Citation Nr: 1329630 Decision Date: 09/16/13 Archive Date: 09/20/13 DOCKET NO. 07-18 036 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Manchester, New Hampshire THE ISSUES 1. Entitlement to service connection for fibromyalgia. 2. Entitlement to service connection for a bilateral foot disorder (to include pes planus). 3. Entitlement to service connection for a sinus disorder. 4. Entitlement to service connection for Bell's palsy as secondary to sinus and left ear disabilities. 5. Entitlement to service connection for a low back disorder (other than a low back strain), to include as secondary to the service-connected low back strain. 6. Entitlement to service connection for a left ear disorder, to include left ear hearing loss and otitis media. 7. Entitlement to service connection for a skin disease. 8. Entitlement to service connection for a gastrointestinal disorder. 9. Entitlement to service connection for a left knee disorder. 10. Entitlement to service connection for a right hip disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD Paul S. Rubin, Counsel INTRODUCTION The Veteran had active service in the U.S. Army from September 1974 to September 1984. The Veteran also had active service for two days from February 22, 1992 to February 23, 1992 during a period of inactive duty for training (INACDUTRA) in which service-connected disabilities were previously established. In addition, the Veteran served in the New York Army National Guard and New Hampshire Army National Guard from 1989 to 1995. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2006 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Manchester, New Hampshire. In April 2011, the Veteran presented testimony at a Board videoconference hearing before the undersigned Acting Veterans Law Judge. A transcript of the hearing is associated with the claims folder. The Board remanded this case in January 2012 for further development. After completion of this development by the RO, the case has been returned to the Board for further appellate consideration. In the January 2012 Board decision, the Board also adjudicated various other new and material evidence issues that were previously on appeal. The Board also accepted the Veteran's withdrawal of several other issues previously on appeal. Thus, these issues are no longer on appeal before the Board. The Board previously characterized the left knee and right hip issues on appeal as "new and material evidence" issues. However, the Board has now recharacterized these issues as service connection issues only. Specifically, service connection for the left knee and right hip were previously denied in a final February 2000 Board decision. However, at the time of that Board decision, the Veteran's active duty service treatment records (STRs) dated from 1974 to 1984 were missing and unassociated with the claims folder. Subsequently, in 2012, the RO was finally able to secure these missing STRs and associate them with the claims folder. In this regard, 38 C.F.R. § 3.156(c)(1) provides that, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim, notwithstanding paragraph (a) of the same section (which defines new and material evidence). The regulation further identifies service records that are related to a claimed in-service event, injury, or disease as relevant service department records. 38 C.F.R. § 3.156(c)(1)(i). In accordance with the above provision, new and material evidence is not needed to reopen the previously denied left knee and right hip claims when relevant STRs and/or any other relevant service department records are received after a prior final denial. Rather, the claim is simply reviewed on a de novo basis. Besides not having to submit new and material evidence, the benefit of this provision is to assign the earliest possible effective date without the claimant having to demonstrate clear and unmistakable error in a prior final determination, if the claims end up being granted. In the instant case, as noted above, the Veteran's active duty STRs dated from 1974 to 1984 were not secured by the RO until 2012. Several of these STRs dated in July 1984 and June 1978 may be relevant to the left knee and right hip service connection claims at issue. Thus, the Board will now address these service connection claims on a de novo basis, as opposed to addressing new and material evidence to reopen. In addition, the Veteran submitted additional, relevant private medical evidence in April 2013, after certification of his appeal. However, in a March 2013 letter, his representative previously waived his right to have the RO initially consider this evidence in order to expedite the processing of his claims. Therefore, the Board accepts this additional private evidence for inclusion in the record and consideration by the Board at this time. See 38 C.F.R. §§ 20.800, 20.1304 (2012). A review of the Virtual VA paperless claims processing system and the Veterans Benefits Management System (VBMS) does not reveal any additional documents pertinent to the present appeal. For reasons discussed below, the issues of entitlement to service connection for Bell's Palsy, a low back disorder, a left ear disorder, a skin disease, a gastrointestinal disorder, a left knee disorder, and a right hip disorder are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The Veteran has a fibromyalgia disorder that was incurred in the line of duty during a period of INACDUTRA service in February 1992. 2. The veteran is noted to have entered active duty in September 1974 with a preexisting foot disorder diagnosed as bilateral pes planus of the feet. There was a permanent increase of the Veteran's bilateral pes planus of the feet beyond its natural progression during service. Stated another way, the bilateral pes planus was permanently aggravated during active service. 3. The Veteran has sinusitis and allergic rhinitis disorders that began during his period of active military service from 1974 to 1984. CONCLUSIONS OF LAW 1. A fibromyalgia disorder was incurred in active service. 38 U.S.C.A. §§ 101, 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.1, 3.6, 3.102, 3.159, 3.303 (2012). 2. A preexisting foot disorder diagnosed as bilateral pes planus was aggravated by active service. 38 U.S.C.A. §§ 101, 1110, 1111, 1131, 1153, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.306 (2012). 3. Sinusitis and allergic rhinitis disorders were incurred in active service. 