Citation Nr: 0004629 Decision Date: 02/23/00 Archive Date: 02/28/00 DOCKET NO. 96-26 060 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Manila, Philippines THE ISSUES 1. Entitlement to an initial rating in excess of 30 percent for neurodermatitis of the hands and elbows. 2. Entitlement to service connection for chronic bilateral eye disability. 3. Entitlement to service connection for chronic organic disability manifested by chest pain. WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD Artur F. Korniluk, Associate Counsel INTRODUCTION The veteran had active naval service from April 1964 to February 1984. This matter comes to the Board of Veterans' Appeals (Board) from Department of Veterans Affairs (VA) Manila Regional Office (RO) rating decisions which in November 1995 denied service connection for bilateral eye disability, and in October 1997 granted service connection for neurodermatitis of the hands, assigning a 10 percent rating, and denied service connection for a "chest condition." By RO rating decision in March 1999, the evaluation of the service-connected neurodermatitis of the hands and elbows was increased from 10 to 30 percent. In view of AB v. Brown, 6 Vet. App. 35, 38 (1993), the claim remains in controversy where less than the maximum available benefit is awarded. Also on appeal before the Board was a November 1995 RO rating decision which granted service connection for chronic rhinitis, assigning it a noncompensable rating. By a rating decision in July 1997, the evaluation of that disability was increased to 10 percent and, by August 1997 letter, the veteran expressed satisfaction with the 10 percent evaluation assigned his service-connected chronic rhinitis. In view of the foregoing, his claim of increased rating for chronic rhinitis is considered to have been withdrawn. 38 C.F.R. § 20.204 (1999). In his May 1996 substantive appeal, the veteran requested a Travel Board hearing but, by January 1997 letter, he withdrew his Travel Board hearing request. 38 C.F.R. § 20.704(e) (1999). FINDINGS OF FACT 1. The service-connected neurodermatitis of the hands and elbows is manifested by pain, pruritus, lesions, cracking, and bleeding of the skin, and is associated with systemic or nervous manifestations consisting of difficulty sleeping. 2. It is plausible that bilateral eye disability may be linked to the veteran's period of active service. 3. The veteran reported experiencing symptoms of recurrent chest pain during active service, but chronic organic disability manifested by chest pain was not evident in service. 4. Medical evidence does not reveal a current diagnosis of chronic organic disability, manifested by chest pain, nor does it show that the veteran's current chest pain is causally related to service, or any incident occurring therein. CONCLUSIONS OF LAW 1. The schedular criteria for a 50 percent rating for neurodermatitis of the hands and elbows have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 4.118, Diagnostic Code 7806 (1999). 2. The claim of service connection for chronic bilateral eye disability is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. The veteran has not presented a well-grounded claim of service connection for chronic organic disability manifested by chest pain. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Increased rating claim: The Board finds that the veteran's claim of a rating in excess of the currently assigned 30 percent for his service- connected neurodermatitis of the hands and elbows is well grounded, Murphy v. Derwinski, 1 Vet. App. 78 (1990), as it stems from the rating initially assigned at the time of the October 1997 grant of service connection for the disability. Shipwash v. Brown, 8 Vet. App. 218 (1995). Once determined that a claim is well grounded, VA has a duty to assist in the development of evidence pertinent to the claim. 38 U.S.C.A. § 5107(a). The Board is satisfied that all relevant facts have been properly developed, and that VA has satisfied its duty to assist. Godwin v. Derwinski, 1 Vet. App. 419 (1991). Under applicable criteria, disability ratings are determined by application of a schedule of ratings based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. VA has a duty to consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1 (1998); Peyton v. Derwinski, 1 Vet. App. 282 (1991). A claim placed in appellate status by disagreement with the initial rating award and not yet ultimately resolved is an original claim, as opposed to a new claim for increase. Fenderson v. West, 12 Vet. App. 119 (1999). On the other hand, where entitlement to compensation has already been established, disagreement with an assigned rating is a new claim for increase, based on facts different from a prior final claim. Suttmann v. Brown, 5 Vet. App. 127, 136 (1993); Proscelle v. Derwinski, 2 Vet. App. 629, 631-32 (1992) (in a claim for increased rating, appellant claims the disability has increased in severity since a prior final decision). In such claims, the present level of disability is of primary concern; although a review of the recorded history of a disability is required to make a more accurate evaluation, past medical reports do not have precedence over current findings. 38 C.F.R. § 4.2 (1999); Francisco v. Brown, 7 Vet. App. 55 (1994). Service connection for neurodermatitis of the hands was granted by rating decision in October 1997, and a 10 percent evaluation was assigned. That decision was based on the veteran's service medical records showing in-service onset of recurrent dry and scaly rashes on his hands, and post-service medical evidence diagnosing neurodermatitis of the hands. Medical records from the U.S. Naval Hospital at Subic Bay from October 1984 to September 1991 reveal, in pertinent part, October 1984 treatment for whitish discoloration, rash, and itching of the hands. On VA dermatologic examination in December 1996, there was evidence of scaly, fissuring/bleeding patches which reportedly required prolonged healing; nervous manifestation associated with the skin disorder was noted as "severe pruritus." Neurodermatitis of the hands was diagnosed. At an August 1998 RO hearing, the veteran testified that his hands were constantly itching and appeared deformed. He suggested that the service-connected dermatologic disability involving his hands was more severely disabling that the 10 percent evaluation reflected. On VA dermatologic examination in August 1998, including a review of the claims file, the veteran indicated that he experienced pain, pruritus of dorsum of the hands and elbows, cracking and bleeding of the skin, and constant lesions, noting that he treated the symptoms with various creams and ointments. On examination, there was evidence of lichenification, depigmentation, scaling, and fissuring involving the elbows area and dorsa of proximal and distal interphalangeal joints; associated systemic or nervous manifestations were noted as difficulty sleeping. Neurodermatitis of the hands and elbows was diagnosed. Currently, the veteran's service-connected neurodermatitis of the hands and elbows is rated by analogy under 38 C.F.R. Part 4, § 4.118, Diagnostic Code 7806, eczema, with exudation or constant itching, extensive lesions, or marked disfigurement, and a 30 percent evaluation is assigned. A maximum evaluation of 50 percent is warranted under the same Code if there is evidence of eczema with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or which is exceptionally repugnant. Based on the entire record, as discussed above, the Board believes that a 50 percent rating for the veteran's service- connected neurodermatitis of the hands and elbows is warranted. Objective evidence of record (most notably consisting of December 1996 and August 1998 VA dermatologic examinations reports) reveals that the skin disorder is productive of pruritus, pain, lesions, bleeding, cracking of the skin, depigmentation, and fissuring, and as indicated on VA dermatologic examination in August 1998, it is associated with systemic or nervous manifestations consisting of difficulty sleeping. Thus, the severity of the service- connected neurodermatitis of the hands and elbows, overall, more nearly approximates the rating criteria consistent with the maximum available rating of 50 percent under Code 7806. In exceptional cases where schedular ratings are found to be inadequate, an extraschedular rating commensurate with the average impairment in earning capacity due exclusively to the service-connected disability may be approved, provided the case presents an exceptional or unusual disability picture with related factors as marked interference with employment or frequent periods of hospitalization rendering impractical application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). A claim for extraschedular rating requires consideration in the first instance by the Under Secretary for Benefits or Director, Compensation and Pension Service; thus, the Board does not have jurisdiction to address § 3.321(b)(1) in the first instance. Floyd v. Brown, 9 Vet. App. 88, 94-96 (1996). Nevertheless, as noted above, VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. Schafrath, 1 Vet. App. 589. In this case, the veteran has not advanced argument which would indicate that his case is so exceptional or unusual to warrant a referral thereof to the RO for assignment of an extraschedular rating under 38 C.F.R. § 3.321(b)(1). The rating of disabilities is based on average impairment of earning capacity in a civil occupation. 38 U.S.C.A. § 1155. In cases such as this, where there is no evidence of an exceptional or unusual disability picture associated with the service-connected neurodermatitis of the hands and elbows, application of the provisions of 38 C.F.R. § 3.321(b)(1) in lieu of the regular rating criteria, is deemed inappropriate. Service connection claims: Service connection may be allowed for a chronic disability, resulting from an injury or disease, which is incurred in or aggravated by the veteran's period of active service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Service connection may also be allowed on a presumptive basis for cardiovascular- renal diseases, if the disability becomes manifest to a compensable degree within one year after the veteran's separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). Congenital or developmental defects and refractive error of the eye are not diseases or injuries within the meaning of applicable legislation. 38 C.F.R. § 3.303(c). Thus, service connection may not be granted for defects of congenital, developmental or familial origin, absent superimposed disease or injury. See VA O.G.C. Prec. Op. 82-90 (July 18, 1990), 55 Fed. Reg. 45,711 (1990). For a showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. Continuity of symptomatology is required when the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1999). The U.S. Court of Appeals for Veterans Claims (the Court) has held that lay observations of symptomatology are pertinent to the development of a claim of service connection, if corroborated by medical evidence. See Rhodes v. Brown, 4 Vet. App. 124, 126-127 (1993). The Court established the following rules with regard to claims addressing the issue of chronicity. Chronicity under the provisions of 38 C.F.R. § 3.303(b) is applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under the Court's case law, lay observation is competent. If the chronicity provision is not applicable, a claim may still be well grounded if (1) the condition is observed during service, (2) continuity of symptomatology is demonstrated thereafter and (3) competent evidence relates the present condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488, 495 (1997). A lay person is competent to testify only as to observable symptoms. A lay person is not, however, competent to provide evidence that the observable symptoms are manifestations of chronic pathology or diagnosed disability. Falzone v. Brown, 8 Vet. App. 398, 403 (1995). A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between the disability and an injury or disease incurred in service. Watson v. Brown, 4 Vet. App. 309, 314 (1994). However, service connection may be granted for a post-service initial diagnosis of a disease that is established as having been incurred in or aggravated by service. 38 C.F.R. § 3.303(d) (1999). The threshold question which must be resolved is whether the veteran has presented evidence that his claim is well grounded. See 38 U.S.C.A. § 5107(a). A well-grounded claim is a plausible claim. Murphy, 1 Vet. App. at 81. A mere allegation that a disability is service connected is not sufficient; the veteran must submit evidence in support of his claim which would justify a belief by a fair and impartial individual that the claim is plausible. In order for a claim to be well grounded, there must be competent evidence of current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the in- service injury or disease and a current disability (medical evidence). See Caluza v. Brown, 7 Vet. App. 498 (1995); see also, Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Where the determinative issue involves a question of medical diagnosis or causation, competent medical evidence to the effect that the claim is plausible or possible is required to establish a well-grounded claim. Libertine v. Brown, 9 Vet. App. 521 (1996); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). A lay person is not competent to make a medical diagnosis or to relate a medical disorder to a specific cause. See Grivois v. Brown, 6 Vet. App. 136, 140 (1994), citing Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Therefore, lay statements regarding a medical diagnosis or causation do not constitute evidence sufficient to establish a well-grounded claim under 38 U.S.C.A. § 5107(a). See Grottveit, 5 Vet. App. at 93. The veteran's service medical records reveal a June 1964 report of left eye soreness; on examination, it was indicated that he had early Meibomian gland infection of the left upper eyelid. On medical examination in August 1969 and October 1971, there was no evidence of disability or impairment of the eyes. In August 1969, uncorrected vision was 20/20, bilaterally. In August 1972, uncorrected vision was 20/15 in the right eye, and 20/10 on the left. In June 1980, he was treated for nasal congestion and, on examination, there was evidence of mild epiphora, bilaterally. In September 1981, he complained of soreness and difficulty opening his eyes in the morning, feeling a sensation of foreign bodies in the eyes; on examination, his vision was 20/20 in the left eye, and 20/25 on the right; there was extreme vascular congestion of both conjunctiva, but there were no foreign bodies or corneal abrasion; possible viral conjunctivitis was diagnosed. On medical examination in April 1982, uncorrected distant vision was 20/50 in the right eye (correctable to 20/40), and 20/17 on the left (both corrected and uncorrected); uncorrected near vision was 20/400 on the right (correctable to 20/200), and 20/200 on the left (correctable to 20/20). In May 1982, he complained of trouble with near vision; on examination, his vision was impaired but there was no evidence of ocular trauma; clinical impression was presbyopia with narrow "<'s." In January 1984, he reported blurry distant and near vision. On medical examination in January 1984, his uncorrected distant vision was 20/20, bilaterally; uncorrected near vision was 20/200, bilaterally (vision was correctable to 20/50 on the right and to 20/25 on the left); on examination, it was noted he had visual acuity defect for near vision. The service medical records reveal intermittent reports of chest pain. In September 1980, the veteran complained of left-sided chest pain; on examination, viral upper respiratory infection was diagnosed. In November 1980, he complained of right-sided chest pain, increasing with movement and deep inspiration, but he denied shortness of breath or change in pain on exertion; on examination, the chest was mildly tender to palpation on the right; electrocardiogram (ECG) study showed mild left axis deviation but was otherwise normal; musculoskeletal chest pain/costochondritis was diagnosed. In July 1981, he reported a 3-day history of right-sided chest pain; on examination, there was no wheezing or rales, and he had no history of cardiac problems; possible right-sided muscle strain was diagnosed. ECG study performed in conjunction with medical examination in April 1982 was normal. In November 1983, he complained of chest pain on inspiration; ECG study showed normal sinus bradycardia; the clinical impression was indigestion. ECG study in January 1984 was normal. Medical records from the U.S. Naval Hospital at Subic Bay from October 1984 to September 1991 reveal intermittent reports of chest pain and numerous ophthalmologic consultations for impaired vision. In February 1985, apparent macular degeneration, based on history of onset (of vision impairment), was diagnosed. In March 1989, he reported chest pain, and an unconfirmed diagnosis of angina was indicated. On VA medical examination in October 1995, the veteran reported experiencing blurred vision. On examination, uncorrected vision was 20/70, bilaterally (it was correctable to 20/25); fundoscopic examination was normal and there was no evidence of visual field deficit. Bilateral presbyopia was diagnosed. On VA examination in October 1995, the veteran indicated that he experienced recurrent chest pain since 1980, noting that the pain was relived by rest. Examination of cardiovascular and pulmonary systems revealed no abnormality, and no pertinent diagnoses were indicated. Chest X-ray study revealed arteriosclerotic thoracic aorta but was otherwise negative. In January 1997, P. Corpus, M.D., indicated that he treated the veteran for frequent respiratory infections (bronchitis), in pertinent part, manifested by chest pain. At a January 1997 RO hearing, the veteran testified that he did not experience any eye/vision problems prior to active service, and he suggested that his vision impairment had its onset in service. At an August 1998 RO hearing, the veteran testified that he experienced symptoms of recurrent chest pain during active service and thereafter, believing that service connection was therefore warranted for disability manifested by chest pain. On VA cardiovascular examination in August 1998, including a review of the claims file, the veteran indicated that he experienced recurrent chest pains since service, noting the pain occurred once or twice per month during service in 1983; he denied a history of cardiac surgery. Reportedly, an ECG study in 1982 revealed sinus bradycardia and possible angina. He indicated that he experienced dyspnea when walking a distance greater than one kilometer or walking up to the second floor of his house. On examination, there was no evidence of congestive heart failure; X-ray study of the chest showed arteriosclerotic aorta; ECG study was normal; 2D echo showed normal a left ventricle with normal systolic function. The examiner indicated that there was no ischemic heart disease and ECG and 2D echo studies were normal. In an October 1998 addendum to the August 1998 VA cardiovascular examination report, the examiner opined that the chest pain, bradycardia, or angina which were evident during the veteran's service (in 1983) were probably due to "some other cause" such as a result of pulmonary or musculoskeletal diseases, other gastrointestinal disorder or anxiety states. If it (chest pain, angina, or bradycardia) was cardiac in origin, the symptoms would have progressed and this could be seen on an X-ray, ECG, and 2D echo. Based on the foregoing, the Board finds that the claim of service connection for chronic bilateral eye disability is well grounded in that it is plausible and capable of substantiation. 38 U.S.C.A. § 5107(a). This finding is based on the veteran's assertion that he experienced eye problems including impaired vision since active service, supported by medical evidence showing that his vision impairment had its onset in service. Although refractive error of the eye is not a disease or injury within the meaning of applicable legislation (38 C.F.R. § 3.303(c)) and service connection may not be granted for defects of congenital, developmental or familial origin, absent superimposed disease or injury, it is not clear in this case whether the veteran has a chronic disability of the eye for which service connection may be awarded; moreover, if his current bilateral eye "condition" consists exclusively of refractive error, it is not clear whether such impairment was aggravated during active service. The Board stresses that the veteran received intermittent treatment for various eye problems in service, that his vision deteriorated in service, and that his vision is currently impaired (and presbyopia is diagnosed). With regard to the claim of service connection for chronic organic disability, manifested by chest pain, the Board finds that the claim is not well grounded. Although he is shown to have reported recurrent symptoms of chest pain during service and thereafter, organic disease shown to cause chronic chest pain was not evident in service; an organic disease shown to cause chest pain, of service origin, has never been identified on examination after service separation. Although Dr. Corpus indicated in January 1997, that the veteran had frequent respiratory infection manifestations which included chest pain, he did not suggest that the veteran had chronic organic disability, manifested by chest pain of service origin. The Board notes that ECG study in November 1980 showed mild left axis deviation, a study in November 1983 showed normal mean bradycardia, and that an unconfirmed diagnosis of angina was indicated during post-service medical treatment in March 1989. However, the veteran was examined by VA in August 1998, and his report of medical history including bradycardia and angina was considered by the examiner. On examination and review of the medical history, the examiner indicated that clinical studies for cardiac disability were normal, but they would not have been if the cause for chest pain, angina, or bradycardia were cardiac in origin. The Board notes that arteriosclerotic aorta was shown on VA cardiovascular examination in October 1995 and August 1998, but the examiners did not suggest that it was etiologically related to active service or that it was productive of chronic chest pain. Moreover, various possible illnesses and disability have been suggested to include symptoms of chest pain (see, e.g. Dr. Corpus' January 1997 opinion and October 1998 addendum to August 1998 VA cardiovascular examination report). However, a confirmed medical diagnosis of chronic organic disability manifested by chronic chest pain has not been shown by competent medical evidence. Thus, the veteran's claim must be denied as not currently well grounded. See Rabideau, 2 Vet. App. 14; see also Brammer v. Derwinski, 3 Vet. App. 223 (1992) (in the absence of proof of a present disability there can be no valid claim); Sanchez- Benitez v. West, No. 97-1948 (U.S. Vet. App. Dec. 29, 1999) (pain alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection may be granted). The Board is mindful of the veteran's contention that he has experienced symptoms of recurrent chest pain since active service. While the credibility of his contention is not challenged (and is in fact supported by the medical evidence of record, as discussed above) and his competence to testify with regard to observable symptoms of recurrent pain is noted, consistent with Cartright v. Derwinski, 2 Vet. App. 24 (1991), he is simply not competent, as a layman, to render a medical diagnosis of chronic organic disability manifested by chest pain, or to provide an etiological link between in- service symptoms and any current symptomatology. See Grivois, 6 Vet. App. at 140, citing Espiritu, 2 Vet. App. at 494. Finally, the evidence of record does not show, nor is it contended by or on behalf of the veteran, that the claimed disability manifested by chest pain is related to combat service; thus, 38 U.S.C.A. § 1154(b) is inapplicable to such claim. If a claim is not well grounded, the Board does not have jurisdiction to adjudicate the claim. Boeck v. Brown, 6 Vet. App. 14 (1993). A not well-grounded claim must be denied. Edenfield v. Brown, 8 Vet. App. 384 (1995). If the initial burden of presenting evidence of a well-grounded claim is not met, VA does not have a duty to assist the veteran in the development of the claim. 38 U.S.C.A. § 5107(a); Murphy, 1 Vet. App. at 81-82. The RO has advised the veteran of the evidence necessary to establish a well-grounded claim, and he has not indicated the existence or availability of any medical evidence (not already of record) that would well ground his claim of service connection for chronic organic disability manifested by chest pain. Epps v. Brown, 9 Vet. App. 341, 344 (1996), aff'd sub nom. Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). ORDER A rating of 50 percent for the service-connected neurodermatitis of the hands and elbows is granted, subject to the law and regulation governing the payment of monetary awards. The claim of service connection for chronic bilateral eye disability is well grounded. Service connection for chronic organic disability manifested by chest pain is denied. REMAND If a claim is well grounded, VA has a duty to assist the veteran in the development of facts pertinent to his claim, see 38 U.S.C.A. § 5107(b), which includes a thorough VA examination. Hyder v. Derwinski, 1 Vet. App. 221 (1991); Green v. Derwinski, 1 Vet. App. 121 (1991). As discussed above, on VA medical examination in October 1995 presbyopia was diagnosed. Although service connection may not be allowed for refractive error of the eye, he is shown to have received medical treatment for various eye problems in service and his vision was impaired both during service and thereafter. Thus, the Board believes that clarification should be sought, including a review of the veteran's entire claims file to determine the nature and etiology of any chronic bilateral eye disability which may now be present. See Suttmann v. Brown, 5 Vet. App. 127, 137 (1993). It should be noted that neither the veteran nor the Board may make medical determinations. Grottveit v. Brown, 5 Vet. App. 91 (1993). In view of the foregoing, the claim of service connection for chronic bilateral eye disability is REMANDED for the following action: 1. The RO should obtain from the veteran the name, address, and approximate date of treatment of any medical care provider who treated him for an eye disorder since service. After any necessary information and authorizations are obtained from the veteran, any such pertinent records of treatment, VA or private, (not already of record) should be obtained and added to the claims folder. 2. Then, the veteran should be afforded a VA ophthalmologic examination to determine the nature and etiology of all eye disabilities now present. The claims folder must be made available to the examiner for review in conjunction with this request for medical opinion, and any report must reflect the examiner's review of pertinent evidence in the claims folder. While refractive error of the eye is not considered a disease or injury for VA compensation purposes (38 C.F.R. § 3.303(c)), a definitive diagnosis is imperative; thus, the examiner should be requested to provide an opinion as to whether it is as likely as not that any other eye disability found is causally related to service. To the extent possible, the examiner should be asked to comment on any in-service eye pathology which may be distinguished from post-service pathology; if so, the examiner should explain such distinction. If any of the foregoing cannot be determined, then that should be stated for the record. 3. The RO should carefully review the examination report and the other development requested above to ensure compliance with this remand. If any development requested above is not accomplished, remedial action should be undertaken. See Stegall v. West, 11 Vet. App. 268 (1998). If the benefit sought on appeal is not granted, the veteran should be provided a supplemental statement of the case and afforded an opportunity to respond. The case should then be returned to the Board for review. The veteran has the right to submit additional evidence and argument on the matter remanded to the RO. Kutscherousky v. West, 12 Vet. App. 369 (1999). J. F. Gough Member, Board of Veterans' Appeals