Citation Nr: 0001096 Decision Date: 01/13/00 Archive Date: 01/27/00 DOCKET NO. 96-13 655A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUES 1. Entitlement to service connection for residuals of a head injury. 2. Entitlement to service connection for hearing loss. 3. Entitlement to service connection for an injury to the neck and shoulders. 4. Entitlement to service connection for a right hand injury. 5. Whether the veteran has submitted new and material evidence to reopen a claim of entitlement to service connection for a right knee disability. 6. Whether the veteran has submitted new and material evidence to reopen a claim of entitlement to service connection for a right foot disability. 7. Whether the veteran has submitted new and material evidence to reopen a claim of entitlement to service connection for a psychiatric disability. REPRESENTATION Appellant represented by: Kentucky Division of Veterans Affairs WITNESSES AT HEARINGS ON APPEAL Appellant, Spouse and J.B. ATTORNEY FOR THE BOARD L. J. Wells-Green, Counsel INTRODUCTION The veteran served on active duty from June 1961 to March 1962. This matter comes to the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appellant's appeal has been obtained. 2. The claims of entitlement to service connection for residuals of a head injury, injury to the neck and shoulders and a right hand injury are not plausible. 3. The claim of entitlement to service connection for hearing loss is plausible. 4. In a March 1991 rating decision, the RO denied the veteran's claims for service connection for a right knee disability, a right foot disability and a psychiatric disability; the veteran did not appeal the rating decision. 5. The evidence received since the March 1991 denial includes evidence, which is so significant that it must be considered in order to fairly decide the merits of the claim for service connection for right knee, right foot and psychiatric disabilities. 6. The evidence does not provide a nexus between an inservice injury and the claimed right knee, right foot and psychiatric disabilities. CONCLUSIONS OF LAW 1. The claims for service connection for residuals of a head injury, injury to the neck and shoulder, and a right hand injury are not well grounded. 38 U.S.C.A. § 5107(a)(West 1991). 2. The claim for service connection for hearing loss is well grounded. 38 U.S.C.A. § 5107(a)(West 1991). 3. New and material evidence to reopen the veteran's claims for service connection for right knee, right foot and psychiatric disabilities has been submitted, and the claims are reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a)(1999). 4. The claims for service connection for a right knee, right foot and psychiatric disabilities are not well grounded. 38 U.S.C.A. § 5107(a)(West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Factual Background The veteran's service medical records show that he injured his right hand in August 1961. X-ray studies of the hand were negative. In September 1961 he complained of stiffness, swelling and painful joints. Although earlier testing for rheumatoid arthritis was weakly reactive, later tests were negative. He continued to be diagnosed with early arthritis in an October 1961 treatment record. In February 1962, the veteran was diagnosed with a chronic moderate passive- aggressive reaction. At the time of his February 1962 separation examination, the veteran indicated that he had swollen or painful joints, frequent or severe headaches, dizziness or fainting spells, arthritis or rheumatism, painful or "trick" shoulder and foot trouble. He denied "trick" or locked knee. He also gave a history of being hospitalized from 1958 to 1960 for a head injury. He was hospitalized in January 1962 for what he described as being "too nervous." The February 1962 separation examination shows that all the veteran's clinical evaluations were normal and his whispered voice hearing was 15/15 bilaterally. His DD Form 214 indicates that the veteran's military occupational specialty was light weapons infantryman. The report of a January 1991 VA orthopedic examination indicates that the veteran gave a history of an inservice right knee injury, for which he did not seek treatment. Subsequent to service, his right knee went out while he was training horses in Chicago. The examiner noted that the veteran was a poor historian, and that he was vague about both injuries. The veteran stated that he had not seen any doctors for treatment of his right knee. X-ray studies of the knee indicated degenerative changes and a probable loose body. The examiner's impression was that the veteran had a possible old right knee injury. During his January 1991 VA psychiatric examination, the veteran recounted the circumstances surrounding his inservice right knee and right foot injuries, this time stating that he was hospitalized for the injury. He acknowledged that he drank beer regularly four to five years previously and had had two DUI's, but stated that he had stopped drinking altogether. The examiner diagnosed generalized anxiety disorder secondary to his physical diagnosis. Based on this information, a March 1991 rating decision denied service connection for a right knee condition, a condition of the feet and for a psychiatric disability. Subsequent evidence added to the record includes a January 1995 VA medical center discharge summary reflecting that the veteran was admitted for treatment of his weakness, irritability and nervous problems. The veteran had a long history of alcohol use but indicated he had "slacked off" to only weekend drinking in the last year. He stated that he had been psychiatrically admitted during service after suffering a beating. He was told he had suffered a nervous breakdown at the time. Physical examination indicated that his neck was supple and symmetrical. He had full, pain-free range of motion in all his extremities with full strength. A computed tomography (CT) scan showed very minimal frontal lobe atrophy, but was otherwise negative for abnormalities. A single-photon emission tomography scan of the brain showed multiple snare areas of focal hypoperfusion in both cerebral hemispheres. The final diagnoses at the time of discharge included dementia, alcohol dependence and intermittent explosive disorder. During his September 1995 VA examination, the veteran stated that he fell in a hole inservice and that his feet began to hurt and swell afterwards. He stated that he was seen at the base clinic for this condition. The veteran had good range of motion in his metacarpophalangeal (MPJ), mid-tarsal, subtalar and ankle joints without pain or crepitus. His arches were present on and off with weight bearing. A slight contracture of the second toe of the right foot was found. X-ray studies showed that the cortises were intact and that there was a good trabecular pattern. The joint spaces were well maintained. The examiner diagnosed hammer digit of the right second toe and noted that the veteran seemed to have difficulty with his balance. A September 1995 VA neurological evaluation showed no obvious cranial nerve involvement present at that time. The report of the veteran's September 1995 VA orthopedic examination shows that he gave a history of falling on his right hand in 1961 and complained of wrist pain dating from that time. Four to five years prior to the examination he developed numbness in his right hand and began dropping objects. Mild median and ulnar neuropathy in the right hand was diagnosed. He also gave a history of sustaining a flexion type injury to his right knee in 1961 and complained of swelling and buckling since that time. The examiner diagnosed torn right medial meniscus, right knee post- traumatic arthritis secondary to the torn medial meniscus and symptomatic medial synovial plaque of the right knee. During the September 1995 VA examination of his neck, the veteran stated that he had been hospitalized in service as a result of a beating. He stated that he was unconscious for four days before awakening. The veteran had difficulty with his memory. The examiner diagnosed chronic neck stiffness with pain and diminished range of motion and opined that it might be due to his injuries suffered while in the military, but that it could not be confirmed either way. In December 1995, the veteran submitted numerous notarized statements from individuals who knew him both before and after his military service. Most indicate that he didn't have problems with his shoulders, hands, headaches, nerves, feet and legs prior to service and experienced some increased problems after his military service. A March 1996 statement of another veteran avers that the veteran suffered a racially motivated severe beating to his head and was hospitalized as a result. After a second incident, the veteran was hospitalized for a mental breakdown. A March 1996 statement from the veteran's ex-wife indicates that the veteran had severe headaches, black outs, memory lapses, right arm and hand pain and swollen feet after his military service. Emotionally he was very unstable and aggressive with outbursts of temper that would sometimes turn into fits of rage. VA treatment records dated from July 1995 to May 1998 show that the veteran was treated for various complaints, including bilateral hearing loss, right hand numbness, neck pain, headaches and right ankle pain. A September 1995 audiology consultation report shows that the veteran had an inservice history of loud noise exposure and had had a mortar blow up in front of him. The examiner found that the veteran had moderate to severe sensorineural hearing loss in his right ear from 2,000 to 4,000 Hertz and moderate to profound sensorineural hearing loss from 250 to 8,000 Hertz in his left ear. The veteran was also diagnosed with peripheral neuropathy, described as carpal tunnel syndrome in September 1995. An October 1995 treatment record shows the veteran's alleged history of a right ankle injury in 1961 with subsequent progression of pain. He also complained of right elbow pain. X-ray studies of the right arm and ankle were negative and the veteran was assessed with right elbow tendinitis and right ankle sprain. April 1996 electromyography studies showed evidence of moderate median neuropathy at the right wrist with no evidence of cervical radiculopathy. A May 1997 triage assessment notes that the veteran had dementia and status post a head injury thirty years previously with a seizure disorder. An August 1997 triage assessment also noted the veteran's alleged earlier head trauma and also noted that he had passed out earlier, and was subsequently extremely dizzy with nausea and vomiting. The examiner opined that it was most likely labyrinthitis. An October 1997 primary care to record indicates that the veteran's ataxia/vertigo "may" be related to a previous brain injury. November 1997 treatment records show that the veteran had bilateral sensorineural hearing loss and a history of noise exposure. During his May 1998 personal hearing, the veteran testified that he fell in a hole during night maneuvers, twisting his foot and hurting his knee. He believes he may have also injured his neck and shoulder at that time. He stated that his right hand would go numb too. He testified that he was treated for all these disabilities during service. He also testified that he was beaten unconscious in a racially charged fight. His friends told him when he awoke that he had been unconscious for three to four days and that his commanding officer had not recognized him because he had been beaten so badly. Afterwards he began to have severe headaches. Subsequently, the veteran was involved in another fight, beating another soldier with a shovel. The military police were called and placed him in a straight jacket. He was taken to the mental hygiene clinic and the officer there told him he had had a nervous breakdown and that he would be discharged to rest and reenlist in another year. The veteran denied that he was ever hospitalized or treated for alcohol abuse. He was also concerned that his service medical records were incomplete, not including records concerning his beating. Subsequent to his hearing, the veteran's service personnel records were obtained by VA. The personnel records show that the veteran was punished in October, November and December 1961 for disorderly conduct. A February 1962 record shows he was to be discharged for unfitness/unsuitability and it was noted that he displayed a sullen and resentful attitude towards the personnel in his unit and that numerous offers of assistance had been refused. During his September 1999 video conference hearing, the veteran's testimony was essentially duplicative of his earlier testimony regarding the issues being discussed. His brother testified that his parents had told him that the veteran had been seriously injured in service and that he had had problems ever since his service that had gotten worse as he got older. The veteran's wife also testified that she had been with the veteran since 1986 and indicated the symptomatology she had witnessed since that time. She testified that the veteran first told her about his inservice beating two years prior to the hearing. The veteran also denied having had a head injury prior to service and that he had ever been admitted to a hospital for treatment of alcoholism. Analysis Service Connection for Residuals of a Head Injury, an Injury to the Neck and Shoulders, and a Right Hand Injury Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Service connection may be demonstrated either by showing direct service incurrence or aggravation or by using applicable presumptions, if available. Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994) (specifically addressing claims based ionizing radiation exposure). Service connection requires a finding that there is a current disability that has a definite relationship with an injury or disease or some other manifestation of the disability during service. Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992); Cuevas v. Principi, 3 Vet. App. 542, 548 (1992). A disorder may be service connected if the evidence of record, regardless of its date, shows that the veteran had a chronic disorder in service or during an applicable presumptive period, and that the veteran still has such a disorder. 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 494-95 (1997). Such evidence must be medical unless it relates to a disorder that may be competently demonstrated by lay observation. Savage, 10 Vet. App. at 495. For the 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." 38 C.F.R. § 3.303(b). If the disorder is not chronic, it may still be service connected if the disorder is observed in service or an applicable presumptive period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present disorder to that symptomatology. Id. at 496-97. Again, whether medical evidence or lay evidence is sufficient to relate the current disorder to the in-service symptomatology depends on the nature of the disorder in question. Id. Disorders diagnosed after discharge may still be service connected if all the evidence, including pertinent service records, establish that the disorder was incurred in-service. 38 U.S.C.A. § 1113(b); 38 C.F.R. § 3.303(d). However, before the Board may address the merits of the appellant's claims it must, first be established that the claims are well-grounded. In this regard, a person who submits a claim for VA benefits shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well-grounded. 38 U.S.C.A. § 5107(a). A well-grounded claim is "a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of [38 U.S.C.A. § 5107]." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). If the claim is not well-grounded there is no duty to assist. Struck v. Brown, 9 Vet. App. 145 (1996). In order for a claim to be well-grounded, there must be competent evidence of a current disability; 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 the current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995). For reasons indicated below, the veteran's claims of entitlement to service connection for residuals of a head injury, head, neck, shoulders and right hand disabilities are not well-grounded. While the veteran has repeatedly contended that his current neck and shoulder disabilities are residuals of a 1961 injury, or alternatively, as a result of an inservice beating, VA treatment records do not etiologically link his current neck and shoulder disabilities to any inservice injuries. Furthermore, service medical records are silent for the claimed injuries. In this respect, the Board finds the September 1995 VA examiner's opinion that the veteran's chronic neck stiffness might be due to his inservice injury, but could not be confirmed either way, to be speculative. Such an opinion, couched in equivocal terms, is not entitled to any real probative value. Obert v. Brown, 5 Vet. App. 30, 33 (1993); Tirpak v. Derwinski, 2 Vet. App. 609 (1992). Further, although the veteran is competent to provide evidence of visible symptoms, he is not competent to provide evidence that requires medical knowledge. See Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Therefore, the veteran's claim of entitlement to service connection for an injury to the neck and shoulders is denied. Likewise the veteran contends that he has residuals of an inservice head injury. In support of this claim he has provided the March 1996 statement of another veteran that he suffered a severe head injury as a result of a beating in service. As noted previously, neither the veteran nor his fellow veteran, is competent to provide evidence that requires medical knowledge. See Espiritu v. Derwinski, 2 Vet.App. 492 (1992). In this respect, the Board notes that while both men are competent to provide evidence regarding whether the veteran was beaten inservice, they are not competent to provide evidence regarding the extent or severity of any head injury suffered. Moreover, while the May 1997 triage assessment notes that the veteran had a head injury thirty years before with a seizure disorder, it is clear that the examiner assumed the veteran's account of an inservice head injury to be true and had not reviewed the veteran's medical records. Evidence, which is simply information recorded by a medical examiner unenhanced by any additional medical comment by that examiner, does not constitute "competent medical evidence." LeShore v. Brown, 8 Vet. App. 406, 409 (1995). Moreover, the Board finds the October 1997 VA examiner's opinion that his ataxia/vertigo "may" be related to previous brain injury to be speculative. See Obert v. Brown, 5 Vet. App. 30, 33 (1993); Tirpak v. Derwinski, 2 Vet. App. 609 (1992). Accordingly, the claim of entitlement to service connection for residuals of a head injury is denied. With respect to the veteran's claim of entitlement to service connection for a right hand injury, although his service medical records indicate that he did injure his right hand in 1961 and the current medical records show that he has median and ulnar neuropathy of the right hand, sometimes described as carpal tunnel syndrome, there is no medical opinion etiologically linking this disability to his inservice injury. The only evidence of record linking the veteran's current right hand neuropathy to his inservice injury consists of his own testimony and statements. However, as a lay person the veteran is not qualified to furnish medical opinions or diagnoses. See Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Since the veteran has submitted no medical evidence supportive of his claim, the Board finds that he has not met his initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claim for service connection for a right hand injury is well grounded. Accordingly, the claim is denied. During his September 1999 video conference before the undersigned Member, the veteran and his representative argued that his claims should be remanded and the RO requested to obtain unit reports and military police reports that might record the incident of his alleged beating. The Board does not find this development to be necessary, as presuming without conceding that the veteran was indeed beaten inservice, the veteran has still failed to provide competent medical evidence of a link between his current claimed disabilities and the incident inservice. Although the Board has considered and denied the veteran's claims for service connection for residuals of a head injury, injury to the neck and shoulders and for a right hand injury on grounds different from that of the RO, that is, whether the claims are well grounded rather than whether he is entitled to prevail on the merits, the veteran has not been prejudiced by the Board's decision. In assuming that the claims were well grounded, the RO accorded the appellant greater consideration than his claims warranted under the circumstances. Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993). To remand this case to the RO for consideration of the issue of whether the appellant's claims are well grounded would be pointless, and in light of the law cited above, would not result in a determination favorable to the appellant. VAOPGCPREC 16-92 (O.G.C. Prec. 16-92). Service Connection for Hearing Loss As noted previously, in order for a claim to be well- grounded, there must be competent evidence of a current disability; 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 the current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995). The Board finds that the veteran has submitted evidence of a plausible claim with regard to his claim for service connection for hearing loss. In this respect, the evidence shows that he has diagnoses of bilateral sensorineural hearing loss, as well as medical evidence of a nexus or causal relationship between his in service noise exposure and his hearing loss. Caluza v. Brown, 7 Vet. App. 498 (1995). New and Material Evidence to Reopen the Claims for Service Connection for Right Knee, Right Foot, and Acquired Psychiatric Disorders The RO originally denied entitlement to service connection for right knee, right foot and acquired psychiatric disorders in a March 1991 rating action. Although the veteran was notified of the decision, he did not appeal. Therefore, the RO's decision of March 1991 is final. 38 U.S.C.A. § 7105; 38 C.F.R. §§ 3.160(d), 20.200, 20.302, 20.1103. The claims may not be reopened and allowed unless new and material evidence is presented. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.104(a). However, if new and material evidence is presented or secured with respect to a claim that has been disallowed, VA must reopen the claim and review its former disposition. 38 U.S.C.A. § 5108. Thus, the Board must perform a three- step analysis when a veteran seeks to reopen a claim based on new evidence. Winters v. West, 12 Vet App 203 (1999). See Hodge v. West, 155 F.3d 1356, 1362 (Fed. Cir. 1998) (overruling the test set forth in Colvin v. Derwinski, 1 Vet. App. 171 (1991), which stated that "new" evidence was "material" if it raised a reasonable possibility that, when viewed in the context of all the evidence, the outcome of the claim would change); Elkins v. West, 12 Vet App 209 (1999) (stating that, after Hodge, new and material evidence may be presented to reopen a claim, even though the claim is ultimately not well grounded). First, the Board must first determine whether the evidence is new and material. Winters. According to VA regulation, "new and material evidence" means evidence not previously submitted to agency decisionmakers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a). This