38 U.S.C.A. §§ 101, 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VA's Duty to Notify and Assist For the fibromyalgia, bilateral pes planus, and sinusitis / rhinitis service connection issues being granted, review of the claims folder reveals compliance with the Veterans Claims Assistance Act of 2000 (VCAA). See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2011). 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 issues. Bernard v. Brown, 4 Vet. App. 384, 392- 94 (1993). With regard to the remaining service connection issues being remanded, the Board finds that further evidentiary development is needed and will be discussed herein below. Therefore, an analysis regarding compliance with the VCAA for the claims of service connection for Bell's Palsy, a low back disorder, a left ear disorder, a skin disease, a gastrointestinal disorder, a left knee disorder, and a right hip disorder is not required at this time. 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. 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)). 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(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). 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). 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 nexus element of service connection may be established by medical evidence, or, in certain circumstances, lay evidence. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009) (rejecting the view that "competent medical evidence is required ... [when] the determinative issue involves either medical etiology or a medical diagnosis." (citing Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007))). Lay evidence can 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). Governing Laws and Regulations for ACDUTRA / INACDUTRA Service A Veteran is "a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable." 38 U.S.C.A. § 101(2); 38 C.F.R. § 3.1(d). The term "active military, naval, or air service" includes the following: active duty; any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty while performing ACDUTRA; or any period of inactive duty for training (INACDUTRA) during which the individual concerned was disabled or died from injury incurred or aggravated in the line of duty while performing INACDUTRA, or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during INACDUTRA. 38 U.S.C.A. § 101(24); 38 C.F.R. § 3.6(a). VA's General Counsel has held that it was the intention of Congress when it defined active service in 38 U.S.C.A. § 101(24) to exclude a period of INACDUTRA during which a member was disabled or died due to nontraumatic incurrence or aggravation of a disease process. See VAOPGCPREC 86-90. ACDUTRA is, among other things, full-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C.A. § 101(22); 38 C.F.R. § 3.6(c)(1). INACDUTRA is part-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C.A. § 101(22); 38 C.F.R. § 3.6(c)(1). Active service also includes authorized travel to or from such duty or service. 38 U.S.C.A. § 106(d); 38 C.F.R. § 3.6(e). In summary, when a claim for service connection is based only on a period of ACDUTRA or INACDUTRA, there must be evidence that the appellant became disabled as a result of a disease or injury incurred or aggravated in the line of duty during that period of ACDUTRA or INACDUTRA. See 38 U.S.C.A. §§ 101(2), (22), (24); 38 C.F.R. § 3.6(a); Donnellan v. Shinseki, 24 Vet. App. 167, 172 (2010); Acciola v. Peake, 22 Vet. App. 320, 324 (2008) (citing Mercado-Martinez v. West, 11 Vet. App. 415, 419 (1998); Paulson v. Brown, 7 Vet. App. 466, 470 (1995)). In the absence of such evidence, the period of ACDUTRA or INACDUTRA would not qualify as "active military, naval, or air service," and the appellant would not qualify as a "Veteran" for that period of ACDUTRA or INACDUTRA service alone. 38 U.S.C. § 101(2), (24); see Acciola, 22 Vet. App. at 324. Generally, no presumptions (including the presumptions of soundness, aggravation, or for presumptive diseases) attach to periods of ACDUTRA and INACDUTRA unless "Veteran" status is attained during those periods. Paulson v. Brown, 7 Vet. App. 466, 470 (1995). The presumption of soundness under 38 U.S.C.A. § 1111 does not apply when a claimant, Veteran or otherwise, has not been examined upon entering a period of ACDUTRA. Smith v. Shinseki, 24 Vet. App. 40, 45 (2010). Likewise, the presumption of aggravation under 38 U.S.C.A. § 1153 does not apply to ACDUTRA or INACDUTRA service. Smith, 24 Vet. App. at 45. See also Acciola v. Peake, 22 Vet. App. 320 (2008); Mercado-Martinez v. West, 11 Vet. App. 415, 419 (1998); Paulson v. Brown, 7 Vet. App. 466, 470 (1995). Neither the presumption of soundness nor the presumption of aggravation is at issue here. Analysis - Service Connection for Fibromyalgia The Veteran claims that he has developed a fibromyalgia disorder stemming from his February 1992 INACDUTRA injury when he slipped on ice and fell on his back and groin. He alleges he now has widespread musculoskeletal pain stemming from this confirmed INACDUTRA injury. He currently takes pain medication, muscle relaxers, and anti-depressants to control this alleged condition. See May 2006 claim; September 2007 Veteran's statement; April 2011 hearing testimony at pages 3-4. Upon review of the evidence of record, the Board grants the appeal for service connection for fibromyalgia. As mentioned, the first and perhaps most fundamental requirement for any service-connection claim is proof the Veteran currently has the claimed disability. Boyer, 210 F.3d at 1353; Brammer, 3 Vet. App. at 225. Here, a private treatment letter from Dr. K.K., DO., dated in April 2013 and a private treatment report from Dr. P.M., MD., dated in October 2008 assessed that the Veteran has a current fibromyalgia disorder. In addition, both VA and private treatment records dated from 2001 to 2011 reveal treatment for fibromyalgia or "osteoarthrosis" with various medications used to treat it. Consequently, the determinative issue is whether this fibromyalgia disorder is somehow attributable to an injury sustained during a period of INACDUTRA service in the Army National Guard in February 1992. 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). Army National Guard records dated in February and March of 1992 confirm that the Veteran sustained a low back strain and abductor tendonitis as the result of slipping on ice during INACDUTRA training in February 1992. He is presently service-connected for both disabilities. Thus, the appellant became disabled as a result of an injury incurred in the line of duty during the February 1992 period of INACDUTRA. See 38 U.S.C. §§ 101(2), (22), (24); 38 C.F.R. § 3.6(a); Donnellan v. Shinseki, 24 Vet. App. 167, 172 (2010); Acciola v. Peake, 22 Vet. App. 320, 324 (2008) (citing Mercado-Martinez v. West, 11 Vet. App. 415, 419 (1998); Paulson v. Brown, 7 Vet. App. 466, 470 (1995)). As such, the February 1992 period of INACDUTRA would qualify as "active military, naval, or air service," and the appellant would already qualify as a "Veteran" for that period of INACDUTRA service. 