Citation Nr: 0003425 Decision Date: 02/10/00 Archive Date: 02/15/00 DOCKET NO. 95-28 287 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston- Salem, North Carolina THE ISSUES 1. Entitlement to service connection for skin cancer, kidney stones, muscular problems other than those related to a service-connected back disability, and sinusitis, each claimed as secondary to exposure to Agent Orange. 2. The propriety of the initial 50 percent rating assigned for service-connected post traumatic stress disorder (PTSD) from May 25, 1994. 3. Entitlement to an increased rating for a service- connected upper strain of the dorsal and lumbar area, currently evaluated as 20 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J. A. Markey, Counsel INTRODUCTION The veteran served on active duty from September 1967 to June 1969. This matter came before the Board of Veterans' Appeals (Board) from an April 1996 decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina that established service connection for PTSD, and established a 10 percent rating, effective from May 1994. The veteran was sent notice of this decision in May 1996. A notice of disagreement with regard to the initial evaluation was received in June 1996. A statement of the case was issued in June 1996. A substantive appeal was received from the veteran in May 1997. A hearing was held at the RO in May 1997. In October 1997, the RO assigned a 50 percent evaluation for PTSD effective from the date of the grant of service connection. The Board notes that the RO adjudicated the claim involving PTSD as one for an increased rating. However, the veteran's appeal involves the initial evaluation assigned following the grant of service connection for this disorder-now, 50 percent. Hence, the Board has recharacterized the issue in light of the distinction noted by the United States Court of Appeals for Veterans Claims (Court) in the decision Fenderson v. West, 12 Vet. App. 119 (1999). Furthermore, inasmuch as a higher evaluation is available this condition, and the veteran is presumed to seek the maximum available benefit for a disability, the claim remains viable on appeal. Id.; AB v. Brown, 6 Vet. App. 35, 38 (1993). This matter also came before the Board from a November 1997 decision by the RO that denied the veteran an increased evaluation for his service-connected upper strain of the dorsal and lumbar area. A notice of disagreement was received in November 1998. A statement of the case was January 1999. Finally, this matter came before the Board from an August 1993 decision by the RO that denied the veteran's claims of entitlement to service connection for skin cancer, kidney stones, muscular problems other than those related to a service-connected back disability, and sinusitis, claimed as secondary to exposure to Agent Orange. A notice of disagreement was received in May 1994. A statement of the case was issued in May 1995. The Board has rendered a decision on the PTSD claim, as set forth below. However, the remaining claims are addressed in the REMAND following the order portion of the decision. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable resolution of the veteran's claim for an increased initial evaluation for service-connected PTSD has been obtained by the RO. 2. Since the date of the grant of service connection in May 1994, the veteran's PTSD has primarily resulted in nightmares, depression, flashbacks, sleep disturbance, agitation, anxiety, and some suicidal ideation without plan or intent. 3. The service-connected PTSD results in no more than considerable industrial and social impairment, or, since November 7, 1996, considerable difficulty in establishing and maintaining effective work and social relationships; there is no showing of occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. CONCLUSION OF LAW As the initial 50 percent evaluation assigned for the veteran's service-connected PTSD was proper, the criteria for a higher evaluation are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.130, Diagnostic Code 9411 (1999); 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996). REASONS AND BASES FOR FINDINGS AND CONCLUSION Background A review of the record reflects that service connection was established for PTSD by the currently appealed April 1996 decision. This decision was based in part on information provided by the veteran - and partially confirmed by the United States Army and Joint Services Environmental Support Group (ESG) (now the Department of the U.S. Armed Services Center for Research of Unit Records (USASCRUR)) - to the effect that while serving in Vietnam, the veteran's unit came under mortar attack and two of his fellow servicemen were killed. This decision was also based on medical evidence that will be discussed below. Based on this medical evidence, a disability evaluation of 10 percent was assigned for this disorder, effective May 25, 1994. Thereafter, and as noted above, in a October 1997 rating action, this disability evaluation was increased to 50 percent