Citation Nr: 1318241 Decision Date: 06/05/13 Archive Date: 06/11/13 DOCKET NO. 11-18 541A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for posttraumatic stress disorder (PTSD). 2. Entitlement to an acquired psychiatric disorder other than PTSD, to include a dysthymic disorder, a mood disorder not otherwise specified (NOS), a generalized anxiety disorder, and a mixed adjustment disorder, including as secondary to now service-connected PTSD. WITNESSES AT HEARING ON APPEAL The Veteran, his parents, and his sister ATTORNEY FOR THE BOARD E. Woodward Deutsch, Counsel INTRODUCTION The Veteran served on active duty from August 1993 to January 1996. This matter comes before the Board of Veterans' Appeals (Board) from rating decisions dated in December 2008 and November 2009, which were issued by the Department of Veterans Affairs (VA) Regional Offices (ROs) in Columbia, South Carolina, and St. Petersburg, Florida, respectively. While the Veteran's claims file was temporarily brokered to each of those ROs for adjudication, jurisdiction of his case has since been transferred to the RO in Atlanta, Georgia. In November 2012, the Veteran testified at a hearing before the undersigned. Also present at the hearing were the Veteran's parents, who testified on his behalf, and his sister, who did not testify. A transcript of the hearing is of record. At the November 2012 Board hearing, the undersigned accepted the Veteran's submission of new evidence, accompanied by a waiver of RO review. 38 C.F.R. §§ 20.800, 20.1304 (c) (2012). The undersigned then held the record open for 30 days to allow the Veteran to submit additional evidence in support of his claim. That evidentiary window has now expired and, thus, appellate review may proceed. As an initial matter, the Board notes that, in its November 2009 rating decision, the RO characterized the Veteran's claim as an application to reopen a claim of entitlement to service connection for PTSD. In this regard, the Board acknowledges that this claim was initially denied by a December 2008 rating decision. Significantly, however, the Board points out that because the Veteran submitted a timely Notice of Disagreement to the December 2008 denial of entitlement to service connection for PTSD in August 2009 (i.e., within one year of notice of the determination), the December 2008 rating decision did not become final. See 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. §§ 20.302, 20.1103 (2012). Accordingly, the submission of new and material evidence is not required for the Board to address the merits of the Veteran's October 21, 2008, claim for entitlement to service connection for PTSD, and this issue is as stated on the first page of this decision. Moreover, the Board observes that, after the issuance of a July 2011 Statement of the Case, the Veteran submitted a Substantive Appeal (VA Form 9), which was date-stamped as having been received at the RO on July 26, 2011. Therefore, while cognizant that the RO subsequently sent the Veteran a December 2011 letter indicating that his VA Form 9 was untimely, the Board nevertheless finds that he perfected a timely appeal. See 38 C.F.R. § 20.302(b) (2012). Additionally, the Board observes that, although the disability at issue was initially limited to PTSD, the record reflects that during pendency of this appeal, the Veteran has been treated not only for PTSD, but also for other acquired psychiatric disorders, including a dysthymic disorder, a mood disorder NOS, a generalized anxiety disorder, and a mixed adjustment disorder. In this regard, in Clemons v. Shinseki, 23 Vet. App. 1 (2009), the Court held that the scope of a disability claim includes any disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. In light of Clemons, the Board concludes that the Veteran's acquired psychiatric disorder claim encompasses claims of entitlement to service connection for PTSD, and entitlement to service connection for an acquired psychiatric disability other than PTSD. Moreover, given the specific legal requirements for establishing entitlement to service connection for PTSD under 38 C.F.R. § 3.304(f), the Board has bifurcated the Veteran's acquired psychiatric disorder claim into two separate issues; namely (1) entitlement to service connection for PTSD, and (2) entitlement to service connection for an acquired psychiatric disorder other than PTSD, to include a dysthymic disorder, a mood disorder NOS, a generalized anxiety disorder, and a mixed adjustment disorder, including as secondary to now service-connected PTSD, as reflected on the first page of this decision. See Locklear v. Shinseki, 24 Vet. App. 311, 315 (2011) (stating that "bifurcation of a claim generally is within the Secretary's discretion"). Finally, the Board notes that the Veteran was previously represented by a private attorney. See December 15, 2011, VA Form 21-22a, Appointment of Individual as Claimant's Representative. In this regard, the Board notes that on November 15, 2012 (i.e., after the appeal was certified to the Board), the attorney submitted a letter indicating that he was withdrawing his representation in the Veteran's case. See November 15, 2012, Letter Withdrawing Power of Attorney. Notably, however, at his November 26, 2012, Board hearing, the Veteran indicated that he wished to remove the private attorney as his representative and signaled his intent to proceed pro se, noting that he wished to represent himself going forward with his appeal. See Board Hearing Tr. at 2, 27; see also 38 C.F.R. § 14.631(f) (2012) (stating that a power of attorney may be revoked at any time, and an agent or attorney may be discharged at any time). The issue of entitlement to a total disability rating based on individual unemployability (TDIU), has been raised by the record, but has not yet been adjudicated by the Agency of Original Jurisdiction (AOJ). See July 13, 2009, Social Security Administration (SSA) examination (noting that, as a result of the Veteran's PTSD, he cannot hold down a job without putting himself and others at risk); Dr. R.B.'s May 12, 2010, statement (noting that the Veteran cannot get a job as a result of his PTSD symptomatology and poor mental functioning). Therefore, the Board does not have jurisdiction over this issue, and it is referred to the AOJ for appropriate action. The Board's decision as to the issue of entitlement to service connection for PTSD is set forth below. For the reasons discussed following the order, the issue of entitlement to service connection for an acquired psychiatric disorder other than PTSD, to include a dysthymic disorder, a mood disorder NOS, a generalized anxiety disorder, and a mixed adjustment disorder, including as secondary to now service-connected PTSD, is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDING OF FACT The Veteran's PTSD is related to his period of military service. CONCLUSION OF LAW The criteria for entitlement to service connection for PTSD have been met. 38 U.S.C.A. §§ 1110, 5107(b) (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Duties to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). In this decision, the Board is granting service connection for PTSD, which represents a complete award of the benefit sought on appeal. Thus, any deficiency in VCAA compliance is deemed to be harmless error, and any further discussion of VA's responsibilities to notify and assist and Veteran is unnecessary. II. Service Connection The Veteran essentially contends that service connection for PTSD is warranted because this disorder developed as a result of two stressful experiences during service. First, the Veteran has reported that, while onboard the USS Juneau, he was involved in a near-death accident while attempting to tie down a helicopter on the ship's deck. Specifically, the Veteran has reported that the pressure release link on the chain that he was using to tie down the helicopter popped while he was grabbing it with both hands, severely cutting both of his thumbs and causing the helicopter to break free. In this regard, the Veteran has reported that he feared for his life during this incident, as he was nearly decapitated by the propellers of the helicopter and realized that he could have been much more seriously injured by the heavy chains he was using to tie down the helicopter. See VA treatment records dated May 23, 2008; March 4, 2009; March 30, 2009; and March 12, 2010; Veteran's August 10, 2009, Stressor Statement; Dr. R.B.'s March 2, 2010, treatment note, and May 12, 2010, letter; September 2010 Decision Review Officer (DRO) Hearing Tr. at 2-4; Board Hearing Tr. at 3-4. Second, the Veteran maintains that, while he and his Juneau crewmates were patrolling the waters off the coast of Iran, he perceived his life to be in danger when an enemy combatant aimed a ".50 cal" machine gun at their vessel. See Board Hearing Tr. at 20-21 (attesting to the perceived threat to the Veteran's life during his service aboard a Navy carrier off the coast of Iran); VA treatment records dated December 5, 2007; March 4, 2009; and March 30, 2009. To establish entitlement to service connection for PTSD, a Veteran must provide (1) medical evidence diagnosing PTSD; (2) credible supporting evidence that the claimed in-service stressor occurred; and (3) a link, established by medical evidence, between current symptoms of PTSD and an in-service stressor. 38 C.F.R. § 3.304(f) (2012). Parenthetically, the Board notes that the Veteran's second alleged in-service stressor is predicated on a fear of hostile military or terrorist activity. See 38 C.F.R. § 3.304(f)(3) (2012). In this regard, the Board notes that, during the pendency of this appeal, the evidentiary standard for establishing such in-service stressors was liberalized under VA's revised regulatory provisions governing service connection for PTSD. See 75 Fed. Reg. 39843 (July 13, 2010). Nevertheless, the Board finds that further consideration of those amendments is unnecessary in this instance as the evidence of record is sufficient to verify the Veteran's first purported stressor. The Board finds that service connection for PTSD is warranted. See 38 C.F.R. §§ 3.303(a), 3.304(f) (2012). In making this determination, the Board finds it significant that the post-service medical evidence of record reveals that the Veteran currently has PTSD. Specifically, the Veteran's VA treatment records reflect that he has consistently been diagnosed with and treated for PTSD. See, e.g., VA treatment records dated April 22, 2008; May 23, 2008; July 8, 2008; March 4, 2009; March 30, 3009; April 13, 2009; May 11, 2009; and March 12, 2010; July 9, 2009, Statement from VA Licensed Clinical Social Worker. Additionally, the July 2009 SSA examiner diagnosed the Veteran with PTSD. See June 13, 2009, SSA examination report. Finally, the Veteran's a private treating psychiatrist, Dr. R.B., has determined that the Veteran's current mental health problems are symptomatic of PTSD. See Dr. R.B.'s March 4, 2010, treatment record and May 12, 2010, letter. In this regard, the Board recognizes that neither the Veteran's VA treatment records, the statements from Dr. R.B., nor the SSA examination report specify whether the Veteran has met all four Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for PTSD. Nevertheless, applicable law directs that a "PTSD diagnosis by a mental-health professional must be presumed . . . to have been made in accordance with the applicable DSM criteria as to both the adequacy of the symptomatology and the sufficiency of the stressor" unless there is clear evidence to the contrary. Cohen v. Brown, 10 Vet. App. 128, 140 (1997); 38 C.F.R. § 3.304(f) (2012); see also Rizzo v. Shinseki, 580 F.3d 1288, 1291 (Fed. Cir. 2009) (finding VA medical examiners are presumed competent in the absence of clear evidence to the contrary). Therefore, the Board finds that the clinical evidence of record is sufficient to show that Veteran has a current diagnosis of PTSD. Accordingly, the Board finds that the first element required for service connection, medical evidence diagnosing PTSD, has been established. Turning to the second element required for service connection for PTSD, the Board acknowledges that, in November 2009, the AOJ formally found that the Veteran had provided insufficient information with which to corroborate his reported in-service stressors. See November 9, 2009, Formal Finding of Lack of Information to Corroborate PTSD Stressor. Significantly, however, the Board finds that there is credible supporting evidence of record with which to verify the Veteran's reported stressor regarding a helicopter accident that occurred while he was aboard the USS Juneau in which he severely injured both thumbs. In making this determination, the Board highlights that this alleged stressor is documented in the Veteran's service treatment records. See August 4, 1995, Service Treatment Record (noting treatment for bilateral thumb injuries that were incurred aboard USS Juneau when the pressure release link on a helicopter chain popped while the Veteran was grabbing it with both hands). In this regard, the Board observes that the AOJ effectively conceded the occurrence of this in-service event in its February 27, 1997, Rating Decision, by granting service connection for residuals of bilateral thumb lacerations as a result of the August 1995 incident. Further, the Board finds it significant that the Veteran has submitted a statement from his commanding officer (Commander "Q.G.W.") aboard the USS Juneau, confirming that the Veteran sustained thumb lacerations while attempting to tie down a helicopter on that ship. See December 12, 2012, Statement of Commander Q.G.W., United States Navy, Retired. Additionally, the Board notes that the Veteran is competent to report that he was nearly decapitated during an in-service accident that occurred while attempting to tie down a helicopter onboard the USS Juneau. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (holding that a Veteran is competent to report what occurred during service because he is competent to testify as to factual matters of which he has first-hand knowledge); see also Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (holding that competent testimony is limited to that which the witness has actually observed and is within the realm of his personal knowledge; such knowledge comes to a witness through use of his senses-that which is heard, felt, seen, smelled or tasted). Furthermore, the Board considers the Veteran's account of this incident to be credible as it is both internally consistent and in line with the other evidence of record. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995). Accordingly, the Board finds that the Veteran's assertions, in tandem with the other evidence of record, are sufficient to verify his in-service stressor, thereby satisfying the second element required for service connection for PTSD. Turning to the third and final element required for service connection for PTSD, the Board finds it significant that, in a May 2010 letter, after discussing the Veteran's pertinent military and medical history, the Veteran's private treating psychiatrist, Dr. R.B., provided his "sincere opinion" that the Veteran's PTSD "is more likely than not a result of the traumatic event of August 4, 1995, on board the USS Juneau." In support of this opinion, Dr. R.B. stated that after personally examining the Veteran, reviewing his medical history, and reviewing his pertinent mental health records, the Veteran "has no other risk factors" for PTSD apart from the in-service injuries he received while working on the deck of his assigned Navy vessel. Similarly, the Veteran's primary VA treating physician's assistant has attributed his PTSD, at least in part, to an unspecified "noncombat military-related" stressor. See, e.g., VA treatment records dated April 22, 2008; May 23, 2008; July 8, 2008; March 4, 2009; March 30, 3009; April 13, 2009; and May 11, 2009. As such, the Board finds that the Veteran's currently diagnosed PTSD is related to his military service, and more specifically, to his verified in-service stressor of a near-death accident in August 1995 involving a helicopter while onboard the USS Juneau, thereby satisfying the third element required for service connection for PTSD. Accordingly, because all three elements required to establish entitlement to service connection have been met, the Board finds that service connection for PTSD is warranted. Therefore, the Veteran's claim of entitlement to service connection for PTSD is granted. ORDER Service connection for PTSD is granted. REMAND As discussed above, the Board has herein granted service connection for PTSD. Significantly, however, as discussed above, entitlement to service connection for an acquired psychiatric disorder other than PTSD is also currently on appeal. Before the Board can adjudicate this claim, however, additional development is required. The Board will discuss each of its reasons for remand in turn. I. VA Treatment Records A review of the Veteran's claims file indicates that some of his VA treatment records remain outstanding. Specifically, in a July 2009 statement, the Veteran's VA social worker indicated that she has counseled the Veteran for his acquired psychiatric disorders since February 2009, noting that he has received additional VA treatment for his acquired psychiatric disorders and related symptomatology since 1999. Moreover, at his November 2012 Board hearing, the Veteran reported that he continues to receive "weekly" VA treatment for his mental health problems. See Board Hearing Tr. at 16. However, with the exception of the social worker's July 2009 statement and VA treatment records dated March 12, 2010, and March 26, 2010, which the Veteran submitted himself, no VA treatment records dated prior to August 16, 2002, or after May 18, 2009, have yet been associated with the Veteran's claims file. Accordingly, on remand, attempts should be made to obtain a complete copy of the Veteran's VA treatment records dated from 1999 to August 2002, and from May 2009, forward, from the VA Medical Center in Dublin, Georgia. See 38 U.S.C.A. § 5103A(b)(1) (West 2002); 38 C.F.R. § 3.159(c)(1) (2012). In making this determination, the Board notes that records generated by VA facilities that may have an impact on the adjudication of a claim are considered to be in the constructive possession of VA adjudicators during the consideration of a claim, regardless of whether those records are physically on file. See Dunn v. West, 11 Vet. App. 462, 466-67 (1998); Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). II. SSA Records A review of the record further reflects that the Veteran applied for, and was denied, SSA disability benefits in 2008 and again in 2009. See June 23, 2008, SSA Social Security Notice; July 13, 2009, SSA examination report; Board Hearing Tr. at 12-13. To date, however, a complete copy of the Veteran's SSA records has not been associated with the claims file. In this regard, the Board notes that the possibility that records submitted in support of the Veteran's SSA claim contain evidence relevant to the Veteran's VA claim cannot be foreclosed absent a review of those records. As such, on remand, attempts should be made to obtain a complete copy of the Veteran's SSA records. See 38 U.S.C.A. § 5103A(b)(1) (West 2002); 38 C.F.R. § 3.159(c)(2) (2011); see also Golz v. Shinseki, 590 F.3d 1317, 1321 (Fed. Cir. 2010) (finding that as long as a reasonable possibility exists that SSA records may be relevant to a Veteran's claim, VA must assist him or her in obtaining the records); Murincsak v. Derwinski, 2 Vet. App. 363 (1992) (holding that VA's duty to assist includes obtaining records from SSA and giving them appropriate consideration and weight in determining whether to award or deny VA disability compensation benefits). III. VA Examination Finally, the Board finds that a VA examination assessing whether the Veteran has an acquired psychiatric disorder other than PTSD that was caused by or incurred during his military service, or is caused or aggravated by his now service-connected PTSD, is warranted in this case. In making this determination, the Board notes that VA is obliged to provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service, or establishing that certain diseases manifested during an applicable presumptive period for which the claimant qualifies; and (3) an indication that the disability or persistent / recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability; but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see also 38 U.S.C.A. § 5103A(d)(2) (West 2002); 38 C.F.R. § 3.159(c)(4)(i) (2012). In determining that a VA examination is necessary in this case, the Board notes that the Veteran's post-service VA treatment records reveal diagnoses of, and treatment for, a dysthymic disorder, a mood disorder NOS, a generalized anxiety disorder, and a mixed adjustment disorder. See VA treatment records dated January 4, 2007; December 5, 2007; April 22, 2008; July 8, 2008; March 4, 2009; April 13, 2009; and March 26, 2010; Dr. R.B.'s March 4, 2010, treatment note. As such, because there is competent evidence showing that the Veteran has an acquired psychiatric disorder other than PTSD, the Board finds that the first McLendon element has been satisfied. Turning to the second McLendon element, the Board acknowledges that the Veteran's service treatment records are devoid of evidence of treatment for an acquired psychiatric disorder other than PTSD. Significantly, however, the Veteran and his family members have consistently reported that, ever since separation from military service, the Veteran has experienced extreme anxiety and nervousness, mood swings, a short temper, depression, and a fear of groups. See Dr. R.B.'s May 12, 2010, letter; March 4, 2009, VA treatment record; Board Hearing Tr. at 18-19. In this regard, the Board notes that the Veteran is competent to report that he has experienced such symptomatology since his military service. See Washington v. Nicholson, 19 Vet. App. 362 (2005); see also Layno v. Brown, 6 Vet. App. 465 (1994). Accordingly, because the evidence of record indicates that the Veteran first began experiencing symptoms such as depression, anxiety, and mood swings following separation from service, the second McLendon element has also been satisfied. Further, turning to the third McLendon element, the Board notes that there is some evidence of record indicating that the Veteran's acquired psychiatric disorders other than PTSD may be associated with his now service-connected PTSD. Specifically, during VA treatment in May 2008 and July 2008, the Veteran's treating physician's assistant reported that the Veteran's PTSD has resulted in an explosive personality and alcohol / marijuana dependency. See VA treatment records dated May 23, 2008, and July 8, 2008. Similarly, during VA treatment in March 2009, the Veteran's treating physician's assistant reported that the Veteran's PTSD has resulted in an explosive personality, alcohol / marijuana dependency, and a mixed adjustment disorder. See March 4, 2009, VA treatment record. Accordingly, the Board finds that there is evidence of record indicating that the Veteran's current acquired psychiatric disorder(s) other than PTSD may be associated with service and/or his service-connected PTSD, thereby satisfying the third McLendon element. Significantly, however, given the complicated nature of the Veteran's disability picture, and because the record contains insufficient medical evidence to determine the nature and etiology of his acquired psychiatric disorder(s) other than PTSD, the Board finds that, on remand, a VA examination and medical opinion is necessary to fully assess whether the Veteran has an acquired psychiatric disorder other than PTSD, to include a dysthymic disorder, a mood disorder NOS, a generalized anxiety disorder, and a mixed adjustment disorder, that was that was incurred during or aggravated by his military service, or is caused or aggravated by his now service-connected PTSD. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see also 38 U.S.C.A. § 5103A(d)(2) (West 2002); 38 C.F.R. § 3.159(c)(4)(i) (2012). Accordingly, the case is REMANDED for the following action: 1. Obtain all treatment records related to the Veteran's acquired psychiatric disorder(s) from the Dublin, Georgia, VA Medical Center, dated from 1999 to August 2002, and from May 2009, forward. All reasonable attempts to obtain such records should be made and documented. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records himself, as provided in 38 U.S.C.A. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Make arrangements to obtain copies of all documents or evidentiary material pertaining to the Veteran's application(s) for SSA disability benefits. All reasonable attempts to obtain such records should be made and documented. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records himself, as provided in 38 U.S.C.A. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 3. After the development requested in items (1) through (2) is completed, schedule the Veteran for a VA examination to determine the nature and etiology of his claimed acquired psychiatric disorder other than PTSD. The entire claims file (i.e., both the paper claims file and any relevant medical records contained in the Veteran's Virtual VA eFolder) should be made available to and be reviewed by the clinician, and it should be confirmed that such records were available for review. After conducting an examination of the Veteran and performing any clinically-indicated diagnostic testing, the examiner should provide an opinion as to the diagnosis of any acquired psychiatric disorder other than PTSD found to be present. For each acquired psychiatric disorder identified (other than PTSD), the examiner should provide an opinion as to the following: (a) Is it at least as likely as not (a 50 percent or greater probability) that the disorder had its clinical onset during active service or is related to any in-service disease, event, or injury? For purposes of providing this opinion, the examiner should accept as true the Veteran's statements to the effect that, while serving on the USS Juneau: (1) he was involved in a near-death accident while attempting to tie down a helicopter on the ship's deck; and (2) he perceived his life to be in danger when an enemy combatant aimed a ".50 cal" machine gun at his vessel while he and his crewmates were patrolling the waters off the coast of Iran. The examiner should also accept as true the Veteran's statements to the effect that, since service, he has experienced extreme anxiety and nervousness, mood swings, a short temper, depression, and a fear of groups. (b) If the answer to the above question is "No," is at least as likely as not (50 percent or greater probability) that the Veteran's service-connected PTSD either (a) caused or (b) aggravated any current acquired psychiatric disorder? In this special context, the Board notes that "aggravation" has occurred when it has been medically determined that the Veteran's acquired psychiatric disorder has undergone an identifiable permanent increase in severity that was proximately due to his service-connected PTSD. A report of the examination should be prepared and associated with the Veteran's VA claims file. A complete rationale must be provided for all opinions rendered. If the examiner cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. 4. Thereafter, and after undertaking any additional development deemed necessary, readjudicate the issue on appeal. If the benefit sought on appeal remains denied, the Veteran should be provided with a Supplemental Statement of the Case and afforded a reasonable opportunity to respond. The case should then be returned to the Board for further appellate review, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims 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). ______________________________________________ NICOLE KLASSEN Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs