Citation Nr: 0001582 Decision Date: 01/19/00 Archive Date: 01/28/00 DOCKET NO. 96-45 526 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to a rating in excess of 10 percent for post traumatic stress disorder. 2. Entitlement to service connection for shell fragment wound (SFW) to the face. 3. Entitlement to service connection for shell fragment wound (SFW) to the left leg. 4. Entitlement to service connection for shell fragment wound (SFW) to the left leg elbow. REPRESENTATION Appellant represented by: Georgia Department of Veterans Service WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD D. P. Havelka, Associate Counsel INTRODUCTION The veteran's active military service extended from April 1968 to October 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 1996 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. That rating decision, granted service connection for PTSD and assigned a 10 percent disability rating. That rating decision also denied service connection for the residuals of shell fragment wounds. In September 1999, a hearing was held before Bettina S. Callaway, who is the Board member making this decision and who was designated by the Chairman to conduct that hearing, pursuant to 38 U.S.C.A. § 7102(b) (West 1991). The issue involving entitlement to a rating in excess of 10 percent for the veteran's service connected PTSD is the subject of a remand which follows the Board's decision. Finally, the Board notes that, in November 1997, the veteran submitted a statement which may be a claim for service connection for "Agent Orange exposure." This claim has not been adjudicated, and is not properly before the Board at this time. This issue is referred to the RO for action deemed appropriate. FINDINGS OF FACT 1. The RO has obtained all relevant evidence necessary for an equitable disposition of the veteran's appeal. 2. The service medical records do not show that the veteran incurred any wounds during military service. 3. The veteran's service personnel records do not reveal that the veteran was awarded a Purple Heart for wounds incurred during service. 4. The January 1968 entrance examination report noted that the veteran had a pre-existing 3 inch scar on his left elbow. 5. There is no indication in any of the evidence of record that the veteran's pre-existing left elbow scar increased in severity during military service. 6. There is no competent medical evidence of any current disability resulting from an alleged shrapnel wound to the face. 7. There is no competent medical evidence of any current disability resulting from an alleged shrapnel wound to the left leg. CONCLUSIONS OF LAW 1. A shell fragment wound to the left elbow was not incurred in active military service, and the veteran's pre-existing scar on his left elbow was not aggravated by his active military service. 38 U.S.C.A. §§ 101(16), 1110 (West 1991); 38 C.F.R. § 3.303 (1999). 2. The appellant has not presented a well grounded claim for service connection for the residuals of a shell fragment wound to the face and therefore there is no statutory duty to assist the appellant in developing facts pertinent to this claim. 38 U.S.C.A. §§ 101(16), 1110, 5107(a) (West 1991); 38 C.F.R. § 3.303(b) (1999). 3. The appellant has not presented a well grounded claim for service connection for the residuals of a shell fragment wound to the left leg and therefore there is no statutory duty to assist the appellant in developing facts pertinent to this claim. 38 U.S.C.A. §§ 101(16), 1110, 5107(a) (West 1991); 38 C.F.R. § 3.303(b) (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Preliminary Matters Service connection may be granted for a disability resulting from disease or injury incurred in, or aggravated by, active military service. 38 U.S.C.A. §§ 101(16), 1110 (West 1991); 38 C.F.R. §§ 3.303, 3.304 (1999). The law provides that "a person who submits a claim for benefits under a law administered by the Secretary shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded." 38 U.S.C.A. § 5107(a) (West 1991)(emphasis added). Establishing a well grounded claim for service connection for a particular disability requires more than an allegation that the disability had its onset in service or is service-connected; it requires evidence relevant to the requirements for service connection and of sufficient weight to make the claim plausible and capable of substantiation. See Franko v. Brown, 4 Vet. App. 502, 505 (1993); Tirpak v. Derwinski, 2 Vet. App. 609, 610 (1992); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The three elements of a "well grounded" claim are: (1) evidence of a current disability as provided by a medical diagnosis; (2) evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, (3) a nexus, or link, between the inservice disease or injury and the current disability as provided by competent medical evidence. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996); see also Epps v Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997); 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1999). Generally, competent medical evidence is required to meet each of the three elements. However, for the second element the kind of evidence needed to make a claim well grounded depends upon the types of issues presented by a claim. Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993). For some factual issues, such as the occurrence of an injury, competent lay evidence may be sufficient. However, where the claim involves issues of medical fact, such as medical causation or medical diagnoses, competent medical evidence is required. Id. at 93. Lay evidence is also acceptable to show incurrence in service if the veteran was engaged in combat and the evidence is consistent with the circumstances, conditions and hardships of such service, even though there is no official record of such incurrence. 38 U.S.C.A. § 1154 (West 1991); 38 C.F.R. § 3.304(d) (1999). Alternatively, the third Caluza element can be satisfied under 38 CFR 3.303(b) (1999) by evidence of continuity of symptomatology and medical or, in certain circumstances, lay evidence of a nexus between the present disability and the symptomatology. See Savage v. Gober, 10 Vet. App. 488, 495 (1997). In this case, the determinative issues presented by the claim are (1) whether the veteran incurred shell fragment wounds during service; (2) whether he has any current disability of the face, left elbow, and left leg; and, if so, (3) whether these current disabilities are etiologically related to active service. The Board concludes that medical evidence is needed to lend plausible support for all of the issues presented by this case because they involve questions of medical fact requiring medical knowledge or training for their resolution. Caluza v. Brown, 7 Vet. App. 498, 506 (1995); see also Layno v. Brown, 6 Vet. App. 465, 470 (1994); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). However, lay evidence may be sufficient to support the first issue in this case, especially considering that the veteran asserts that he was wounded in combat. The evidence of record reveals that the veteran was awarded a Combat Infantry Badge (CIB). As such, the Board acknowledges that the veteran engaged in combat with the enemy and his allegations of receiving a shell fragment wound during said combat are consistent with the circumstances, conditions and hardships of such service. 38 U.S.C.A. § 1154 (West 1991); 38 C.F.R. § 3.304(d) (1999). II. Evidence The RO has obtained the veteran's service medical records. These records appear to be complete. They contain entrance and separation examination reports along with medical treatment records. An entrance examination of the veteran was conducted in January 1968. The examining physician noted a "3 inch scar left elbow." On the accompanying report of medical history the veteran reported a history of a fracture of the left forearm and mild pain in his right shoulder. Review of the veteran's service medical records does not reveal any indication that he incurred a shell fragment wound during service. There are treatment records which reveal treatment for left knee pain from March to November 1969. The veteran had pain, tenderness, and swelling of the left knee during this time. Various diagnoses were rendered including arthritis, bursitis, and synovitis. Specifically, the record indicates that the veteran was hospitalized in May 1969 for three days for acute left knee bursitis of unknown cause. The Board has checked these dates against the veteran's personnel records and notes that the veteran was indeed in Vietnam at this period of time. The veteran's September 1972 separation examination is of record. There is no indication of any abnormalities noted on this examination. On the accompanying report of medical history, the veteran did not report a history of any wounds during service. The RO obtained copies of the veteran's separation papers, DD 214, and copies of his service personnel records. There is no indication in any of these records that the veteran was awarded the Purple Heart. The veteran has asserted that he has a copy of his DD 214 that showed the award of a Purple Heart; however, he has never produced a copy of this alleged evidence. The veteran asserts that he was wounded in combat during service in Vietnam. He alleges that he received shell fragment wounds to the face, left leg, and left elbow. He asserts that he was hospitalized during service as a result of these wounds. The veteran has submitted photographs which appear to show him in a military hospital in Vietnam with his left leg bandaged. In January 1996 a VA examination of the veteran was conducted. The veteran reported that he received combat shrapnel wounds to the chin, left leg, and left elbow. Physical examination revealed a "fully mobile 3-inch scar" on the posterior aspect of the left elbow. The veteran indicated no impairment in mobility of his left elbow. Later in the examination report the examining physician stated in the "past aspect of the left elbow is a fully pliable, non- attached 3-inch scar, obvious combat wound in that area. . . . the left elbow flexes 145 degrees. Extension to null point. Normal supination of 85 and pronation of 80 degrees." The physician also noted that on the left knee there was a "non-attached 1/4-inch in diameter somewhat nominal shrapnel injury scar. The left knee flexes 140 degrees. Extension is null point." Examination of the veteran's face revealed normal appearance. In the chin area there was "a miniscule papule demonstrate which is nontender to palpation but no overt scarring or disfiguration." The diagnosis included: "superficial shrapnel wound, chin not manifest by scar. . . . posterior left elbow shrapnel wound manifest by scar, nontender. Shrapnel scar proximal left foreleg nontender." At this point the Board must make some observations about the findings of the January 1996 VA examination report. The examining physician specifically relied on a medical history provided by the veteran in this examination. The veteran stated that he incurred a fragment wound to the left elbow and the physician noted a 3 inch scar on the left elbow and diagnosed this as a fragment wound scar. However, as noted above, the veteran's entrance examination report noted that the veteran had a 3 inch scar on his left elbow. The noted size and position is identical. In December 1996 an MRI of the veteran's head was conducted at a VA medical center (VAMC). No retained metallic fragments were found. In May 1997 another VA examination of the veteran was conducted. The veteran related a history of fragment wound to his left leg. Physical examination of the left leg and knee revealed extension to 175 degrees and flexion to 34 degrees. There was no effusion noted and the veteran had good left knee stability. The diagnosis was "left knee - objectively and functionally normal." In November 1997 another VA examination of the veteran was conducted. The veteran complained of left knee instability; however, physical examination revealed no instability. A VA MRI examination of the left knee was conducted. The impression was of small effusion and possible medial meniscal tears. However, this finding was not related in anyway to the veteran's military service. In May 1997 the veteran presented sworn testimony before an RO hearing officer. The veteran testified that he was "shot in the left arm, shrapnel in my face, shot in this [left] leg, shrapnel in this [left] leg." When questioned about his left arm wound the veteran indicated that the bullet went straight though his arm and was not retained. He also testified that he was awarded a Purple Heart, but that there is no documentation of this award. Finally, he stated that he was hospitalized for over a month at Long Binh for his leg wound. The veteran also testified that he had been told by VA physicians that he had retained shrapnel in his face and left leg. In September 1999 the veteran presented sworn testimony before the undersigned member of the Board. The veteran again testified that he received shrapnel wounds to the left leg, left elbow, and face. This time he testified that he was hospitalized at Long Binh for three months. When directly questioned as to why he did not report his alleged combat wounds on his separation examination medical history initially the veteran answered that it did not occur to him to report the wounds on the medical history. Then the veteran indicated that he did tell the examining physician but could not explain why such information was not contained in his separation examination. Finally, he referred to a fire and missing records. III. Analysis "The appellant's evidentiary assertions must be accepted as true for the purpose of determining whether the claim is well grounded. Exceptions to this rule occur when the evidentiary assertion is inherently incredible or when the fact asserted is beyond the competence of the person making the assertion. Samuels v. West, 11 Vet. App. 433, 435 (1998). The veteran's testimony is competent to establish the occurrence of an injury. See Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). The veteran's lay evidence is also acceptable to show incurrence of his alleged shrapnel wounds if the veteran was engaged in combat and the evidence is consistent with the circumstances, conditions and hardships of such service, even though there is no official record of such incurrence. 38 U.S.C.A. § 1154 (West 1991); 38 C.F.R. § 3.304(d) (1999). The veteran asserts that he received shrapnel and/or gunshot wounds to his left, left elbow, and face. He asserts that he was wounded in combat, that he was hospitalized for greater than an month because of these wounds, and that he received a Purple Heart. He avers that the records of his hospitalization during service and his Purple Heart award are lost or destroyed. The Board has reviewed all of the evidence of record. The Board finds as fact that the veteran's service medical records are complete and that none have been destroyed. The Board also finds as fact that the veteran's service personnel records are complete and that there are no apparent omissions of any decorations, including that of a Purple Heart. A. Left Elbow With respect to the veteran's left elbow, the veteran has at times asserted that he received a shrapnel wound to the left elbow. At other times he has testified that he received a bullet wound to the left elbow that went clean through and was not retained. The veteran informed the examining physician in the January 1996 VA examination that he received a shrapnel wound to the left elbow and based on this information the physician diagnosed the scar on the veteran's left elbow as being the result of an inservice shrapnel wound. The Board finds that the veteran's testimony with respect to incurring a wound to the left elbow during service lacks credibility. It is also clear that the veteran purposefully misinformed the VA physician conducting the 1996 VA examination as to the history related to the scar on his left elbow. Specifically, the veteran's 1968 entrance examination clearly notes the presence of a 3-inch scar on the veteran's left elbow prior to entry into active service. The scar reported on the 1996 VA examination is identical, a non-tender 3-inch scar of the left elbow. Moreover, there has never been any indication of an exit wound scar on his left arm in the vicinity of his left elbow to support his allegations of a through and through bullet wound. As such, the Board must find that the veteran's assertions related to his having incurred a fragment wound to the left elbow lack credibility. Moreover, this evidence resulted in the physician rendering a diagnosis related to the veteran's left elbow that was in error because it was based upon the such information. See Sanchez-Benitez v. West, No. 97-1948 (U.S. Vet. App. Dec. 29 (1000). The Board finds as fact that the veteran entered service with a nontender 3-inch scar on his left elbow. The veteran was not wounded in his left elbow during service and there was no increase in severity of the left elbow scar during service. The competent medical evidence of record reveals that the veteran still has a nontender, 3-inch scar on his left elbow. As such, the preponderance of the evidence is against service connection for a shell fragment wound to the left elbow. B. Face Wound With respect the veteran's claim for service connection for a SFW to the face. The veteran again asserts being hit with shrapnel in the chin area. He has testified that he had retained shrapnel. The Board will assume that the veteran did sustain a shrapnel injury in the chin area. However, the competent medical evidence of record reveals that the veteran has merely has a miniscule papule on the chin which is nontender to palpation with no overt scarring, no disfiguration, and no retained metallic fragments. Simply put, the veteran does not have any current disability resulting from the alleged inservice SFW to the face. As such, the veteran does not meet the first element required for the claim to be well grounded. See Caluza, 7 Vet. App. at 506. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. § 1110, 1131 (West 1991); see Degmetich v. Brown, 104 F. 3d 1328 (1997) (holding that Secretary's and Court's interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary and therefore the decision based on that interpretation must be affirmed). C. Left Leg The veteran asserts that he incurred a SFW of the left leg, left knee area. Even assuming that the veteran did incur a SFW to his left leg during service, there is no indication that he required hospitalization for the wound. The service medical records reveal that the veteran did have symptoms of left knee pain in 1969 and required hospitalization for three days for aspiration of effusion of the left knee. The 1996 VA examination revealed that the veteran had a non- attached 1/4-inch in diameter somewhat nominal injury scar, with no impairment of left knee function. While the examining physician indicated that this was a nominal shrapnel injury scar based upon the history provided by the veteran, the Board strongly suspects that it is a small surgical scar from the inservice left knee aspiration procedure. VA x-ray examination of the left knee revealed a normal left knee and no retained metallic fragments have ever been noted. The diagnosis rendered on the May 1998 VA examination report was that the veteran's left knee was "objectively and functionally normal." Simply put, the veteran does not have any current disability resulting from the alleged inservice SFW to the left leg. As such, the veteran does not meet the first element required for the claim to be well grounded. See Caluza, 7 Vet. App. at 506. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. § 1110, 1131 (West 1991); see Degmetich v. Brown, 104 F. 3d 1328 (1997) (holding that Secretary's and Court's interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary and therefore the decision based on that interpretation must be affirmed). IV. Conclusion With respect to the veteran's claims for service connection related to his left leg and face, the Board has thoroughly reviewed the claims file. However, we find no evidence of a plausible claim. Since the veteran has not met his burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claims are well grounded, they must be denied. See Boeck v. Brown, 6 Vet. App. 14, 17 (1993) (if a claim is not well-grounded, the Board does not have jurisdiction to adjudicate it). Where a claim is not well grounded, VA does not have a statutory duty to assist a claimant in developing facts pertinent to the claim, but VA may be obligated under 38 U.S.C.A. § 5103(a) to advise a claimant of evidence needed to complete his application. This obligation depends on the particular facts of the case and the extent to which the Secretary has advised the claimant of the evidence necessary to be submitted with a VA benefits claim. Robinette v. Brown, 8 Vet. App. 69, 78 (1995). Here, unlike the situation in Robinette, the veteran has not put the VA on notice of the existence of any specific, particular piece of evidence that, if submitted, could make his claims well grounded. See also Epps v. Brown, 9 Vet. App. 341 (1996). Accordingly, the Board concludes that VA did not fail to meet its obligations under 38 U.S.C.A. § 5103(a) (West 1991). ORDER Service connection for a shell fragment wound of the left elbow is denied. Because it is not well-grounded, the veteran's claim for service connection for a shell fragment wound to the face is denied. Because it is not well-grounded, the veteran's claim for service connection for a shell fragment wound to the left leg is denied. REMAND The Board has recharacterized the issues of entitlement to an increased rating for PTSD at issue in order to comply with the recent opinion by the United States Court of Appeals for Veterans Affairs (Court), in Fenderson v. West, 12 Vet. App. 119 (1999). In that case, the Court held, in pertinent part, that the RO had never properly provided the appellant with a statement of the case (SOC) concerning an issue, as the document addressing that issue "mistakenly treated the right-testicle claim as one for an '[i]ncreased evaluation for service[-]connected ... residuals of surgery to right testicle' ... rather than as a disagreement with the original rating award, which is what it was." Fenderson. 12 Vet. App. 132 (1999), emphasis in the original. The Court then indicated that "this distinction is not without importance in terms of VA adjudicative actions," and remanded the matter for issuance of a SOC. Id. As in Fenderson, the RO in this case has also identified the issue on appeal as a claim for an increased disability rating for the appellant's service-connected PTSD , rather than as a disagreement with the original rating award for this disorder. The VA has a duty to assist the veteran once his claims are found to be well-grounded. 38 U.S.C.A. § 5107(a)(West 1991). A well-grounded claim is one which is meritorious on its own or capable of substantiation. It need not to be conclusive, but only plausible. Murphy v. Derwinski, 1 Vet. App. 78 (1990). The veteran's claim for an increased rating in this case is shown to be well grounded, but the duty to assist him in its development have not yet been fulfilled. See Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992) (where a veteran asserted that his condition had worsened since the last time his claim for an increased disability evaluation for a service-connected disorder had been considered by VA, he established a well grounded claim for an increased rating). The veteran asserts that he has been treated for his service connected PTSD at VAMC Clairmont since the 1980s. The Board questions the veracity of this assertion. However, an attempt should be made to retrieve these records. Records generated by VA are constructively included within the record. If records of VA treatment are material to the issue on appeal and are not included within the claims folder, a remand is necessary to acquire such VA records. Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). In December 1996 the most recent VA psychiatric examination of the veteran was conducted. The examination findings are equivocal at best. In one section of the examination report the veteran's PTSD is described as moderate to severe, in another section it is described as moderate. Another examination should be conducted to resolve the ambiguity. The United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (hereinafter, "the Court") has also held that, when the medical evidence is inadequate, VA must supplement the record by seeking an advisory opinion or ordering another medical examination. Colvin v. Derwinski, 1 Vet. App. 171 (1991) and Halstead v. Derwinski, 3 Vet. App. 213 (1992). In light of the foregoing, the Board would be remiss if it were to attempt to decide the issues on appeal without first obtaining all the pertinent evidence that is missing and scheduling the veteran for another VA disability compensation examination. To ensure that VA has met its duty to assist the claimant in developing the facts pertinent to the claim the case is REMANDED to the RO for the following development: 1. The veteran should be asked to provide a list containing the names of all health care professionals and/or facilities (private and governmental) where he had been treated for his PTSD. Subsequently, and after securing the proper authorizations where necessary, the RO should make arrangements in order to obtain all the records of treatment from all the sources listed by the veteran which are not already on file. The Board is particularly interested in obtaining all records and reports of treatment from VAMC Clairmont / Decatur dating from 1980 to present. All information obtained should be made part of the file. 2. Following the above, the veteran should be examined by a VA psychiatrist to determine the nature and extent of the service-connected PTSD. The report of examination should include a detailed account of all manifestations of PTSD found to be present. If there are different psychiatric disorders, the board should reconcile the diagnoses and should specify which symptoms are associated with and which disorders are part of or caused by the service-connected disorder. If certain symptomatology cannot be disassociated from one disorder or another, it should be specified. The psychiatrist should describe how the symptoms of the service-connected PTSD affect the veteran's social and industrial capacity. All necessary special studies or tests including psychological testing are to be accomplished. The examiner should assign a numerical code under the Global Assessment of Functioning Scale (GAF). It is imperative that the physician include a definition of the numerical code assigned. Thurber v. Brown, 5 Vet. App. 119 (1993). The diagnosis should be in accordance with the DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS (4TH ed. 1994). The entire claims folder and a copy of this remand must be made available to and reviewed by the examiner. 3. Following completion of the above actions, the RO must review the claims folder and ensure that all of the foregoing development has been conducted and completed in full. If any development is incomplete, appropriate corrective action is to be implemented. Specific attention is directed to the examination report. If the examination report does not include fully detailed descriptions of pathology and all test reports, special studies or adequate responses to the specific opinions requested, the report must be returned for corrective action. 38 C.F.R. § 4.2 (1999) ("if the [examination] report does not contain sufficient detail, it is incumbent upon the rating board to return the report as inadequate for evaluation purposes."). Green v. Derwinski, 1 Vet. App. 121, 124 (1991); Abernathy v. Principi, 3 Vet. App. 461, 464 (1992); and Ardison v. Brown, 6 Vet. App. 405, 407 (1994). 4. Subsequently, the RO should consider the issues on appeal. In this regard, the RO is reminded that stage ratings are permitted in a claim involving the initial disability rating of a service connected disability. Fenderson v. West, 12 Vet. App. 119 (1999). Once the foregoing has been accomplished, and if the veteran remains dissatisfied with the outcome of the adjudication of the claim, both the veteran and his representative should be furnished a supplemental statement of the case covering all the pertinent evidence, law and regulatory criteria. They should be afforded a reasonable period of time in which to respond. Thereafter, the case should be returned to the Board for further appellate consideration. The veteran needs to take no action until so informed. The purpose of this REMAND is assist the veteran and to obtain clarifying information. The Board intimates no opinion as to the ultimate outcome of this case. Further adjudication of the question involving rating the veteran's service connected PTSD will be postponed until the remand action is completed. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. 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 The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44- 8.45 and 38.02-38.03. BETTINA S. CALLAWAY Member, Board of Veterans' Appeals