Citation Nr: 0001788 Decision Date: 01/21/00 Archive Date: 01/28/00 DOCKET NO. 96-07 366 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office in Columbia, South Carolina (RO) THE ISSUES 1. Entitlement to compensation for additional disability claimed to have been incurred during surgical treatment of a cervical spine disability at the Oklahoma City, Oklahoma, VA Medical Center (VAMC) on December 19, 1990, pursuant to 38 U.S.C. § 1151. 2. Entitlement to service connection for a left foot disability. 3. Entitlement to service connection for a right foot disability. 4. Entitlement to specially adapted housing or a special home adaptation grant. 5. Entitlement to an automobile and adaptive equipment or for adaptive equipment only. 6. Entitlement to special monthly compensation based on the need for aid and attendance or at the housebound rate. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD Bernard T. DoMinh, Counsel INTRODUCTION The veteran served on active duty from November 1964 to May 1965 and from November 1965 to February 1969. His service records show that he is a combat veteran of the Vietnam War, and that his military decorations include the Combat Infantryman Badge and three Purple Heart Medals. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a January 1996 decision by the Columbia, South Carolina, Regional Office (RO) of the Department of Veterans Affairs (VA), which denied the veteran's claims for compensation for additional disability claimed to have been incurred during surgical treatment at the Oklahoma City VAMC on December 19, 1990; for service connection for a disability of both feet; for specially adapted housing or a special home adaptation grant; for an automobile and adaptive equipment (or for adaptive equipment only); and for special monthly compensation based on the need for Aid and Attendance or at the Housebound rate. In an August 1998 VA Form 1-646, the veteran raised a claim of entitlement to an increased rating for his service- connected low back disability. At his VA Central Office (CO) hearing of January 1999, he also presented a claim of entitlement to service connection for a neurologic disability of his left ankle, separate and apart from his service- connected ankylosis, which he contends was due to an injury incurred in active duty. As these issues have not been adjudicated, they are referred to the RO for appropriate action. In an April 1998 rating decision, the RO denied a reopened claim of entitlement to a compensable evaluation for service- connected ankylosis of the left ankle. In a lengthy, handwritten statement which was received by VA in May 1998, the veteran submitted statements which constitute a timely notice of disagreement with the April 1998 rating decision. The RO is thus advised that the veteran should be furnished with a statement of the case addressing this issue. Significant recent changes in the law applicable to compensation claims under 38 U.S.C.A. § 1151 require that some detailed discussion is provided. The governing statutory law for claims of this sort is set forth at 38 U.S.C.A. § 1151. That section provides that, when a veteran suffers injury or aggravation of an injury as a result of VA hospitalization or medical or surgical treatment, not the result of the veteran's own willful misconduct or failure to follow instructions, and the injury or aggravation results in additional disability or death, then compensation, including disability, death, or dependency and indemnity compensation, shall be awarded in the same manner as if the additional disability or death were service- connected. The regulations implementing that statute appear at 38 C.F.R. §§ 3.358, 3.800 (1999). They provide, in pertinent part, that, in determining whether additional disability exists, the veteran's physical condition immediately prior to the disease or injury on which the claim for compensation is based is compared with the physical condition subsequent thereto. With regard to medical or surgical treatment, the veteran's physical condition prior to the disease or injury is the condition which the medical or surgical treatment was intended to alleviate. 38 C.F.R. § 3.358(b)(1). Compensation is not payable if additional disability or death is a result of the natural progress of the injury or disease for which the veteran was hospitalized. 38 C.F.R. § 3.358(b)(2). Further, the additional disability or death must actually result from VA hospitalization or medical or surgical treatment and not be merely coincidental therewith. 38 C.F.R. § 3.358(c)(1), (2). In addition, compensation is not payable for the necessary consequences of medical or surgical treatment properly administered with the express or implied consent of the veteran or, in appropriate cases, the veteran's representative. "Necessary consequences" are those which are certain or intended to result from the VA hospitalization or medical or surgical treatment. 38 C.F.R. § 3.358(c)(3). So as to avoid possible misunderstanding as to the governing law, the Board notes that in Gardner v. Brown, 115 S. Ct. 552, the United States Supreme Court held that an earlier version of 38 C.F.R. § 3.358 was invalid because the earlier version required evidence of fault on the part of VA or the occurrence of an accident or otherwise unforeseen event. In March 1995, the Secretary published an interim rule amending 38 C.F.R. § 3.358 to conform to the Supreme Court decision. The amendment was made effective November 25, 1991, the date of the Gardner decision by the United States Court of Appeals for Veterans Claims. 60 Fed. Reg. 14,222 (March 16, 1995). The interim rule was later adopted as a final rule, 61 Fed. Reg. 25,787 (May 23, 1996), and codified at 38 C.F.R. § 3.358(c) (1999). Recently, Congress amended 38 U.S.C.A. § 1151, effective for claims filed on or after October 1, 1997, to preclude benefits in the absence of evidence of VA negligence or an unforeseen event. Pub. L. No. 104-204, § 422(a), 110 Stat. 2926 (1996); see also VAOPGCPREC 40-97 (Dec. 31, 1997). The claim herein was filed with VA in October 1993, and therefore it must be adjudicated in accord with the earlier version of 38 U.S.C.A. § 1151 and the May 23, 1996, final regulation. Thus, neither evidence of an unforeseen event nor evidence of VA negligence is required here. FINDINGS OF FACT 1. There is competent evidence of a plausible claim, pursuant to 38 U.S.C. § 1151, for compensation for additional disability incurred during surgical treatment of a non- service-connected cervical spine disability at the Oklahoma City VAMC on December 19, 1990. 2. There is competent evidence of a plausible claim of service connection for a left foot disability as a separate and independent diagnostic entity from his service-connected ankylosis of the left ankle. 3. The veteran has not submitted competent evidence of a plausible claim for service connection for a right foot disability. 4. The veteran is currently rated as total disabled due to individual unemployability as a result of his service- connected disabilities. He is currently service-connected for residuals of a low back injury (rated 70 percent disabling); post-traumatic stress disorder (PTSD) (rated 50 percent disabling); residuals of a gunshot wound, left calf, with history of painful neuroma (rated 30 percent disabling); malaria (rated noncompensably disabling); residuals of a gunshot wound, right shin (rated noncompensably disabling); sebaceous cyst of the neck, post-operative (rated noncompensably disabling); shell fragment wound with scar, left hand (rated noncompensably disabling); and ankylosis of the left ankle (rated noncompensably disabling). 5. The veteran's claim for specially adapted housing is plausible; the VA has complied with the duty to assist. 6. The veteran's service-connected disabilities, which are productive of total impairment due to individual unemployability, do not cause blindness in both his eyes, loss or loss of use of both lower extremities, loss or loss of use of one lower extremity together with the loss or loss of use of one upper extremity, or the loss or loss of use of one lower extremity together with residuals of organic disease or injury which so affects the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair. 7. The veteran is not entitled to compensation for permanent and total disability which is due to blindness in both eyes or includes the loss or loss of use of both hands. CONCLUSIONS OF LAW 1. The veteran has submitted evidence of a well-grounded claim, pursuant to 38 U.S.C. § 1151, for compensation for additional disability incurred during surgical treatment of a non-service-connected cervical spine disability at the Oklahoma City VAMC on December 19, 1990. 38 U.S.C.A. § 5107(a) (West 1991). 2. The veteran has submitted evidence of a well-grounded claim of service connection for a left foot disability. 38 U.S.C.A. § 5107(a) (West 1991). 3. The veteran's claim of service connection for a right foot disability is not well grounded. 38 U.S.C.A. §§ 1110, 5107(a) (West 1991). 4. The statutory and regulatory criteria for entitlement to a certificate of eligibility for assistance in acquiring specially adapted housing have not been met. 38 U.S.C.A. § 2101(a), 5107 (West 1991); 38 C.F.R. § 3.809 (1999). 5. The veteran is not eligible for a special home adaptation grant. 38 U.S.C.A. § 2101(b) (West 1991); 38 C.F.R. § 3.809a (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background The veteran's service medical records from his first period of active duty, with regard to his left and right foot, show that on enlistment examination in November 1964, and on separation examination in May 1965, his feet were clinically normal. The May 1965 examination noted that there was a scar on his left foot which the veteran attributed to a skin graft operation performed when he was 13 years old. On his second period of active duty, a November 1965 enlistment examination noted no abnormalities of his feet. Subsequently, it was learned that, prior to service, the veteran had a history of osteomyelitis (also identified in the record as septic arthritis) when he was 2 years old, and that he had a pantalar arthrodesis of his left ankle for treatment of traumatic arthritis when he was 15 years old. During service, in January 1967, he sustained a traumatic injury to his left ankle after a fall. A March 1968 X-ray examination revealed no bony abnormality of his left foot except for pantalar fusion of the left foot and ankle. The report shows that the veteran complained of having left foot pain. A medical examination conducted in June 1968, pursuant to a Medical Board Proceeding, shows that ankylosis of the veteran's left ankle and subtalar joints secondary to his history of pantalar arthrodesis was observed, but also noted that the veteran's feet were normal on clinical evaluation. The report of a September 1968 Medical Board Proceeding determined that he was medically unfit for service due to ankylosis of his left ankle and subtalar joints, secondary to the pantalar arthrodesis which existed prior to his entry into service. The veteran's service medical records also show that he sustained missile wounds to his left hand, right shin, and left calf during combat against enemy forces during his tour of duty in Vietnam. The records show that the left calf gunshot wound caused only soft tissue injury affecting the veteran's musculature and nerves, but without any involvement of the underlying bone or joints. After separating from service in February 1969, the veteran was examined by VA in April 1969. The report of this examination shows that the veteran's left ankle and foot were fused prior to his entry into active duty, but that his left foot and ankle symptoms were aggravated by service. The veteran's VA medical records show that his occupational history following his separation from active duty was as a container packer for 3 weeks, and then thereafter a truck driver for 12 years until his progressively increasing level of impairment as a result of his service-connected disabilities rendered him individually unemployable. The veteran, whom the medical and service records show was born in September 1946, was awarded a total disability rating for individual unemployability as a result of service-connected disabilities. This award took effect in February 1986, when the veteran was 39 years old, and has remained in effect ever since that time. The veteran's claims files contain his records of medical treatment, primarily from VA sources, dated from 1969 to 1998, which include his records of surgery for a non-service- connected cervical spine disability at the Oklahoma City VAMC on December 19, 1990. These records show that prior to surgery in December 1990, the veteran had a history of chronic neck pain with radicular symptoms affecting his right arm and, to a lesser degree, his left arm, and that though he had a history of using a wheelchair, he was not regarded as wheelchair bound and could ambulate with the use of leg braces and crutches. A myelogram which was taken prior to surgery revealed osteophytes on his cervical spine which caused impingement of his anterior cervical cord and symptoms consistent with his complaints of a burning sensation in his right arm and shooting pains down his triceps to the lateral three digits of his right hand. VA medical records show that on December 19, 1990, a surgical procedure involving an anterior cervical disc and fusion with bone donor bone graft at C6-C7 was performed on the veteran. The VA medical records from the time period following this surgery are significant for showing that the veteran complained of experiencing increased symptoms following surgery as compared to his condition prior to December 19, 1990. Several months later, in May 1991, the veteran underwent another surgical procedure at the C5-C6 vertebral level of his cervical spine. Thereafter, a VA medical report dated in September 1991 shows that the treating physician commented that the veteran's December 1990 surgery worsened the severity of his pain. A September 1991 VA treatment report shows that the veteran complained of having a burning pain in his left arm and thumb, and also in his right anterior neck, since surgery in December 1990. On VA examination in September 1994, the physician noted that the veteran's medical history showed traumatic arthritis involving multiple joints, and also that this history, in addition to spinal surgery in December 1990, had rendered the veteran wheelchair bound. The examiner also stated that, according to the veteran's history, the bone graft inserted between the C6-C7 vertebral space in December 1990 "...reportedly dislodged into his spinal cord." The diagnoses presented in this examination report included cervical myopathy with left greater than right upper extremity motor weakness and loss of fine motor skills, and cervical myelopathy accounting for some global weakness and loss of coordination. A VA treatment report dated in January 1991 shows that the veteran had complained of left heel pain and right ankle pain and was diagnosed with plantar fasciitis. A March 1991 report shows that the veteran reported experiencing some improvement of his left heel pain with use of a heel cup and soft shoe heel. He also reported having recurrent right ankle sprains. X-rays of his right ankle revealed some loose bone fragments in the joint. Treatment reports dated in August 1991 show that the veteran had mild degenerative joint disease of his hips, that he ambulated with the aid of Canadian crutches, and that he wore metal leg braces and needed assistance with putting on and removing his orthotics. A series of VA medical records which were received by the RO and associated with the veteran's file in April 1995 show that in 1971, 1972, and 1974, the veteran complained of having pain in his left foot, left heel, and left great toe. Though corns and callosities were noted in 1974, no definitive medical diagnosis was shown in the record. A 1975 treatment report shows that the veteran required a special orthotic shoe for his left foot and that the foot was swollen due to his pre-service pantalar arthrodesis. An October 1992 VA treatment report, received by the RO in June 1994, shows that the veteran received medical treatment for neck pain and mentioned a reported history of a grenade injury and bone chips in his right ankle. The report of an August 1994 VA examination shows that the veteran complained of pain on the anterior aspect of his left ankle and the lateral aspect of his left foot, with pain radiating down from his left ankle to his arch. The pain was reportedly aggravated by weight-bearing and was accompanied by swelling of the foot. He also reported experiencing hypersensitivity of the left foot. The veteran's history of left ankle joint fusion prior to service was noted by the examiner, as well as his in-service left ankle joint injury, and his combat-related missile wound of his left calf. The examiner also noted that he was confined to a wheelchair, secondary to a spinal cord injury, and that he was unable to ambulate. Following examination, the physician diagnosed the veteran as status post pantalar fusion, left ankle, with residual dystrophy of the foot and ankle which may have been secondary to his spinal cord injury and/or his projectile injury to the left leg and/or the residuals of his pantalar arthrodesis, or a combination thereof. In November 1995, a medical examination report was received by the RO which was dated in May 1991 which contained a signed affirmation from a VA physician that the veteran had a diagnosis of cervical disc disease, status post anterior cervical decompression, and that he used a wheelchair, arm crutches, braces on both legs, a back and chest brace, and a TENS unit. The examiner certified that the veteran required the daily personal health care services of a skilled provider, without which he would require hospital, nursing home or other institutional care. A December 1995 VA Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (VA Form 21- 2680) shows that the veteran was in a wheelchair and was unable to walk. He displayed fair to good strength of his upper extremities. He had hired two persons to assist him with bathing, dressing and preparing his meals, and also to shop for him, clean his house, and launder his clothes. His teenaged daughter also provided some assistance. (Other records and personal statements associated with the claim show that the veteran was divorced.) He was able to feed himself, but he suffered many intense muscle spasms and lacked the dexterity to perform fine motor movements. The examiner diagnosed the veteran with spinal cord injury, spinal stenosis, carpal tunnel syndrome and arthritis. At the above examination, the veteran displayed very limited movements of his lower extremities, hips and knees; movement was accompanied with intense pain. He wore leg braces on both lower extremities, a back brace, and two TENS units. He needed to use a bedside commode and had an incontinent urinary bladder, necessitating the use of a condom catheter to collect his urine. The examiner determined that the veteran was unable to walk without the assistance of another person and that he was homebound except for doctor's appointments. He spent approximately half of his waking day in bed. The report of a November 1995 VA medical database worksheet for spinal cord injury or disease shows that a registered nurse and a social worker both affirmed that the veteran sustained a spinal injury at his C7 vertebra on December 18, 1990, as a result of an unsuccessful surgery for spinal fusion, with resultant complications of increased pain on weight-bearing joints, bladder problems, and bowel blockages. The discharge summary of the veteran's period of VA hospitalization, from July 1996 to August 1996, shows that the veteran underwent rehabilitation for deconditioning secondary to multiple problems which included chronic pain, traumatic arthritis, PTSD, obesity, adiposa dolorosa, and bilateral carpal tunnel syndrome. On examination, the veteran was noted to have degenerative spondylosis of his lumbar spine, with some loss of lordotic curvature, but no abnormal findings in his sacroiliac or hip joints and an intact sacrum. The 1996 hospitalization report shows that the veteran's eyes were normal on examination, with pupils which were equal and reactive to light and accommodation, and intact extraocular muscles. Examination of his hands revealed "okay" hand grips and some decreased fine motor skills and decreased finger-to-nose coordination. He was considered to be independent with electric wheelchair and joystick control on his right. X-rays of both hands revealed intact osseous structures, no joint disease, no evidence of injuries either old or recent and no opaque foreign bodies in the soft tissues. Examination of the veteran's lower extremities during the 1996 VA hospitalization revealed decreased range of motion, with passive range of motion being unassessible secondary to pain and spasm. Muscle power was rated as 2/5, with no plantar or dorsiflexion, bilaterally. The left lower extremity was thinner than the right secondary to disuse and atrophy. Deep tendon reflexes were zero, with sensory inconsistency, though cranial nerves II through XII were grossly intact. A 10-centimeter, well-healed scar was noted on the posterior lateral portion of the left leg. The examiner noted that the veteran was in a wheelchair and was unable to ambulate. At the time of his discharge from the hospital, the physician who wrote the summary determined that he required maximum assistance for activities of daily living. The report of a February 1998 VA examination, with regard to the veteran's feet, shows that he complained of daily pain across the area of his left ankle and foot. His history of pre-service osteomyelitis and a triple arthrodesis of his left ankle was noted. Following examination, the examiner determined that the veteran had a good left ankle fusion and that his current complaints of soft tissue pain and severe pain to light touch and palpation of his left foot could not be due to his ankle fusion site because it was well-fused and displayed no evidence of motion. His pain, in the examiner's opinion, was also out of proportion with the arthritic changes noted at the site. The examiner opined that the veteran's pain and color changes of the skin of his foot were consistent with a reflex sympathetic dystrophy or a severe soft tissue injury and recommended that the veteran be provided with an evaluation from a pain clinic to fully analyze his symptoms. The physician concluded that the veteran's history of left ankle trauma during service, separate from his history of ankle fusion prior to entry into service, may have been the initiating event for his reflex sympathetic dystrophy, and that the degenerative changes that he had on his joints distal to his fused joints were likely a remnant of his increased activity or continued activity after having fused joints. The file contains two photographs, both dated in May 1998. One of these shows the veteran at home in a special bed equipped with an overhead rail apparatus to allow him to hoist himself out of bed. The other shows the veteran in an electric wheelchair aboard an automobile containing special adaptive equipment, including an elevator, to allow him to enter and exit his vehicle. The transcript of a January 1999 VA Central Office (CO) hearing shows that the veteran presented oral testimony before the undersigned Board Member in support of his claims. With regard to his claim of entitlement to compensation under 38 U.S.C.A. § 1151, he stated that he incurred additional disability of his upper and lower extremities, bowel blockages and urinary incontinence, neurological problems involving his chest, and also experienced numbness of the right side of his face and lost his sense of taste as a result of cervical spine surgery at a VA medical facility in December 1990. He identified a VA physician named "Dr. Ablo" who performed a cervical surgical procedure subsequent to the December 1990 operation who reportedly told the veteran that his additional disability was the result of the December 1990 cervical spine fusion. Dr. Ablo reportedly was able to cure the veteran of his right upper extremity symptoms with surgery. With regard to his claim of service connection for loss of a left foot disability, the veteran testified that his left ankle fusion prior to service was not a bar against his acceptance into active duty and that the ankylosis was not the cause of his current claimed disability of his left foot. He contended that he incurred a traumatic injury to his left foot during combat for which he was entitled to receive compensation. He stressed that he was aware that he was already service-connected for the ankle fusion, based on aggravation of the pre-existing ankylosis, and that his present claim was not based on disability due to the ankle fusion but rather on a separate disability incurred during service and manifest by neurological deficits and musculoskeletal changes. Alternately, he alleged that he had been told by his physicians that his "drop foot" of his left ankle was due to spinal injury from his cervical spine surgery. The veteran described his current left foot symptoms as being manifest by hypersensitivity to touch. With regard to the veteran's claims for a housing grant, he contended that he had physical impairment necessitating the aforementioned benefit which was due to both a cervical spine injury as a result of VA surgery and also to his service- connected low back injury. He asserted that these both contributed to his need to use special home adaptations to accommodate his disabilities. He testified that prior to his surgery in December 1990, he was able to move around for distances of up to 100 feet before having to sit down and rest due to severe pain in his low back. At that time, he reported using pain medications, a TENS unit, a back brace, a cane, and two leg braces to assist him. According to the veteran, after his cervical spine surgery, his ability to use his upper extremities effectively was impaired and he was unable to use them to assist himself with ambulating on braces, thus restricting himself to a wheelchair. He reported that his wife had divorced him, and that he lived at home with the assistance of his daughter and another hired person. At the time of the current appeal, the veteran is service- connected for the following disabilities: 1) Residuals of a low back injury, currently rated as 70 percent disabling. (The veteran's disability is rated at 60 percent based on residuals of fracture, with a 10 percent rating added for demonstrable deformity of the vertebral body.) 2) PTSD, currently rated as 50 percent disabling. 3) Residuals of a gunshot wound, left calf, with history of painful neuroma, currently rated as 30 percent disabling. 4) Malaria, currently rated as noncompensably disabling. 5) Residuals of a gunshot wound, right shin, currently rated as noncompensably disabling. 6) Sebaceous cyst of the neck, post-operative, currently rated as noncompensably disabling. 7) Shell fragment wound with scar, left hand, currently rated as noncompensably disabling. 8) Ankylosis of the left ankle, currently rated as noncompensably disabling. (Service connection was granted on the basis of aggravation of a pre-existing disability.) The impairments listed above produce a combined disability rating of 90 percent, and the veteran has been awarded a total rating for individual unemployability, effective from February 1986. II. Analyses (a.) Entitlement to compensation for additional disability claimed to have been incurred during surgical treatment of a non-service-connected cervical spine disability at the Oklahoma City VAMC on December 19, 1990, pursuant to 38 U.S.C. § 1151. The threshold question to be answered concerning this case is whether or not the veteran has presented evidence of a well- grounded claim for compensation for additional disability claimed to have been incurred during VA surgical treatment of a cervical spine disability; that is, one that is plausible, meritorious on its own, or capable of substantiation. 38 U.S.C.A. § 5107(a) (West 1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Murphy v. Derwinski, 1 Vet. App. 78 (1990). Section 5107 provides that the claimant's submission of a well-grounded claim gives rise to VA's duty to assist and to adjudicate the claim. However, if he has not presented such a claim, his appeal must fail and there is no duty on the part of VA to assist him in the development of his claim because such additional development would be futile. Id.; Morton v. West, 12 Vet. App. 477 (1999). It should be emphasized that to be deemed well grounded, a claim must be supported by evidence, not just allegations. Tirpak v. Derwinski, 2 Vet. App. 609 (1992). Lay assertions of medical diagnosis or causation do not constitute competent evidence sufficient to render a claim well grounded. Grottveit v. Brown, 5 Vet. App. 91, 93 (1992); Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). Generally, a well-grounded claim made pursuant to Section 1151 requires: (a) VA treatment or vocational rehabilitation; (b) additional disability or death of the veteran; and (c) a nexus between the VA treatment or vocational rehabilitation and the additional disability or death. In the present case, the Board finds that there is sufficient evidence satisfying these three aforementioned criteria to well ground the veteran's claim for Section 1151 compensation. Specifically, the veteran has demonstrated that he had received surgical treatment at a VA medical facility for a non-service- connected cervical spine disability on December 19, 1990, and the medical records indicate that, thereafter, his symptoms had worsened and that this increase in impairment was related to the December 1990 surgery. The September 1991 VA medical report previously discussed shows that a physician had commented that the December 1990 cervical surgery worsened the severity of the veteran's pain. Additionally, the September 1994 VA examination report indicates that the veteran was rendered wheelchair bound due, in part, to his December 1990 spinal surgery. Finally, there is the report of a November 1995 VA medical database worksheet for spinal cord injury or disease, which shows that a registered nurse and a social worker reported that the veteran sustained a spinal injury at his C7 vertebra as a result of spinal fusion surgery in December 18, 1990, with resultant complications of increased pain on weight-bearing joints, bladder problems, and bowel blockages. Medical evidence indicating additional disability due to VA treatment has been demonstrated for purposes of well-grounding the veteran's claim of entitlement to compensation, pursuant to 38 U.S.C. §§ 1151 and 5107(a), for additional disability incurred during surgical treatment of a cervical spine disability at the Oklahoma City VAMC on December 19, 1990. (b.) Entitlement to service connection for a left foot disability. As previously discussed, the threshold question to be answered concerning this issue is whether or not the veteran has presented evidence of a well-grounded claim for service connection for a disability of the left foot; that is, one that is plausible, meritorious on its own, or capable of substantiation. 38 U.S.C.A. § 5107(a) (West 1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Murphy v. Derwinski, 1 Vet. App. 78 (1990). In the present case, the veteran has contended that he has a chronic disability of his left foot which is manifested by pain and hypersensitivity which was not related to his service-connected ankylosis of the left ankle. In support of his claim, the service medical records show that he sustained a traumatic left ankle injury in January 1967, and that he also sustained a missile injury to his left lower extremity during combat. A diagnosis of a disability manifest by pain and hypersensitivity of the left foot was not shown until over 20 years after service, in the report of an August 1994 VA examination. This report shows that the veteran's complaints of pain and hypersensitivity on the anterior aspect of his left ankle and the lateral aspect of his left foot were diagnosed as status post pantalar fusion, left ankle, with residual dystrophy of the foot and ankle which may have been secondary to his spinal cord injury and/or his projectile injury to the left leg and/or the residuals of his pantalar arthrodesis, or a combination thereof. Thereafter, the report of a February 1998 VA examination shows that veteran's left foot symptoms were consistent with a reflex sympathetic dystrophy or a severe soft tissue injury and that his history of left ankle trauma during service, separate from his history of ankle fusion prior to entry into service, may have been the initiating event for the reflex sympathetic dystrophy. Though the aforementioned medical opinions are somewhat equivocal as the physicians who expressed them use the operative word "may" in the statements which associate the left foot dystrophy to service, they are sufficient to well ground the veteran's claim in this regard. The U.S. Court of Appeals for Veterans Claims has held in the case of Lathan v. Brown, 7 Vet. App. 359, 366 (1995), that a medical opinion does not necessarily have to be expressed in terms of certainty in order to serve as the basis for a well-grounded claim. In view of this medical evidence which relates the veteran's reflex sympathetic dystrophy of his right foot to his period of active military service, the Board finds that he has presented a well-grounded claim of entitlement to service connection for a left foot disability, and that he has activated VA's duty to assist him in developing this issue. (See 38 U.S.C.A. § 5107(a) (West 1991); Morton v. West, 12 Vet. App. 477 (1999).) (c.) Entitlement to service connection for a right foot disability. 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. The Secretary shall assist such a claimant in developing the facts pertaining to the claim. 38 U.S.C.A. § 5107(a). The initial matter for determination in this case is whether the veteran has presented evidence of a well-grounded claim. If not, the appeal must fail, because the Board has no jurisdiction to adjudicate the claim. Boeck v. Brown, 6 Vet. App. 14, 17 (1993). A well-grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of proof of 38 U.S.C.A. § 5107 (a). Murphy v. Derwinski, 1 Vet. App. 78, 81. However, to be well grounded, a claim need not be conclusive but must be accompanied by evidence that suggests more than a purely speculative basis for granting entitlement to the requested benefits. Dixon v. Derwinski, 3 Vet. App. 261, 262-263 (1992). Evidentiary assertions accompanying a claim for VA benefits must be accepted as true for purposes of determining whether the claim is well grounded, unless the evidentiary assertion is inherently incredible or the fact asserted is beyond the competence of the person making the assertion. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). When the question involved does not lie within the range of common experience or common knowledge, but requires special experience or special knowledge, then the opinions of witnesses skilled in that particular science to which the question relates are required. Questions of medical diagnosis or causation require such expertise. A claimant would not meet this burden merely by presenting lay testimony, because lay persons are not competent to offer medical opinions. Id. at 495. A claim for service connection requires three elements to be well grounded. There must be competent evidence of a current disability (a medical diagnosis); incurrence or aggravation of a disease or injury in service (lay or medical evidence); and a nexus between the in service injury or disease and the current disability (medical evidence). The third element may be established by the use of statutory presumptions. Caluza v. Brown, 7 Vet. App. 498, 506 (1995). In the alternative, the chronicity provisions of 38 C.F.R. § 3.303(b) are applicable where evidence, regardless of its date, shows that a claimant had a chronic condition in service, or during an applicable presumptive period, and still has such condition. Such evidence must be medical unless it relates to a condition as to which under case law of 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"), lay observation is competent. If chronicity is not applicable, a claim may still be well grounded on the basis of 38 C.F.R. §3.303(b) if the condition is noted during service or during an applicable presumptive period, and if competent evidence, either medical or lay, depending on the circumstances, relates the present condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488 (1997). Section 1154(b), title 38, of the U.S. Code provides as follows: In the case of any veteran who engaged in combat with the enemy in active service with a military, naval, or air organization of the United States during a period of war, campaign, or expedition, the Secretary shall accept as sufficient proof of service-connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service, and, to that end, shall resolve every reasonable doubt in favor of the veteran. Service- connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary. The reasons for granting or denying service-connection in each case shall be recorded in full. 38 U.S.C.A. § 1154 (West 1991), While it is true that section 1154(b) of title 38, United States Code, provides for a reduced evidentiary burden for combat veterans (see Velez v. West, 11 Vet. App. 148, 153 (1998) (citing Jensen v. Brown, 19 F.3d 1413, 1416-17 (Fed. Cir. 1994)), nonetheless, the United States Court of Appeals for Veteran's Claims reaffirmed in Wade v. West, 11 Vet. App. 302 (1998), that section 1154(b) does not relieve the veteran of his obligation to submit competent medical evidence of a nexus between his present disability and military service. 38 U.S.C.A. § 1154(b); Kessel v. West, 13 Vet. App. 9 (1999) (en banc). Only the service incurrence requirement of Caluza is relaxed under section 1154(b). In the present case, the veteran essentially maintains that he should be granted service connection for a right foot disability. However, he has proffered no competent medical evidence which tends to show that the right foot complaints for which he was treated after service can be attributed to service. For a service connection claim to be deemed plausible, there must be competent medical evidence of both a current disability and competent medical evidence of a causal relationship between that current disability and service. Caluza at 506. While the is certainly competent to provide testimony regarding the occurrence of an in-service event such as the grenade injury which he has described, see Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990), there is no indication in the record that he has the medical expertise necessary to proffer the conclusion that his bone chips of his right ankle which were found on X-ray could be attributed to this alleged grenade injury or to his period of active service. Id. The Board notes that his work history, as it is shown in the VA medical records included in his file, did not reflect any medical training. Although he has described the nature of his current problems and the circumstances in which he believes they arose, there has been no proffering of evidence by competent authority that his right foot complaints are due to a chronic disability which can be attributed to military service. Absent presentation of competent evidence establishing causation, the veteran's claim of service connection for a right foot disability may not be considered well-grounded. Espiritu at 495. VA therefore has no duty to assist him in developing this claim under 38 C.F.R. § 3.159 (1999). See Morton v. West, 12 Vet. App. 477 (1999). (d.) Entitlement to specially adapted housing or a special home adaptation grant. The veteran's claim of entitlement to specially adapted housing is well-grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991), in that it is not inherently implausible in view of his totally disabled status. Relevant evidence has been properly developed, and no further assistance is required to comply with VA's duty to assist. Id. In a precedent opinion, VA General Counsel held that a veteran with a disability that resulted from VA hospitalization or medical or surgical treatment who has been determined eligible for compensation "as if" such injury were service-connected pursuant to 38 U.S.C.A. § 1151 is not eligible for specially adapted housing or a special home adaptation grant as a result of the disability caused by VA medical care. VAOPGCPREC 24-97 (July 3, 1997). Thus, even if service connection were granted under the provisions of 38 U.S.C.A. § 1151 for disabilities relating to the veteran's neck, the disabilities could not be considered in the determination concerning housing benefits. A certificate of eligibility for assistance in acquiring specially adapted housing under 38 U.S.C. 2101(a) (West 1991) may be extended to a veteran if the following requirements are met: (a) Service. Active military, naval or air service after April 20, 1898, is required. Benefits are not restricted to veterans with wartime service. (b) Disability. The disability must have been incurred or aggravated as the result of service as indicated in paragraph (a) of this section and the veteran must be entitled to compensation for permanent and total disability due to: (1) The loss, or loss of use, of both lower extremities, such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair, or (2) Blindness in both eyes, having only light perception, plus the anatomical loss or loss of use of one lower extremity, or (3) The loss or loss of use of one lower extremity together with residuals of organic disease or injury which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair. (4) The loss or loss of use of one lower extremity together with the loss or loss of use of one upper extremity which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair. (c) Duplication of benefits. The assistance referred to in this section will not be available to any veteran more than once. (d) "Preclude locomotion.'' This term means the necessity for regular and constant use of a wheelchair, braces, crutches or canes as a normal mode of locomotion although occasional locomotion by other methods may be possible. 38 C.F.R. § 3.809 (1999). Applying the facts of the case to the regulations discussed above, the Board finds that the veteran has not met the requirements set by the regulations to be entitled to receive a certificate of eligibility for assistance in acquiring specially adapted housing under 38 U.S.C. 2101(a). In the current case, he is rated as totally disabled due to individual unemployability as a result of the following service-connected disabilities: residuals of a low back injury (rated 70 percent disabling); post-traumatic stress disorder (PTSD) (rated 50 percent disabling); residuals of a gunshot wound, left calf, with history of painful neuroma (rated 30 percent disabling); malaria (rated noncompensably disabling); residuals of a gunshot wound, right shin (rated noncompensably disabling); sebaceous cyst of the neck, post- operative (rated noncompensably disabling); shell fragment wound with scar, left hand (rated noncompensably disabling); and ankylosis of the left ankle (rated noncompensably disabling). He also clearly has the requisite military service. However, the aforementioned service-connected disabilities do not produce blindness in both his eyes, nor are they associated with the loss, or the loss of use, of both lower extremities, such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair. The veteran's lower extremities are service-connected only for the right shin shell fragment wound which is noncompensable, and the gunshot wound of the left calf which, while productive of 30 percent impairment, is not productive of the requisite total loss of use of the affected lower extremity. Medical records associated with the claims file, dated from 1969 to 1998, show that prior to the veteran's surgery in December 1990, he had a history of using a wheelchair but was not regarded as wheelchair bound at that time and was able to ambulate with the use of leg braces and crutches. After the 1990 surgery, the report of a September 1994 VA examination shows that a physician concluded that the veteran's medical history of traumatic arthritis involving multiple joints and his spinal surgery in December 1990 had rendered him wheelchair bound. However, the veteran is not service- connected for the cervical spine disability which led to the December 1990 surgery, and his service-connected low back injury and missile wound residuals of both lower extremities were not demonstrated by the medical records as productive of loss of use of either lower extremity. To the extent that the veteran may contend on strength of his own personal medical knowledge that his service-connected disabilities did cause loss of use of one or both of his lower extremities, as a medical layperson he lacks the expertise to comment upon medical observations, make medical diagnoses, or present opinion regarding medical etiology, and thus any personal statements which he presents in this regard are entitled to no probative weight. Layno v. Brown, 6 Vet. App. 465 (1994); Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). In arriving at the above decision, the Board is mindful that there is a pending issue of service connection for a left foot disability. However, even if service connection were granted, this would not affect the above decision. Any such grant of service connection would not establish loss of use of "both" lower extremities nor would it establish the presence of loss of use of one lower extremity together with "an organic disease or injury which so affects the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair." In other words, no useful purpose would be served by delaying a decision on this issue. Though entitlement to specially adapted housing is not established, the veteran may qualify for a special home adaptation grant under the provisions of 38 U.S.C.A. § 2101(b) (West 1991) and 38 C.F.R. § 3.809a (1999). A certificate of eligibility for assistance in acquiring necessary special home adaptations, or, on or after October 28, 1986, for assistance in acquiring a residence already adapted with necessary special features, under 38 U.S.C. 2101(b) may be issued to a veteran who served after April 20, 1898, if the following requirements are met: (a) The veteran is not entitled to a certificate of eligibility for assistance in acquiring specially adapted housing under Sec. 3.809 nor had the veteran previously received assistance in acquiring specially adapted housing under 38 U.S.C. 2101(a). A veteran who first establishes entitlement under this section and who later becomes eligible for a certificate of eligibility under Sec. 3.809 may be issued a certificate of eligibility under Sec. 3.809. However, no particular type of adaptation, improvement, or structural alteration may be provided to a veteran more than once. (b) The veteran is entitled to compensation for permanent and total disability which (1) is due to blindness in both eyes with 5/200 visual acuity or less, or (2) includes the anatomical loss or loss of use of both hands. 38 C.F.R. § 3.809a (1999). The facts of the case clearly show that the veteran is not entitled to compensation due to blindness in both eyes or the anatomical loss or loss of use of both hands. He is not service connected for a visual problem and he is service connected for disability of one hand which is noncompensable. Therefore, he has not met the requisite regulatory requirements to be entitled to a special home adaptation grant. The veteran has not satisfied the regulatory requirements to be entitled to consideration for a special home adaptation grant pursuant to 38 C.F.R. § 3.809a. Thus, on its face, his claim in this regard would fail for lack of entitlement under the law. Sabonis v. Brown, 6 Vet. App. 426 (1994). ORDER To the extent that the issue of entitlement to compensation, pursuant to 38 U.S.C. § 1151, for additional disability incurred during surgical treatment of a non-service-connected cervical spine disability at the Oklahoma City VAMC on December 19, 1990, is well grounded, the claim is granted. To the extent that the issue of entitlement to service connection for a left foot disability is well grounded, the claim is granted. The claim for service connection for a right foot disability is not well-grounded; the appeal of this issue is therefore denied. Entitlement to a certificate of eligibility for assistance in acquiring specially adapted housing under 38 U.S.C.A. § 2101(a) is denied. Entitlement to a special home adaptation grant under 38 U.S.C.A. § 2101(b) is denied. REMAND The veteran claims entitlement to compensation for additional disabilities which he alleges to have resulted from VA treatment for surgery of his cervical spine at the C7 vertebra at the VAMC in Oklahoma City, Oklahoma, on December 19, 1990. As previously discussed, he has established a well-grounded claim in this regard, thereby activating VA's duty to assist him in developing his claim. (See 38 U.S.C.A. § 5107(a)). In his written assertions, and in oral testimony presented by him at a hearing before the undersigned Board Member at the VA Central Office in Washington, D.C., in January 1999, the veteran contended that he had undergone an increase in his cervical symptomatology, manifest by increased cervical pain, additional cervical arthritis, and additional disability manifest by neurological impairment affecting his right upper extremity, the right side of his face and neck, and portions of his anterior and posterior torso, with muscle spasms of both lower extremities and the soles of his feet, due to his December 19, 1990 cervical surgery at the VAMC. He also contends that the December 1990 surgery caused additional disability that necessitated several subsequent corrective cervical surgeries in attempts to alleviate his physical symptoms. The claims file shows that photocopies of some of the VA records which pertain to the veteran's treatment at the Oklahoma City VAMC, including for cervical spine surgery in December 1990, have been obtained. However, due to the factual intricacies involved in the adjudication of compensation claims pursuant to 38 U.S.C.A. § 1151 and 38 C.F.R. § 3.358, it is necessary to have the complete VA treatment records of the veteran's hospitalization in December 1990 for review. Therefore, the case should be remanded so that the RO may obtain these records for inclusion into the record. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. §§ 3.103(a), 3.159, 19.9 (1999); Murphy v. Derwinski, 1 Vet. App. 78, 82 (1990); Littke v. Derwinski, 1 Vet. App. 90 (1990). A review of the file shows that the examiner who had examined the veteran at the VA medical examination of September 1994, noted his history of cervical spine surgery in December 1990. Additionally, there is a VA medical statement dated in May 1994 which, while discussing the veteran's medical history at length with regard to his multiple orthopedic problems, only cursorily mentions the veteran's December 1990 surgery. However, neither report has addressed the veteran's contentions about additional impairment incurred during the surgery at issue, nor has either report presented a medical opinion of any sort regarding the etiology of the veteran's increased impairment, or whether there is any correlation between his increased impairment and his December 1990 surgery, or whether the increased impairment is due to the natural progression of his cervical disability, unassociated with his December 1990 procedure. Such an opinion would be useful in adjudicating the Section 1151 claim on appeal, and therefore a remand is warranted so that the RO may furnish him with an appropriate examination so that a medical opinion may be obtained. 38 U.S.C.A. § 5107(a) (West 1991); See Green v. Derwinski, 1 Vet. App. 121 (1991). The RO may exercise its discretion regarding whether or not to refer the veteran to a VA or a private physician to conduct the requested examination and opinion, but it is respectfully advised of the need for the medical examiner to be objective and unbiased when rendering his determinations. The veteran has also presented a well-grounded claim of entitlement to service connection for a left foot disability, thereby activating VA's duty to assist him in developing this issue. In this regard, the Board notes that in the report of the February 1998 VA examination, the reviewing physician recommended that the veteran be provided with an evaluation from a pain clinic to fully analyze his left foot symptoms. Therefore, a remand is warranted so that the veteran may be scheduled for the recommended evaluation. Afterwards, his file should be reviewed by the same VA physician who conducted the February 1998 examination. Based on the findings obtained from the pain clinic and the evidence of record, the physician should be asked to provide an addendum to his report in which he would present a definitive opinion as to the relationship, if any, between the veteran's left foot disability and his period of active duty, including whether it is at least as likely as not that any current chronic foot disability had its onset in service, is proximately due to or the result of a service-connected disability or is being aggravated by a service connected disability. The veteran seeks assistance for providing automobile and adaptive equipment, or for adaptive equipment only, pursuant to the provisions of 38 U.S.C.A. § 3902 (West 1991 & Supp. 1999). In pertinent part, an "eligible person" is "[a]ny veteran entitled to compensation under chapter 11 [of title 38, United States Code] for any of the disabilities described: (1) loss or permanent loss of use of one or both feet; or (2) loss or permanent loss of use of one or both hands; or (3) permanent impairment of vision of both eyes. (This is defined in the regulations as 20/200 or less in the better eye with corrective glasses; or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20 degrees in the better eye.) - if the disability is the result of an injury incurred or disease contracted in or aggravated by active military, naval, or air service." 38 U.S.C.A. § 3901(1) (West 1991). As there is a well-grounded claim of service connection for his left foot which, through this Board's action, has been remanded for additional evidentiary development, it is conceivable that a favorable determination could affect the issue pertaining to automobile and adaptive equipment, or for adaptive equipment only. As the outcome of this left foot claim has a material impact on the issue of entitlement to an automobile and adaptive equipment, the two issues are inextricably intertwined. Therefore, the veteran's automobile claim will be held in abeyance pending the outcome of the claim for service connection for a left foot disability. The veteran has filed a claim of entitlement to special monthly compensation based on the need for aid and attendance or at the housebound rate. As discussed earlier, the claim of service connection for a left foot disability has been remanded for further development. It is also inextricably intertwined with the claim for regular aid and attendance and housebound benefits because it may impact upon this issue if service connection is granted for the left foot. Therefore, these claims will be held in abeyance pending resolution of the left foot issue on remand. In light of the foregoing, this case is REMANDED to the RO for the following actions: 1. Complete, original treatment records (not photocopies) should be obtained of the veteran's hospitalizations at VAMC Oklahoma City, Oklahoma, for surgical treatment of his cervical spine in December 1990. The request for records should include the hospital summaries, operative reports, doctors' orders, nurses' notes, and medication records. All records obtained should be associated with the claims folder. 2. The RO should take appropriate steps in order to obtain and associate with the claims file any outstanding records of the veteran's private and/or VA medical treatment for foot complaints not already associated with the file, pursuant to 38 C.F.R. § 3.159 (1999). 3. Thereafter, the veteran should be afforded a neurological examination. The claims folders and a copy of this remand must be made available to the examining physician in conjunction with the examination so that he/she may review pertinent aspects of the veteran's medical history. Prior to conducting the examination, the examining physician should review all the medical records associated with the veteran's claims files, with special attention directed to those records of hospitalization for an anterior cervical disc and fusion with bone donor bone graft at C6-C7, performed on December 19, 1990. Then, the examiner should report all symptoms, and provide diagnoses of all disorders affecting the cervical spine. Such tests as the examining physician deems appropriate should be performed. After examining the veteran, the physician should express an opinion in response to the following questions: a. Is it at least as likely as not that the disabilities affecting the veteran's face, neck, right and left upper extremities, torso, and lower extremities (to include his feet) with which he has been diagnosed are due to injury or disease or an aggravation of an injury or disease suffered as a result the cervical spine surgery of December 1990? b. If so, were these disabilities a necessary consequence of the surgery for an anterior cervical disc and fusion with bone donor bone graft at C6-C7, performed on December 19, 1990? 4. Pursuant to the recommendation of the VA physician who conducted the February 1998 medical examination, the veteran should be scheduled for an evaluation at a VA pain clinic to investigate his left foot symptoms and present a definitive diagnosis of the underlying disability. Thereafter, the veteran should be scheduled for a VA examination, preferably by the VA physician who conducted the February 1998 examination. The physician should provide an opinion as to whether it is at least as likely as not that the veteran's left foot disability had its onset in service, is proximately due to or the result of a service connected disability or is being aggravated by a service connected disability. If aggravated, the degree of aggravation should be quantified to the extent feasible. With regards to the veteran's claim of entitlement to an automobile and/or adaptive equipment, the examiner should also provide an opinion as to whether any left foot disability (for which service connection has been granted or which had it onset in service or is proximately due to or the result of or is being aggravated by a service connected disability) is productive of such impairment as to either equate to loss of the foot or result in permanent loss of its use. 5. The RO should provide the veteran with a medical examination to determine whether or not he is so helpless as a result of his service connected disabilities that he requires regular aid and attendance of another person. The examiner should answer the following questions: a. Is the veteran able to dress or undress himself? Is he able to keep himself ordinarily clean and presentable? b. Does the veteran need frequent adjustment of any special prosthetic or orthopedic appliances which, by reason of the particular disability, cannot be done without his aid (not to include the adjustments of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.)? c. Is the veteran able to feed himself? If not, is this inability to feed himself due to loss of coordination of his upper extremities or to extreme weakness? d. Is the veteran able to attend to the wants of nature? e. Is the veteran so physically or mentally incapacitated that he requires care or assistance on a regular basis to protect him from hazards or dangers incident to his or her daily environment? f. Is the veteran bedridden? If the examining physician finds that the veteran requires regular aid and attendance, he should list all those disabilities, both physical and mental, which have acted either singly or in concert to render veteran into such a state. 6. After the development requested above has been completed, the RO should review the veteran's claims folder and ensure that all the foregoing developments have been conducted and completed in full. If any development is incomplete, appropriate corrective action should be taken. Then the RO should do the following: a. The RO should readjudicate the veteran's claim of entitlement to compensation, under the provisions of 38 U.S.C.A. § 1151, for additional disabilities alleged to have been incurred during hospitalization and surgical treatment for an anterior cervical disc and fusion with bone donor bone graft at C6-C7 at the Oklahoma City, Oklahoma, VA Medical Center in December 1990. b. The RO should readjudicate the veteran's claim of entitlement to service connection for a left foot disability. c. The RO should readjudicate the veteran's claim of entitlement to an automobile and adaptive equipment or for adaptive equipment only. In so doing, consideration should be given to VAOGCPREC 24-97 (July 3, 1997). d. The RO should readjudicate the veteran's claim of entitlement to special monthly compensation based on the need for regular aid and attendance or at the housebound rate 7. If any decision regarding the aforementioned claims remains adverse to the veteran, he and his representative should be furnished a Supplemental Statement of the Case. They should then be afforded a reasonable opportunity to respond. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration, if appropriate. The veteran need take no further action until he is informed. The purpose of this REMAND is to obtain additional information. No inference should be drawn regarding the final disposition of the claim as a result of this action. 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). The law requires full compliance with all orders in this remand. See Stegall v. West, 11 Vet. App. 268 (1998), and these claims 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. Iris S. Sherman Member, Board of Veterans' Appeals