38 U.S.C. § 101(2), (24); see Acciola, 22 Vet. App. at 324. Both STRs dated from 1974 to 1984 and National Guard records at the time of the February 1992 injury during INACDUTRA are negative for any diagnosis of fibromyalgia. Post-service, Dr. P.M has treated the Veteran since 2001 for fibromyalgia symptoms. A review of VA and private treatment records dated in the 1990s also discloses symptomatology similar to fibromyalgia at times in terms of widespread musculoskeletal pain. With regard to a nexus, there is probative medical and lay evidence of a nexus or link between the Veteran's current fibromyalgia and the traumatic injury incurred in the line of duty in February 1992 during a period of INACDUTRA. Holton, 557 F.3d at 1366. See also 38 U.S.C. §§ 101(2), (23), (24); 38 C.F.R. §§ 3.6(a), 3.303(a), (d). Specifically, in an October 2008 private medical opinion, Dr. P.M. opined that there "could well be" a connection between the Veteran's 1992 history of back injury and his fibromyalgia. Dr. P.M. added that there is no way to disprove or prove it, but certainly it is noted in the causality of fibromyalgia-like symptoms. More significantly, in an April 2013 private medical opinion, Dr. K.K. opined that the Veteran's fibromyalgia by history started after two major back surgeries suffered in 1992, with one injury occurring while in the military (during the above period of INACDUTRA) and the other from a motor vehicle accident. Dr. K.K. assessed that these injuries led to the current fibromyalgia. Dr. K.K. noted that while there was no formal testing of diagnostic study for fibromyalgia, the Veteran's blood work consistently shows high levels of inflammation as evidenced by persistently elevated WBC count an elevated CRP levels. Overall, this opinion was thorough, supported by an explanation, and circumstantially supported by the evidence of record. There is no contrary, negative medical opinion of record. Moreover, in further support of these medical opinions, the Veteran has submitted medical treatise evidence received in April 2011 discussing that a possible cause or trigger for fibromyalgia includes physical trauma. In fact, some cases of fibromyalgia have been specifically linked to individuals who sustained some kind of back injury similar to the Veteran's injury. It was also noted that the pain and symptoms of fibromyalgia can come and go over the years. Generally, an attempt to establish a medical nexus between service and a disease or injury solely by generic information in a medical journal or treatise "is too general and inclusive." Sacks v. West, 11 Vet. App. 314, 317 (1998) (a medical article that contained a generic statement regarding a possible link between a service-incurred mouth blister and a present pemphigus vulgaris condition did not satisfy the nexus element). However, medical treatise evidence can provide important support when combined with an opinion of a medical professional. Mattern v. West, 12 Vet. App. 222, 228 (1999). See Rucker v. Brown, 10 Vet. App. 67, 73-74 (1997) (holding that evidence from scientific journal combined with doctor's statements was "adequate to meet the threshold test of plausibility"). In the present case, the Veteran has submitted favorable medical opinions in support of his claim, as well as medical treatise evidence. With regard to lay evidence, the Veteran is competent and credible in his lay assertions regarding fibromyalgia symptomatology beginning after a February 1992 INACDUTRA injury. Barr v. Nicholson, 21 Vet. App. 303, 307-09 (2007). Accordingly, resolving doubt in the Veteran's favor, the evidence supports service connection for fibromyalgia by way of an injury incurred in the line of duty during a February 1992 period of INACDUTRA. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Governing Laws and Regulations for Aggravation of a Preexisting Disorder When an issue is raised as to whether the disorder claimed by the Veteran preexisted service, the governing law provides that every Veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable (obvious or manifest) evidence demonstrates that (1) an injury or disease existed before acceptance and enrollment into service (2) and was not aggravated by such service. See 38 U.S.C.A. §§ 1111, 1132, 1137; 38 C.F.R. § 3.304(b); Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). See also VAOPGCPREC 3-2003 (July 16, 2003). This statutory provision is referred to as the "presumption of soundness." Horn v. Shinseki, 25 Vet. App. 231, 234 (2012). In July 2003, VA's General Counsel issued a precedent opinion holding that in order to rebut the presumption of soundness in 38 U.S.C.A. § 1111, VA must demonstrate by clear and unmistakable evidence both that the disease or injury in question existed prior to service and that it was not aggravated by service. VAOPGCPREC 3-2003 (July 16, 2003). The claimant is not required to show that the disease or injury increased in severity during service before VA's duty under the second prong of this rebuttal standard attaches. This holding replaced the previous standard under 38 C.F.R. § 3.304(b), which had required that if a condition was not noted at entry but was shown by clear and unmistakable evidence to have existed prior to entry, the burden then shifted to the claimant to show that the condition increased in severity during service. The Court and Federal Circuit Court have adopted the General Counsel's position. Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009); Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). However, if a preexisting disability is noted upon entry into service, the Veteran cannot bring a claim for service connection for that particular disability, but the Veteran may bring a claim for service-connected aggravation of that disability. In that case, § 1153 applies and the burden falls on the Veteran to establish aggravation. Wagner, 370 F.3d at 1096; Jensen v. Brown, 19 F.3d 1413, 1417 (Fed. Cir. 1994). A preexisting injury or disease will be considered to have been aggravated during service when there is an increase in disability during service, unless there is a specific finding (clear and unmistakable evidence) that the increase in disability is due to the natural progression of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a). Clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity during service. 38 C.F.R. § 3.306(b). The presumption of aggravation applies only when the Veteran shows the preservice disability increases in severity during service. Beverly v. Brown, 9 Vet. App. 402, 405 (1996). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306; Falzone v. Brown, 8 Vet. App. 398, 402 (1995). See also Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002) (which holds that evidence of a temporary flare-up, without more, does not satisfy the level of proof required of a non-combat Veteran to establish an increase in disability). Temporary or intermittent flare-ups of a preexisting injury or disease are not sufficient to be considered "aggravation in service" unless the underlying condition itself, as contrasted with mere symptoms, has worsened. See Jensen v. Brown, 4 Vet. App. 304, 306-307 (1993); Green v. Derwinski, 1 Vet. App. 320, 323 (1991); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). Accordingly, "a lasting worsening of the condition" - that is, a worsening that existed not only at the time of separation but one that still exists currently is required. See Routen v. Brown, 10 Vet. App. 183, 189 n. 2 (1997); see also Verdon v. Brown, 8 Vet. App. 529, 538 (1996). The presumption of aggravation only requires evidence of an actual worsening of a preexisting condition during service; it does not require direct evidence of nexus, that is, that the worsening was actually caused by service. Smith v. Shinseki, 24 Vet. App. 40, 47-48 (2010) (emphasis added). If a permanent increase is shown, the presumption of aggravation may be rebutted only by clear and unmistakable evidence that the increase in disability is due to the natural progress of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a), (b). Independent medical evidence is needed to support a finding that the preexisting disorder increased in severity in service beyond its natural progression. See Paulson v. Brown, 7 Vet. App. 466, 470-471 (1995); Crowe v. Brown, 7 Vet. App. 238, 246 (1994). Analysis - Service Connection for Bilateral Foot Disorder The Veteran contends that he has pes planus or other bilateral foot disorder that began during his active duty service from 1974 to 1984. He says that he hurt the arches of his feet during training in 1974 and 1975. He had to run for miles and miles, and was provided special shoes for his pes planus. He indicates he was repeatedly treated for his bilateral pes planus during active duty, especially in the 1970s. See March 2013 Veteran's statement; April 2011 hearing testimony at pages 13-14. Upon review of the evidence of record, the Board grants the appeal for service connection for bilateral foot pes planus. However, the Board is granting this claim based on evidence of record that supports aggravation of a preexisting pes planus condition that was noted at the Veteran's September 1974 STR entrance examination. As mentioned, the first and perhaps most fundamental requirement for any service-connection claim is proof the Veteran currently has the claimed disability. Boyer, 210 F.3d at 1353; Brammer, 3 Vet. App. at 225. Here, a VA podiatry consult dated in August 2005 diagnosed the Veteran with bilateral foot pes planus with forefoot varus, rearfoot varus, with "excessive" pronation. The VA podiatrist assessed flatfoot with symptoms along the plantar surface of both feet. VA X-rays dated in August 2005 also confirmed bilateral pes planus. Treatment records dated in 2006 record inversion and eversion of the feet. The Veteran was treated in VA and private treatment records in the 1990s and 2000s for bilateral foot pain on various occasions. Consequently, the determinative issue is whether this bilateral pes planus disorder of the feet was incurred in or aggravated by the Veteran's period of active duty service from 1974 to 1984. 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). With regard to the existence of a preexisting condition, STRs reveal that the Veteran underwent an entrance examination into active service in September 1974. His September 1974 entrance examination noted preexisting pes planus that was "mild" and "asymptomatic." The condition was not considered disabling at that time. A disorder can be asymptomatic, but still considered as "noted" on entrance. Verdon v. Brown, 8 Vet. App. 529, 534-535 (1996). Therefore, based on this evidence, a bilateral pes planus condition of the feet was clearly noted at entrance. Since this disability was noted at the time of the Veteran's entrance into service, the Veteran is not entitled to the presumption of soundness for this particular disability when entering service. See 38 U.S.C.A. § 1111; 38 C.F.R. § 3.304(b). According to VAOPGCPREC 3-2003, when a preexisting condition is noted at entrance, VA is not required to show that there clearly and unmistakably was no aggravation of his preexisting pes planus during service beyond its natural progression. Rather, since the Veteran's preexisting pes planus was noted at entrance, it is the Veteran's burden to show a chronic (meaning permanent) worsening of his preexisting bilateral pes planus during service. In other words, the Veteran may only bring a claim for aggravation of this preexisting pes planus condition. Wagner, 370 F.3d at 1096. A preexisting injury or disease will be considered to have been aggravated during service when there is an increase in disability during service, unless there is a specific finding (by clear and unmistakable evidence) that the increase in disability is due to the natural progression of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a). With regard to aggravation of a preexisting condition during active service from 1974 to 1984, STRs document that a short time after his September 1974 entrance examination, the Veteran was treated for painful heels in October 1974 during basic training. STRs dated in January 1975, July 1975, and September 1975 reveal further treatment for "severe" bilateral foot pes planus. A March 1977 STR mentions "fallen arches" and pes planus since basic training. Subsequent STRs dated in October 1978, March 1980, May 1981, May 1982, and September 1982 diagnose bilateral flat feet with "recurrent" swelling. It was noted that the Veteran "broke" his arches during training. Frequent "pain when running" was observed. He was prescribed arch supports and special shoes. In fact, he was transferred out of infantry due to this condition, and placed on profile on several occasions. The Veteran's STRs are therefore supportive of permanent worsening of his preexisting pes planus condition. See 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a). Post-service, with regard to aggravation of a preexisting condition, the Veteran was treated in VA and private treatment records in the 1990s and 2000s for bilateral foot pain on various occasions. The Veteran has credibly reported bilateral foot pain, difficulty walking, and discomfort over the years. Most importantly, a VA podiatry consult dated in August 2005 diagnosed the Veteran with bilateral foot pes planus with forefoot varus, rearfoot varus, and with "excessive" pronation. The VA podiatrist assessed flatfoot with symptoms along the plantar surface of both feet. VA X-rays dated in August 2005 also confirmed bilateral pes planus. Treatment records dated in 2006 record inversion and eversion of the feet as the result of bilateral pes planus. Therefore, the Veteran's post-service records are also supportive of permanent worsening of his preexisting pes planus condition. See 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a). See also Routen, 10 Vet. App. at 189 n. 2; Verdon, 8 Vet. App. at 538. The Boards adds that there is no countervailing medical evidence of record suggesting the increase in his pes planus disability was due to the natural progress of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a), (b); Paulson 7 Vet. App. at 470-471. That is, there is no clear and unmistakable evidence that the increase in the pes planus disability was due to the natural progression of the disease. Id. The Board emphasizes that the clear-and-unmistakable-evidence standard is an "onerous" one. Laposky v. Brown, 4 Vet. App. 331, 334 (1993) (citing Akins v. Derwinski, 1 Vet. App. 228, 232 (1991)). Consequently, the probative evidence of record demonstrates a permanent aggravation of the veteran's preexisting bilateral pes planus condition during service. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a),(b). Accordingly, resolving doubt in the Veteran's favor, the evidence supports service connection for bilateral foot pes planus on the basis of this aggravation during service. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. The veteran may only be service connected for bilateral pes planus for the degree of disability over and above the degree of disability existing at the time of entrance into active service. See 38 C.F.R. §§ 3.322, 4.22. In order words, the Veteran can be service-connected up to the extent of aggravation of the pes planus disorder during service. The appeal is granted as to that issue. Analysis - Service Connection for Sinus Disorder The Veteran contends that he has sinusitis or other sinus disorder that began during his active duty service from 1974 to 1984. He says he was treated for pneumonia at Ft. Knox during active duty, possibly leading to his sinusitis. By 1990 he had to undergo surgery to correct his sinusitis. See April 2011 hearing testimony at pages 7-9. Upon review of the evidence of record, the Board grants the appeal for service connection for sinusitis and allergic rhinitis. As mentioned, the first and perhaps most fundamental requirement for any service-connection claim is proof the Veteran currently has the claimed disability. Boyer, 210 F.3d at 1353; Brammer, 3 Vet. App. at 225. Here, private treatment records dated throughout 2011 document chronic sinusitis. VA treatment records dated from 2005 to 2009 also document recurrent, chronic sinusitis. A private Suncoast Family Medical Associates dated in December 2011 diagnosed allergic rhinitis as well. Earlier VA treatment records dated in 2006 and 2007 also mention allergic rhinitis. The Veteran takes various medications to treat these disorders. Consequently, the determinative issue is whether his sinus conditions are somehow attributable to the Veteran's period of active duty service from 1974 to 1984. 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). STRs document treatment for pharyngitis and upper respiratory infections in September 1974, January 1976, March 1977, May 1977, September 1978, November 1978, August 1981, and March 1984. A November 1974 STR reflected a diagnosis of rhinitis. A May 1980 STR assessed "doubtful sinusitis." Post-service, private Concord Hospital records dated in March 1990 reveal that the Veteran underwent a septoplasty for chronic sinusitis and nasal septal deviation. A July 1994 National Guard Medical Evaluation Board (MEB) summary noted the Veteran's complaints of sinusitis since active duty service. It was also noted that the Veteran had previously undergone surgery to reattach his nose at the age of five after amputation. VA medical certificates dated in June 1997 and September 1997 diagnosed sinusitis and allergic rhinitis. VA and private treatment records dated from 1998 to 2012 consistently assessed recurrent, chronic sinusitis and allergic rhinitis. The Board is mindful that certain disorders by their very nature tend to have active versus inactive stages. See Ardison v. Brown, 6 Vet. App. 405, 408 (1994). The Veteran has credibly reported recurring sinus problems in the 1990s and 2000s. Thus, the Board finds that there is probative lay and medical evidence that the Veteran's in-service sinus problems have continued post-service. At the very least, the possibility of sinusitis and rhinitis were identified during service, and subsequently confirmed as clear diagnoses post-service. Thus, there is some evidence of a nexus or link. Holton, 557 F.3d at 1366. See also 38 C.F.R. § 3.303(a), (d). Accordingly, resolving doubt in the Veteran's favor, the evidence supports service connection for sinusitis and allergic rhinitis. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. ORDER Service connection for fibromyalgia is granted. Service connection for a bilateral foot disorder diagnosed as pes planus is granted. Service connection for sinusitis and allergic rhinitis is granted. REMAND However, before addressing the merits of the service connection claims for Bell's palsy, a low back disorder, a left ear disorder, a skin disease, a gastrointestinal disorder, a left knee disorder, and a right hip disorder, the Board finds that additional development of the evidence is required. First, concerning VCAA notice, the VCCA notice letters of record failed to discuss secondary service connection for Bell's palsy on the premise that this alleged disability is proximately due to or chronically aggravated by the Veteran's service-connected sinus disability and his left ear disability. The VCAA notice letters also failed to discuss secondary service connection for a low back disorder (such as spondylolysis with sciatica or arthritis) on the premise that this alleged disability is proximately due to or chronically aggravated by the Veteran's already service- connected low back strain disability. See 38 C.F.R. § 3.310 (2012). These contentions were raised by the evidence of record as well as the Veteran's videoconference hearing testimony. See e.g., April 2011 hearing testimony at page 6. Therefore, a remand is required for the RO/AMC to issue another VCAA letter that is compliant with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) and with all legal precedent for these particular issues on appeal. Second, pursuant to the Board's earlier January 2012 remand, in a November 2012 VCAA letter the RO informed the Veteran that it was scheduling him for VA examinations to determine the etiology of any current left ear disorder (including hearing loss and otitis media), skin disease, gastrointestinal disorder, and lower back disorder (other than a low back strain) on the basis of in-service incurrence. However, in a November 2012 Report of General Information, the Veteran called a VA representative by telephone informing her that he was refusing to appear to the VA examinations and requesting that VA issue a decision without the VA examinations being conducted. Subsequently, in a March 2013 Report of General Information, the Veteran again confirmed that he wished to forgo the VA examinations and have his appeal adjudicated. However, confusingly, several weeks later in March 2013, the Veteran submitted an inconsistent statement essentially saying there was a misunderstanding and that actually he wanted to appear to his VA examinations. Also, the Veteran had previously told the undersigned Veterans Law Judge at the hearing that he would report to a VA examination if scheduled. See April 2011 hearing testimony at page 20. Therefore, the Board requests the RO / AMC to reschedule the Veteran for his previous VA examinations. This is the last opportunity for the Veteran to appear at a VA examination to determine the etiology of his claims. Third, the Veteran must be scheduled for VA examinations with opinions to determine the etiology of any current Bell's palsy, left knee, and right hip disorders on the basis of in-service incurrence. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4). See also McLendon v. Nicholson, 20 Vet. App. 79, 81-85 (2006). Furthermore, the theory of secondary service connection for Bell's palsy on the premise that this alleged disability is proximately due to or chronically aggravated by the Veteran's service-connected sinus disability and his left ear disability must also be addressed by the VA examiner. Accordingly, the case is REMANDED for the following action: 1. The RO/AMC must send the Veteran a VCAA letter notifying him and his representative of the evidence necessary to substantiate the claim for SECONDARY SERVICE CONNECTION for Bell's palsy on the premise that this alleged disability is proximately due to or chronically aggravated by the Veteran's service-connected sinus disability and his left ear disability. This letter must also address SECONDARY SERVICE CONNECTION for a low back disorder (such as spondylolysis with sciatica or arthritis) on the premise that this alleged disability is proximately due to or chronically aggravated by the Veteran's already service-connected low back strain disability. See 38 C.F.R. § 3.310 (2012). This letter must (1) inform the Veteran of the information and evidence that is necessary to substantiate these claims ON A SECONDARY BASIS; (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. See 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). 2. After sending the above VCAA notice, the RO / AMC must reschedule the Veteran for a VA examination to determine the nature and etiology of any current left ear disability. All indicated tests and studies should be conducted. The claims folder, including this remand, must be sent to the examiner for review; consideration of such should be reflected in the completed examination report or in an addendum. The Veteran should be afforded audiology testing, including a puretone audiometry test and a speech recognition test (Maryland CNC test), and all results of such tests should be recorded. The examiner must also fully describe the functional effects of the Veteran's hearing disability. The examiner should opine as to whether it is at least as likely as not (50 percent probability or more) that any current left ear disability (including hearing loss, otitis media, and any other left ear disability diagnosed since August 2005) is related to the Veteran's period of active duty service from September 1974 to September 1984 (in particular an alleged left ear injury in service while riding unsheltered in the back of a truck (in June 1978)), or any period of ACDUTRA / INACDUTRA. One STR documents that in June 1978, at the time of the alleged truck injury, the Veteran was treated for external otitis for several weeks. In July 1994, a National Guard MEB summary revealed left ear sensorineural hearing loss disability according to the established requirements of 38 C.F.R. § 3.385. However, a subsequent March 1996 VA audiology examination and September 2000 private audiological examination failed to establish left ear sensorineural hearing loss disability according to the established requirements of 38 C.F.R. § 3.385. VA treatment records dated in the 1990s and 2000s also document treatment for left ear otitis media, left ear otitis externa, and a left tympanic membrane scar. The examiner must provide a rationale for each opinion given. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran's reports, he or she must provide a reason for doing so. 3. After sending the above VCAA notice, the RO / AMC must reschedule the Veteran for a VA examination to determine the etiology of his current skin disease. All indicated tests and studies should be conducted. The claims folder, including this remand, must be sent to the examiner for review; consideration of such should be reflected in the completed examination report or in an addendum. The examiner should opine as to whether it is at least as likely as not (50 percent probability or more) that the Veteran's current skin disease (any skin disease diagnosed since October 2005 such as dermatitis or folliculitis) had its onset during his period of active duty service from September 1974 to September 1984, or any period of ACDUTRA / INACDUTRA. In this regard, a February 1978 STR reveals a rash over the Veteran's body for which he was provided ointment. Post-service, a September 2005 VA dermatology consult discusses the Veteran having a history of rashes since 1994. The examiner must provide a rationale for each opinion given. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran's reports, he or she must provide a reason for doing so. 4. After sending the above VCAA notice, the RO / AMC must reschedule the Veteran for a VA examination to determine the nature and etiology of any current gastrointestinal disability. All indicated tests and studies should be conducted. The claims folder, including this remand, must be sent to the examiner for review; consideration of such should be reflected in the completed examination report or in an addendum. The examiner should opine as to whether it is at least as likely as not (50 percent probability or more) that any current gastrointestinal disability had its onset during the Veteran's period of active duty service from September 1974 to September 1984, or is related to any period of ACDUTRA / INACDUTRA, or is related to any injury incurred during a period of INACDUTRA. At present, the Veteran is diagnosed with irritable bowel syndrome (IBS, or spastic colon), gastroesophageal reflux disease (GERD), hiatal hernia, and Barrett's esophagus. The examiner must provide a rationale for each opinion given. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran's reports, he or she must provide a reason for doing so. 5. After sending the above VCAA notice, the RO / AMC must reschedule the Veteran for a VA examination to determine the etiology of any current lower back disability other than a lower back strain. All indicated tests and studies should be conducted. The claims folder, including this remand, must be sent to the examiner for review; consideration of such should be reflected in the completed examination report or in an addendum. The examiner should opine as to whether it is at least as likely as not (50 percent probability or more) that any current lower back disability other than a lower back strain (such as spondylolysis with sciatica or arthritis) had its onset during the Veteran's period of active duty service from September 1974 to September 1984, or any period of ACDUTRA / INACDUTRA, or began during his February 1992 low back injury incurred during a period of INACDUTRA. The examiner should also opine whether it is at least as likely as not (50 percent or more probable) that a low back disorder (such as spondylolysis with sciatica or arthritis) is proximately due to or the result of the Veteran's service-connected low back strain? In making this determination, the examiner should consider whether a separate low back disorder (such as spondylolysis with sciatica or arthritis) developed over time as the result of the service-connected low back sprain. The examiner should also opine whether it is at least as likely as not (50 percent or more probable) that a low back disorder (such as spondylolysis with sciatica or arthritis) is chronically aggravated or worsened by his service-connected low back strain, regardless of the date of onset of either disorder? If and only if the examiner believes that there is chronic aggravation or worsening of another low back disorder by his service-connected low back strain, the examiner should also provide a medical opinion as to the degree of identifiable increased disability that has been produced by the aggravation. If the degree of increased disability cannot be quantified, the examiner should so indicate. The examiner must provide reasons for each opinion given. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran's reports, he or she must provide a reason for doing so. 6. After sending the above VCAA notice, the RO/AMC must schedule the Veteran for a VA examination by an appropriate clinician to determine the etiology of any current Bell's palsy disorder on a secondary basis. The examination should include any diagnostic testing or evaluation deemed necessary, including laboratory tests. The examiner must provide a clear rationale for the opinion. The Veteran must be advised that failure to report for a scheduled VA examination without good cause shown may have adverse consequences for his claim. The claims folder must be made available for review for the examination and the examination report must state whether such review was accomplished. THE VA EXAMINER MUST RESPOND TO THE FOLLOWING INQUIRIES: (a) Upon clinical examination, does the Veteran have a current Bell's palsy disorder or residuals thereof? (b) If a current Bell's Palsy disorder or residuals thereof is diagnosed, is it at least as likely as not (i.e., 50 percent or more probable) that a current Bell's Palsy disorder is proximately due to or the result of the Veteran's service-connected connected sinusitis disability or his left ear disability? (c) If a current Bell's Palsy disorder or residuals thereof is diagnosed, is it at least as likely as not (50 percent or more probable) that a current Bell's Palsy disorder is chronically aggravated or worsened by his service-connected sinusitis disability or his left ear disability, regardless of the date of onset of either disorder? If and only if the examiner believes that there is chronic aggravation or worsening of Bell's palsy disorder by his service-connected sinusitis disability or his left ear disability, the examiner should also provide a medical opinion as to the degree of identifiable increased disability that has been produced by the aggravation. If the degree of increased disability cannot be quantified, the examiner should so indicate. (d) In rendering this opinion, the examiner is advised of the Veteran's contention that his Bell's palsy disorder, first documented post-service in 2000, was caused by the Veteran's frequent sinus problems and ear infections. Private and VA treatment records document recurrent Bell's Palsy in 2001, but a December 2005 VA consult noted no Bell's Palsy occurrences in the last three years. 7. After sending the above VCAA notice, the RO/AMC must schedule the Veteran for a VA examination by an appropriate clinician to determine the etiology of any current left knee disorder. The purpose of this examination is to determine whether any current left knee disorder is directly related to service. The examination should include any diagnostic testing or evaluation deemed necessary, including laboratory tests. The examiner must provide a clear rationale for the opinion. The Veteran must be advised that failure to report for a scheduled VA examination without good cause shown may have adverse consequences for his claim. The claims folder must be made available for review for the examination and the examination report must state whether such review was accomplished. THE VA EXAMINER MUST RESPOND TO THE FOLLOWING INQUIRIES: (a) Upon clinical examination, does the Veteran have a current left knee disorder? (b) If a current left knee disorder is diagnosed, is it at least as likely as not (i.e., 50 percent or more probable) that a current left knee disorder is related to an event or incident during his period of active duty service from 1974 to 1984 or to any injury incurred during a period of INACDUTRA in February 1992? (c) In rendering this opinion, the examiner is advised that the Veteran contends that his current left knee disorder was due to a 1984 night training injury when he stepped into a hole between a train and a platform in Germany, thereby injuring his left knee. He also contends that he injured his left knee in February 1992 after slipping on ice during INACDUTRA training. Active duty STRs document that in July 1984 in Germany the Veteran hurt his left knee in training causing a laceration and stitches. He was instructed not to run for five days, and it was noted that the condition was resolving. National Guard records also document that in February 1992 and March 1992 the Veteran reported left knee pain to military medical personnel after slipping on ice and injuring his low back during INACDUTRA training on February 22, 1992. His left knee was examined in March 1992 and deemed "stable." Post-service, a VA examiner in March 1996 diagnosed a chronic left knee strain. VA X-rays dated in April 2006 revealed mild degenerative changes of the left knee. 8. After sending the above VCAA notice, the RO/AMC must schedule the Veteran for a VA examination by an appropriate clinician to determine the etiology of any current right hip disorder. The purpose of this examination is to determine whether any current right hip disorder is directly related to service. The examination should include any diagnostic testing or evaluation deemed necessary, including laboratory tests. The examiner must provide a clear rationale for the opinion. The Veteran must be advised that failure to report for a scheduled VA examination without good cause shown may have adverse consequences for his claim. The claims folder must be made available for review for the examination and the examination report must state whether such review was accomplished. THE VA EXAMINER MUST RESPOND TO THE FOLLOWING INQUIRIES: (a) Upon clinical examination, does the Veteran have a current right hip disorder? (b) If a current right hip disorder is diagnosed, is it at least as likely as not (i.e., 50 percent or more probable) that a current right hip disorder is related to an event or incident during his period of active duty service from 1974 to 1984 or to any injury incurred during a period of INACDUTRA in February 1992? (c) In rendering this opinion, the examiner is advised that the Veteran contends that he has a current right hip disorder due to frostbite to the right thigh sustained during active duty in Germany in 1978. He says he was not provided prompt treatment, eventually causing right hip arthritis. He also contends that he injured his right hip in February 1992 after slipping on ice during INACDUTRA training. (d) In rendering this opinion, the examiner is advised that active duty STRs document that in June 1978 in Germany the Veteran reported numbness of the right thigh. However, no injury was noted, and no objective findings were noted. National Guard records also document that in September 1992 and October 1992 the Veteran was diagnosed with trochanteric bursitis of the right hip after reporting pain subsequent to his injury where he slipped on ice and hurt his low back during INACDUTRA training on February 22, 1992. However, a National Guard November 1992 MRI of the right hip was negative for any abnormalities. In a July 1994 National Guard MEB summary, the Veteran complained about arthritis of the right hip. (e) In rendering this opinion, the examiner is advised that post-service, a March 1996 VA examiner diagnosed a chronic right hip strain. Another March 1996 VA examiner diagnosed acetabular sclerosis of the right hip. An October 1997 VA medical certificate noted degenerative changes of the right hip. But a July 1999 VA examiner found that the right hip was normal and the prior diagnoses were no longer present. 9. No action is required of the Veteran until further notice. However, the Board takes this opportunity to advise the Veteran that the conduct of the efforts as directed in this remand, as well as any other development deemed necessary, is needed for a comprehensive and correct adjudication of his claim. The Board is not entirely persuaded by the Veteran's explanations for cancelling the previous VA examinations scheduled for him in November 2012, especially since he directly told the undersigned Veterans Law Judge that he would appear to any VA examination scheduled for his claims. His cooperation in VA's efforts to develop his claim, including reporting for any scheduled VA examinations, is both critical and appreciated. The Veteran is also advised that failure to report for any scheduled examinations may result in the denial of a claim. 38 C.F.R. § 3.655. 10. The RO/AMC must review the claims file and ensure that all of the foregoing development actions have been conducted and completed in full. If any development is incomplete, appropriate corrective action is to be implemented. If any report does not include adequate responses to the specific opinions requested, it must be returned to the providing physician for corrective action. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 11. Thereafter, the RO/AMC must consider all of the evidence of record and readjudicate the service connection claims for Bell's Palsy, a low back disorder, a left ear disorder, a skin disease, a gastrointestinal disorder, a left knee disorder, and a right hip disorder. If the benefit sought is not granted, issue a Supplemental Statement of the Case and allow the Veteran and his representative an opportunity to respond. 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). ______________________________________________ M. MAC Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs