Citation Nr: 0007184 Decision Date: 03/16/00 Archive Date: 03/23/00 DOCKET NO. 97-01 917 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to an increased rating for a left knee disorder, currently evaluated as 20 percent disabling. 2. Entitlement to a rating in excess of 10 percent for fracture of the left wrist. 3. Entitlement to service connection for a right knee disorder. 4. Entitlement to service connection for a low back disorder. 5. Entitlement to a rating in excess of zero percent for thalassemia minor. 6. Entitlement to service connection for headaches. 7. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a cervical spine disorder. 8. Entitlement to service connection for herpes. 9. Entitlement to a compensable rating for a fractured nose. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Daniel R. McGarry INTRODUCTION The veteran had active service from January 1972 to February 1976. This matter came before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the regional office (RO) dated in 1992 and 1994. In June 1999, the veteran's representative submitted additional evidence directly to the Board without a waiver of review by the regional office. As such evidence is not relevant to the issues decided in this decision, a remand for review of such evidence by the RO is not necessary. See 38 C.F.R. § 20.1304 (1999). This evidence is referred to the RO for appropriate action. The veteran's claims for service connection for herpes genitalis and for a compensable rating for fracture of the nose are the subject of the Remand part of this decision. FINDINGS OF FACT 1. In an October 1992 rating decision, the RO denied an increased rating for a left knee disorder and denied service connection for right knee and low back disabilities. 2. The RO notified the appellant of the October 1992 rating decision by a letter dated December 11, 1992. 3. In November 1993, the appellant filed a notice of disagreement (NOD) concerning the denial of an increased rating for a left knee disorder and service connection for right knee and low back disabilities. 4. In December 1993, the RO issued a statement of the case (SOC) concerning the denial of an increased rating for a left knee disorder and service connection for right knee and low back disabilities. 5. The veteran did not file a substantive appeal as to any of the issues in the December 1993 SOC within 60 days of the SOC or within one year of the notice of the October 1992 rating decision. 6. In a July 1994 rating decision, the RO denied an increased rating for a left wrist disability. 7. The RO notified the appellant of the July 1994 rating decision by a letter dated July 18, 1994. 8. In March 1995, the appellant filed a NOD concerning the issues decided by the RO in its July 1994 rating decision. 9. In March 1995, the RO issued a SOC concerning, inter alia, entitlement to an increased rating for a left wrist disorder. 10. The veteran did not file a substantive appeal as to the issue of entitlement to an increased rating for a left wrist disorder within one year of the notice of the July 1994 rating decision, or within 60 days of the March 1995 SOC. 11. In March 1995, the veteran was notified by the RO that service connection had been granted for thalassemia minor, and that a noncompensable rating had been assigned for the disability. 12. On March 30, 1995, the veteran filed a NOD with the RO's rating of his disability from thalassemia minor. 13. On August 31, 1995, the RO issued a SOC concerning, inter alia, the noncompensable rating assigned for thalassemia minor. 14. The veteran did not file a substantive appeal as to the issue of a compensable rating for thalassemia minor within one year of the notice of the March 1995 rating decision, or within 60 days of the August 1995 SOC. 15. The record contains no competent medical evidence or opinion which indicates that the veteran has a current disability manifested by headaches which is related to any disease or injury he incurred during his active military service. 16. In an October 1992 rating decision, the RO denied entitlement to service connection for a cervical spine disorder. 17. The veteran was notified of the denial of service connection for a cervical spine disorder by a letter dated December 11, 1992, and did not appeal that denial. 18. Since the October 1992 rating decision, the veteran has not submitted evidence that was not previously considered by agency decisionmakers and that bears directly and substantially on the question of whether he has current disability from cervical spine disorder which is related to a disease or injury he incurred during his active military service. 19. The record contains no competent medical evidence that the veteran has current disability from a disorder manifested by headaches which is related to any disease or injury he incurred during his active military service. 