Citation Nr: 21002503 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 13-05 129 DATE: January 13, 2021 ORDER Entitlement to service connection for a neck condition, to include rheumatoid arthritis and as secondary to service-connected bilateral knee condition, is denied. Entitlement to service connection for a right shoulder condition, to include rheumatoid arthritis and as secondary to service-connected bilateral knee condition, is denied. Entitlement to service connection for a left shoulder condition, to include rheumatoid arthritis and as secondary to service-connected bilateral knee condition, is denied. Entitlement to service connection for a right elbow condition, to include rheumatoid arthritis and as secondary to service-connected bilateral knee condition, is denied. Entitlement to service connection for a left elbow condition, to include rheumatoid arthritis and as secondary to service-connected bilateral knee condition, is denied. Entitlement to service connection for a condition of the right index finger, to include rheumatoid arthritis and as secondary to service-connected bilateral knee condition, is denied. Entitlement to service connection for a right ankle condition, to include rheumatoid arthritis and as secondary to service-connected bilateral knee condition, is denied. Entitlement to service connection for a left ankle condition, to include rheumatoid arthritis and as secondary to service-connected bilateral knee condition, is denied. Entitlement to service connection for a condition of the right great toe, to include rheumatoid arthritis and as secondary to service-connected bilateral knee condition, is denied. REMAND Entitlement to service connection for hypertension is remanded. FINDINGS OF FACT 1. The evidence of record is against finding that the Veteran’s neck condition occurred in, or is the result of, his period of active duty service. 2. The evidence of record is against finding that the Veteran’s right shoulder condition occurred in, or is the result of, his period of active duty service. 3. The evidence of record is against finding that the Veteran’s left shoulder condition occurred in, or is the result of, his period of active duty service. 4. The evidence of record is against finding that the Veteran’s right elbow condition occurred in, or is the result of, his period of active duty service. 5. The evidence of record is against finding that the Veteran’s left elbow condition occurred in, or is the result of, his period of active duty service. 6. The evidence of record is against finding that the Veteran’s condition of the right index finger occurred in, or is the result of, his period of active duty service. 7. The evidence of record is against finding that the Veteran’s right ankle condition occurred in, or is the result of, his period of active duty service. 8. The evidence of record is against finding that the Veteran’s left ankle condition occurred in, or is the result of, his period of active duty service. 9. The evidence of record is against finding that the Veteran’s condition of the right great toe occurred in, or is the result of, his period of active duty service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a neck condition are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 2. The criteria for entitlement to service connection for a right shoulder condition are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 3. The criteria for entitlement to service connection for a left shoulder condition are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 4. The criteria for entitlement to service connection for a right elbow condition are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 5. The criteria for entitlement to service connection for a left elbow condition are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 6. The criteria for entitlement to service connection for a condition of the right index finger are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 7. The criteria for entitlement to service connection for a right ankle condition are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 8. The criteria for entitlement to service connection for a left ankle condition are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 9. The criteria for entitlement to service connection for a condition of the right great toe are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1992 to January 1993. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. The procedural history of these claims is complex and, therefore, will be discussed before addressing the merits. In March and December 2014, the Veteran filed for hypertension and rheumatoid arthritis of the associated joints herein, respectively. Prior to filing for these issues, the Veteran also was pursuing service connection for his bilateral knees. A February 2015 Board decision denied the knee claims and remanded the hypertension claim for VA’ failure to issue a statement of the case (SOC) pursuant to Manlincon v. West, 12 Vet. App. 238 (1999). The requisite SOC was provided in March 2016. In a February 2018 decision, the Board denied all claims addressed in this decision. The Veteran appealed those determinations to the United States Court of Appeals for Veterans Claims (Court). In a February 2019 Memorandum Decision, the Court vacated the Board’s February 2018 decision. With respect to the hypertension claim, the Court faulted the Board for (1) not having discussed elevated blood pressure readings taken during service and noting that blood pressure first was diagnosed in 2010, (2) failing to address whether a VA examination was warranted under McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006), and (3) failing to discuss the fact that relevant records had been destroyed. With respect to the claims for the various joints, the Court faulted the Board for misconstruing the Veteran’s theory of entitlement altogether. As the Court pointed out, the Veteran’s overall theory is that he has in his various joints rheumatoid arthritis that began as stiffness and pain in his knees, slowly developing/spreading over the years to other areas of his body. The Board likewise failed to discuss whether VA examinations were warranted and the destroyed records. The Court also highlighted that, at this point, the issue of service connection for the knees separately was being litigated. Despite the Secretary’s decision to adjudicate them apart from these claims, the Court stressed that the “evidence obtained regarding the progression of rheumatoid arthritis of the knee joints thus may be relevant to the veteran’s claims based on rheumatoid arthritis of the other joints. On remand, the Board should discuss this evidence to the extent that it is relevant to the claims before it.” In a December 2019 decision, the Board remanded these claims, as well as the ones for the knees. VA was to afford the Veteran examinations and opinions for all conditions. In January 2020, examinations and opinions for all the conditions were provided, and a January 2020 rating decision awarded the Veteran service connection of the bilateral knees for patellofemoral pain syndrome (rated under diagnostic code (DC) 5260 based on limitation flexion). The examinations all confirmed a diagnosis of rheumatoid arthritis except in the Veteran’s neck. The Veteran since has filed a March 2020 VA Form 10182, challenging the disability rating and effective date for his knee conditions, and those issues will be the subject a future Board decision. In April 2020, the Board again remanded these claims, noting that the associated opinions all were inadequate. With respect to hypertension, the examiner was to answer whether it was related to service and was to address all instances of elevated blood pressure during service. Regarding the rheumatoid arthritis claims, the examiner was to identify all joint conditions found; if rheumatoid arthritis was not present, then the examiner was to reconcile that determination with the prior January 2020 examinations and other evidence of record. For each condition identified, the examiner was to opine whether said condition(s) was related to the Veteran’s service, specifically whether it was caused by the Veteran’s knee condition noted in service and slowly spread to other joints. In June 2020, the Board remanded the claims because VA failed to schedule the Veteran for examinations at his nearest VA facility. The Veteran did not attend the scheduled examinations at a different location, and VA continued its denial via an April 2020 Supplemental SOC (SSOC). Remand was required for VA to schedule new examinations at the Kernersville, North Carolina, location. In October 2020, new examinations and opinions were obtained (discussed more fully below). Thus, for the rheumatoid arthritis claims, the Board finds that substantial compliance has been afforded and it now may adjudicate these claims on the merits. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). To establish service connection, there must exist medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013); 38 C.F.R. § 3.303(a). To establish secondary service connection, a veteran must provide evidence of (1) a current, non-service-connected disability, (2) a current service-connected disability, and (3) evidence that the non-service-connected disability is either (i) proximately due to or the result of a service-connected disability or (ii) aggravated (increased in severity) beyond natural progression by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 446 (1995); 38 C.F.R. § 3.310. For the purposes of service connection, pain alone, without any underlying pathology or disease process, can constitute a current disability if there is objective evidence that the pain causes functional impairment resulting in a decrease of earning capacity. Saunders v. Wilkie, 886 F.3d 1356, 1363 (Fed. Cir. 2018). In rendering a decision on appeal, the Board must analyze the competency, credibility, and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Buchanan v. Nicholson, 451 F.3d 1331, 1335–37 (Fed. Cir. 2006). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall resolve all reasonable doubt in favor of the claimant. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 C.F.R. § 3.102. As articulated above, the Veteran’s theory of entitlement is that the pain and stiffness in his knees, developed during service, was his initial onset of rheumatoid arthritis, which slowly spread to the remaining joints on appeal. As his theory of entitlement is the same for all claims, they rise and fall together and shall be discussed in tandem. There is conflicting evidence in the record regarding whether the Veteran has a diagnosis of rheumatoid arthritis. Of importance are various laboratory results. A private October 1996 record revealed a positive rheumatoid factor (RF) test. The record also shows an October 2013 negative RF test and positive antinuclear antibody (ANA) test. Based on these findings, the January 2020 VA examiner stated that the Veteran has rheumatoid arthritis in all the joints on appeal, except for the neck. Throughout the pendency of this appeal, however, the Board never conclusively has found that the Veteran has a diagnosis of rheumatoid arthritis in any joint. In its April 2020 remand, the Board specifically asked the examiner that if “rheumatoid arthritis is not identified, the examiner should reconcile this finding with the diagnoses of rheumatoid arthritis present in the record.” April 7, 2020, Board Decision at 4. This language very distinctly left open the possibility for the Board to find that no such diagnosis of rheumatoid arthritis is present. The October 2020 VA examiner had the following to stay on matter: Veteran reported DX of RA to the examiner. The exam findings at that time did not support DX of RA. [T]he labs in 01/03/2020 and 03/30/2020 do not confirm a diagnosis of RA. Which is consistent with the PCP 03/2020 PCP note findings of “does not seem to have any deformity or loss of function.” DX was rendered per the Veteran’s report. The January 2020 VA examiner merely took at face value the Veteran’s statements that he had rheumatoid arthritis and the lab results from October 1996 and 2013. The October 2020 examiner, however, stated that such laboratory results are “weakly positive, usually not clinically significant.” While this examiner also performed a RF and ANA test (both of which were negative), she determined that the Veteran’s erythrocyte sedimentation rate (ESR) and C-reactive protein were normal. Based on this information, she rendered a conclusive opinion that the Veteran does not have rheumatoid arthritis, and the Board concurs with this finding. Nevertheless, the Board is mindful that, pursuant to Saunders, the Veteran’s pain in his various joints still may qualify as a disability if it causes functional impairment that results in a decrease of earning capacity. On the January 2020 VA examinations for the Veteran’s neck, shoulders, elbows, ankles, right index finger, and right great toe, the examiner indicated that all conditions would impact the Veteran’s ability to work. Thus, the Board will find that his pain in these joints constitutes a disability for VA purposes, satisfying the first element of service connection for either a direct or secondary basis. See Saunders, 886 F.3d at 1363; Romanowsky, 26 Vet. App. 293; Allen, 7 Vet. App. at 446; 38 C.F.R. §§ 3.303(a); 3.310. With respect to the second element of direct service connection, the Board finds that the record is insufficient. The Veteran has claimed that he has rheumatoid arthritis that began during service in his knees (joints for which he now is service connected) and slowly spread to his other joints after his separation from service. The Veteran’s knees, however, are not service connected for rheumatoid arthritis; they were service connected for patellofemoral pain syndrome and subsequently have been rated under DC 5260 for limitation of motion. Rheumatoid arthritis is rated under DC 5002. As the Court noted in its Memorandum Decision, the Board was to consider the Veteran’s knee claims as it was relevant to these claims. To that end, the Board highlights that no VA-adjudicative body has found that the Veteran suffers from rheumatoid arthritis. The record further does not disclose that the Veteran suffered any other injury or event in service with respect to the issues on appeal. While the Veteran argues that he was diagnosed with arthralgia in service, see April 7, 2015, Correspondence, his service treatment records (STRs) contain no such diagnosis or treatment. Thus, the second element of service connection on a direct basis has not been established. See Romanowsky, 26 Vet. App. 293; 38 C.F.R. § 3.303(a). As indicated in the April 2020 remand, the Board will go a step further and assume that the Veteran does have rheumatoid arthritis of the bilateral knees. In answering whether rheumatoid arthritis began during service and spread to other joints, the October 2020 VA examiner stated the following: claimed RA is less likely as not started with pain and stiffness in his knees that continuously progressed over the years and spread to joints throughout his body. Rationale: RA is an autoimmune condition caused by the immune system attacking healthy body tissue. It is not medically plausible that it spread from his knees to other joints. Additionally, 2020 lab findings do not confirm DX of RA. While the Veteran continually has advanced his theory on appeal, he is not competent to render such a complex medical opinion, see Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007), and he otherwise has not presented any other medical opinion to the Board that supports his theory. On the other hand, the October 2020 VA examiner provided the Board with a sufficiently supported opinion uncontradicted by the other competent and credible evidence of record. Thus, the Board affords the October 2020 examiner’s opinion considerable probative value on appeal. Thus, even presuming the Veteran does have a diagnosis of rheumatoid arthritis in his knees, the third element of service connection for rheumatoid arthritis, on a direct basis, has not been met. See Romanowsky, 26 Vet. App. 293; 38 C.F.R. § 3.303(a). Returning to secondary service connection, the Board acknowledges that the Veteran is service connected for bilateral patellofemoral pain syndrome. Thus, the second element of secondary service connection has been established. See Allen, 7 Vet. App. at 446; 38 C.F.R. § 3.310. In expressing her medical opinion for secondary service connection, the October 2020 examiner stated: RA is an autoimmune condition caused by the immune system attacking healthy body tissue. RA is not caused by nor aggravated by B/L genu varum (A.K.A. bow-leggedness). 10/10/2013 CCHP clinic note documents, “Born with Blounts disease”. Additionally, 2020 lab findings do not confirm DX of RA. The Board likewise finds that this is the only competent and credible medical opinion of record, uncontradicted by the other competent and credible evidence, that expresses a relationship between the Veteran’s service-connected condition and the pain he experiences in his various joints. In this circumstance, the Board affords this opinion considerable probative value on appeal and finds that the third element of service connection has not been established. See Allen, 7 Vet. App. at 446; 38 C.F.R. § 3.310. In an October 2020 post-remand correspondence, the Veteran seeks to discredit the October 2020 VA opinions. The Veteran states the examiner conducted a “bias[ed] and unfair exam of [his] condition.” The Veteran believes the examiner’s opinion is a personal retaliation against him and demands removal of the examination from the record, as the examiner “changed evidence of a rheumatoid arthritis diagnosis, already in the record . . . .” A presumption of regularity is applied to all manner of VA processes and procedures. Miley v. Principi, 366 F.3d 1343, 1346–47 (Fed. Cir. 2004) (“The presumption of regularity provides that, in the absence of clear evidence to the contrary, the court will presume that public officers have properly discharged their official duties.”). When the adequacy of the examination is challenged, however, the Board still may assume the competency of any VA medical examiner if the examiner is qualified through education, training, or expertise to offer medical diagnoses, statements, or opinions. Cox v. Nicholson, 20 Vet. App. 563, 568 (2007); 38 C.F.R. § 3.159(a)(1). The examiner need not be a physician and can be another medical professional, such as a licensed nurse practitioner. Id. at 571. While the presumption of regularity applies to VA examinations, the United States Court of Appeals for the Federal Circuit (Federal Circuit), in Francway v. Wilkie, 940 F.3d 1304 (Fed. Cir. 2019), recently held that, when an examiner’s competency is challenged, the “presumption of competency requires nothing more than is required for veteran claimants in other contexts—simply a requirement that the veteran raise the issue.” Id. at 1308. Since the Veteran is obligated to raise the issue of a medical examiner’s competency in the first instance, once done, the presumption has no further effect, and VA must provide to a veteran, absent unusual circumstances, the necessary information to raise a competency challenge, including the examiner’s curriculum vitae and other information about qualifications of a medical examiner. Id. The Federal Circuit was careful to note that “to the extent that the decision here is inconsistent with Rizzo v. Shinseki, 580 F.3d 1288 (Fed. Cir. 2009), and Bastien v. Shinseki, 599 F.3d 1301 (Fed. Cir. 2010), those cases are overruled.” Id. at 1307 n.1. The Federal Circuit did not disrupt the holding in Cox. Thus, the Board finds that, to the extent the Veteran expresses generalized displeasure with the fact that his examination and opinion was performed by a licensed nurse practitioner and not a medical doctor, it is not enough to raise a challenge to the competency of the examiner’s credentials, as Cox clearly has stated that such medical professionals fall squarely within the regulations’ requirements. Furthermore, the Board is not persuaded by the claim that the October 2020 examiner had ill intentions toward the Veteran personally when providing her medical opinion. The examiner provided a thorough opinion that was backed by tests and independent verification, as well as supporting rationale. To the Veteran’s credit, the Board herein has analyzed his claim from all directions, assuming that he does have rheumatoid arthritis in his knees and that he has pain in various joints causing functional impairment of earning capacity. In that scenario, the examiner still explained why these claims must fail. It is not indicative of malice that this examiner determined that the Veteran does not have a diagnosis of rheumatoid arthritis. The examiner identified any and all conditions of the Veteran’s joints, as required by the Board’s prior remand directives, and it is the Board that has ultimate fact-finding authority to accept or reject any diagnosis. In this instance, it finds more probative the October 2020 examiner’s conclusions that no diagnosis of rheumatoid arthritis exists, and the Board has articulated above its reasons for that finding. Thus, the Board finds that the October 2020 opinions are adequate. For completion’s sake, there is an additional point that the Board must address. As noted above, the Court instructed the Board to consider the fact that some of the Veteran’s private treatment records were destroyed, citing Washington v. Nicholson, 19 Vet. App. 362 (2005). With all due respect to the Court, the Board finds there in no heightened duty where it has knowledge that private treatment records are destroyed or unobtainable. VA’s duty to assist includes assisting the veteran in the procurement of relevant private treatment records. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c)(1). A veteran, however, must provide VA with enough information to obtain the private treatment records, such as the person, company, agency, or other custodian holding the records; the approximate time frame covered by the records; and, in the case of medical treatment records, the condition for which treatment was provided; the veteran also must execute the necessary authorization for VA to obtain these records. The Court has held that “reasonable efforts” under 38 C.F.R. § 3.159(c) generally consists of “an initial request for the records and, if the records are not received, at least one followup request.” McKinney v. McDonald, 28 Vet. App. 15, 35 (2016). If, however, VA is unable to obtain those records after making reasonable attempts, it must provide notice of that fact to the claimant; such notice must include that it is the ultimate responsibility of the claimant to obtain the records and a description of any further action VA will take regarding the claim, including, but not limited to, notice that VA will decide the claim based on the evidence of record unless the claimant submits those records. 38 C.F.R. § 3.159(e)(1). Since the Court’s inception, it has recognized that, “where the service medical records are presumed destroyed,” the Board’s “obligation to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule is heightened.” O’Hare v. Derwinski, 1 Vet. App. 365, 367 (1991) (emphasis added). The cases since O’Hare rightfully have determined that a heightened duty is triggered where service records are unobtainable. See Yagonia v. Nicholson, 21 Vet. App. 411 (2006) (noting that a heightened duty is required where the RO was unable to obtain SMRs because they possibly were fire-related); Schlaupitz v. Nicholson, 21 Vet. App. 105 (2006) (holding that the heightened duty applies where “it appears from the record that at least a portion of Mr. Schlaupitz’s records may have been lost in the infamous July 12, 1973, fire at the National Personnel Records Center in St. Louis, Missouri.”); Daye v. Nicholson, 20 Vet. App. 512 (2006) (“Where, as here, an appellant’s records are “NOT AVAILABLE” (R. at 143), the Secretary’s duty to assist is heightened.”); Washington v. Nicolson, 19 Vet. App. 362, 370 (2005) (“Specifically, VA’s failure to request the relevant morning reports constitutes noncompliance with its heightened duty to assist when SMRs are lost.”). The Court has been clear: a heightened duty exists when the Veteran’s service department records or not available, for whatever reason. Such a duty is not triggered where, here, the Veteran merely has informed VA that older private treatment records were destroyed and not available for submission. Indeed, such a conclusion makes sense. If the Veteran’s service records were unavailable, then the Government should be under a heightened standard, as it was the custodian of those records. Here, however, it would be unreasonable to place a heightened burden on VA. It cannot control the practices or acts of third-party medical providers; to hold them accountable for such action would be overburdensome. Short of unlawfully awarding benefits to the Veteran, there is no more assistance that the Board can provide him. It has ensured VA provided medical examinations and secured adequate opinions for these claims. The Board has run through every possible scenario, affording every benefit to the Veteran when analyzing these claims. No matter which way one looks at, the necessary elements for his claims have not been met, and the Board finds that VA has fulfilled its obligations. REASONS FOR REMAND In the April 2020 remand, the Board requested a medical opinion answering whether the Veteran’s hypertension was related to service and for the examiner specifically to address the in-service notations of elevated blood pressure. The October 2020 examiner provided the following opinion: Hypertension is less likely as not onset in or is otherwise caused by his active service. Rationale: medical records reviewed. AD: 12/10/1992-01/08/1993. 03/30/2020 vital signs document HTN with BP 161/90 and 126/90. 06/05/1992 enlistment exam documents BP 142/82 (normal BP is below 140/90). The finding of HTN at the time of enlistment indicates a pre-existing condition. There is no found evidence that pre-existing HTN worsened beyond its natural progression during AD. As the examiner noted, the Veteran’s blood pressure at the time of enlistment was 142/82. Under VA law, hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. 38 C.F.R. § 4.104, DC 7101 Note (1). Thus, while the Veteran’s blood pressure at the time of service may have qualified for a diagnosis of hypertension according to the general medical community, it did not comport to VA’s definition of hypertension. Thus, the Veteran’s blood pressure at the time of entry was “elevated” at best. The examiner’s belief that the Veteran’s blood pressure qualified for a diagnosis of hypertension does not transform this claim into one for service aggravation rather than service connection. Because the medical opinion rendered is one for aggravation of a preexisting medical condition, it substantially does not comply with the Board’s prior remand directives, and further development is required. See Stegall, 11 Vet. App. at 271; 38 C.F.R. § 20.904(a). The matter is REMANDED for the following action: 1. Obtain an addendum to the October 2020 opinion. The addendum shall answer the following: Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s hypertension occurred in, or is the result of, his period of active duty service? In answering this question, the examiner must address all in-service notations of elevated blood pressure. Please note that, for VA purposes, hypertension is defined as diastolic blood pressure predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. 2. Conduct any other development deemed necessary and then readjudicate the Veteran’s claim. The Veteran has the right to submit additional evidence and argument on the matter that the Board has remanded. See Kutscherousky v. West, 12 Vet. App. 369, 372 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded for additional development or other appropriate action by the Board or the Court must be handled in an expeditious manner. 38 U.S.C. §§ 5109B, 7112. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Trevor T. Bernard, Associate Counsel 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.