effective May 25, 1994, the date of the grant of service connection. The relevant evidence of record pertaining to evaluation of the severity of the veteran's PTSD includes VA outpatient treatment records, examination reports, and private medical records. VA records reflect that the veteran has received individual counseling and has consistently attended group counseling ("combat group") since October 1992. In May 1994, the veteran was admitted to the VA Medical Center (VAMC) in Durham, North Carolina with increased dysphoria, suicidal thoughts without plan or intent, flashbacks, emotional disturbance, nightmares, nightsweats, paranoia, and increased anxiety. On mental status examination, the veteran appeared to be in no acute distress, was calm, cooperative, and euthymic. His affect was full and appropriate, and he had good registration and recall. He was alert and oriented times three, and psychomotor activity was within normal limits. Speech was slow in rate and flat in tone, and thought processes were cogent without flight of ideas or looseness of association. The veteran denied auditory and visual hallucinations, and did not appear to be suffering from delusions. He did admit passive suicidal ideation without any intent or plan, and his judgment and insight were described as being poor. The veteran was discharged about a week later, at which time he denied suicidal or homicidal ideations, denied visual hallucinations, and was found to be calm and appropriate. Outpatient treatment records from the VA psychology and psychiatry clinic(s) reflect that the veteran was seen periodically from late June 1994 to February 1996, and was variously diagnosed with an anxiety disorder, anxiety with depression and symptoms of PTSD , and PTSD. For the most part, he was found to be alert, oriented, and cooperative, and sometimes tense. In December 1994 and February, March, and July 1995, the veteran complained of anxiety, tension, depression, sleep disturbance, and intrusive thought, noting in December 1994 that he was able to refocus his attention to current issues. He also pointed out that his girlfriend was understanding and supportive, and that he remained fairly active and involved in family and social endeavors. In December 1995, the veteran reported recent increased periods of depression and suicidal thinking, but denied any specific intent and recognized that he was able to cope with these symptoms with support from family and friends, and group therapy. A VA psychiatric examination was accomplished in March 1996, the report of which indicates that the veteran reported PTSD- type symptoms such as nightmares, sleeplessness, intrusive thoughts of his Vietnam experience, flashbacks, feelings of paranoia, and periods of depression, at times described as severe. The veteran indicated that he was unemployed. Objective findings included that the veteran was neatly dressed, appeared alert and pleasant, and that verbal productivity, orientation, memory, insight, and judgment appeared adequate. The veteran was referred for a psychological evaluation and a diagnosis was deferred. This psychological evaluation took place in late March 1996. The evaluation report documents the veteran's family and Vietnam history, and that due to problems in maintaining work expectations (due to physical and psychiatric impairment), he was fired from his most recent job in 1992. Regarding the current structure of his life, the veteran reported that he has few plans and places much of the responsibility of his stability on his relationship with his girlfriend. It was noted that he was previously married, but separated in 1989. He noted that his functioning had deteriorated during the previous two months, which he thought might be related to his decision to stop taking medication. He also reported that his sleep pattern was poor, that he has nightmares about three times a week, and that he avoids crowds and prefers to spend time alone with his girlfriend. The veteran noted that he was troubled by the possibility of an eruption of his temper and referred to guilt over his participation in the Vietnam War. The veteran reported an exaggerated startle response, and he expressed concern over a variety of health problems, denying that he was in good physical health. Behavioral observations included that the veteran remained cooperative and pleasant, was slow in response, and cautious and soft-spoken in his comments. He displayed a brittleness in presentation, and tended to think carefully before responding. His mood was described as sad and tinged with apprehension, and eyes teared periodically, particularly when describing combat experiences. There were no unusual features to the veteran's thoughts or verbal expressions, and he seemed to be well oriented. Based on the utilization of a series of evaluation tools, the veteran was diagnosed with PTSD and dysthymic disorder. The examiner essentially noted that the veteran was often saddened by his condition, and that the veteran did not have a bright outlook on his future. The examiner noted that the veteran's self-identified persistent symptoms of increased arousal, sleep problems, irritability, concentration problems, feelings of hopelessness, and exaggerated startle response caused clinically significant distress and impairment in social and occupational functioning. Records from the VA psychology and psychiatry clinic(s) dated from April to November 1996 reflect that the veteran was again variously diagnosed with an anxiety disorder, depressive disorder, and PTSD, and was found to be alert, oriented, and cooperative. The veteran resumed taking his medication in April 1996 with some success, but described some continued sleep difficulty, nightmares, intrusive thoughts, and bouts of depression. He reported that there were some problems with his girlfriend, but that she remained was understanding and supportive. It was indicated that the veteran remained fairly active and involved with his family and household responsibilities. In December 1996 and February 1997 letters, a readjustment counseling therapist at the Vet Center notes that the veteran had been attending the Center since October 1992, participating in both individual and group counseling. He noted that at that time the veteran had presented with depression, nightmares, and isolation after losing his job. The therapist noted that the veteran works extremely hard in the counseling sessions, that he displays a lot of survival guilt, and has had a difficult time accepting his disability. He stated that it appears that the veteran cannot maintain employment due to PTSD and various physical limitations. During a May 1997 RO hearing, the veteran testified that he was terminated from employment in August 1992 due to the crippling effects of medication taken for depression. He testified that his daily activities consist of light housework, and some auto maintenance and yard work. He noted that he speaks with his brother on a daily basis. Further, the veteran related that the manifestations of his psychiatric disorder include flashbacks to war experiences, nightmares, fear of being around people, occasional hallucinations, and insomnia. He essentially noted that he has had suicidal thoughts, and that on one occasion in 1993 was close to committing suicide but was interrupted. A neighbor of his testified to the effect that she checks in on the veteran on a daily basis due to his depression, and helps him clean his house and do yard work. She noted that the veteran is sometime unkempt but knows to straightened himself up prior to going somewhere. Records from the VA psychology and psychiatry clinic(s) dated in June 1997 reflect that the veteran reported continued PTSD symptoms including periods of agitation, flashbacks, nightmares, anxiety, depression, and sleep disturbance, exacerbated by chronic medical problems and pain. The veteran was again found to be alert, oriented, and cooperative. He reported that he remained fairly active with household responsibilities and his relationship with his girlfriend. A VA psychiatric examination was accomplished in July 1997, the report of which notes the veteran's complaints of sleep disturbance, inability to deal with people, irritability, isolation, poor concentration, and seeing images of his Vietnam experience. He noted that his appetite was good, and that he was taking medication. It was noted that the veteran was previously divorced but has had a companion for the past five years, and that he has not worked since 1992. He related that he has few friends but was active at the Vet Center and gets along with his mother, brothers, and sisters. The veteran noted that he spends a lot of time around the house doing odd jobs. Objective findings included that the veteran was alert and cooperative, without loose associations of flight of ideas, and with no bizarre motor movements or tics. His mood was tense, his affect appropriate, and there were no delusions, hallucinations, or ideas of reference or suspiciousness. The veteran was oriented times three, and his memory, both remote and recent, was good. His insight, judgment, and intellectual capacity appeared to be adequate. The veteran was diagnosed with PTSD with a Global Assessment of Functioning Scale (GAF Scale) of 55. A record from the VA psychiatry clinic dated in August 1997 reflects that the veteran continued to be alert and pleasant and reported little changes in his psychiatric symptoms. Records from the psychology clinic dated in November 1997 and February 1998 reflect that the veteran was, again, alert, oriented times four, and cooperative, and again complained of periods of anxiety, tension, depression, sleep disturbance, social isolation, and intrusive thoughts. The veteran again reported that he remained fairly active with household responsibilities and that his girlfriend remained understanding and supportive. Finally, a February 1998 record from Dayspring Medical Center notes the veteran's complaints of chronic back pain, headaches, PTSD, and fibromyalgia, and that he was alert and oriented to person, place, and time. Analysis The veteran and his representative contend, in substance, that a disability evaluation higher than that the 50 percent evaluation initially assigned following the grant of service connection for PTSD disability is warranted. As a preliminary matter, the Board finds that this claim is plausible and capable of substantiation and is therefore well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). See Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); Proscelle v. Derwinski, 2 Vet. App. 629, 631-632 (1992). The Board also is satisfied that all relevant facts have been properly developed and no further assistance to the veteran is required in order to comply with the duty to assist. Id. At the outset, the Board notes that, recently, the Court observed that there is a distinction between a claim based on the veteran's dissatisfaction with the initial rating (a claim for an original rating) and a claim for an increased rating. It was also indicated that in the case of an initial rating, separate ratings can be assigned for separate periods of time based on the facts founds, a practice known as "staged rating." Fenderson v. West, 12 Vet. App. 119 (1999). While, at the outset, the Board acknowledges that the RO has not explicitly considered whether staged rating is appropriate in this case, the RO's actions in reconsidering the claim under the criteria then in effect as additional evidence was received is tantamount to consideration of staged rating. For that reason, as well reasons set forth below, the Board finds that a remand for the RO to explicitly consider the claim in light of Fenderson is unnecessary. By regulatory amendment, effective on November 7, 1996, substantive changes were made to the schedular criteria for evaluating psychiatric disorders, as defined in 38 C.F.R. §§ 4.125-4.132. See 61 Fed. Reg. 52695-52702 (1996). Where the law or regulations governing a claim change while the claim is pending, the version most favorable to the claimant applies., absent congressional intent to the contrary. See Karnas v. Derwinski, 1 Vet. App. 308, 312-313 (1991). As reflected in the January 1999 Supplemental Statement of the Case, the RO has considered both the former and the revised applicable criteria; hence, there is no due process bar to the Board doing likewise, and applying the more favorable result. The Board points out consideration will be given to the effective date of the revised regulation. In other words, for any date prior to effective November 7, 1996, the Board will not apply the revised psychiatric rating schedule to the claim, but from that date onward the Board will apply both the former and revised criteria. Prior to November 7, 1996, PTSD was evaluated using criteria from the general rating formula for psychoneurotic disorders. 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996). Under this formula, a 50 percent evaluation was appropriate where the ability to establish or maintain effective or favorable relationships with people is considerably impaired; by reason of psychoneurotic symptoms the reliability, flexibility, and efficiency levels were so reduced as to result in considerable industrial impairment. Assignment of a 70 percent rating was warranted for a severely impaired ability to establish and maintain effective or favorable relationships with people; the psychoneurotic symptoms were of such severity and persistence that there was severe impairment in the ability to obtain or retain employment. A 100 percent evaluation was contemplated where the attitudes of all contacts except the most intimate were so adversely affected as to result in virtual isolation in the community; for totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic, and explosions of aggressive energy resulting in profound retreat from mature behavior; or for demonstrable inability to obtain or retain employment. Under the revised criteria, set forth at 38 C.F.R. § 4.130, Diagnostic Code 9411 (1999), a 50 percent rating is appropriate where there is occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect, circumstantial, circumlocutory or stereotyped speech, panic attacks more than once a week, difficulty in understanding complex commands, impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks), impaired judgment, impaired abstract thinking, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships. Assignment of a 70 percent evaluation is contemplated where occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Assignment of a 100 percent evaluation for major depression is contemplated where there is a showing of total occupational and social impairment, due to such symptoms as: gross impairment in thought process or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting oneself or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives own occupation, or own name. That said, applying the evidence dated prior to November 7, 1996, to the old criteria, the Board finds that this evidence does not show that the veteran's PTSD produced more than a considerable (50 percent) degree of industrial impairment during that time period. The veteran's disability could not have been characterized as producing severe impairment in the ability to establish or maintain effective or wholesome relationships with people, and it was not shown that psychoneurotic symptoms were of such severity and persistence that there was a severe impairment to obtain or retain employment. In fact, while it is indicated that the veteran had difficulty sleeping, was irritable, passively suicidal, depressed, avoided crowds, and experienced nightmares, among other things, during this time period, he was also cooperative, alert, oriented, and pleasant, and was engaged in effective relationships, as demonstrated by several references to support given by his girlfriend, and documented family support. Further, the relevant objective evidence does not suggest that the veteran was severely impaired from obtaining employment due to his PTSD. In considering the evidence dated subsequent to the change in regulation, the Board finds that an evaluation higher than 50 percent is not warranted under either the old or new rating criteria. Regarding the new criteria, the evidence does not in any way demonstrate that the veteran's PTSD is manifested by occupational and social impairment with deficiencies in most areas due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. While this evidence documents the veteran's complaints of nightmares, depression, flashbacks, sleep disturbance, some suicidal ideation (without plan or intent), and agitation, he maintains apparent healthy relationships, including with his girlfriend, brother, and neighbor, engages in light activity daily, and continues to be alert and cooperative, oriented, and pleasant. Furthermore, while his mood was recently described as "tense," his memory is good, his affect appropriate, his judgment and intellect adequate, and he has not been found to be delusional. It also appears that the veteran maintains appropriate hygiene at the appropriate times. Further, as noted above, a GAF Score of 55 was noted on VA examination in July 1997, which, according to the Fourth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), is indicative of moderate symptoms (e.g. flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g. few friends, conflicts with peers or co-workers). This evidence clearly demonstrates to the Board no more than a 50 percent rating under 38 C.F.R. § 4.130, Diagnostic Code 9411 (1999) is warranted. As well, under the old criteria, again, the evidence shows that that the manifestations of the veteran's PTSD are no more than considerable with complaints as noted above. The evidence does not demonstrate that this disorder produces severe impairment in the ability to establish or maintain effective or wholesome relationships with people, or that the psychoneurotic symptoms were of such severity and persistence that there was severe impairment in the ability to obtain or retain employment. As noted, the veteran does maintain at least some effective personal relationships (most notably with his girlfriend), and while it is arguable that the manifestations of the veteran's PTSD cause considerable industrial impairment, the evidence does not establish that such impairment is severe (it is noted that it also appears that there may be a physical component factoring into the veteran's alleged inability to maintain or obtain employment). As such, a 50 percent rating under 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996) is not warranted for the period after November 7, 1996. In conclusion, the Board finds that the evidence establishes that, since May 1994, the effective date of the grant of service connection for the veteran's PTSD, that disability is shown to be no more than 50 percent disabling under either the former or revised applicable schedular criteria. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and an increased rating must be denied. 38 U.S.C.A. § 5107(b) (West 1991); Gilbert v. Derwinski, 1 Vet. App 49, 55-57 (1990). Further, the Board finds, as did the RO, that the evidence of record does not present such an exceptional or unusual disability picture so as to render impractical the application of the regular rating schedule standards and to warrant assignment of an increased evaluation on an extra- schedular basis. See 38 C.F.R. § 3.321(b)(1) (1999). As noted above, there is no showing that the veteran's PTSD has resulted in more than considerable (therefore, not marked) interference with employment or necessitated frequent periods of hospitalization. Again, the veteran's apparent inability to maintain employment has been related to both psychiatric and physical impairment. In any event, there simply is no evidence that the veteran's PTSD alone, either renders him unemployable, or results in more than the considerable interference with employment contemplated by the assigned 50 percent evaluation. Furthermore, the service-connected PTSD has not resulted in frequent periods of hospitalization. Finally, symptoms of the service-connected PTSD are not otherwise shown to be so exceptional or unusual that the schedular criteria are inadequate to evaluate them. In the absence of evidence of such factors, the Board finds that criteria for submission for assignment of an extra-schedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337 (1996); Floyd v. Brown, 9 Vet. App. 88, 94-95 (1996); Shipwash v Brown, 8 Vet. App. 218, 227 (1995). Finally, as this issue deals with the rating assigned following the original claim for service connection, consideration has been given to the question of whether "staged rating," as addressed by the Court in Fenderson, would be in order. However, as noted above, inasmuch as the 50 percent evaluation reflects the highest degree of impairment shown since the date of the grant of service, and that evaluation is effective since that time, there is no basis for staged rating in the present case. ORDER As the initial 50 percent evaluation assigned for service- connected PTSD is proper, a higher evaluation is denied. REMAND Governing law and regulations provide that a proper appeal consists of a timely notice of disagreement in writing and, after a statement of the case has been furnished, a timely substantive appeal. 38 U.S.C.A. § 7105 (West 1991); 38 C.F.R. § 20.200 (1999). A substantive appeal must be filed within 60 days from the date of mailing of the statement of the case or within the remainder of the one-year period from the date of mailing of the notification of the initial review and determination being appealed, whichever period ends later. 38 U.S.C.A. § 7105 (West 1991); 38 C.F.R. § 20.302(b) (1999). As noted in the "Introduction" portion of the decision, a November 1997 decision by the RO that denied the veteran an increased evaluation for his service-connected upper strain of the dorsal and lumbar area, a notice of disagreement was received in November 1998, and a statement of the case was issued in January 1999. Further, an August 1993 RO decision denied the veteran's claims of entitlement to service connection for skin cancer, kidney stones, muscular problems other than those related to a service-connected back disability, and sinusitis, claimed as secondary to exposure to Agent Orange; a notice of disagreement was received in May 1994, and a statement of the case was issued in May 1995. However, it does not appear that the veteran filed any substantive appeal with respect to either of these issues, or that the RO considered this question during the pendency of the appeal. In June 1999, these issues were certified to the Board (see the VA Form 8 dated June 11, 1999). Thus, a remand is warrant to enable the RO to consider whether a timely substantive appeal (within the meaning of 38 C.F.R. §§ 20.200 and 20.302) was filed with respect to each of the claims remaining on appeal. This is required because the Board does not have jurisdiction to act if an appeal was not perfected with respect to each issue. See Roy v. Brown, 5 Vet. App. 554, 556 (1993); Cf. Rowell v. Principi, 4 Vet. App. 9 (1993); VAOPGCPREC 9-99. Furthermore, the RO should address this matter in the first instance, affording the veteran adequate notice and opportunity to comment on this jurisdictional question, to avoid any prejudice to the veteran. Bernard v. Brown, 4 Vet. App 384 (1993); VAOPGCPREC 9-99. Accordingly, this case is hereby REMANDED for the following action: 1. The RO should determine whether a timely substantive appeal was received as to the veteran's claims for an increased evaluation for his service-connected upper strain of the dorsal and lumbar area, as well as for his claim of entitlement to service connection for skin cancer, kidney stones, muscular problems other than those related to a service-connected back disability, and sinusitis, claimed as secondary to exposure to Agent Orange. See 38 C.F.R. §§ 20.200, 20.302, 20.303 (1999). 2. If the RO finds that any of the substantive appeals were not timely filed (or not filed at all) then the RO should notify the veteran and his representative, furnish appellate rights, and afford him the appropriate opportunity to respond. The purpose of this REMAND is to ensure that all due process requirements are met; it is not the Board's intent to imply whether the benefits requested should be granted or denied. The veteran need take no action until otherwise notified, but he may furnish additional evidence and/or argument during the appropriate time frame. See Kutscherousky v. West, 12 Vet. App. 369 (1999); Colon v. Brown, 9 Vet. App. 104, 108 (1996); Booth v. Brown, 8 Vet. App. 109 (1995); Quarles v. Derwinski, 3 Vet. App. 129, 141 (1992). This REMAND 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 Veterans Appeals 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. 1997) (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. JACQUELINE E. MONROE Member, Board of Veterans' Appeals