Citation Nr: 21026361 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 17-64 750 DATE: April 30, 2021 ORDER Entitlement to service connection for chronic asthma is denied. Entitlement to service connection for vertigo, to include as secondary to chronic asthma, is denied. Entitlement to service connection for sinusitis, to include as secondary to chronic asthma, is denied. Entitlement to service connection for sleep disturbances, to include as secondary to chronic asthma, is denied. Entitlement to service connection for headaches, to include as secondary to chronic asthma, is denied. REMANDED Entitlement to service connection for a left hip condition, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for a right hip condition, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for a back condition, to include as secondary to service-connected disability, is remanded. FINDINGS OF FACT 1. The preponderance of the evidence shows that the Veteran’s chronic asthma disability was not manifest during active service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 2. The preponderance of the evidence shows that the Veteran’s vertigo disability was not manifest during active service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 3. The preponderance of the evidence shows that the Veteran’s sinusitis disability was not manifest during active service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 4. The preponderance of the evidence shows that the Veteran’s sleep disturbance disability was not manifest during active service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 5. The preponderance of the evidence shows that the Veteran’s headaches disability was not manifest during active service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a chronic asthma disability have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2020). 2. The criteria for service connection for a vertigo disability have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2020). 3. The criteria for service connection for a sinusitis disability have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2020). 4. The criteria for service connection for a sleep disturbances disability have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2020). 5. The criteria for service connection for a headaches disability have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1981 to August 1981. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. The Veteran testified before the undersigned Veterans Law Judge (VLJ) in a Board video hearing in January 2021. A transcript of the hearing is of record. Veterans Claims Assistance Act of 2000 (VCAA) The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2020). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert. denied, U.S.C. Oct. 3, 2016) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board….to search the record and address procedural arguments when the [appellant] fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant’s failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran’s claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on her behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Service Connection Legal Criteria for Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, 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)). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be established for a current disability on the basis of a presumption that certain chronic diseases, to include arthritis, manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). For arthritis, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3). Service connection can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. For chronic diseases shown as such in service or within the applicable presumptive period, subsequent manifestations of the same chronic disease at any later date are service-connected unless attributable to an intercurrent cause. 38 C.F.R. § 3.303(b). For a chronic disease to be considered to have been “shown in service,” there must be a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. Id. When the condition noted in service or within the presumptive period is not a chronic disease, a showing of continuity of symptomatology after discharge is required. Id. A disability can be service-connected on a secondary basis if proximately due to, or the result of, a service-connected condition. See 38 C.F.R. § 3.310(a). In order to establish entitlement to service connection on a secondary basis, there must be (1) a current disability; (2) a service-connected disability; and (3) a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Additional disability resulting from the aggravation of a non-service-connected condition by a service-connected condition is also compensable. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439, 448 (1995). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336–37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran’s lay statements. Id. Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff’d sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). In making that decision, the Board must determine the probative weight to be ascribed as among multiple medical opinions, and state the reasons and bases for favoring one opinion over another. See Winsett v. West, 11 Vet. App. 420, 424-25 (1998); see also Evans v. West, 12 Vet. App. 22, 30 (1998), citing Owens v. Brown, 7 Vet. App. 429, 433 (1995). This responsibility is particularly important where medical opinions diverge. The Board is also mindful that it cannot make its own independent medical determinations, and that there must be plausible reasons for favoring one medical opinion over another. See Evans at 31; see also Colvin v. Derwinski, 1 Vet. App. 171 (1991). After the evidence is assembled, it is the Board’s responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that “a veteran need only demonstrate that there is an ‘approximate balance of positive and negative evidence’ in order to prevail.” To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Evidence and Analysis The Veteran is claiming entitlement to service connection for chronic asthma with labored breathing, and also service connection for vertigo, sinusitis, sleep disturbances, and headaches, all as due to the asthma. The Veteran’s service treatment records are silent for any asthma, labored breathing, or any other respiratory condition during active service from July 1981 to August 1981. Those records are also silent for any note or mention regarding vertigo, sinusitis, sleep disturbances, or headaches. The Veteran testified during her January 2021 Board hearing with the undersigned VLJ that during basic training in July 1981 that there was a time where she was pushed into a narrow entryway, and that physical pressure on her chest led to asthma. The service treatment records note a late July 1981 incident where the Veteran hyperventilated and was treated by a medic, who provided a prescription anti-anxiety drug for one time use, and the Veteran’s remaining medical records are silent for any follow-on to that incident. There is no note or reference in any of the service medical or personnel records regarding a respiratory condition such as asthma, labored breathing, or any other. The Veteran stated during her hearing that her asthma was diagnosed in 1988 at the earliest, and the other claimed disabilities occurred over time after that diagnosis. 1. Entitlement to service connection for chronic asthma 2. Entitlement to service connection for vertigo, to include as secondary to chronic asthma 3. Entitlement to service connection for sinusitis, to include as secondary to chronic asthma 4. Entitlement to service connection for sleep disturbances, to include as secondary to chronic asthma 5. Entitlement to service connection for headaches, to include as secondary to chronic asthma The earliest record in the claims file that indicate any diagnosis or mention of asthma, sinusitis, headaches is a January 2013 medical record added to the claims file in April 2015 that notes the Veteran has a history of seasonal allergies that she treats with over the counter medication, and that she has complained of sinusitis and headaches as a result of those allergies. There is no mention of sleep disturbances or vertigo in those records. The passage of many years between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); Shaw v. Principi, 3 Vet. App. 365 (1992). Although lay persons are competent to provide opinions on some medical issues, the specific disabilities in this case, asthma, vertigo, sinusitis, sleep disturbances, or headaches, fall outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Diagnosing asthma, vertigo, sinusitis, sleep disturbances, or headaches, to include their etiology, requires specialized training and medical diagnostic testing for a determination as to diagnosis and causation, and is not susceptible of lay opinions on etiology. While the Veteran is competent to report what she has experienced, she is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Layno v. Brown, 6 Vet. App. 465 (1994); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever). Accordingly, her assertions to that effect are of no probative value. Therefore, the Board finds that the Veteran’s lay statements of record cannot be accepted as competent evidence sufficient to establish a nexus for service connection for asthma, vertigo, sinusitis, sleep disturbances, or headaches, or establish a secondary service connection relationship of causation or aggravation for those disabilities. The Board is cognizant that the Veteran has not received a formal VA examination for her claimed asthma, vertigo, sinusitis, sleep disturbances, or headaches conditions as part of her claim for entitlement to service connection, and for the following reasons, declines to remand for that purpose. In McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006), the United States Court of Appeals for Veterans Claims (Court) held that an examination is required when (1) there is evidence of a current disability, (2) evidence establishing an “in-service event, injury or disease,” or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. Here, the Board finds the first of the four elements to be satisfied by the diagnosis of asthma, vertigo, sinusitis, sleep disturbances, and headaches in 2013 by competent private medical providers as noted in the Veteran’s claims file. The Court noted that the first element only requires consideration of whether there is evidence of a current disability or persistent or recurrent symptoms thereof and an assessment that the evidence is competent. McLendon, 20 Vet. App at 81. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (finding that lay testimony is competent to establish the presence of observable symptomatology). The second McLendon element requires evidence establishing an “in-service event, injury or disease,” or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation. McLendon, 20 Vet. App at 82. The Court has found that the assessment of whether the evidence establishes the Veteran suffered an event, injury or disease in service is a “classic factual assessment, involving the weighing of facts.” Id.; see Duenas v. Principi, 18 Vet. App. 512, 517 (Vet. App. 2004) (noting that a medical examination could not aid in substantiating a claim where the record does not already contain evidence of an in-service event, injury, or disease). Ordinarily, the claimant’s service treatment records will be relied on for primary evidence that an in-service event, injury, or disease occurred. But here, as analyzed in detail earlier, the Board finds any incident necessary for satisfying the second criteria of service connection does not fall within the time period of the Veteran’s active service from July 1981 to August 1981. The Board notes there is no mention of any asthma, vertigo, sinusitis, sleep disturbances, or headaches in the Veteran’s service medical or personnel records, to include entrance and separation examinations. As such, the Board finds that that the Veteran has failed to establish “in-service event, injury or disease,” or a disease manifested in accordance with service connection regulations occurred which would support incurrence or aggravation, and thus fails the second element of the McLendon analysis. McLendon, 20 Vet. App at 82. The third McLendon element requires an indication that the current disability may be related to the in-service event. The Court has held that the requirement that a disability “may be associated” with service is a “low threshold” standard. McLendon, 20 Vet. App. at 83. “The types of evidence that ‘indicate’ that a current disability ‘may be associated’ with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation.” McLendon, 20 Vet. App. at 83 (emphasis added). Here, the Veteran’s claims file lacks competent evidence beyond lay statements of the Veteran regarding the claimed current disabilities discussed earlier. The Veteran stated that her claimed asthma, vertigo, sinusitis, sleep disturbances, or headaches did not arise until as early as 2008, which the Board notes is approximately 7 years after active service. There is no medical record earlier than 2013 that specifically notes any of the five claimed disabilities. Furthermore, there are no reports of continuity of symptomatology related to the claimed asthma, vertigo, sinusitis, sleep disturbances, or headaches. No competent medical opinion as to nexus for any asthma, vertigo, sinusitis, sleep disturbances, or headaches exists in the claims file. The Board thus finds that the Veteran’s claims fail to satisfy the requirements of McLendon, and thus will not remand for further examination of the claimed asthma, vertigo, sinusitis, sleep disturbances, or headaches. McLendon v. Nicholson, 20 Vet. App. 79, 82-83 (2006); 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). Therefore, while the Board acknowledges that the Veteran has been diagnosed with asthma, vertigo, sinusitis, sleep disturbances, and headaches at various times after active service, there is no indication of any diagnosis during service or within the one-year period thereafter. In addition, after considering the length of time between service and post-service diagnosis and determining that the Veteran does not meet the requirements for any relevant presumptions, the Board finds that the preponderance of the evidence is against the Veteran’s claim of service connection for asthma, vertigo, sinusitis, sleep disturbances, or headaches. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Based on the above, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran’s claimed asthma, vertigo, sinusitis, sleep disturbances, or headaches were not incurred in service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for asthma, vertigo, sinusitis, sleep disturbances, or headaches, and the claims must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a left hip condition, to include as secondary to service-connected disability, is remanded. 2. Entitlement to service connection for a right hip condition, to include as secondary to service-connected disability, is remanded. 3. Entitlement to service connection for a back condition, to include as secondary to service-connected disability, is remanded. The Veteran filed a service connection claim for her left hip, right hip, and back in April 2015, saying she has consistent pain in each of her hips and her lower back that is due to her service-connected bilateral pes planus disability. The Board also notes that the Veteran is service-connected for other lower extremity disabilities, including compensable ratings for bilateral knee osteoarthritis, bilateral ankle strain, bilateral tarsal tunnel syndrome, and noncompensable ratings for bilateral hallux valgus and bilateral hammer toe. A disability can be service-connected on a secondary basis if proximately due to, or the result of, a service-connected condition. See 38 C.F.R. § 3.310(a). In order to establish entitlement to service connection on a secondary basis, there must be (1) a current disability; (2) a service-connected disability; and (3) a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Additional disability resulting from the aggravation of a non-service-connected condition by a service-connected condition is also compensable. 38 C.F.R. § 3.310 (a); Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Veteran submitted private medical records that indicate complaints and treatment for lumbar pain. The Board notes a September 2015 VA examination for the back in September that lacked a statement regarding a possible diagnosis; the Board is unable to ascertain whether the examiner affirmatively determined there was no diagnosis or pathology of a lumbar back condition, or whether there was a defect in the completion of the examination form. That examiner provided a negative opinion for secondary service connection, again not mentioning a possible diagnosis, and did not discuss direct service connection. A January 2018 VA treatment record indicates a diagnosis of lumbar spondylosis and the possibility of psoriatic arthritis in the back. A December 2018 VA examination for the bilateral hips shows a diagnosis of psoriatic arthritis in the bilateral hips but does not mention the back at all, and again, an opinion for service connection is incomplete is that both direct and secondary service connection are not addressed. During testimony with the undersigned VLJ in January 2021, the Veteran stated that her bilateral pes planus had interfered with her gait while walking and caused pain in the hips and lower back. During the testimony, the Veteran’s representative cited a medical study from a leading Ivy League university that in women, bilateral foot pain was related to bilateral hip pain, with correlated and compensatory posture changes that leads to the development of arthritis. The Board also takes notice of the recent precedential Federal Circuit case, Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), which held that pain alone may constitute a disability for VA compensation purposes when it results in “functional impairment of earning capacity.” Id. at 1368. The Federal Circuit found that the term “disability” as used in 38 U.S.C. § 1110 “refers to the functional impairment of earning capacity, not the underlying cause of said disability,” and held that “pain alone can serve as a functional impairment and therefore qualify as a disability.” In other words, where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. VA is obligated to develop and consider all theories of entitlement that are raised by the record or by the claimant. See Robinson v. Mansfield, 21 Vet. App. 545 (2008). VA must examine the record with a view towards ascertaining whether the claimant or the evidence raises consideration of any theory of entitlement, regardless of specific disability claims. VA must provide an examination that is adequate for rating purposes. Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board finds that remand of the Veteran’s claims for her back, left hip, and right hip is necessary to first ascertain the exact diagnoses of each, and to consider the possibility direct service connection and secondary service connection, to include whether there is causation or aggravation of the hips and/or back by the service-connected disabilities including bilateral pes planus. The matters are REMANDED for the following action: 1. Make appropriate efforts to obtain and associate with the claims file any updated private or VA medical records identified and authorized for release by the Veteran. 2. Schedule the Veteran for a VA examination by an appropriate VA medical professional with the appropriate expertise to determine the nature and etiology of the Veteran’s left hip, right hip, and back disabilities. The claims file must be made available to and reviewed by the examiner. The examiner then should answer the following question for the claimed left hip, right hip, and back disabilities: a) Whether it is at least as likely as not (probability of 50 percent or greater) that the Veteran’s claimed left hip, right hip, and back disabilities had its onset in service or is otherwise related to any in-service disease, event, or injury? b) If not, is it at least as likely as not (a fifty percent probability or greater) that the claimed left hip, right hip, and back disabilities were caused by any of the Veteran’s service-connected disabilities, to include the bilateral pes planus disability? c) If the service-connected disability did not cause the claimed left hip, right hip, and back disabilities, is it at least as likely as not (a fifty percent probability or greater) that the claimed left hip, right hip, and back disabilities were aggravated by the service-connected disability? d) If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to aggravation of the claimed left hip, right hip, and back disabilities by the service-connected disability. Attention is invited to the Veteran’s reports and statements of chronic pain in her back and hips. The Board takes notice of the recent precedential Federal Circuit case, Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), which held that pain alone may constitute a disability for VA compensation purposes when it results in “functional impairment of earning capacity.” Id. at 1368. A detailed rationale supporting the examiner’s opinion should be provided. In forming the opinion, the examiner must consider all lay statements of record. If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required or the examiner does not have the needed knowledge or training). Jones v Shinseki, 23 Vet. App. 382 (2010). The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. 3. Thereafter, readjudicate the issues on appeal. If the determination remains unfavorable to the Veteran, she and her representative should be furnished a supplemental statement of the case which addresses all evidence associated with the claims file since the last statement of the case. The Veteran and her representative should be afforded the applicable time period to respond. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369, 372 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112 (2012). MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Setter, 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.