20. The veteran has submitted some evidence of current disability from herpes genitalis and some evidence of continuous symptoms similar to a disorder diagnosed as herpes genitalis during the veteran's active military service. CONCLUSIONS OF LAW 1. There is no appeal pending before the Board concerning the issues of entitlement to an increased rating for a left knee disorder, service connection for a right knee or low back disorder, an increased rating for a left wrist disorder, or a rating in excess of zero percent for thalassemia minor. 38 U.S.C.A. § 7105 (West 1991); 38 C.F.R. §§ 20.200, 20.201, 20.202, 20.302 (1999). 2. The claim of entitlement to service connection for headaches is not well grounded. 38 U.S.C.A. §§ 101(16), 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1999). 3. The RO's December 1989 rating decision, which denied service connection for a cervical spine disorder is final. 38 U.S.C.A. § 7105 (West 1991); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (1999). 4. The veteran has not submitted new and material evidence to reopen his claim of entitlement to service connection for a cervical spine disorder. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156 (1999). 5. The claim of entitlement to service connection for herpes genitalis is well grounded. 38 U.S.C.A. §§ 101(16), 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Dismissal of Claims Appellate review of a RO decision is initiated by a timely filed NOD and completed by a timely filed substantive appeal after a SOC is furnished. 38 U.S.C.A. § 7105(a) (West 1991), 38 C.F.R. § 20.200 (1999). An NOD is a written communication from a claimant or his representative expressing dissatisfaction or disagreement with an adjudicative determination by the agency of original jurisdiction and a desire to contest the result. 38 C.F.R. § 20.201 (1999). A substantive appeal consists of a properly completed VA Form 9 "Appeal to the Board of Veterans' Appeals," or correspondence containing the necessary information. 38 C.F.R. § 20.202 (1999). A substantive appeal must be filed within 60 days of the date that the agency of original jurisdiction mails the SOC to the appellant, or within the remainder of the one-year period from the date of mailing of the notification of the determination being appealed, whichever period ends later. 38 C.F.R. § 20.302(b) (1999). A substantive appeal postmarked prior to the expiration of the applicable time period will be accepted as timely filed. In the event that the postmark is not of record, the postmark date will be presumed to be five days prior to the date of receipt of the document by the Department of Veterans Affairs (VA). 38 C.F.R. § 20.305 (1999). In November 1993, the veteran filed a NOD with the October 1992 denial of an increased rating for a left knee disorder and of service connection for a right knee disorder and a low back disorder. On December 23, 1993, the RO provided him with a SOC that addressed such issues. In April 1994, the RO granted the veteran an extension of time until December 13, 1994, to perfect an appeal. The veteran did not file a VA Form 9 to perfect his appeal of those issues until March 30, 1995. In March 1995, the veteran filed a NOD with a rating decision in which the RO denied service connection for thalassemia minor (claimed as anemia), herpes, and headaches, denied an increased rating for fracture of the left wrist, assigned a zero percent rating for fracture of the nose, and determined that no new and material evidence had been submitted to reopen a claim for service connection for a cervical spine disorder. On March 14, 1995, the RO provided the veteran a SOC which addressed these issues. On March 30, 1995, the veteran filed a VA Form 9 which identified as issues for appeal his claims for service connection for herpes, headaches, and a cervical spine disorder, and his claim for an increased rating for a fracture of the nose. The file contains no subsequently dated correspondence or other written communication which would suffice as a timely substantive appeal concerning the issue of an increased rating for a left wrist disorder. In March 1995, the RO granted service connection and assigned a noncompensable disability evaluation for thalassemia minor. Later that month, the veteran filed a NOD with the rating assigned by the RO for thalassemia minor. On August 31, 1995, the RO provided him with a SOC which addressed the rating. The file contains no subsequently dated correspondence or other written communication that would suffice as a timely substantive appeal concerning the issue of entitlement to a compensable rating for thalassemia minor. The Board notes that the Court, in Fenderson v. West, 12 Vet. App. 119 (1999) held, in part, that the RO never issued a SOC concerning an appeal from the initial assignment of a disability evaluation, as the RO had characterized the issue in the SOC as one of entitlement to an increased evaluation. In this case, however, the RO characterized the issue in the August 1995 SOC as "Evaluation of service connected thalassemia minor currently evaluated as 0 percent disabling." Consequently, the Board concludes that this SOC did not characterize the issue as one of entitlement to an increased rating and, hence, Fenderson does not apply to require the issuance of another SOC concerning this issue. The Board finds that the veteran did not timely file a substantive appeal on the issues of entitlement to service connection for a right knee disorder, a low back disorder, increased ratings for a left knee disorder and a left wrist disorder, and a compensable rating for thalassemia minor. The Court has held that it was proper for the Board to dismiss the appeal of a veteran who did not file a timely substantive appeal and did not request prior to the expiration of the time limit for such filing an extension of time within which to file a substantive appeal. See Roy v. Brown, 5 Vet. App. 554 (1993). The Court opined that the Secretary was correct in arguing that the "formality" of perfecting an appeal to the Board is part of a clear and unambiguous statutory and regulatory scheme which requires the filing of both a NOD and a formal appeal. Id. at 555. The Board concludes that there is no appeal pending before it concerning the issues of entitlement to service connection for a right knee disorder or a low back disorder, increased ratings for a left knee disorder or a left wrist disorder, and a compensable rating for thalassemia minor. II. Claims for Service Connection 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 (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). A well- grounded claim is a plausible claim which is meritorious on its own or is capable of substantiation. See Murphy v. Derwinski, 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 between the in-service disease or injury and the current disability as provided by competent medical evidence. See Caluza v. Brown, 7 Vet. App. 498 (1995); see also 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 to make a claim well grounded depends upon the types of issues presented by the claim. Grottveit v. Derwinski, 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 diagnosis, competent medical evidence is required. Id. at 93. For the reasons discussed below, the Board finds that the veteran's claim of entitlement to service connection for headaches is not well grounded. Although the RO did not specifically state that it denied this claim on the basis that it was not well grounded, the Board concludes that this error was not prejudicial to the claimant. See Edenfield v. Brown, 8 Vet. App. 384 (1995) (deciding that the remedy for the Board's deciding on the merits a claim that is not well grounded should be affirmance, on the basis of nonprejudicial error). While the RO denied service connection on the merits, the Board concludes that denying the claim because the claim is not well grounded is not prejudicial to the appellant, as the appellant's arguments concerning the merits of the claim included, at least by inference, the argument that sufficient evidence to establish a well-grounded claim is of record. Therefore, the Board finds that it is not necessary to remand the matter for the issuance of a supplemental statement of the case concerning whether or not the claim is well grounded. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993); VAOPGCPREC 16-92 (O.G.C. Prec. 16-92) at 7-10. Where a claim is not well grounded it is incomplete, and the Department of Veterans Affairs (VA) is obliged under 38 U.S.C.A. § 5103(a) to advise the claimant of the evidence needed to complete his application. Robinette v. Brown, 8 Vet. App. 69, 77-80 (1995). In this case, the RO informed the appellant of the necessary evidence in the claims form he completed, in its notice of rating decision, and in the statement of the case. The discussion below informs the veteran of the types of evidence lacking, and which he should submit for a well-grounded claim. Unlike the situation in Robinette, in this case the veteran has not advised VA of the existence of any particular evidence which, if obtained, would render his claim well grounded. A. Headaches The veteran testified in May 1999 that he had two types of headaches. One type was in the nasal area, the other in the back of his head. He implied that the headaches were related to injuries he sustained when he dove into a pool, hitting his nose and injuring his neck. A service medical record dated in July 1972 indicates that the veteran had fractured his nose two weeks earlier and currently had complaints of pain in the frontal sinus area. He was given Fiorinal. In August 1972, his nose was "bumped" and he again experienced headache and pain over the bridge of his nose. X-rays showed no new fracture. In May 1974, the veteran was referred for a neurological consultation after he complained of headaches during the preceding year. His symptoms were diagnosed as tension headache. A neurologist found no evidence of a disease of the central nervous system and reported that the veteran's history was compatible with tension headache syndrome. In October 1974, the veteran's complaints of headaches and insomnia were diagnosed as depression. Subsequently dated in-service medical treatment records do not show complaints, diagnoses, or treatment associated with headaches. However, a report of a December 1975 medical examination noted that the veteran complained of frequent headaches which were diagnosed as tension headaches. The veteran reported a current complaint of headaches during a February 1979 VA examination. The examination report contains no related diagnosis. A computed tomography scan of the veteran's brain in May 1982 was within normal limits. VA outpatient treatment records show that the veteran complained of headache in January 1990. No diagnosis of a disorder manifested by headache was reported. The subsequently dated medical records contained in the claims folder do not show that the veteran has current disability from a disorder manifested by headaches that is related to any disease or injury he incurred during his active military service. B. Herpes Concerning the second element of a well-grounded claim -- evidence of incurrence or aggravation of a disease or injury in service - the veteran's service medical records show that he was given a diagnosis of herpes progenitalis during his active military service. As for current disability, the report of the September 1992 VA examination contains a diagnosis of herpes genitalis. There is also some evidence of continuity of symptomatology, as the veteran testified in May 1999 that he has had continuous symptoms similar to those which were first manifested in service. He reported that he had been prescribed Acyclovir from a VA medical facility. The Board concludes that the record contains some evidence for each of the elements of a well-grounded claim for service connection. More development of the evidence is necessary, however, as discussed in the remand portion of the decision. III. New and Material Evidence In an October 1992 rating decision, the RO denied the veteran's claim of entitlement to service connection for a cervical spine disorder, diagnosed during a VA examination as chronic postural strain of the cervical spine. The veteran did not file a NOD or perfect an appeal of that disallowance of the claim. The decision is final. 38 U.S.C.A. § 7105 (West 1991); 38 C.F.R. §§ 20.302, 20.1103 (1999). The claim can be reopened only with the submission of new and material evidence. 38 U.S.C.A. § 5108 (West 1991). As defined by regulation, new and material evidence means evidence not previously submitted to the agency decisionmakers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a) (1999). In considering whether a claim may be reopened, a two-step analysis must be performed. First, the Board must determine whether the evidence submitted in support of reopening the claim since the last final disallowance of the claim is new and material. If the Board determines that the veteran has produced new and material evidence, the claim is deemed to be reopened and the case must then be evaluated on the basis of all the evidence. Manio v. Derwinski, 1 Vet. App. 140 (1991). See also Glynn v. Brown, 6 Vet. App. 523 (1994). For the limited purpose of determining whether to reopen a claim, the Board must generally accept new evidence as credible and entitled to full weight. Justus v. Principi, 3 Vet. App. 510 (1992). The new and material evidence must be presented or secured since the time that the claim was finally disallowed on any basis, rather than since the time that the claim was last disallowed on the merits. See Evans v. Brown, 9 Vet. App. 273 (1996) (a decision by an RO refusing, because of a lack of new and material evidence, to reopen a previously and finally disallowed claim, after having considered newly presented evidence, is a "disallowance" of a claim). If new and material evidence has not been submitted, the Board does not need to address the merits of the claims. Sanchez v. Derwinski, 2 Vet. App. 330 (1992). When service connection for cervical strain was denied in October 1992, the evidence in the record consisted of service medical records, VA hospital and outpatient treatment records, and a report of a September 1992 VA orthopedic examination. During his service, medical records indicate that the veteran underwent a neurosurgery consultation in May 1974. He had given a history of neck stiffness and occipital headaches. The referring physician reported an impression of probable tension headache. The neurologist reported that his findings were consistent with tension headache syndrome. Service medical records do not show diagnoses or treatment of a cervical spin disorder. In a report of a medical examination dated in December 1975, the examiner indicated that the veteran's spine was clinically normal. The records of post-service VA treatment in the claims folder at the time of the RO's October 1992 decision contain no indication that the veteran had current disability from a cervical spine disorder which was related to any disease or injury he incurred during his active military service. During VA outpatient treatment in January 1983, an examiner noted that the veteran had mild tenderness over C6-7 and mild loss of curve of the cervical spine. His neck was supple. The September 1992 VA examination report contains a history that the veteran had had medical treatment in 1973 for headaches and neck pains. On examination of the cervical spine, there was tenderness along the spinous processes of the third, fourth, and fifth cervical vertebrae (C3-5). There was no muscle spasm, muscle guarding, swelling, or deformity. The veteran had full range of motion in his neck. An X-ray of the cervical spine showed lower cervical spondylosis, loss of disc space height at C6-7, posterior osteophyte formation at C5-6 and C6-7. The pertinent diagnosis was chronic postural strain of the cervical spine, and minimal retrolisthesis. The examiner who conducted the clinical examination reported a diagnoses of chronic postural strain of the cervical spine, spondylosis of the lower cervical spine, degenerative disc disease at C5-7, and minimal retrolisthesis at C4. In denying service connection for cervical strain in October 1992, the RO reasoned that the record contained no medical evidence indicating a nexus between the veteran's disability from a cervical spine disorder and any disease or injury he incurred during his active military service. The evidence received since the RO's October 1992 disallowance of the claim for service connection for a cervical spine disorder consists of VA hospital and outpatient treatment records, a statement from a mental health care provider, and statements and treatment records of a private chiropractor. All of such evidence is new in the sense that it had not been previously considered by agency decisionmakers. However, except as discussed below, such evidence does not bear in any way on the claim for service connection for a cervical spine disorder. Some of the records submitted since the October 1992 rating decision show that the veteran has current disability from a cervical spine disorder. During VA outpatient treatment in February 1994, the veteran had visibly deceased neck motion. An examiner noted an impression of degenerative joint disease at C5-7. Another examiner noted that a computed tomography scan in April 1993 had shown questionable narrowing of the neural foramina in the lower cervical spine. During a hearing in March 1995, the veteran asserted that his current neck-related disability resulted from trauma he sustained in service when he dove into a pool and hit the bottom. He denied having sustained any trauma to his neck after his separation from service. An MRI in June 1995 showed a spinal cord cyst at C6-7 which appeared unchanged from an MRI performed in June 1994. Also detected was bony canal stenosis with multiple extradural defects, most severe at C4-5 and C5-6, causing spinal stenosis abutting the spinal cord. More recently dated notes of private chiropractic treatment show that the veteran has continued to have symptoms of neck pain, stiffness, and cervical paravertebral muscle spasm. In a letter dated in May 1999, the chiropractor reported that the veteran continued to suffer from extreme upper back, neck, and low back pain. I have considered the veteran's May 1999 testimony. He testified that he injured his cervical spine during his active service when he dove into a pool and hit the bottom. He asserted that thereafter, he developed neck stiffness and ache. He stated that such symptoms were diagnosed as "degeneration between the C5 and C7 section of the neck" and that he was told that this was caused by a "major trauma." He asserted that the only neck trauma he had sustained was from the diving incident during his active service. I have reviewed the entire record and find that the new evidence submitted since the RO's October 1992 disallowance of the claim for service connection for a cervical spine disorder does not bear directly and substantially of the question at issue, as such evidence does not indicate a nexus between the veteran's current disability from a cervical spine disorder and any disease or injury he incurred during his active military service. The only evidence suggestive of such a nexus is the veteran's testimony. The veteran is competent to testify that he had a pool diving accident after which he had symptoms of neck pain and stiffness. However, it does not appear from the record that he has the expertise to render an opinion about the etiology of his cervical spine disorders. Therefore, his testimony does not constitute the medical evidence which is necessary to establish a nexus between his current disability and any disease or injury he incurred during his active military service. The Board concludes that no evidence has been submitted since the October 1992 disallowance of the claim for service connection for a cervical spine disorder which is both new and material. Therefore, the claim is not reopened. ORDER Entitlement to service connection for headaches is denied. The claim of entitlement to service connection for a cervical spine disorder is not reopened. The claims of entitlement to service connection for a right knee disorder, a low back disorder, increased ratings for a left knee disorder and a left wrist disorder, and a compensable rating thalassemia minor, are dismissed. The claim of entitlement to service connection for herpes is well grounded. To this extent only, the appeal is allowed. REMAND Because the claim of entitlement to service connection for herpes is well grounded, VA has a duty to assist the appellant in developing facts pertinent to the claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.159 (1999); Murphy v. Derwinski, 1 Vet. App. 78 (1990). Concerning the rating to be assigned for the service- connected nose fracture, the Board notes that, effective October 7, 1996, regulations concerning the evaluation of respiratory disorders were revised. The SOC in March 1995 and the supplemental SOC in August 1995 indicate that the RO evaluated the veteran's disability from fracture of the nose using the former rating criteria. In Karnas v. Derwinski, 1 Vet. App. 308, 312-13 (1991), the Court held that, when there has been a change in an applicable stature or regulation after a claim has been filed but before a final decision has been rendered, VA must apply the version of the statute or regulation which is most favorable to the claimant, unless Congress has expressly provided otherwise or has authorized VA to provide otherwise and VA has done so. Accordingly, with respect to claims involving ratings for respiratory disorders which were pending on October 7, 1996, it well be necessary to determine whether the amended regulations or the previously existing regulations are more favorable to the claimant. The more favorable regulation must then be applied. The General Counsel of VA, in a precedent opinion, has held that the determination of whether an amended regulation is more beneficial to a claimant than the prior provisions must be made on a case-by-case basis. VAOPGCPREC 11-97 (O.G.C. Prec 11-97). To ensure that VA has met its duty to assist the claimant in developing the facts pertinent to the claim and to ensure full compliance with due process requirements, the case is REMANDED to the RO for the following development: 1. The RO should obtain the names and addresses of all medical care providers who have recently treated the veteran for disability associated with fracture of the nose or herpes genitalis. The RO should take all necessary steps to obtain any pertinent records which are not currently part of the claims folder and associate them with the claims folder. 2. The veteran should be afforded a VA examination to evaluate his disability from fractured nose. The examiner should determine the degree, if any, to which the veteran's nasal passages are obstructed due to fracture of the nose. The veteran should also be afforded a VA medical examination to determine if he has current disability from herpes genitalis. If such disability is found, the examiner should express an opinion whether it is as likely as not that the current disability is related to the diagnoses of herpes progenitalis which are contained in the veteran's service medical records. All indicated tests and diagnostic studies must be performed. The claims folder should be reviewed by the examiner. 3. After the development requested above has been completed to the extent possible, the RO should again review the record and readjudicate the claim for service connection for herpes genitalis. Also, the RO should evaluate the veteran's disability from fractured nose. The RO should determine whether the revised regulations pertinent to evaluation of respiratory disorders are more or less favorable to the veteran than the former regulations, and should evaluate the veteran's disability from fracture nose under the more favorable regulation. 4. If any benefit sought on appeal remains denied, the appellant and his representative should be furnished a supplemental SOC, which should include the revised regulations for rating respiratory disorders, and given the opportunity to respond thereto. Thereafter, the case should be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The appellant need take no action unless otherwise notified. 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. MARY GALLAGHER Member, Board of Veterans' Appeals