determinative issue is whether the Veteran's current hypertension disability is somehow attributable to his military service. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service."). See, too, Maggitt v. West, 202 F.3d 1370, 1375 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000); and Collaro v. West, 136 F.3d 1304, 1308 (Fed. Cir. 1998). The Veteran's service treatment records document that he was diagnosed with and treated for "borderline hypertension" from May 1988 through July 1988. A service treatment record dated in May 1988 revealed elevated blood pressure readings (systolic/diastolic) of 140/98, 142/102, and 144/110. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1 (the term hypertension means that the diastolic blood pressure (i.e., bottom number) is predominantly 90 mm or greater, and isolated systolic hypertension means the systolic blood pressure (i.e., top number) is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm). As a result, the Veteran was placed on an exercise and diet program that lowered his blood pressure readings for a time. Upon separation in December 1988, the Veteran reported a history of high blood pressure; however, his blood pressure reading at the time of separation was normal, as it was 102/70. Following his military service, VA treatment records dated in January 1998, February 1998, and September 2001 recorded a diagnosis of hypertension. He has continued with medication and other treatment to keep his high blood pressure under control. There is also medical evidence of a nexus or link between his current hypertension and his in-service treatment for "borderline hypertension" and high blood pressure readings. Holton, 557 F.3d at 1366. See also 38 C.F.R. § 3.303(d). Specifically, after reviewing the evidence of record in May 2011, a VA physician noted that the date of onset for the Veteran's hypertension was during service, even though the VA examiner added that the hypertension did not require continuous medication to control it within the first post- service year. There is no contrary medical opinion of record. This opinion, based on a review of the pertinent evidence of record, lends probative support to the Veteran's hypertension claim. Accordingly, resolving doubt in the Veteran's favor, the evidence supports service connection for hypertension. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Governing Laws and Regulations for PTSD The establishment of service connection for PTSD has unique evidentiary requirements. It generally requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-IV); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). See also Cohen v. Brown, 10 Vet. App. 128 (1997). If it is established through military citation or other supportive evidence that the Veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(2). See also 38 U.S.C.A. § 1154(b) and 38 C.F.R. § 3.304(d); Gaines v. West, 11 Vet. App. 353 (1998) (Board must make a specific finding as to whether the Veteran engaged in combat). To gain the benefit of a relaxed standard for proof of service incurrence of an injury or disease, 38 U.S.C.A. § 1154(b) requires that the Veteran have actually participated in combat with the enemy. See VAOPGCPREC 12-99. If VA determines either that the Veteran did not engage in combat with the enemy or that the Veteran did engage in combat, but that the alleged stressor is not combat related, the Veteran's lay testimony, by itself, is not sufficient to establish the occurrence of the alleged stressor. Instead, the record must contain credible supporting evidence that corroborates the Veteran's testimony or statements. 38 C.F.R. § 3.304(f); Stone v. Nicholson, 480 F.3d 1111 (Fed. Cir. 2007); Cohen v. Brown, 10 Vet. App. 128, 147 (1997); Moreau v. Brown, 9 Vet. App. 389, 395 (1996). However, corroboration of every detail of a claimed stressor, including the Veteran's personal participation, is not required; rather, a Veteran only needs to offer independent evidence of a stressful event that is sufficient to imply his or her personal exposure. See Pentecost v. Principi, 16 Vet. App. 124, 128 (2002) (quoting Suozzi v. Brown, 10 Vet. App. 307 (1997)). In other words, the Veteran's presence with the unit at the time such attacks occurred corroborates his statement that he experienced such attacks personally. Suozzi v. Brown, 10 Vet. App. 307, 311 (1997). Effective July 13, 2010, if a stressor claimed by a Veteran is related to that Veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that a Veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of that Veteran's service, a Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(3) (2012). "[F]ear of hostile military or terrorist activity" means that a Veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, such as from an actual or potential improvised explosive device; vehicle- imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the Veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. See id. A Veteran must have experienced, witnessed, or have been confronted by an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of that Veteran or others, and that Veteran's response to the event or circumstance must have involved a psychological or psycho-physiological state of fear, helplessness, or horror. The occurrence of an actual event or circumstance is necessary. In making this determination, VA must duly consider the places, types, and circumstances of a Veteran's service as shown by the service record, the official history of each organization in which such a Veteran served, a Veteran's medical records, and all pertinent medical and lay evidence. The new rule is limited to cases in which the claimed stressor is related to a Veteran's fear of hostile military or terrorist activity. See 75 Fed. Reg. 39843(Jul. 13, 2010). The final requirement of 38 C.F.R. § 3.304(f) is medical evidence of a nexus between the claimed in-service stressor and the current disability. However, such after-the-fact medical nexus evidence generally cannot also be the sole evidence of the occurrence of the claimed stressor. Moreau, 9 Vet. App. at 396. In determining whether service connection for PTSD is warranted, the Board shall consider the benefit-of-the-doubt doctrine. 38 U.S.C.A. 5107(b); 38 C.F.R. § 3.102; Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1991). Analysis - Service Connection for PTSD In this case, the Veteran contends that he has PTSD attributable to noncombat-related stressors. He has alleged that he had PTSD-related symptoms during and since the time of his active military service. See March 2002 PTSD claim; August 2002 Veteran's statement; May 2013 hearing testimony at pages 3-5, 8-15. Based on the above records, he consistently described three alleged in-service stressors. First, he has described the suicide of a close friend who was a JAG in training school in February 1985. The service member, H.B. (initials used to protect privacy), shot himself in the mouth with a 22 caliber gun. Second, he described the investigation of explosions, homicides, suicides, crashes, and accidents as part of his duties as a JAG while stationed in Honduras and Panama in a low-intensity warfare situation. As a result of these investigations, he was exposed to autopsies, body parts, dead bodies, and accident scenes. He remembers one soldier who was caught between two trucks, the shooting deaths of military policemen, and the deaths of soldiers in parachute jumps, among many other graphic incidents. He found the environment in Central America to be dangerous, unpredictable, and volatile. Third, he described a climate of anti-gay persecution in the Army, to include derisive stories and insults that left him stressed. He indicated that, as an Army JAG, he had to investigate and prosecute crimes for what were consensual acts. He was in a constant state of terror that he himself would be discovered as a gay male. Upon review of the evidence of record, the Board concludes that the Veteran is entitled to service connection for PTSD. Initially, the Veteran's service personnel records and Report of Separation from the Armed Forces (DD Form 214) do not reflect receipt of medals, badges, or decorations that specifically denote combat with the enemy. His service personnel records and DD-Form 214 do document that he received medals and awards, such as the Army Service Ribbon, the Overseas Service Ribbon, the Army Commendation Medal, and the Joint Service Commendation Medal, among others, but there is no award that establishes that he engaged in combat. Moreover, his military occupational specialty (MOS) was a JAG attorney. In fact, the Veteran never alleges that he was in combat. Thus, the combat presumption in connection with PTSD is not for application. 38 C.F.R. § 3.304(f)(2). See also 38 U.S.C.A. § 1154(b) and 38 C.F.R. § 3.304(d) (pertaining to combat Veterans). With respect to the non-combat stressor involving the suicide of another JAG who was the Veteran's friend in February 1985, there is credible supporting evidence that this stressor occurred. 38 C.F.R. § 3.304(f); Cohen, 10 Vet. App. at 147; Moreau, 9 Vet. App. at 395. In particular, the Veteran has submitted a March 1985 U.S. Army Criminal Investigation Command (CID) report confirming that another soldier undergoing JAG training at the same time as the Veteran, H.B., committed suicide by shooting himself in the head with a 22 caliber revolver in February 1985. This stressor was also confirmed by an August 2007 report from the U.S. Army Joint Services and Research Center (JSRRC). Again, a stressor need not be corroborated in every detail. Pentecost, 16 Vet. App. at 128. Thus, there is sufficient credible evidence to verify the occurrence of this stressor. 38 C.F.R. § 3.304(f). With respect to the non-combat stressor involving the Veteran's investigation of explosions, homicides, suicides, crashes, and accidents as part of his duties as a JAG while stationed in Honduras and Panama, there is credible supporting evidence that this stressor occurred. 38 C.F.R. § 3.304(f); Cohen, 10 Vet. App. at 147; Moreau, 9 Vet. App. at 395. The Veteran's service personnel records confirm that he served as a JAG in Panama and Honduras from April 1985 to September 1987. His description of exposures to details of body parts from homicides, suicides, and accidents is consistent with the places, types, and circumstances of the Veteran's service as a JAG stationed in Panama and Honduras in the mid-1980s, as documented in his records. 38 U.S.C.A. § 1154(a); 38 C.F.R. § 3.303(a). There is no specific information suggesting the Veteran did not engage in these duties. Again, the specific unit he was assigned to as a JAG attorney adds credibility to this assertion. The Board emphasizes that a stressor need not be corroborated in every detail. Pentecost, 16 Vet. App. at 128. In short, there is sufficient and credible circumstantial verification of his exposure to traumatic stressors in his general duties as a JAG investigator. 38 C.F.R. § 3.304(f). The Veteran's service treatment records do not reveal complaints, treatment, or diagnosis of PTSD or any other acquired psychiatric disorder. However, as to PTSD, an in- service diagnosis is not required. See 38 C.F.R. § 3.304(f). With respect to the criteria of a current diagnosis of PTSD, the threshold consideration for any service connection claim is the existence of a current disability. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303; Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In particular, aside from credible evidence of an in-service stressor, current medical evidence diagnosing PTSD in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-IV) is required, as well as competent evidence of a nexus between current PTSD symptomatology and his verified in-service stressor. 38 C.F.R. § 3.304(f). See also Cohen v. Brown, 10 Vet. App. 128 (1997). In the present case, VA mental health treatment records beginning in 2001 diagnose the Veteran with PTSD, as did an August 2002 VA psychiatric examiner. VA Vet Center records dated in 2008 also reveal treatment for PTSD. Some of this evidence appears to have been based on testing in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-IV). Consequently, the Veteran has a current diagnosis of PTSD. 38 C.F.R. § 3.304(f). With respect to the criteria of a nexus, there is medical evidence of a link between current PTSD symptomatology and the verified in-service stressors of exposure to trauma as part of the Veteran's general duties as a JAG investigator in Central American in the 1980s and the suicide of another JAG who was the Veteran's friend in February 1985. See 38 C.F.R. § 3.304(f). Specifically, in a May 2002 private Cascade Clinic psychological evaluation, Dr. P.O., PhD., performed a comprehensive interview with the Veteran and psychiatric testing and concluded that the Veteran "may" have PTSD related to the death of his JAG classmate when he was an officer in basic training. In addition, in a June 2008 Boston Vet Center evaluation, a VA nurse opined that the Veteran had PTSD due to several in- service traumatic stressors, to include the death of his friend and fellow JAG by suicide in 1985, as well as his role as a JAG investigating the deaths and suicides of U.S. soldiers and Honduran civilians in the context of low- intensity warfare situation in Central America in the 1980s. It was noted that the Veteran was an "excellent historian." PTSD symptoms of recurring distressing dreams, chronic anger and irritability, sleep disturbance, detachment, estrangement, and avoidance were documented. A July 2008 private clinical social worker opinion from Fenway Health also diagnosed the Veteran with PTSD due to his duties as an investigator in the Army. This opinion was proffered after an interview and mental health examination of the Veteran. However, a detailed discussion of the stressor and how it caused PTSD was not provided. Finally, a July 2009 VA psychiatric examiner concluded that the Veteran met the DSM-IV criteria for PTSD due to the Veteran's work as a JAG investigating murders in Central America and due to the in-service suicide of his friend. The VA examiner provided a long discussion of the Veteran's psychiatric history and a detailed medical examination and interview of the Veteran. Overall, this VA examination and opinion was thorough, supported by detailed explanations with DSM-IV testing, based on a review of the claims folder, and supported by the evidence of record. There are no contrary medical opinions of record. Thus, resolving any doubt in the Veteran's favor, the evidence supports service connection for PTSD. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. The Board has also considered whether the Veteran's PTSD claim raised the issue of whether service connection is warranted for any other acquired psychiatric disorder in addition to PTSD. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (holding that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record). Although the Veteran is also diagnosed with paranoid personality disorder (see e.g., private May 2002 Cascade Clinic evaluation and July 2009 VA psychiatric examination), congenital or developmental defects such as personality disorders are not "diseases" or "injuries" within the meaning of applicable legislation. 38 C.F.R. §§ 3.303(c), 4.9, 4.127. Defects are defined as "structural or inherent abnormalities or conditions which are more or less stationary in nature." VAOPGCPREC 82-90. Consequently, service connection is not warranted for the Veteran's personality disorder. The Veteran also has a diagnosis for an alcohol abuse disorder, which is now in full remission. See July 2009 VA psychiatric examination. Regardless, it was previously determined his alcohol abuse was not related to his PTSD. See August 2002 VA psychiatric examination. Moreover, as to his alcohol abuse diagnosis, the Board notes that service- connected disability compensation is precluded for disability that is the result of the Veteran's willful misconduct or the abuse of alcohol or drugs. 38 U.S.C.A. §§ 1110, 1131. See also 38 C.F.R. §§ 3.1(n), 3.301; VAOPGCPREC 7-99 (June 9, 1999); VAOPGCPREC 2-98 (Feb. 10, 1998). ORDER Subject to the provisions governing the award of monetary benefits, service connection for bilateral knee chondromalacia patella with arthritis is granted. Subject to the provisions governing the award of monetary benefits, service connection for rosacea is granted. Subject to the provisions governing the award of monetary benefits, service connection for hypertension is granted. Subject to the provisions governing the award of monetary benefits, service connection for PTSD is granted. REMAND Before addressing the merits of the remaining three service connection issues on appeal for a kidney disorder, intestinal/digestive disorder, and anal irritation, the Board finds that additional development of the evidence is required. First, the law provides that VA shall make reasonable efforts to notify a claimant of the evidence necessary to substantiate a claim and requires the VA to assist a claimant in obtaining that evidence. 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159. The Court has held that the failure by the Board to enforce compliance with the requirements of 38 U.S.C.A. § 5103(a) for the VA to inform a claimant of the information or evidence necessary to substantiate a claim, as well as to inform a claimant of which evidence the VA would seek to provide and which evidence the claimant is to provide, is remandable error. Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). In this case, it does not appear that the Veteran has been provided adequate VCAA notice for the issues of secondary service connection for a kidney disorder, an intestinal/digestive disorder, and anal irritation. The RO did send him earlier VCAA letters in August 2008 and November 2010, but these letters did not advise him of the evidence necessary to substantiate a claim for service connection for a kidney disorder, an intestinal/digestive disorder, and anal irritation on a secondary basis. These letters only addressed direct service connection. During the course of the appeal, the evidence has reasonably raised the issue of whether the Veteran has a kidney disorder secondary to his service-connected hypertension, an intestinal/digestive disorder secondary to his service- connected PTSD, and anal irritation secondary to an intestinal/digestive disorder. Therefore, a remand is necessary to ensure that the Veteran is provided a proper notice letter for these secondary service connection issues. Second, the Veteran should be scheduled for a VA examination and opinion to determine the likely etiology of any current kidney disorder. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see also 38 U.S.C.A. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4). The previous May 2011 and August 2009 VA examiners did not address the theory of secondary service connection. In addition, a VA physician in an August 2009 addendum indicated that any question addressing etiology should be reviewed by a VA urology specialist. Third, the Veteran should be scheduled for a VA examination and opinion to determine the likely etiology of any current intestinal/digestive disorder, on the basis of in-service incurrence, as well as on the basis of being secondary to his service-connected PTSD. The VA examiner should also opine whether anal irritation is secondary to any intestinal/digestive disorder. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see also 38 U.S.C.A. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4). The previous May 2011 VA opinion did not address the theory of secondary service connection. In addition, as to direct service connection, the VA examiner failed to acknowledge November 1985 service treatment records documenting viral gastroenteritis and diarrhea. Accordingly, the case is REMANDED for the following action: 1. The RO should send the Veteran a notice letter in connection with his claim for service connection for a kidney disorder, to include as secondary to service-connected hypertension; his claim for service connection for an intestinal/digestive disorder, to include as secondary to service-connected PTSD; and his claim for anal irritation, to include as secondary to an intestinal/digestive disorder. The letter should (1) inform him of the information and evidence that is necessary to substantiate the claim; (2) inform him about the information and evidence that VA will seek to provide; and, (3) inform him about the information and evidence he is expected to provide. Specifically, the letter should notify him of the evidence necessary to substantiate the claims on both a direct and secondary basis. 2. After providing additional notice and securing any other additional evidence, the RO should schedule the Veteran for a VA examination to determine the nature and etiology of any kidney disorder that may be present. If possible, the examination should be scheduled with a urology specialist. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. If there is a clinical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The VA examiner is advised that the Veteran contends, in part, that his kidney disorder is secondary to his service- connected hypertension. The Veteran's service treatment records do not reveal any treatment for a kidney disorder. Post-service, in 1997, 1998, and 1999, VA urograms of the kidneys revealed hydronephrosis, among other abnormalities. An August 2009 VA examiner assessed bladder spasm or vesical spasm, cause unknown. In an August 2009 addendum, the VA examiner indicated the question of etiology should be reviewed by a urology specialist. The examiner should identify all current diagnoses of any kidney disorder present during the pendency of the appeal or any residuals of previous hydronephrosis. For each diagnosis identified, the examiner should state whether it is at least as likely as not that any current kidney disorder was caused by or permanently aggravated by the Veteran's service- connected hypertension disability. If not, he or she should state whether the disorder is otherwise causally or etiologically related to the Veteran's military service. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) The VA examiner should offer a clear rationale for any opinion provided. Because it is important that a disability be viewed in relation to its history, copies of all pertinent records in the Veteran's claims file must be made available to the VA examiner for review. 3. After providing additional notice and securing any other additional evidence, the RO should schedule the Veteran for a VA examination to determine the nature and etiology of any intestinal/digestive disorder and anal irritation that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. If there is a clinical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The VA examiner is advised that the Veteran contends that his intestinal/digestive disorder is secondary to his service-connected PTSD, or in the alternative, began in service. The Veteran also contends that he has anal irritation secondary to an intestinal/digestive disorder. The Veteran's service treatment records reveal treatment for viral gastroenteritis with diarrhea for three days duration in November 1985. Upon separation in December 1988, the Veteran denied a history of stomach, intestinal, or frequent indigestion problems. Post-service, at a July 1989 VA examination, the Veteran denied any constipation symptoms. A September 2001 VA treatment record noted that the Veteran was on medication due to increased stomach acid. A July 2002 VA examiner indicated that the Veteran's food intolerance leads to diarrhea. The examiner also noted "anal irritation." In July 2010, colonoscopy records diagnosed irritable bowel syndrome (IBS), colon polyps, diverticulosis, and hemorrhoids. It was noted that IBS caused the Veteran's hemorrhoids. The VA examiner should identify all current diagnoses of any intestinal/digestive disorder or anal irritation disorder present during the pendency of the appeal. For each diagnosis identified, the examiner should state whether it is at least as likely as not that any current intestinal/digestive disorder is related to the Veteran's military service, including his in-service treatment for viral gastroenteritis with diarrhea in November for three days duration in 1985. The VA examiner should also indicate whether it is as at least as likely as not that any current intestinal/digestive disorder was caused by or permanently aggravated by the Veteran's service- connected PTSD disability. Finally, he or she should also indicate whether it is as at least as likely as not that any current anal irritation disorder was caused by or permanently aggravated by the Veteran's intestinal/digestive disorder. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) The VA examiner should offer a clear rationale for any opinion provided. Because it is important that a disability be viewed in relation to its history, copies of all pertinent records in the Veteran's claims file must be made available to the VA examiner for review. 4. The RO should review the claims file and ensure that all of the foregoing development actions have been conducted and completed in full. 5. After completing these actions, the RO should conduct any other development as may be indicated by a response received as a consequence of the actions taken in the preceding paragraphs. 6. When the development requested has been completed, the case should be reviewed by the RO on the basis of additional evidence. If the benefit sought is not granted, the Veteran and his attorney should be furnished a supplemental statement of the case (SSOC) and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. Thereafter, if indicated, the case should be returned to the Board for the purpose of appellate disposition. No action is required of the Veteran until she is otherwise notified by the RO. By this action, the Board intimates no opinion, legal or factual, as to any ultimate disposition warranted in this case. 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). 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). ______________________________________________ JESSICA J. WILLS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs