Citation Nr: 21000775 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 15-30 273 DATE: January 6, 2021 ORDER Service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD), a delusional disorder and alcohol use disorder, is denied. Service connection for traumatic brain injury (TBI) residuals is denied. Service connection for a neck disorder is denied. Service connection for a lower back disorder is denied. REMANDED The issue of service connection for a left ankle disorder, to include synovitis, is remanded. The issue of service connection for tinnitus is remanded. The issue of service connection for a lung, disorder, to include chronic obstructive pulmonary disease (COPD), is remanded. FINDINGS OF FACT 1. The Veteran does not have a diagnosis of PTSD under the Diagnostic and Statistical Manual of Mental Disorders (DSM V). 2. The probative medical evidence indicates the Veteran’s current psychiatric disorders are not related to in-service stressors. 3. There is no probative medical evidence indicating the Veteran has residuals of a TBI. 4. The probative medical evidence indicates the Veteran’s current neck disorder was not incurred in service. 5. The probative medical evidence indicates the Veteran’s current lower back disorder was not incurred in service. CONCLUSIONS OF LAW 1. The criteria to establish service connection for an acquired psychiatric disorder, including PTSD, a delusional disorder or alcohol use disorder, have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria to establish service connection for residuals of a TBI have not met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria to establish service connection for a neck disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309. 4. The criteria to establish service connection for a lower back disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 1972 to March 1976. In June 2014, the Veteran was afforded a hearing before a Decision Review Officer (DRO). In July 2017, the Veteran was afforded a videoconference hearing before the undersigned Veterans Law Judge. The undersigned noted the issues on appeal and engaged in a colloquy with the Veteran toward substantiation of the claims. See Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). A copy of the hearing transcript is associated with the claims file. In August 2018, the Board of Veterans’ Appeals (Board) remanded the issues of service connection for a lower back disorder, neck disorder, TBI, and an acquired psychiatric disorder. The Board directed the VA Regional Office (RO) to schedule new medical examinations which were completed in early 2020. The examinations were completed and the remand directives were completed. Stegall v. West, 11 Vet. App. 268 (1998). The August 2018 Board decision also denied service connection for a left ankle disorder, tinnitus, and COPD, among other issues. The Veteran appealed the specified denials to the United States Court of Appeals for Veterans’ Claims (Court). In February 2020, the Court vacated the August 2018 denial of service connection for a left ankle disorder, tinnitus and COPD, and remanded the Veteran’s appeal to the Board. As outlined in the remand section below, these issues are remanded in order to comply with the Court’s February 2020 Decision. The August 2018 Board decision directed the RO to attempt to locate records from the Joint Services Record Research Center (JSRRC) that could corroborate the Veteran’s reports of working in crash recovery during service. Since the Board remand, the Veteran submitted additional lay statements providing a date range which he was assigned to crash recovery but not the specific dates of the crashes he alleges he was involved with. In a September 2019 Administrative Decision, the RO indicated it reviewed the February 2012 and July 2019 statements submitted by the Veteran and determined those documents did not provide enough information to conduct a records search. The August 2018 Board decision directed the RO to attempt to obtain any further records related to worker’s compensation claims in 1983, 1994, and 2007. An October 2019 VA letter reports that the RO contacted the U.S. Department of Labor in August 2019 and October 2019 but received no response to VA’s records request. The Veteran has not alleged, and the record does not otherwise suggest any further records are outstanding. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). “To establish a right to compensation for a present disability, a Veteran must show: ‘(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 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Additionally, service connection for PTSD requires (1) medical evidence diagnosing the condition; (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304 (f). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Certain disorders, listed as “chronic” in 38 C.F.R. § 3.309 (a) and 38 C.F.R. § 3.303 (b), are capable of service connection based on a continuity of symptomatology without respect to an established causal nexus to service. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Arthritis is among the diseases listed under 38 C.F.R. § 3.309 (a). Therefore, with respect to the Veteran’s neck and lower back disorders, the presumptive service connection provisions based on “chronic” in-service symptoms and “continuous” post-service symptoms under 38 C.F.R. § 3.303 (b) apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. 38 C.F.R. § 3.303 (b). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases, such as arthritis, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309 (a). While the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination about the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104 (a). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 1. Entitlement to service connection for an acquired psychiatric disorder, including PTSD, a delusional disorder, and alcohol use disorder. The Veteran contends he has post-traumatic stress disorder (PTSD), although no medical provider has diagnosed him with that disorder. His current diagnoses include a delusional disorder, mixed type, continuous; schizophrenia; a tobacco use disorder; an alcohol use disorder; and an unspecified cannabis-related disorder. The Veteran’s claim has been recharacterized as one for an acquired psychiatric disorder, including any disorder that may be reasonably encompassed by the Veteran’s description of the claim, the Veteran’s symptoms, and other information of the record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Veteran contends his psychiatric disorders were caused by three in-service stressors: (1) his indirect exposure to injury and death while recovering crashed aircraft; (2) his experiencing mental anguish in response to the 1972 Vietnam Christmas Bombing; and (3) his in-service arrest for drug possession and theft. In a December 2012 statement, the Veteran reported working on an aircraft crash recovery team at Naval Air Station (NAS) Whiting Field from 1973 to 1976. He reported assisting with least two aircraft crashes, including one resulting in the death of the pilot and a student. However, the Veteran indicated he did not observe death or injury firsthand. In a November 2012 statement, a fellow servicemember (W.W.) reported working with the Veteran in Crash Recovery and Salvage from 1973 to 1975 but did not provide specific details. At the July 2017 Board hearing, the Veteran alleged experiencing psychiatric symptoms due to the 1972 Vietnam Christmas bombings. However, the Veteran did not serve in Vietnam. He reported that he began drinking heavily in response to the bombings and wanted to leave the service, although his father dissuaded him from this action. A September 1973 biochemist assay report indicates the Veteran was found to have used barbiturates, amphetamine, LSD and marijuana. An October 1973 military personnel record reports that the Veteran received nonjudicial punishment for wrongfully possessing equipment belonging to the military. The Veteran’s service treatment records (STRs) do not reference any complaints, diagnoses or treatment for a psychiatric disorder in service. The Veteran’s March 1972 report of medical history at enlistment indicates he denied depression, excessive worry or nervous trouble of any sort and his clinical psychiatric evaluation was normal. A September 1972 sick call treatment record indicates the Veteran refused to submit to drug/alcohol testing to comply with a competence for duty examination. However, there are no further references to drug possession charges or any references to the Veteran’s other alleged stressors in the STRs. In his March 1976 pre-discharge examination, his clinical psychiatric evaluation was normal. STRs are highly probative evidence because they were generated with the specific view of recording the events they describe. In this respect, they are akin to official records, which generally enjoy a high degree of probative value in the law. Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (observing that although formal rules of evidence do not apply before the Board, recourse to the Federal Rules of Evidence may be appropriate if it assists in the articulation of the reasons for the Board’s decision). Post service treatment records reflect continuing treatment for various psychiatric disorders. VA medical records indicate the Veteran sought treatment for chronic anger management issues in 2009. In a December 2009 VA mental health consultation note, the Veteran reported stressors including political, religious and racial conspiracy theories, and difficulty with alcohol abuse. The Veteran identified alcohol use as “his only real problem.” The attending VA physician indicated a provisional diagnosis of a delusional disorder and alcohol abuse. In a January 2010, the Veteran underwent a psychological assessment in connection with his claim for social security disability insurance (SSDI). He reported that four years prior he began experiencing “severe frustration” with various political, religious and other topics. He indicated he began drinking alcohol at age 14 and used alcohol to cope with his current frustrations. The examiner indicated diagnostic impressions of a mood disorder, not otherwise specified; polysubstance abuse; and alcohol dependence. There was no mention in this record of the Veteran’s military service, other than its occurrence. VA treatment records from 2010 to 2011 indicate that the Veteran enrolled in VA substance abuse treatment programs (SATP) and was initially diagnosed with paranoid schizophrenia in January 2010. In June 2010, the Veteran underwent a psychological assessment by S. Loring, Ph.D., during development of his claim for SSDI benefits. Dr. Loring noted that the Veteran had a history of severe frustration beginning about four years previously; that he drank alcohol to calm himself and that he had “chronic anger management issues.” The Veteran advised Dr. Loring of his upbringing; his work history including 11 years of employment at a lumber mill; and as a carpenter and bartender. Although Dr. Loring noted the Veteran’s report of having four years of Navy service, there was no mention in her report of PTSD or of the Veteran’s service as causing the Veteran’s mental symptoms. Dr. Loring did note, however, that the Veteran perceived he had been “blackballed” by Masonic societies and the Jesuit Roman Catholic order – his belief otherwise having been reiterated throughout the record. Dr. Loring diagnosed the Veteran as having a “mood disorder.” In a September 2010 counseling record, the Veteran reported alcohol and drug use prior to his military service. He indicated his substance addiction was connected to poor money management and impulsive spending. Also in September 2010, the Veteran was admitted to a VA domiciliary program. A mental health screening note indicated a negative score as to PTSD. In his August 2015 substantive appeal (VA Form 9), the Veteran alleged that he became addicted to alcohol and drugs during service after he came to believe he was an “integral part” in what he perceived as the U.S. Military’s “campaign to target innocent civilians.” The Veteran alleged he self-medicated with drugs and alcohol, which lead to his in-service charges of theft and drug possession. He indicated he continues to experience stress and anxiety related to injury and death associated with U.S Military operations, generally. At the July 2017 Board hearing, the Veteran reported working at two or three aircraft crash sites near Whiting Field, although he did not recall exact dates. He continued to report stress from those experiences. In a July 2019 VA psychiatric evaluation, the Veteran continued to report military trauma stemming from his in-service felony charges, his disagreement with the Vietnam Christmas bombing, and working in crash recovery. The Veteran did not elaborate on his military trauma, but stated he was aware of another veteran’s receiving compensation stemming from crash recovery. Other than alleging nightmares related to his recent treatment at VA, the Veteran did not explicitly report any other PTSD symptoms. The VA psychiatrist noted the Veteran’s longstanding history of adversarial relationships with VA staff and the Veteran’s mistrust of certain political and religious institutions. Based on the Veteran’s mental health history and their interview, the VA psychiatrist opined that the Veteran’s diagnosis was more likely paranoid personality disorder rather than schizophrenia. In a September 2019 VA substance abuse disorder (SUD) clinic intake assessment, the Veteran “firmly denied” any mental health concerns and stated he disagreed with his diagnoses of delusional disorder and paranoid personality disorder. He indicated his primary concern was that his mental health diagnoses would negatively impact his ability to own hunting rifles. When asked about military trauma, the Veteran did not report stressors that met DSM-V PTSD criteria, although he did allege that he was traumatized by his in-service drug possession and theft charges. The Veteran was afforded a VA psychiatric examination in January 2020. In addition to his other alleged stressors, the Veteran reported that he was traumatized by his VA psychiatric treatment; the examiner clarified that this trauma stems from the Veteran’s opposition to his delusional disorder diagnosis. The VA examiner indicated the Veteran does not meet DSM-V criteria for PTSD because he does not claim to have been directly exposed to, or to have directly witnessed actual or threatened death or serious injury. Given the Veteran’s medical history and reported symptoms, the examiner diagnosed the Veteran with a delusional disorder, delusional disorder, mixed type, continuous; an alcohol use disorder; and an unspecified cannabis-related disorder. The VA examiner noted there was no evidence of psychiatric treatment in service and that the Veteran continued his period of service until 1976 despite his alleged stressors. The examiner noted that, other than the polysubstance biochemist assay report, there was no evidence of occupational or social impairment in service, and the Veteran received an honorable discharge. The VA examiner indicated the Veteran’s symptoms of conspiracy obsession and persecutorial beliefs may be fed by his alcohol and/or substance use, and the examiner noted that the Veteran reported drug and alcohol use prior to the military. Based on this evidence, the examiner opined that the Veteran’s current delusional disorder and alcohol and polysubstance abuse disorders are less likely than not related to the Veteran’s claimed in-service stressors. In a February 2020 statement, the Veteran reported experiencing sleep difficulty and having nightmares he believes are related to crash recovery. He reported that he initially told the VA examiner that he could not remember his nightmares but has since made a point to remember. In a statement received April 2020, the Veteran reported crying and having mental anguish stemming from his frustration with the United States’ military operations abroad. He speculated that he may have depression and indicated he did not inform the January 2020 VA examiner about these psychiatric symptoms. The preponderance of the evidence is against the claim of service connection for PTSD. As indicated above, after many attempts, VA has not received evidence sufficient to conduct a meaningful search in order to corroborate the Veteran’s claimed stressors. Regardless of the Veteran’s claimed stressors, the evidence reflects that he does not have a diagnosis of PTSD based on any service-related stressor. Specifically, the psychologist who conducted the January 2020 VA psychiatric examination concluded that the Veteran did not meet full DSM-V PTSD criteria. While PTSD is often referenced in the Veteran’s post-service medical records, these notations appear in connection with treatment modalities (e.g., individual counseling, “recovery” groups, etc.) for his various psychiatric disorders and do not amount to a clinical diagnosis under the DSM-V. Without such a diagnosis, service connection for PTSD must be denied. In addition, though the Veteran has acquired psychiatric disorders other than PTSD, the preponderance of the evidence is against a finding of a linkage between the onset of those current acquired psychiatric disorders and a period of service. Rather, the evidence shows that the Veteran’s current acquired psychiatric disorders had no relationship to service. This conclusion is probative as it is based on facts presented by both the service treatment records and the assertions made by the Veteran at the time of the January 2020 VA examination. The VA psychologist considered the Veteran’s assertions, reviewed the Veteran’s entire claims file and concluded that his acquired psychiatric disorders did not onset due to event or incident of his military service. The Board has the authority to, and affords more probative weight to the opinion of the VA examiner offered in January 2020. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997); Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993); Owens v. Brown, 7 Vet. App. 429, 433 (1995); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). In reaching its decision, the Board has considered the Veteran’s numerous statements that he has PTSD or some other psychiatric condition that is related to service. While the Veteran is competent to report symptoms and events he experienced in service, he is not competent to diagnose himself with a psychiatric disorder or give an opinion as to the etiology (cause) of his psychiatric disorder(s). The question regarding the etiology of such disorders is a complex medical issue that cannot to be addressed by a layperson. See Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009) (“It is generally the province of medical professionals to diagnose or label a mental condition, not the claimant”); 38 C.F.R. § 3.304 (f) (specifically requiring medical evidence diagnosing PTSD). Consequently, the Veteran’s lay statements are not probative as to the ultimate issue of the cause of his psychiatric disorders. The claim of entitlement to service connection for an acquired psychiatric disorder must be denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 2. Entitlement to service connection for a TBI. The Veteran contends that he has residuals of a TBI related to a bodysurfing injury that occurred during active service. However, as no medical provider has diagnosed the Veteran with a TBI, the claim must be denied as a matter of law. A September 1975 STR indicates that the Veteran injured his neck while surfing one and a half weeks prior. The Veteran reported diving headfirst into the sand but did not report losing consciousness at that time. He reported neck and middle back pain but did not report any other symptoms. The clinician reviewed thoracic and cervical X-rays and concluded they were within normal limits. The Veteran was prescribed medication and instructed to return to the clinic for a follow-up. The assessment was paraspinal muscle pain in the cervical and thoracic spine. STRs do not document any further complaints, symptoms, or follow-up treatment related to the 1975 surfing injury. In the Veteran’s February 1976 medical examination at discharge, his spine, musculoskeletal, and neurologic evaluations were all normal. The examiner indicated there was no significant interval history. During a June 2010 examination conducted by S. Loring, Ph.D. in development of his claim for SSDI benefits, the Veteran reported that he had injured his back three weeks previously while lifting a heavy box. There was no mention of any in-service head injury in Dr. Loring’s report. At the June 2014 DRO and July 2017 Board hearings, the Veteran gave additional details about his in-service surfing injury, stating that he lost consciousness and temporarily lost control of his arms and legs during the accident. He testified that he regained control of his arms, paddled to shore, and laid on the beach for twenty minutes until he regained use of his legs. He further testified that he was bedridden for several days but ultimately regained mobility. The Veteran stated that he returned to regular duty but initially had middle back pain when bending to tie his shoes. He speculated that he sustained a concussion, although no medical provider has affirmed that. The Veteran was afforded a VA TBI evaluation in February 2020. He reported symptoms of irritability, impulsivity, verbal aggression, mood swings, difficulty recalling conversations, and trouble concentrating. The Veteran continued to report having a brief alteration of consciousness and temporary paralysis of his arms and legs immediately after his in-service surfing accident. However, the VA examiner noted the STRs did not document a head injury or an alteration or loss of consciousness; X-rays of the neck and middle back were normal; and the Veteran was given medication and released to regular duty after the accident. The examiner indicated that clinical testing, including the Mini-Mental State Examination (MMSE), did not indicate symptoms indicative of TBI residuals. Based on this evidence, the examiner did not diagnose a TBI and concluded it is less likely than not that the Veteran presently has TBI residuals related to any service injury. The claim of service connection for residuals of TBI must be denied. Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. §§ 1110, 1131. Here, the more probative medical evidence establishes that the Veteran does not have residuals of TBI. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Without a current diagnosis, the claim fails as a matter of law. The Board has considered the Veteran’s lay statements that he lost consciousness and had temporary limb paralysis after his surfing accident. The Board has also considered the Veteran’s reports of current memory difficulty and other symptoms he believes are indicative of TBI residuals. While the Veteran is competent to report his in-service events and describe symptoms that are capable of lay observation, TBI is a complex medical condition that requires specialized training to diagnose. See Jandreau, 492 F.3d at 1377 n.4; Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). As a layperson, the Veteran is not competent diagnose himself with a TBI in connection with his surfing injury or offer a medical opinion as to the etiology (cause) of his current symptoms. Accordingly, his lay statements are outweighed by the February 2020 VA neurologist’s opinion that the Veteran does not have a clinical diagnosis of a TBI or residuals therefrom. For these reasons, the claim of service connection for residuals of a TBI is denied. As the preponderance of the evidence is against the claim, benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 3. Entitlement to service connection for a neck disorder. The Veteran has been diagnosed with degenerative disc disease (DDD) and degenerative arthritis of the cervical spine (neck). He contends his current neck disorder was caused by his in-service bodysurfing accident. A September 1975 chronological record of medical care reports that the Veteran injured his neck while bodysurfing. The Veteran reported being thrown headfirst into the sand and feeling each vertebra in his neck “crack.” He reported his discomfort initially improved but on the following Monday he could not bend over because of pain in his mid-thoracic spine area (middle back). The clinician reviewed thoracic and cervical X-rays and concluded they were within normal limits. The Veteran was prescribed medication and instructed to return to the clinic for a follow-up. The assessment was paraspinal muscle pain in the cervical and thoracic spine. The remaining STRs contain no complaints, symptoms, or follow-up treatment for a neck injury or chronic neck condition. The Veteran’s February 1976 pre-separation examination reflects normal spine, musculoskeletal, and neurologic evaluations and was negative for any diagnoses or abnormalities. These records are highly probative both as to the Veteran’s subjective reports and their resulting objective findings. They were generated with a view towards ascertaining the Veteran’s then-state of physical fitness and are akin to statements of diagnosis or treatment. See Rucker, supra. At the July 2017 Board hearing, the Veteran testified that his neck pain gradually worsened after service due to his post-service job at a lumber mill. He stated that he injured his neck at work in 1983, was evaluated by a non-VA doctor, and was told that his work-related injury aggravated his prior in-service injury. The Veteran indicated X-rays were taken in 1983, however his attempts to obtain those and other medical records related to the 1983 neck injury were unsuccessful. In a January 2004 record entitled “Health History and Questionnaire,” the Veteran stated his neck pain began in 1983 when he injured his neck while working at a lumber mill. In a November 2005 statement, a non-VA physician indicated the Veteran was under his care for treatment for a neck and back sprain from January 2004 to June 2004. There was no discussion of the cause of the Veteran’s neck pain. In a July 2006 Report of Contact (VA Form 119), the Veteran denied seeking treatment for a neck condition between his 1975 injury and 1983 workplace injury. The Veteran was afforded a VA spinal examination in August 2006. He reported working on farms and in the lumber business prior to entering the Navy, where he worked as a metalsmith. He reported working in lumber mill after service and later leaving that position because of neck and back injuries. The Veteran reported that while working at the lumber mill, he injured his neck and back in the “exact same place” where he was previously injured while bodysurfing in 1975. He also reported that he hit his head against a truck door in 2003. The VA examiner reviewed 2005 MRI of the neck which revealed an old wedge compression, multilevel DDD, and possible old trauma manifested by slight vertebral body height loss. The examiner noted there were no X-ray findings related to the Veteran’s 1983 work-related neck injury and that X-rays taken in 1975 were negative for any damage to the cervical spine. Based on this evidence, the examiner opined that the Veteran’s current neck conditions were much more likely related to his recent work-related injuries than his in-service injury. In an April 2007 VA treatment record, the Veteran reported being assaulted, specifically being restrained at the neck, and having neck tightness afterward. In a November 2009 VA record, the Veteran reported he had a cracking and popping sensation in his neck since working at the lumber mill. He alleged that exposure to static electricity at the lumber mill negatively affected his spine. In a September 2010 VA medical record, the Veteran reported having a history of head injuries while drinking. In a May 2016 letter, a private chiropractor (R.K., D.C.) indicated that the Veteran’s in-service diving injury played a role in the Veteran’s current chronic neck, shoulder and arm pain. The chiropractor indicated he reviewed the Veteran’s medical records, imaging studies, and the Veteran’s statement that he was temporarily paralyzed after the diving injury. The chiropractor stated that a disc “compression loading” injury often results in accelerated disc degeneration in the 10 years after the injury. He indicated that disc degeneration is often associated with whiplash but is also consistent with the Veteran’s injury mechanism. The chiropractor suggested that the Veteran’s injury mechanism produces upper cervical spine ligament or bony trauma and potential trauma to the mid to lower cervical discs. He acknowledged that imaging at the time of the injury did not reveal overt vertebral fractures, however he stated that cervical ligament structures are often undetected without modern digital imaging. In a June 2016 follow-up letter, the same chiropractor opined that the Veteran’s current progressive neck and upper back/shoulder complaints represent long term sequelae of the Veteran’s in-service diving injury. The clinician stated that it is well known that severe axial compression force to the spine causes excessive compression loading of the vertebral discs, which induces accelerated degenerative changes in the decade following the trauma. He noted the Veteran’s in-service injury was “similar in character” to whiplash, where post-injury disc degeneration has been found to occur in 35-40% of cases within the following decade. In order for a medical opinion to be probative, the medical examiner must have correct information regarding the relevant facts of the case. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), Stefl v. Nicholson, 21 Vet. App. 120 (2007); Guerrieri v. Brown, 4 Vet. App. 467 (1993) (observing that the evaluation of medical evidence involves inquiry into, inter alia, the medical expert’s personal examination of the patient, the physician’s knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches); see Shipwash v. Brown, 8 Vet. App. 218 (1995); Flash v. Brown, 8 Vet. App. 332 (1995) (regarding the duty of VA to provide medical examinations conducted by medical professionals with full access to and review of the veteran’s claims folder)The May 2016 and June 2016 opinions of R.K. have limited probative value because they are speculative, conclusory and are not based on a full and accurate factual history. See Sanchez-Benitez v. West, 13 Vet. App. 282, 286 (1999) (medical evaluation that is merely a recitation of a veteran’s self-reported and unsubstantiated history has no probative value). From this perspective, in formulating his opinion, R.K. did not address the Veteran’s post-service medical or occupational history, including at least two work-related head/neck injuries in 1983 and 2003. In a June 2019 letter, another non-VA chiropractor (J.T., D.C.) opined that the Veteran’s upper, middle and lower back problems developed over time from a compression injury to the neck. The chiropractor stated that the Veteran’s thoracic and lumbar spine injuries may have developed in time relating to the longstanding cervical dysfunction associated with the now cervical pathology. In a June 2019 chiropractic record, J.T. noted that the Veteran’s spinal disorders are “secondary” injuries that developed over time and the Veteran may have been predisposed due to his neck injury almost 40 years ago. The June 2019 letter is of limited probative value because it is conclusory, speculative, and is not based on a full medical history. The opinion concludes that the Veteran’s in-service neck injury “may” have predisposed him to his current spinal disorders, without offering a medical explanation. See Swann v. Brown, 5 Vet. App. 229, 232 (1993) (noting the weight of a medical opinion is diminished where that opinion is ambivalent, based on an inaccurate factual premise, based on an examination of limited scope, or where the basis for the opinion is not stated.) Additionally, the opinion does not address the Veteran’s full medical history and is based solely on the Veteran’s self-reported history. See Sanchez-Benitez, supra. The Veteran was afforded a VA neck examination in February 2020. The VA examiner indicated he reviewed the Veteran’s service treatment records, post-service medical records, and lay statements. The examiner highlighted the fact that since the in-service neck injury, there were no further reports of a neck condition until 2005. Based on his review of the Veteran’s medical history, the examiner concluded there was no documented chronicity of neck complaints or treatment. The February 2020 and August 2006 VA examinations are entitled to significantly greater probative weight than the May 2016, June 2016, and June 2019 non-VA medical opinions. The VA examinations were based on knowledge of the Veteran’s full medical history, including two post-service incidents where he sustained trauma to his neck. The August 2006 report offers a factually-based opinion linking the Veteran’s neck disability with post-service occupational trauma. The Board has considered the Veteran’s assertions that his neck disorder is related to his bodysurfing injury in service and that he has had chronic neck pain since that injury. While he is competent to report symptoms of a neck disorder, the Veteran is not competent to offer an opinion as to the etiology of this type of neck condition due to the medical complexity of the matter involved. See Jandreau; Layno, supra. Further, there is no objective medical evidence documenting treatment or symptoms related to a neck condition until December 2005. Thus, the Board affords probative weight to the VA examiners’ opinions that there is no evidence of a chronic neck condition that began in service and continued to the present. The preponderance of the evidence is against a finding of service connection for a neck disorder. Weighing the positive and negative medical opinions, the probative medical evidence indicates the Veteran’s current neck disorder was not incurred in service, but rather related to post-service injuries. There is no objective medical evidence indicating the Veteran had a chronic neck condition that manifested to a compensable degree within one year of service separation. For these reasons, service connection is not warranted, and the claim is denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § § 5107; 38 C.F.R. § § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 4. Entitlement to service connection for a lower back disorder. The Veteran has been diagnosed with DDD and arthritis of the lumbar spine (lower back). He contends his lower back disorder is linked to his in-service bodysurfing injury. STRs are silent for complaints, diagnosis or treatment for a lower back condition. While the Veteran reported cervical and thoracic pain following his 1975 bodysurfing injury, he did not report lower back pain. The Veteran’s February 1976 pre-separation physical examination indicated normal spine, musculoskeletal, and neurologic evaluations. As indicated above, these STRs are highly probative both as to the Veteran’s subjective reports and their resulting objective findings. See Rucker, supra. At the June 2014 DRO and July 2017 Board hearings, the Veteran testified he had lower back pain after service that gradually worsened because of his post-service job at a lumber mill. He stated that he injured his back at work in 1994 and was treated at a VA Medical Center (VAMC). The Veteran reported that a VA doctor took X-rays in 1994 and informed the Veteran he “blew out a disc.” In a January 2004 record entitled “Health History and Questionnaire,” the Veteran stated his lower back pain began while working at a lumber mill after service. He asserted that he injured his lower back in 1994 during a lifting accident. In a November 2005 statement, a non-VA physician indicated the Veteran was under his care for treatment for a back sprain from January 2004 to June 2004. There is no discussion of the cause of the Veteran’s back sprain. A December 2005 VA MRI report indicated an impression of multilevel DDD in the lumbar spine. In a July 2006 Report of Contact (VA Form 119), the Veteran stated his back condition did not begin in service and indicated he wished to withdraw that claim. At the August 2006 VA examination, the Veteran reported he twisted his lower back in 1994 while lifting a toolbox. He reported experiencing residual left buttock pain and numbness from his leg to his foot. Based on the Veteran’s reports and the December 2005 MRI report, the VA examiner concluded that the Veteran’s current spinal disorders were much more likely related to the Veteran’s recent workplace injuries than his 1975 bodysurfing injury. A July 2007 worker’s compensation record indicates the Veteran injured his lower back at work while lifting a crate. In a February 2010 VA treatment record, the Veteran reported having “years of heavy lifting” in addition to injuries during his military service. In letters dated May and June 2016, the Veteran’s private chiropractor (R.K., D.C.) opined that the Veteran’s current neck, shoulder and middle back disorders are linked to the Veteran’s in-service bodysurfing injury. However, the chiropractor did not offer an opinion as to the cause of the Veteran’s lower back DDD or its relationship, if any, to the Veteran’s in-service neck injury. In a June 2019 letter, a different chiropractor opined that the Veteran’s lower back injuries “may have developed” from the Veteran’s in-service neck compression injury. As indicated above, this opinion carries low probative weight because it is conclusory; it does not explain its rationale based on medical principles and uses speculative language. See Swann, supra. The Veteran was afforded a VA lower back examination in February 2020. The VA examiner opined it is less likely than not that the Veteran’s current lower back DDD is related to his 1975 in-service injury. The examiner noted the Veteran had lower back injuries in 1994 and 2007 but the record does not contain reports of back pain until 2006. Based on his review of the Veteran’s medical history, the examiner concluded there was no evidence in the record of a chronic lower back condition that began in service. The preponderance of the evidence is against a finding of service connection for a lower back disorder. The probative medical evidence indicates the Veteran’s current lower back disorder was not incurred in service, but rather related to post-service, work-related injuries. There is no objective medical evidence indicating the Veteran had a chronic back condition that manifested to a compensable degree within one year of service separation. For these reasons, service connection is not warranted, and the claim is denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § § 5107; 38 C.F.R. § § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). REASONS FOR REMAND 1. The issue of service connection for a left ankle disorder, to include synovitis, is remanded. 2. The issue of service connection for tinnitus is remanded. 3. The issue of service connection for a lung disorder, to include COPD, is remanded. The matters are REMANDED for the following actions: 1. BACKGROUND FOR THE RO ADJUDICATOR: To comply with the Court’s February 2020 remand, and to fully adjudicate the remaining issues, the Board requires additional factual and medical development as below. 2. REMAND DIRECTIVES: Contact the Veteran and determine if he has any further medical treatment records or other evidence not currently in the record as to the disorders at issue. Assist him in obtaining these records. Conduct appropriate research as to the question of whether the Veteran was exposed to toxic substances and chemicals during his active Naval service from March 1972 to March 1976 as a “bodyman 807” naval occupational specialty. During his Naval service, the Veteran was stationed at Whiting Field in Florida from October 1973 to March 1976. The Veteran contends that during this service, he was worked in a paint shop, and was exposed to methyl ethyl ketone, yellow epoxy primer, zinc chromate primer, lacquer thinner, toluene, xylene and other paints. Obtain any further VA medical records not currently in the record. This includes the January 2020 VA psychiatric examination report and medical opinion and associate them with the electronic claims file. All development should be recorded in the claims file. If further development is deemed futile, advise the Veteran and document in the record. a. LEFT ANKLE DISORDER INCLUDING SYNOVITIS: Request an addendum opinion from the June 2015 examiner to clarify inconsistencies in the examination report about whether the Veteran has a current left ankle disorder including synovitis, and if so, whether the disorder was caused by any incident of service including that described below. The examiner may conduct any further clinical examination if the evidence is not sufficient to fully respond to the inquiries. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that the Veteran’s reports must be considered in formulating the requested opinion. The examiner must specifically address the Veteran’s lay statements. If the examiner rejects the Veteran’s reports, the examiner must explain the medical bases for that conclusion. If the examiner is no longer available, request a new opinion be completed by an appropriately qualified PHYSICIAN. In either case, the examiner MUST REVIEW the June 2015 examination, all relevant medical records on file. The examiner must confirm the review in the report. Although the examiner must review the entire record, his/her attention is called to the following: *The Veteran’s service medical records indicate that in December 1974, he was treated for pain in his left foot and ankle. He reported he ran into bleachers while playing basketball. On examination, his ankle was slightly swollen and sore. X-ray results were reported as “? Chip fx. Of the cuboid and talus.” He was prescribed a splint and crutches. Four days later, the split was removed and he was provided a cane. *The Veteran’s February 1976 pre-separation physical examination showed no abnormalities of the lower extremities. *In a July 2007 VA treatment note, the Veteran reported that he was having left ankle pain. He told medical care providers that he had recurring pain of his left ankle in the past, but that it had become worse within the last three days. He reported that he recalled no injury to the left ankle, but recalled a past right ankle injury. *A June 2015 VA examiner found that the Veteran’s December 10, 1974 left ankle injury was “consistent with a left ankle sprain.” However service treatment records do not document “ankle sprain” specifically. As noted, a December 10, 1974 treatment note indicates that X-rays revealed a possible chip fracture of the cuboid and talus. *The June 2015 examiner stated the Veteran’s 1974 ankle injury must have resolved because there was no further follow-up care, the Veteran’s separation physical examination indicated normal lower extremities evaluations and noted “no significant interval history.” The examiner also noted the time frame between the Veteran’s 1974 ankle injury and June 2015 synovitis diagnosis but did not explain the medical significance of that time frame. In the addendum opinion, the examiner must FULLY RESPOND TO THE FOLLOWING TWO QUESTIONS: (1) Indicate whether the Veteran has a left ankle disorder including synovitis, and if so, whether it was caused by the December 1974 accident; (2) Explain what, if any, significance is attached to the time lapse between the December 1974 accident, the Veteran’s March 1976 separation examination report and any current treatment or diagnoses. If the examiner is unable to clarify the diagnosis without resorting to speculation, he/she must state why that is so. A thorough explanation must be provided for the opinions rendered. If the examiner cannot provide the requested opinions without resorting to speculation, she should expressly indicate the same and explain why the opinions cannot be made without resorting to speculation. THE EXAMINER IS ADVISED THAT BY LAW, THE MERE STATEMENT THAT THE CLAIMS FOLDER WAS REVIEWED AND/OR THE EXAMINER HAS EXPERTISE IS NOT SUFFICIENT TO FIND THE EXAMINATION/ OPINION SUFFICIENT. b. TINNITUS: Obtain an addendum medical opinion from a VA AUDIOLOGIST to assist in determining the nature and etiology of the Veteran’s tinnitus. The examiner must provide an opinion as to whether the Veteran’s current tinnitus was caused by any in-service event, injury, disease, or disorder, or in any way originated during service. The examiner MUST REVIEW the September 2011 VA hearing loss and tinnitus examination and all relevant medical records. The report should specifically state that such a review was conducted. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that the Veteran’s reports must be considered in formulating the requested opinion. The examiner must specifically address the Veteran’s lay statements. If the examiner rejects the Veteran’s reports, the examiner must explain the medical bases for that conclusion. The examiner is advised that while the Veteran served on active military duty as a “bodyman,” performing repairs to Naval aircraft, including with the use of machinery when he likely would have been exposed to acoustic trauma. He alleges that he experienced tinnitus since leaving service. However, after service, the Veteran worked as a metalworker and in a lumber mill. The examiner must express an opinion as to whether, given the Veteran’s subjective reports, his tinnitus began in service. If the examiner finds that the Veteran’s tinnitus was caused by noise exposure after service or some other cause not related to service, they must explain the medical bases for that conclusion. A thorough explanation must be provided for the opinion rendered. If the examiner cannot provide the requested opinions without resorting to speculation, she should expressly indicate the same and provide supporting rationale as to why the opinions cannot be made without resorting to speculation. The examiner should schedule a new examination only if necessary to provide an adequate opinion. THE EXAMINER IS ADVISED THAT BY LAW, THE MERE STATEMENT THAT THE CLAIMS FOLDER WAS REVIEWED AND/OR THE EXAMINER HAS EXPERTISE IS NOT SUFFICIENT TO FIND THE EXAMINATION /OPINION SUFFICIENT. c. CHRONIC OBSTRUCTIVE PULMONARY DISEASE/LUNG DISORDER: Request an addendum opinion from the June 2015 examiner to clarify whether the Veteran’s COPD or any other lung disorder, was caused by his Naval service from March 1972 to March 1976. Apart from the file review, the examiner may conduct any other appropriate clinical testing. If the examiner is no longer available, request a new opinion be completed by a pulmonologist or other appropriately qualified PHYSICIAN. In either case, the examiner MUST REVIEW the prior June 2015 examination and relevant medical records. The report should specifically state that such a review was conducted. The Veteran claims that during active Naval service working as an aircraft frame repairman from 1972 to 1975, he was exposed to various toxic substances which resulted in his ultimately being diagnosed with COPD. He alleges that he was told while in service in September 1975 that an X-ray revealed scarring consistent with pneumonia. THE EXAMINER IS ADVISED THAT IF DEVELOPMENT DIRECTED IN THIS REMAND RESULTS IN CONFIRMATION OF THE VETERAN’S EXPOSURE TO VARIOUS TOXINS WHILE ON ACTIVE NAVAL DUTY, to include methel ethyl ketone, yellow epoxy primer, zinc chromate primer, laquer thinner, toluene, zyleene and toxic paints, the EXAMINER MUST ACKNOWLEDGE RECEIPT OF THIS INFORMATION IN ANY REPORTS. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that the Veteran’s reports must be considered in formulating the requested opinion. The examiner must specifically address the Veteran’s lay statements. If the examiner rejects the Veteran’s reports, the examiner must explain the medical bases for that conclusion. The examiner must FULLY RESPOND TO THE FOLLOWING QUESTION, IN PARTICULAR ADDRESSING ALL THREE POSSIBLE CAUSE OF THE VETERAN’S DISORDER: Whether the Veteran’s current COPD was caused by any in-service event, injury, disease, or disorder, to include: (1) an in-service respiratory disease or disorder; and (2) exposure to certain chemicals during active service, if such exposure is confirmed or; (3) any other cause, including but not limited to tobacco use. Although the examiner must review the entire record, his/her attention is called to the following: *April 26, 1972 sick call treatment record indicating the Veteran reported having a sore throat, rhinorrhea, and cough with yellow sputum. *May 16, 1972 sick call treatment record indicating the Veteran reported having a sore throat, cough and sinus congestion. See “STR – Medical,” received January 9, 2006, at page 27 of 32. See “STR – Medical,” received January 9, 2006, at page 27 of 32. *May 18, 1972 sick call treatment record indicating the Veteran reported fever, lung congestion and a “small amount of white phlegm” on the same day the Veteran received several immunizations. See “STR – Medical,” received January 9, 2006, at pages 28-29 of 32. *May 18, 1972 chronological record of care indicating the Veteran was hospitalized for complaints of fever, general malaise, sore throat, and a cough. The given diagnosis was “upper respiratory infection in the line of duty, not due to misconduct.” Physical examination revealed an erythematous posterior pharynx and the remainder of the examination was entirely within normal limits. He was treated symptomatically, was noted to have responded well to treatment, and was discharged to three days’ light duty. See “STR – Medical,” received January 9, 2006, at page 8 of 32. *May 22, 1972 notation that the Veteran still had rales in his left lung lobe and was to be seen again in the clinic the next week. See “STR – Medical,” received January 9, 2006, at page 28 of 32. *October 27, 1972 sick call treatment record indicating the Veteran reported a cold, congestion, 99-degree fever and that he was “worried about getting pneumonia or bronchitis.” See “STR – Medical,” received January 9, 2006, at page 24 of 32. *An abstract of STR chronological medical entries reflects the Veteran was treated from May 18 through May 22 1972 for “pneumonitis.” *February 1973 sick call record where the Veteran reported a sore throat and cough, and the attending clinician indicated the throat appeared good, with no pus or inflammation, and the Veteran did not have a fever. See “STR – Medical,” received January 9, 2006, at page 24 of 32. *June 12, 1975 sick call treatment record where the Veteran reported a cold, his throat felt like “an open sore,” and an impression of “viral URI” was noted. See “STR – Medical,” received January 9, 2006, at page 22 of 32. *September 9, 1975 chronological record of care indicating X-rays of the cervical and thoracic spine were “within normal limits,” but contains no indication whether the Veteran’s lungs were within normal limits. See “STR – Medical,” received January 9, 2006, at page 3 of 32. *The Veteran’s February 1976 pre-separation physical examination showed no abnormalities of his lungs. *A December 2009 VA treatment note indicates the Veteran had “nicotine dependence” and he reported that he was smoking from one and one-half to four packs of cigarettes per day. *Veteran’s December 2012 lay statement where he alleged he was told by a medical provider in September 1975 that X-rays taken at that time demonstrated “spider web scarring” in his lungs due to pneumonia in boot camp. See “VA 21-4138 Statement in Support of Claim,” received December 5, 2012. *December 5, 2012 Statement in Support of Claim (VA Form 21-4138) where the Veteran reports working in a paint shop during service and being exposed to chemicals used in paint, primer, and paint strippers, including: “Methyl Ethyl Ketone, Yellow Epoxy Primer, Zinc Chromate Primer, Lacquer Thinner, Toluene, and Xylene.” *The Veteran’s general allegations that after he received vaccines in service, he experienced pneumonia symptoms, including “seeing double.” *June 2015 X-ray showing “mild bilateral pleural parenchymal scarring, stable since October 3, 2011.” See “C&P Examination,” received June 23, 2015, at pages 2-3. *The Veteran’s smoking history, as evidenced by: • A December 2005 VA treatment note indicated that the Veteran “is a smoker most probably has (COPD)” and that the Veteran “has smoked for about 30 years. He currently smokes five cigars a day,” and separate December 2005 treatment note indicates that the Veteran reported he had chronic shortness of breath, and denied chest pain, yellowish-greenish sputum. • An April 2006 VA treatment note indicated that the Veteran smoked from one to two packs of cigarettes per day for 30 years. • During an August 2006 VA spinal examination, the Veteran reported that he “has smoked for thirty years.” • Social Security Disability records indicate that in February 2009, the Veteran was treated for a complaint of dyspnea. He reported that he was “still smoking but had decreased his habit from 1.5 PPD to less than one PPD due to symptoms. • In September 2009, the Veteran was noted to have a “tobacco use disorder;” • In a September 2010 VA mental health care note, the Veteran was reported as smoking from one to two packs of cigarettes per day. • In a March 2011 VA treatment record, it was noted the Veteran had “tobacco use disorder.” • In May 2011, the Veteran reported to VA medical treatment providers that he was smoking “1 PPD.” If the examiner concludes the Veteran’s COPD is consistent with tobacco use or some other cause not related to service, the examiner must explain the medical bases for that conclusion. A thorough explanation must be provided for the opinion rendered. If the examiner cannot provide the requested opinions without resorting to speculation, she should expressly indicate the same and provide supporting rationale as to why the opinions cannot be made without resorting to speculation. The examiner should schedule a new examination only if necessary to provide an adequate opinion. THE EXAMINER IS ADVISED THAT BY LAW, THE MERE STATEMENT THAT THE CLAIMS FOLDER WAS REVIEWED AND/OR THE EXAMINER HAS EXPERTISE IS NOT SUFFICIENT TO FIND THE EXAMINATION/OPINION SUFFICIENT. If the benefit is not awarded, the RO will issue a Supplemental Statement of the Case and return this matter to the Board. The Veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims must be afforded expeditious treatment. The law requires that all claims remanded by the Board or by the United States Court of Appeals for Veterans Claims (Court) for additional development or other appropriate action be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Hiaasen The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.