Citation Nr: 0004468 Decision Date: 02/18/00 Archive Date: 02/23/00 DOCKET NO. 97-22 373 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for a right knee disorder. 2. Entitlement to service connection for a left knee disorder. 3. Entitlement to service connection for bilateral plantar fasciitis. 4. Entitlement to an increased (compensable) evaluation for a right shoulder disability. 5. Entitlement to an increased (compensable) evaluation for a mitral valve prolapse with chest pain disability. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD M. Hannan, Counsel INTRODUCTION The appellant had active service in the Army from July 1974 to July 1994, when he retired. This case comes to the Board of Veterans' Appeals (Board) on appeal from rating decisions issued by the Montgomery, Alabama Regional Office (RO) of the Department of Veterans Affairs (VA) which, in part, denied entitlement for right and left knee disorders and bilateral plantar fasciitis, as well as entitlement to compensable evaluations for cardiac and right shoulder disabilities. In October 1999, a Travel Board hearing was held in Montgomery before Michael D. Lyon, who is the Board Member making this decision and who was designated by the Chairman to conduct that hearing, pursuant to 38 U.S.C.A. § 7102. A transcript of the hearing testimony is in the claims file. The Board notes that the RO issued a rating decision, in April 1999, which increased the evaluation for the appellant's headache disability to 10 percent, but not more. Because the appellant has apparently neither initiated nor completed the procedural steps necessary for an appeal as to this issue, the Board has not included it in its consideration of the claims on appeal. The Board also notes that the appellant has repeatedly referred to having arthritis of the left foot that was diagnosed in-service; the service medical records include a September 1987 x-ray report that states arthritic changes in the left foot about the first metatarsophalangeal joint were noted. The matter is referred to the RO for appropriate action. The issue of entitlement to a compensable evaluation for the mitral valve disability will be addressed in the REMAND section which follows the ORDER section in the decision below. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appellant's appeal as to these issues has been obtained by the RO. 2. The evidence does not establish that the appellant currently has any disability of either knee that is related to service. The appellant has submitted no evidence showing any continuing or existing right knee or left knee pathology that is related to service, nor has he submitted any evidence showing a current diagnosis or treatment for any right knee or left knee disorder. 3. The appellant also has not submitted medical evidence of any nexus between any alleged knee disorder and any disease or injury incurred during service. 4. The evidence does not establish that the appellant currently has any plantar fasciitis of either foot that is related to service. The appellant's isolated in-service instances of plantar fasciitis have not been shown to have been other than acute and transitory. The appellant has submitted no evidence showing any continuing or existing left or right plantar fasciitis that is related to service, nor has he submitted any evidence showing a current diagnosis or treatment for any left or right plantar fasciitis. 5. The appellant's right shoulder disability is currently manifested by subjective complaints of limited motion with pain on use and objective medical evidence of crepitus and an audible pop, as well as a slightly limited range of shoulder motion. CONCLUSIONS OF LAW 1. The appellant has not submitted evidence of a well- grounded claim for service connection for a right knee disorder or for a left knee disorder. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. §§ 3.303 (1999). 2. The appellant has not submitted evidence of a well- grounded claim for service connection for bilateral plantar fasciitis. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. §§ 3.303 (1999). 3. The criteria for an evaluation of 10 percent, but not more, for a right shoulder disability have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 3.102, Part 4, §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.40, 4.45, 4.55, 4.59, 4.71, 4.71a, Diagnostic Codes 5003-5024, 5299-5200-5203 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS For purposes of consideration of a claim for VA benefits, a claimant has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claim is well grounded. 38 U.S.C.A. § 5107(a). As defined by the United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (hereinafter Court), a well-grounded claim is one which is plausible, meritorious on its own, or capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990); Tirpak v. Derwinski, 2 Vet. App. 609 (1992). Evidentiary assertions by the veteran must be accepted as true for the purposes of determining whether a claims is well-grounded, except where the evidentiary assertions is inherently incredible or is beyond the competence of the person making the assertion. See King v. Brown, 5 Vet. App. 19 (1993). These considerations pave the way for the analysis below. I. Service Connection Claims. Service connection may be established for disability resulting from personal injury or disease incurred in or aggravated by military service. 38 U.S.C.A. §§ 101, 106, 1110, 1131. In addition, service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). A claim for service connection must be accompanied by evidence establishing that the veteran currently has the claimed disability. See Chelte v. Brown, 10 Vet. App. 268 (1997); Rabideau v. Derwinski, 2 Vet .App. 141 (1992); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (there can be no valid claim "in the absence of proof of a present disability"); Caluza v. Brown, 7 Vet. App. 498 (1995). The appellant testified at his personal hearing, conducted at the RO in August 1997, that his knees stiffened up daily and that his feet swell. See RO Hearing Transcript p. 3. He also testified that he was given pain medication in-service for his knees and his feet and that he was given a device to put into his shoes to support his heels. See RO Hearing Transcript p. 5. The appellant further stated that he did not suffer any specific injury to his knees in-service and that he had not received any treatment for the knees or the feet since his discharge from service. See RO Hearing Transcript pp. 6-7. The appellant testified at his October 1999 Travel Board hearing that he began having problems with his knees in the 1980s, that he was placed on profile due to his knees, and that he was diagnosed with plantar fasciitis in 1987. See Travel Board Hearing Transcript pp. 4-7. He also testified that he was not told of any arthritic changes in his knees while in-service and that he was given pain medication in- service for knee and foot pain. See Travel Board Hearing Transcript pp. 11-15. Review of the service medical records reveals that there are no complaints concerning any right or left knee injury, nor is there any record of any diagnosed right or left knee pathology. The appellant was treated, in 1987, and 1988, for bilateral plantar fasciitis. However, no treatment for plantar fasciitis is of record after that. The appellant underwent an annual examination in September 1991, and after he reported foot trouble, the examining physician noted that the appellant had been diagnosed with plantar fasciitis in 1987, and that there was no trouble at present and no sequelae. The appellant underwent a retirement examination in February 1994; he complained of swollen painful joints and foot trouble, namely foot swelling and knee stiffness. On examination, the physician noted that the feet were nontender and without edema and that the knees demonstrated a full range of motion without any ligament laxity. The appellant underwent a VA joint examination in September 1997. The examiner stated that there was no swelling of the knees and that no knee impairment was detected. Radiographic examination revealed no skeletal abnormality in either knee. The examiner rendered a diagnosis of history of knee stiffness with no loss of function due to pain in either joint. The appellant also underwent a VA foot examination in September 1997. He complained of bilateral foot swelling. On physical examination, the appearance of both feet was noted to be excellent and their function was noted to be fine. No deformity was observed and the appellant was noted to walk without a limp and without the use of any cane or appliance. His gait was described as jaunty. The examiner stated that there were no secondary skin or vascular changes; the appellant's feet were warm and dry with good pulses. The examiner rendered a diagnosis of history of plantar fasciitis, inactive at the present time. As previously noted, evidentiary assertions by the veteran must be accepted as true for the purposes of determining whether a claim is well-grounded, except where the evidentiary assertion is inherently incredible or is beyond the competence of the person making the assertion. See King v. Brown, 5 Vet. App. 19 (1993). In this case, the evidentiary assertions that he suffered from chronic knee pathology in-service and that he currently suffers from chronic plantar fasciitis are beyond the competence of the appellant. Also as previously noted, where the determinative issue involves either medical etiology or a medical diagnosis, competent medical evidence is required to fulfill the well- grounded claim requirement of 38 U.S.C.A. § 5107(a). See Lathan v. Brown, 7 Vet. App. 359, 365 (1995) (citing Grottveit v. Brown, 5 Vet. App. 91, 93 (1993)); see also Moray v. Brown, 5 Vet. App. 211, 214 (1993) (laypersons are not competent to offer medical opinions and, therefore, those opinions cannot serve as the basis for a well-grounded claim); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). This means that competent medical evidence to the effect that the claim is possible or plausible is required. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). A claimant does not meet this burden by merely presenting his lay opinion because he is not a medical health professional and does not constitute competent medical authority. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The same is true of a claimant's representative. Viewing the evidence in a light most favorable to the appellant, the evidence of record indicates that the appellant never received any in-service treatment for any diagnosed pathology of either knee. The existence of a left knee disorder has not been shown; the existence of a right knee disorder has not been shown. The appellant has not provided any medical evidence, except the statement of his opinions contained in his written statements, to establish that he currently suffer from any knee disorder that is related to service, and his statements are not competent evidence as to medical diagnosis or causation. Moray v. Brown, 5 Vet. App. 463 (1993), Espiritu v. Derwinski, 2 Vet. App. 492 (1992). While the appellant did receive treatment for plantar fasciitis when he was in the Army, there is no medical evidence of record to establish that it was other than acute and transitory. He has presented no evidence that any plantar fasciitis is now present, or that any residuals of plantar fasciitis are now present. No current plantar fasciitis has been clinically demonstrated in the evidence of record. Furthermore, the appellant has not indicated that there is any interference with his current activities or his mobility, just that he allegedly suffers from swelling and pain. The appellant has not provided any medical evidence, except the statement of his opinions contained in his testimony and his written statements to establish that he suffers from any right or left disability or bilateral foot disability and his statements are not competent evidence as to medical diagnosis or causation. Moray v. Brown, 5 Vet. App. 463 (1993), Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. § 1110, 1131; see Degmetich v. Brown, 104 F. 3d 1328 (1997) (holding that Secretary's and Court's interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary and therefore the decision based on that interpretation must be affirmed). The veteran has the burden to bring evidence to render plausible that an underlying disability, which can account for symptoms alleged, currently exists or that the symptoms themselves are medically verifiable and constitute disabilities for which he is claiming service connection in order to establish a well grounded claim. There is no medical evidence in this case which indicates that the appellant incurred a knee injury or otherwise suffered from any diagnosed knee pathology in-service or that the appellant currently suffers from any plantar fasciitis or that there is a service relationship to either condition, and such would be required to make the claims plausible. Grottveit v. Brown, 5 Vet. App. 91 (1993). Furthermore, a claim for service connection must be accompanied by evidence establishing that the veteran currently has the claimed disability. See Chelte v. Brown, 10 Vet. App. 268 (1997); Rabideau v. Derwinski, 2 Vet. App. 141 (1992); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (there can be no valid claim "in the absence of proof of a present disability"); Caluza v. Brown, 7 Vet. App. 498 (1995). In this case, there is no medical evidence of record that demonstrates the existence of any right or left knee pathology or the current existence of any plantar fasciitis or residuals of plantar fasciitis. There is no medical evidence of record that indicates that the stiffness and pain complained of by the appellant constitute clinical pathology or a disability, as opposed to merely subjective symptomatology. Thus, the claims for service connection for right and left knee disorders and bilateral plantar fasciitis must be denied as not well-grounded. Where there is no medical evidence demonstrating that the claimed disorder currently exists, the claim is not well- grounded. See Montgomery v. Brown, 4 Vet. App. 343 (1993). Because the appellant's claims are not well-grounded, the VA is under no duty to assist the appellant in further development of the claim. 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78 (1990). Where a claim is not-well grounded it is incomplete, and the VA is obliged under 38 U.S.C.A. § 5103(a) to advise the claimant of the evidence needed to complete his application. Robinette v. Brown, 8 Vet. App. 69, 77-80 (1995). The Board finds in this case that the RO fulfilled its obligation to the appellant in its March 1995 rating decision and in its February 1998 Supplemental Statement of the Case (SSOC) in which the appellant was informed that his service medical records were negative for any clinical evidence of any permanent bilateral knee or foot pathology. Thus, the Board concludes that the notice required in Robinette has been satisfied. Moreover, there is no indication that there are any available records which would make the claims well- grounded. Since the appellant has failed to present competent medical evidence that he currently suffers from any bilateral knee or foot disability, and since he has failed to present competent medical evidence that his claims of bilateral knee and foot disorders are plausible, that is, he has failed to present medical evidence that links the alleged bilateral knee and foot disorders to service, the claims for service connection for a right knee disorder, a left knee disorder and bilateral plantar fasciitis must be denied as not well-grounded. Dean v. Brown, 8 Vet. App. 449 (1995). II. Increased Evaluation Claim. The appellant's right shoulder claim is well-grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is plausible. The evidence on file includes service medical records, reports of VA examinations and transcripts of the appellant's personal and Travel Board hearings. All relevant facts have been properly developed and no further assistance is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). Disability ratings are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Furthermore, 38 C.F.R. § 4.31 provides that in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant on motion. The Board notes that disability of the musculoskeletal system is the inability to perform normal working movement with normal excursion, strength, speed, coordination, and endurance, and that weakness is as important as limitation of motion, and that a part which becomes disabled on use must be regarded as seriously disabled. However, a little-used part of the musculoskeletal system may be expected to show evidence of disuse, through atrophy, for example. 38 C.F.R. § 4.40. The provisions of 38 C.F.R. §§ 4.45 and 4.59 also contemplate inquiry into whether there is limitation of motion, weakness, excess fatigability, incoordination, and impaired ability to execute skilled movements smoothly, and pain on movement, swelling, deformity, or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing, and weight-bearing are also related considerations. The appellant testified at his August 1997 personal hearing at the RO that he was right-handed and that he suffered from pain in the right shoulder anytime he raised his right arm. He further stated that that pain restricted his activities and that he had difficulty participating in any activity that required fast movements or strenuous lifting. See RO Hearing Transcript pp. 1-3. The appellant subsequently testified at his October 1999 Travel Board hearing that the motion in his right shoulder was very limited; that there was an audible pop anytime he raised his arm; that he was unable to reach or do work above his head; that his shoulder bothered him after use; and that it was the calcification in the joint that caused the pain and limitation of motion. See Travel Board Hearing Transcript pp. 3 and 9-11. The appellant underwent a VA joint examination in September 1997. He complained of his right shoulder bothering him intermittently. On physical examination, no swelling or deformities were noted. Crepitus of the right shoulder was noted and the examiner described hearing an audible pop . Radiographic examination revealed no skeletal abnormality and the joint space was preserved. The examiner diagnosed a history of calcinosis of the right shoulder and stated that the appellant demonstrated a slight restriction of motion of the right shoulder. There is no specific diagnostic code for calcinosis. VA regulations provide that when an unlisted condition is encountered it is permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. Traumatic arthritis is to be rated as degenerative arthritis. Degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint involved. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71, Diagnostic Codes 5003, 5010. The movement of the shoulder and arm joint is covered in the regulations by Diagnostic Codes 5200 to 5203. In addition, bursitis, synovitis and periostitis, are to be evaluated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. Part 4, Diagnostic Codes 5003-5019, 5020, 5022. Where there is x-ray evidence of arthritis, and limitation of motion but not to a compensable degree, a 10 percent rating can be assigned for such major joints. Id. Under the applicable provisions, a 30 percent for the major extremity is warranted for favorable ankylosis of the scapulohumeral articulation. Ankylosis is considered to be favorable when abduction is possible to 60 degrees and the individual can reach his or her mouth and head. 38 C.F.R. § 4.71a, Diagnostic Code 5200. A 20 percent evaluation may be warranted for limitation of motion of the major or the minor arm when motion is possible to the shoulder level or to midway between the side and shoulder level. Diagnostic Code 5201. Normal range of motion for the shoulder is as follows: forward elevation (flexion) to 180 degrees; abduction to 180 degrees; internal rotation to 90 degrees; and external rotation to 90 degrees. 38 C.F.R. § 4.71, Plate I. See also Lineberger v. Brown, 5 Vet. App. 367 (1993) (pursuant to 38 C.F.R. § 4.71, Plate I, normal range of flexion (forward elevation) and abduction of the shoulder is to 180 degrees). In addition, a 20 percent evaluation may be warranted for malunion of the humerus of the major or minor upper extremity with either moderate or marked deformity. A 20 percent evaluation is also warranted for infrequent episodes of dislocation of the scapulohumeral joint of the major or the minor upper extremity with guarding of movement only at the shoulder level. Diagnostic Code 5202. Finally, malunion of the clavicle or scapula, or nonunion without loose movement, warrants a 10 percent evaluation for the major or the minor extremity. A 20 percent evaluation requires nonunion with loose movement or dislocation. These disabilities may also be rated on the basis of impairment of function of the contiguous joint. Diagnostic Code 5203. The appellant has a medically demonstrated slight impairment of the right shoulder range of motion. The Board has also acknowledged the appellant's complaints of pain on use. See DeLuca v. Brown, 8 Vet. App. 202 (1995). Taking into consideration the provisions of 38 C.F.R. §§ 4.7, 4.10 and 4.40, and giving the appellant the benefit of the doubt, such slight limitation of the right shoulder motion coupled with the clinical finding of crepitus with an audible pop and his complaints of pain with resultant limitation of use, the Board finds that the appellant's symptomatology more closely approximates impairment of function of the contiguous joint. See 38 C.F.R. § 4.71a, Diagnostic Code 5299-5203. It is the conclusion of the Board, after reviewing the most recent medical records associated with the claims file, that a schedular rating in excess of 10 percent is not warranted. The appellant has complaints of pain on use and limitation of motion, and the most recent VA examination report, while demonstrating the presence of crepitus and an audible pop, does not demonstrate sufficient evidence of limitation of motion of the right shoulder to warrant an increased evaluation. Only slight impairment was noted on examination. Therefore, the appellant's complaints of pain and functional impairment, when taken together with the crepitus and slight limitation of motion without other clinical findings, more nearly approximate a 10 percent evaluation under Diagnostic Code 5299-5203, but not more. The Board finds, based on the evidence of record, that the objective findings of the appellant's right shoulder disability do warrant a 10 percent evaluation, but not more, under Diagnostic Codes 5200, 5201, 5202 or 5203. Specifically, there is no evidence that the appellant suffers from ankylosis of the scapulohumeral articulation; therefore, Diagnostic Code 5200 is not for application. Further, limitation of motion of the arm at the shoulder level is slightly limited; this is not severe enough to meet the standard of Diagnostic Code 5201. In addition, the September 1997 radiology report showed no bony abnormalities of the right shoulder. Therefore, the Board can find no basis under the applicable Diagnostic Codes to grant an evaluation in excess of 10 percent based on bony impairment of the humerus, clavicle or scapula. ORDER Well-grounded claims for entitlement to service connection for a right knee disorder, a left knee disorder and bilateral plantar fasciitis not having been submitted, those claims are denied. Entitlement to an evaluation of 10 percent, but not more, for a right shoulder disability is granted, subject to the law and regulations governing the award of monetary benefits. REMAND The appellant's assertions, as to the mitral valve prolapse increased (compensable) rating issue, constitute a well- grounded claim within the meaning of 38 U.S.C.A. § 5107(a), requiring the VA to fulfill the statutory duty to assist the veteran in developing all facts relevant to the claim. Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). The appellant has come before the VA claiming that his service- connected mitral valve condition is underrated. During the course of the appellant's appeal to the Board, the disability criteria under which his heart disability was rated was changed. Pursuant to the holding in Karnas v. Derwinski, 1 Vet. App. 308 (1991), the appellant is entitled to have his claim considered under these new criteria, and have the rating criteria most favorable to his claim applied. In reviewing the claim, the Board notes that the RO has attempted to do this. However, under the new diagnostic criteria found at 38 C.F.R. Part 4, Diagnostic Code 7016 and 7000, a veteran's disability will be measured and rated in relation to METs. A MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, as it is in this situation, and a laboratory determination of METs by exercise testing cannot be accomplished for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. In reviewing the various cardiology examination reports that appear in the appellant's claim file, a measurement of METs does not appear to have been accomplished. The Board must have these measurements before it can issue a decision on the merits of the claim. Thus, the claim is remanded to the RO for the purpose of obtaining a new examination and the MET scores calculated. Accordingly, this case is REMANDED to the RO for the following actions: 1. The RO should arrange for a comprehensive VA cardiovascular examination to determine the current severity of the appellant's service- connected mitral valve prolapse, and to obtain information which will provide for its evaluation under the new rating criteria for cardiovascular disorders. All indicated testing in this regard should be accomplished and all findings should be type-written and reported in detail. The examining physician should be provided with a copy of the new rating criteria for the cardiovascular system, including Diagnostic Code 7000 and 7016, effective on January 12, 1998, as well as a copy of the criteria in effect prior to that date. The complete claims file, including a copy of this remand order, should be reviewed by the examiner. Following examination of the appellant and review of the claims file, the physician should comment as to the following: (a) Whether the appellant suffers from fatigue, dizziness, syncope, weakness or shortness of breath as a result of his service-connected heart disease; (b) Whether there is evidence of a definitely enlarged heart, diastolic murmur or arrhythmias; (c) Whether the appellant is currently having angina, and, if so, the severity thereof; (d) Whether his heart disease is such that more than light manual labor is precluded; and (e) Whether his heart disease is such that more than sedentary employment is precluded. The examiner also must indicate the level of metabolic equivalent (MET) that the appellant is capable of, and comment on whether there is associated left ventricular dysfunction, dyspnea, fatigue, angina, dizziness or syncope. A complete rationale for any opinion expressed must be provided. 2. The RO should review the claims file and ensure that all of the foregoing development actions have been conducted and completed in full. If any development is incomplete, appropriate corrective action is to be implemented. Specific attention is directed to the examination report. If the report does not include all test reports, special studies or fully detailed descriptions of all pathology or adequate responses to the specific opinions requested, the report must be returned to the examiner for corrective action. 38 C.F.R. § 4.2. "If the [examination] report does not contain sufficient detail it is incumbent upon the rating board to return the report as inadequate for evaluation purposes." Green v. Derwinski, 1 Vet. App. 121, 124 (1991); Abernathy v. Principi, 3 Vet. App. 461, 464 (1992); and Ardison v. Brown, 6 Vet. App. 405, 407 (1994). 3. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). 4. Following completion of the requested development, the RO should proceed with any additional appropriate development and then the RO should readjudicate the appellant's claim of entitlement to an increased rating with application of all applicable laws and regulations, to include consideration of both old and new rating criteria for cardiovascular disorders. The RO should also give specific consideration as to whether the matter should be referred for the assignment of an extraschedular evaluation. 38 C.F.R. § 3.321(b)(1). 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. When this development has been completed, and if the benefits sought are not granted, the case should be returned to the Board for further appellate consideration, after compliance with appropriate appellate procedures, including issuance of a supplemental statement of the case. It is requested that the supplemental statement of the case specifically set forth the reasons and bases for the decision. The Board intimates no opinion, either legal or factual, as to the ultimate disposition of this appeal. No action by the appellant is required until he receives further notice. MICHAEL D. LYON Member, Board of Veterans' Appeals