Citation Nr: 0000866 Decision Date: 01/11/00 Archive Date: 01/27/00 DOCKET NO. 94-23 845 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to service connection for tinea versicolor. 2. The propriety of the initial 10 percent rating assigned for postoperative residuals of lattice retinal degeneration of the right eye, with atrophic hole. 3. The propriety of the initial 60 percent rating assigned for asthma with a history of blackouts and noncardiac chest pain. ATTORNEY FOR THE BOARD Keith W. Allen, Counsel INTRODUCTION The veteran served on active duty in the military from January 1967 to January 1969, and from February 1969 to October 1992. In August 1993, the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia, denied-in relevant part-the veteran's claim for service connection for tinea versicolor. The RO granted service connection for asthma with a history of blackouts and noncardiac chest pain and assigned a 30 percent rating. The RO also granted service connection for postoperative residuals of lattice retinal degeneration of the right eye, with atrophic hole, and assigned a noncompensable (0 percent) rating. The veteran appealed to the Board of Veterans' Appeals (Board)- requesting service connection for the tinea versicolor and higher ratings for the asthma and right eye condition. He also appealed other claims for hearing loss and sinusitis that are no longer at issue. In June 1996, the Board remanded the skin, asthma, and right eye claims to the RO for further development and consideration and, in June 1997, the RO increased the rating for the asthma from 30 to 60 percent, effective from the day following the veteran's discharge from the military. In October 1997, the Board again remanded the claims to the RO and, in August 1999, the RO increased the rating for the right eye condition from the noncompensable level to 10 percent, also effective from the day following the veteran's discharge from the military. It must be presumed that the veteran is seeking the maximum possible ratings for his disabilities unless he expressly indicates otherwise-which he has not done. See AB v. Brown, 6 Vet. App. 35, 39 (1993). Also, since he contested the initial ratings assigned for his asthma and right eye condition-which are now 60 and 10 percent, respectively-the issues on appeal concern the propriety of those initial evaluations, and whether he is entitled to service connection for tinea versicolor. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). The Board will adjudicate the claims for service connection for tinea versicolor and for a rating higher than 60 percent for the asthma. The Board will REMAND the remaining claim for a rating higher than 10 percent for the right eye condition. FINDINGS OF FACT 1. There is no medical evidence of record suggesting that the veteran currently has active tinea versicolor or, even assuming that he does, that it is related to his service in the military or to medication taken for a service-connected condition. 2. The claim for service connection for tinea versicolor is not plausible. 3. Since service, the veteran's asthma has been severe, but essentially stable, manifested by chronic dyspnea, expiratory wheezing, and occasional light headedness and noncardiac chest pain. CONCLUSIONS OF LAW 1. The claim for service connection for tinea versicolor is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. As the assignment of an initial 60 percent rating for the asthma was appropriate, the criteria for a higher rating have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.97 Diagnostic Code 6602 (1996 & 1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection for Tinea Versicolor The veteran alleges he has tinea versicolor and that it began during service or is due to medication taken for a service- connected condition. Service connection may be granted for disability resulting from an injury or a disease that was incurred in or aggravated by active military service, or for disability that is proximately due to or the result of a service-connected condition. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. §§ 3.303(a), 3.310. Section 3.310 also has been interpreted to permit service connection for the degree of aggravation of a nonservice-connected condition that is proximately due to or the result of a service-connected condition. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). A preliminary determination, however, that must be made in a case involving a claim for service connection is whether the claim is "well grounded." A claim is "well grounded" if it is "plausible, meritorious on its own or capable of substantiation." 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The initial burden of showing that a claim is well grounded-if judged by a fair and impartial individual-resides with the veteran; if it is determined that he has not satisfied his initial burden of submitting evidence sufficient to show that his claim is well grounded, then his appeal must be denied, and VA does not have a "duty to assist" him in developing the evidence pertinent to his claim. See Slater v. Brown, 9 Vet. App. 240, 243 (1996); Murphy, 1 Vet. App. at 81-82. In order for a claim for service connection to be well grounded, there must be competent evidence (lay or medical, as appropriate) of: (1) a current disability; (2) an in- service injury or disease; and (3) a nexus between the current disability and the in-service injury or disease. Epps v. Gober, 126 F.3d 1464, 1468 (1997); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995). The chronicity provision of 38 C.F.R. § 3.303(b) is applicable where evidence, regardless of its date, shows that a veteran had a chronic condition during service, and that he still has such condition. See also 38 C.F.R. § 3.303(d). Such evidence, however, must be medical unless it relates to a condition as to which, under the case law of the United States Court of Appeals for Veterans Claims (Court)- formerly, the United States Court of Veterans Appeals-lay observation is competent. If the chronicity provision is not applicable, a claim still may be well grounded on the basis of 38 C.F.R. § 3.303(b) if the condition is observed during service, provided that continuity of symptomatology is demonstrated thereafter, and if competent evidence relates the present condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488, 498 (1997). In this case, the veteran's service medical records confirm he received treatment for problems with his skin on three occasions during the more than 20 years of service. His service medical records also confirm that a doctor in service diagnosed tinea versicolor in 1985, and that he treated it with a topical lotion. There was no evidence of the condition during a medical evaluation the veteran underwent in December 1991, about a year prior to his discharge from the military in October 1992, or when he initially was examined by VA after service, in June 1993 (that examiner indicated it had "resolved" and was "not present"). See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Notwithstanding evidence of tinea versicolor in service, for this claim to be well grounded, there still must be medical evidence suggesting that he currently has it (to show that it is indeed "chronic") and, if so, that it is related to his service in the military or to medication taken for a service- connected condition. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). There is no such medical evidence in this case. Medical records dated after service show that the veteran received treatment for tinea versicolor in October 1993, and follow-up treatment in April 1994, but a VA physician who examined him more recently, in January 1997, indicated that it was "not present [or] seen" during that evaluation "due to excellent selenium sulfide compliance." That VA examiner went on to note, nonetheless, that the veteran would continue to have the condition "indefinitely," requiring lifelong treatment with the selenium sulfide, since tinea versicolor is "a chronic condition [without] cure, [having] nothing to do [with] any present or past medication." However, the VA examiner diagnosed it by history only, and he indicated that the veteran had numerous other skin disorders affecting various parts of his body that-unlike the tinea versicolor- were currently active (e.g., Xerosis, Seborrheic Dermatitis, Acrochordomas, Acne Vulgaris, Dermatofibromas, idiopathic guttate hypovelarosis, Lichen spinuloses, keratosis pilaris, verruca pilaris, and Acanthosis). Moreover, a dermatologist who examined the veteran for compensation purposes even more recently, in November 1998, with the primary objective of providing a medical opinion concerning the etiology of the tinea versicolor, indicated that the veteran did not have it at all-at least at the time of that evaluation-noting that the results of a potassium-hydroxide ("KOH") scraping test from two different sites on his body were negative for signs of the characteristic micro-organisms that are indicative of this condition. That dermatologist diagnosed, instead, chronic and recurrent eczematous dermatitis with resultant pigmentary change-adding that there did not appear to be any areas of scarring in the veteran's skin, but rather, some pigment irregularity. In a supplemental opinion submitted in July 1999, that same dermatologist reiterated his earlier conclusion-that the veteran did not have tinea versicolor when he examined him- and that this opinion was based, not only on the results of the clinical evaluation, itself, but also on a review of his pertinent medical history and circumstances. That dermatologist also said that, although the veteran may claim that it is a "chronic" problem, the examiner did not see how he could support this assertion if, as was the case, the rash was not visible and no fungus was detected during the potassium-hydroxide scraping. The dermatologist added that the eczema he diagnosed at the conclusion of the evaluation was not related to tinea versicolor. In light of the medical evidence alluded to above, there are legitimate reasons to question whether the veteran currently has tinea versicolor, which is important because medical evidence of "current disability" is a prerequisite to well grounding a claim for service connection. See Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). However, aside from that evidentiary deficiency, even were the Board to assume, arguendo, that he does have the condition, it has not been shown by competent medical evidence to be "chronic per se," as defined by the governing laws, regulations, and legal precedent, and there still is no medical evidence indicating that it is related to his service in the military or to medication taken for any of his service-connected disabilities. Consequently, his claim still would not be well grounded because medical nexus evidence is required to satisfy these criteria. See Libertine v. Brown, 9 Vet. App. 521, 524 (1996); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). It is important to bear in mind that the VA physician who diagnosed tinea versicolor after examining the veteran in January 1997 did so by history only-noting that it was not actually "present [or] seen" during the clinical portion of that evaluation. Therefore, even though that physician characterized the tinea versicolor as a "chronic condition [without a] cure," his mere use of those words was not, in turn, tantamount to inferring that it is "chronic" in the sense contemplated by the governing laws, regulations, and legal precedent-especially considering that even he acknowledged that it was not currently active. See e.g., 38 C.F.R. § 3.303(b). Similarly, since the veteran is a layman, he does not have the medical expertise or training, himself, to diagnose a medical condition to confirm its current presence, nor can he give a competent opinion on the etiology of it and its possible relationship to his military service. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). Rather, his competence is limited to commenting on such things as visible symptoms (e.g., scars, lesions, hyperpigmentation, etc.) that he personally observed on his skin during service-and during the years since his discharge-not the cause of them. Consequently, his allegation that he has "chronic" tinea versicolor is not tantamount to concluding that he actually does-particularly since even he acknowledges that it is well controlled by his medication, and since, according to the report of the January 1997 VA examination, which is probably the most favorable evidence supporting his claim, he has numerous (at least 10) other skin disorders that may be causing, or have caused, the dermatological symptoms he experiences or has experienced. See King v. Brown, 5 Vet. App. 19, 21 (1993); see also Savage v. Gober, 10 Vet. App. at 498. The Board emphasizes that a well-grounded claim for service connection must be supported by "medical" evidence-not just allegations-and there is no such evidence in this case. See Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). Also, to the extent that some of the medical records on file contain a self-reported history-recounted by the veteran himself-of relevant dermatological symptoms dating back to when he was on active duty in the military, this is not, in and of itself, sufficient to well ground his claim, particularly since there were several times when he was examined during service (e.g., in December 1991), and several additional times when he has been examined during the years since his discharge from service (e.g., in June 1993 and November 1998), when there was no objective clinical evidence of tinea versicolor-despite his subjective complaints. See LeShore v. Brown, 8 Vet. App. 406, 409 (1995) (where the Court held that evidence that is simply information recorded by a medical examiner, unenhanced by any additional medical comment by that examiner, does not constitute "competent medical evidence" satisfying the Grottveit requirement for well groundedness). Since the veteran has not satisfied his initial burden of submitting evidence sufficient to show that his claim for service connection for tinea versicolor is well grounded, VA is under no "duty to assist" him in developing the evidence pertinent to this claim. See Morton v. West, 12 Vet. App. 477 (1999); Epps, 126 F.3d at 1468 (1997). Moreover, the Board is aware of no circumstances in this case that would put VA on notice that any additional relevant evidence may exist that, if obtained, would make this claim well grounded. See McKnight v. Gober, 131 F.3d 1483, 1485 (Fed. Cir. 1997). The RO denied this claim on the same premise as the Board- because it is not well grounded. The RO also apprised him in the August 1999 Supplemental Statement of the Case (SSOC) of the need to submit evidence showing that his claim is well grounded and that his tinea versicolor either was incurred in or aggravated by his service in the military. Clearly, he is not prejudiced by the Board's decision to deny his claim on this same basis. See Bernard v. Brown, 4 Vet. App. 384, 392- 93 (1993). The Board also considers its (and the RO's) actions as sufficient to inform him of the evidence necessary to well ground his claim and warrant further consideration on the merits. See 38 U.S.C.A. § 5103(a); Franzen v. Brown, 9 Vet. App. 235, 238 (1996); Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995). II. The Propriety of the Initial 60 Percent Rating Assigned for the Asthma As a preliminary matter, the Board finds that the veteran's claim for a higher rating for his asthma is plausible and, therefore, well grounded within the meaning of 38 U.S.C.A. § 5107(a). A claim, as here, that a service-connected disability is more severe than presently rated is well grounded where the veteran alleges that a higher rating is justified due to the severity of his condition. See Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); Proscelle v. Derwinski, 2 Vet. App. 629, 631-632 (1992). When a veteran submits a well-grounded claim, the VA must assist him in developing the facts pertinent to his claim. Id. After remanding this claim to the RO in June 1996 and October 1997, the Board is satisfied that all relevant evidence has been obtained-and fully developed-and that no further assistance to the veteran is required to comply with the "duty to assist." 38 U.S.C.A. § 5107(a). Disability evaluations are determined by comparing the symptoms the veteran is presently experiencing with criteria set forth in VA's Schedule for Rating Disabilities-which is based on average impairment in earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. When making determinations as to the appropriate rating to be assigned, VA must take into account his entire medical history and circumstances. See 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1995). Before proceeding with its analysis of this claim, the Board finds that some discussion of the Fenderson case is warranted. In that case, the Court emphasized the distinction between a new claim for an increased (i.e., higher) rating for an already service-connected disability, as opposed to a case in which the veteran expresses dissatisfaction with the assignment of an initial rating where the disability in question has just been recognized as service connected. In the former instance, the Court held that the holding of Francisco v. Brown, 7 Vet. App. 55, 58 (1994)-that the current level of disability is of primary importance when assessing an increased rating claim-applies. In the latter case, however, where, as here, the veteran has expressed dissatisfaction with the assignment of the initial rating for his asthma, the Francisco holding does not apply; rather, the VA must assess his level of disability from the date of his initial application for service connection and determine whether his level of disability warrants the assignment of different disability ratings at different times over the life of the claim-a practice known as "staged rating." In this appeal, the RO has issued a Statement of the Case (SOC) that does not explicitly reflect consideration of the propriety of the initial rating, or include a discussion of whether a "staged rating" would be appropriate in this instance. However, the Board does not consider it necessary to remand this case to the RO for issuance of a Supplemental Statement of the Case (SSOC) addressing these concerns. This is because the claims file reflects consideration of additional evidence in light of the applicable rating criteria at various times during the course of the appeal. When service connection was established for the asthma in August 1993-and the 30 percent rating assigned-the RO based its decision on consideration of all of the evidence available at that time. On all subsequent occasions that the RO considered additional evidence, including when it increased the rating for the asthma to 60 percent in June 1997 (with the same effective date), the RO thereafter issued an appropriate SSOC discussing the evidence considered in its decision, the findings pertaining to it, and the applicable laws, regulations, and Court precedent. Thus, the RO effectively considered the appropriateness of the initial rating that it assigned under the applicable rating criteria in conjunction with the submission of the additional evidence at the various times during the pendency of the appeal. The Board considers that to have been tantamount to a determination of whether a "staged rating" was appropriate; consequently, the Board finds that remanding this claim would not be productive, as it would not produce a markedly different analysis on the RO's part, or give rise to markedly different arguments on the veteran's part. Therefore, the Board will proceed with the adjudication of this claim since he will not be prejudiced. See Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993). During the pendency of the veteran's appeal, VA amended the criteria used for evaluating the severity of diseases of the trachea and bronchi-such as asthma. Consequently, VA must rate the severity of his asthma under both the former and revised criteria and apply the version that is most favorable to him. See Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). Under the former criteria (which were effective prior to October 7, 1996), a 60 percent rating was warranted for asthma when it was severe-manifested by frequent attacks (one or more weekly), marked dyspnea on exertion between the attacks with only temporary relief by medication, and preclusion of more than light manual labor. A 100 percent rating was warranted when the asthma was pronounced- manifested by very frequent attacks with severe dyspnea on even slight exertion between them, and with marked weight loss or other evidence of severe impairment of health. See 38 C.F.R. § 4.97, Diagnostic Code 6602 (1996). According to the revised criteria, a 60 percent rating is warranted if the forced expiratory volume in one second (FEV- 1) is 40- to 55-percent of the predicted value; or if the ratio of the forced expiratory volume in one second to forced vital capacity (FEV-1/FVC) is 40 to 55 percent; or if there is evidence of at least monthly visits to a physician for required care of exacerbations; or of intermittent (at least 3 per year) courses of systemic (oral or parenteral) corticosteroids. A 100 percent rating requires an FEV-1 of less than 40 percent of predicted value; or an FEV-1/FVC ratio of less than 40 percent; or evidence of more than one attack per week with episodes of respiratory failure; or daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications. See 38 C.F.R. § 4.97, Diagnostic Code 6602 (1999). The veteran does not satisfy the criteria for a rating higher than 60 percent under either the former or revised standards. During his June 1993 VA examination, there was evidence of shortness of breath (SOB), expiratory wheezing, and rhonchi in his lungs due to his asthma. There also were indications of lightheadedness and noncardiac chest pain associated with it. However, X-rays of his chest were completely negative ("normal"), and he had an FEV-1/FVC ratio of 88.5 percent, which far exceeds the threshold (that this ratio be less than 40 percent) for a rating higher than 60 percent under Code 6602. Also, although he received ongoing treatment for his asthma in a VA outpatient clinic in April 1993, May 1993, October 1993, and January 1994, his treating physician usually described it as "stable." During later outpatient consultations in April and August 1994, the treating physician indicated the veteran needed to gain better control of his asthma (via the medication he was taking). Records show that in November 1994 his medication was adjusted and his treating physician indicated in April 1995 that the asthma was "better." He also indicated during subsequent consultations in September 1995, February 1996, May 1996, and September 1996, that it was again under control (essentially "stable")-albeit with some "good and bad days." When examined by VA in January 1997, the veteran reported that he experienced asthma attacks about every 2-3 days manifested by severe dyspnea and wheezing. He also acknowledged, however, that some of his symptoms were alleviated by his inhalers (bronchodilators) and by rest. On objective clinical evaluation, the examiner confirmed the presence of wheezing, even at rest, but there was no evidence of cor pulmonale or indications that the veteran needed oxygen (O2) therapy while at home. His FEV-1 was 46.1 percent of predicted value, and his FVC was 53.6 percent of predicted value, which, in turn, correlated to a FEV-1/FVC ratio of 86 percent. The results of a pulmonary function test (PFT) showed that he had a "moderate" degree of airway obstruction with "severe" air trapping. In assessing the overall status of the asthma, the examiner indicated in his diagnosis that it was "severe" and manifested by attacks occurring several times each week and symptoms at rest. More recent VA outpatient treatment records show additional consultations in July and November 1997, when X-rays of the veteran's chest and ribs again were negative ("normal"). Also, his treating physician continued to describe the asthma as essentially "stable," although he complained of some left-sided chest pain, which he said was unrelated to his level of activity, and some decreased breath sounds ("BS") in his lungs. However, unlike previously, he did not have any signs of expiratory wheezing. The VA physician who examined the veteran most recently for compensation purposes, in May 1998, was the same physician who earlier examined him in January 1997. This doctor indicated in the report of his most recent evaluation that the veteran's overall respiratory status had "not changed significantly" since the earlier examination. The objective clinical findings bore this out, as they were essentially identical to those previously noted; there continued to be no evidence of weight loss attributable to the asthma or indications of cor pulmonale or pulmonary hypertension. There were, however, signs of bilateral diffuse wheezing and dyspnea, which the veteran said he experienced after ascending even one flight of stairs. He also said he experienced asthma attacks every 2-3 days and that they were alleviated by using his inhalers (bronchodilators), taking steroids, and by resting. The examiner indicated the oral Prednisone was required monthly, and best rest about every month or two. His diagnostic assessment of the overall status of the veteran's asthma was the same as previously-i.e., "severe," manifested by attacks occurring several times each week and symptoms at rest. The 60 percent rating the veteran currently has for his asthma-when considered under either the former or revised criteria-takes into account the fact that he will experience "severe" symptoms associated with it (e.g., frequent attacks of dyspnea, expiratory wheezing, early fatigability, etc.), and that his symptoms will require ongoing treatment for recurring exacerbations of the condition. His 60 percent rating also contemplates that his respiratory impairment will not be totally abated merely by the use of medication and, in fact, will require the continued use of it. Rather, the more determinative issue in determining the severity of his asthma is one of extent-insofar as the degree and frequency of his symptoms. And, although the VA examiner's assessment of the overall status of the asthma as "severe" is not, in and of itself, dispositive of the rating that should be assigned, the Board may consider the examiner's opinion-which, incidentally, correlates to a 60 percent rating-provided that the rating accurately reflects all elements of the disability, based on consideration of all of the pertinent evidence of record, and the result obtained is "equitable and just" according to the law. See 38 C.F.R. §§ 4.2, 4.6. The veteran does not experience symptoms of sufficient severity or frequency to support a rating higher than 60 percent under either the former or revised criteria. Of note, his FEV-1 and FVC tabulations, regardless of whether the Board uses the values recorded during the June 1993 or January 1997 VA examinations, do not meet the requirements for a 100 percent rating under Code 6602. His FEV-1 during the January 1997 VA examination was 46.1 percent, which is within the range specified for a 60 percent rating under the revised criteria of Code 6602, but not higher. Similarly, he did not have a sufficient FEV-1/FVC ratio during that evaluation to warrant a rating higher than 60 percent under the revised criteria of this code, nor did he have signs of marked weight loss or other evidence of respiratory impairment to an extent that might warrant a higher rating under the former criteria of this code. Again, the veteran obviously experiences "severe" respiratory impairment due to his asthma, and no doubt has for quite sometime, but there simply is no medical basis to support a rating higher than 60 percent in view of the evidence currently of record. Lastly, there is no medical evidence indicating the veteran is entitled to a higher rating under any other potentially applicable diagnostic code, as most used to determine the severity of pulmonary and respiratory disorders consider the same (or very similar) criteria. For the aforementioned reasons, the Board finds that the overall severity of his asthma is most commensurate with a 60 percent rating, and has been since service. Therefore, this is the rating that must be assigned. 38 C.F.R. § 4.7. Since the 60 percent rating represents the maximum level of disability since service, there is no basis for assigning a "staged rating" pursuant to Fenderson. The preponderance of the evidence is against a rating higher than 60 percent, so the benefit-of-the-doubt rule does not apply. See 38 U.S.C.A. § 5107(b); Alemany v. Brown, 9 Vet. App. 518, 519 (1996); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). The above determination is based on application of the pertinent provisions of the VA's Schedule for Rating Disabilities. Additionally, however, the Board notes that there is no indication that the schedular criteria are inadequate to evaluate the veteran's asthma, as there has been no showing that his disability has caused marked interference with employment (i.e., beyond that contemplated in the assigned evaluation), necessitated frequent periods of hospitalization, or otherwise rendered impractical the application of the regular schedular standards. In the absence of evidence of such factors, the Board is not required to remand this claim to the RO for the procedural actions outlined in 38 C.F.R. § 3.321(b)(1). See Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). ORDER As evidence of a well-grounded claim has not been submitted, service connection for tinea versicolor is denied. The claim for an initial rating higher than 60 percent for the asthma is denied. REMAND In both the June 1996 and October 1997 Remands, the Board directed the RO to adjudicate an additional claim for service connection for a left eye condition because, if granted, this will affect the method for rating the veteran's already service-connected right eye condition since unilateral and bilateral eye disabilities are rated differently. Consequently, the issue of his possible entitlement to service connection for a left eye condition is "inextricably intertwined" with the issue of whether he is entitled to a higher rating for his already service-connected right eye condition. In this regard, VA examiners indicated in January 1997, May 1997, and July 1998 that he now has high myopia associated with lattice degeneration in both of his eyes, as opposed to only his right eye, and that, although this is a very common association and is probably unrelated to his service in the military, the possibility still exists (i.e., it is "as likely as not") that his bilateral eye condition first appeared-or became worse-during his early adulthood while he was on active duty in the military. See Ephraim v. Brown, 82 F.3d 399 (Fed. Cir. 1996); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Since the RO has not fully complied with the directives of the prior remands, these issues must be returned to the RO for resolution. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Accordingly, this matter is REMANDED to the RO for the following development and consideration: 1. The RO should determine whether the veteran is entitled to service connection for a left eye condition in light of the statements of the VA examiners in January 1997, May 1997, and July 1998. The RO should undertake any necessary development prior to adjudicating this claim, including, but not limited to, having him reexamined or obtaining a supplemental opinion to the earlier examinations. The RO must provide adequate reasons and bases for its decision, citing to all governing laws, regulations, and legal precedent. 2. If service connection is granted for the left eye condition, then the RO must determine the appropriate rating for the bilateral eye disability. 3. Thereafter, if the benefits requested by the veteran are not granted to his satisfaction, he should be provided a Supplemental Statement of the Case (SSOC) or a Statement of the Case (SOC), as appropriate, and given an opportunity to submit additional evidence and/or argument in response prior to his claims being returned to the Board for further appellate consideration on all issues to which an appeal has been perfected. The veteran has the right to submit additional evidence and argument on the matters the Board has remanded to the RO. 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. K. OSBORNE Acting Member, Board of Veterans' Appeals