definition "emphasizes the importance of the complete record for evaluation of the veteran's claim." Hodge, 155 F.3d at 1363. In determining whether evidence is "new and material," the credibility of the new evidence must be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992); Evans, 9 Vet. App. at 283; but see Duran v. Brown, 7 Vet. App. 216, 220 (1994) ("Justus does not require the Secretary to consider the patently incredible to be credible"). Second, if the Board determines that new and material evidence has been produced, immediately upon reopening the case, the Board must determine whether, based on all the evidence of record, the reopened claim is well grounded pursuant to 38 U.S.C.A. § 5107(a). Winters. Finally, if the claim is well grounded, the Board may proceed to evaluate the merits of the claim after ensuring that VA's duty to assist has been fulfilled. Id. The evidence which was of record at the time of the RO decision in 1991 included the veteran's service medical records and the 1991 VA medical examination, all of which have been detailed above. The additional evidence received since the March 1991 rating decision includes a VA discharge summary and several examinations dated in 1995 showing diagnoses of dementia, alcohol dependence, hammer digit in the right foot and a torn right medial meniscus with post-traumatic arthritis of the right knee. Treatment records dated from July 1995 to May 1998 that reflect complaints and treatment for a right ankle sprain and dementia were also added to the record, as well as a several statements and the veteran's own testimony. Upon review of the aforementioned evidence, the Board concludes that evidence submitted since the March 1991 decision is new and material within the meaning of VA regulations. 38 C.F.R. § 3.156(a). This evidence, particularly the veteran's May 1998 testimony and the March 1996 statement of another veteran, that had not previously been submitted to agency decisionmakers, bears directly and substantially upon the specific matters under consideration. This evidence addresses the possibility of residuals from an inservice injury. This newly submitted evidence is neither cumulative nor redundant, and is so significant that it must be considered in order to fairly decide the merits of the claims. Having found that new and material evidence has been submitted to reopen the claims, the Board must now evaluate the claims based on all the evidence of record. Winters, 12 Vet. App. at 206. The Board notes that the veteran has had an opportunity to submit evidence and argument on these issues such that no prejudice will result from the Board's present consideration of his claims. Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993). The Board finds that the subsequent evidence submitted regarding the veteran's right knee, right foot and acquired psychiatric disorders is not sufficient to well-ground the claims. Presuming without conceding that the veteran was beaten inservice, he has failed to provide competent medical evidence of a nexus between any current right knee, right foot and acquired psychiatric disorders and his service or any incident therein; an essential element to his claims. In this regard, as noted although several treatment records record the veteran's history of an inservice beating, as noted previously, evidence which is simply information recorded by a medical examiner unenhanced by any additional medical comment by that examiner does not constitute "competent medical evidence." LeShore v. Brown, 8 Vet. App. 406, 409 (1995). In light of these circumstances, the Board must conclude that the veteran has failed to meet his initial burden of producing evidence of well-grounded claims for service connection for right knee, right foot and acquired psychiatric disorders. ORDER The claim for service connection for hearing loss is well- grounded. New and material evidence having been submitted, the veteran's claims for service connection for right knee disability, right foot disability and a psychiatric disability are reopened. Service connection for residuals of a head injury, injury to the neck and shoulders, right hand injury, right knee disorder, right foot disorder and an acquired psychiatric disorder is denied. REMAND VA audiology records dated in September 1995 and November 1997 may show hearing loss levels sufficient to meet the provisions of 38 C.F.R. § 3.385 and note that the veteran had a history of loud noise exposure during service. The veteran's DD Form 214 shows that his primary military occupational specialty was a light weapons infantryman. Based on this information, the Board is of the opinion that further development is necessary. Accordingly, the case is REMANDED to the RO for the following action: 1. The RO should obtain all treatment records for the veteran for hearing loss from the VA Medical Center in Lexington, Kentucky, dated from May 1998 to the present. 2. Thereafter, the RO should arrange for the veteran to undergo a VA examination, to include an audiogram, by a board certified specialist in audiology, if available, to determine the nature and severity of any present hearing loss. The examiner is specifically requested to review the evidence in the veteran's claims file and offer an opinion, with complete rationale, as to the etiology of any hearing loss, to include whether it is at least as likely as not that it was caused by the veteran's asserted inservice exposure to acoustic trauma. Any special diagnostic studies deemed necessary should be performed. The veteran's claims file must be made available to the examiner for review prior to the examination. Prior to the examination, the RO must inform the veteran, in writing, of all consequences of his failure to report for the examination in order that he may make an informed decision regarding his participation in said examination. 3. Thereafter, the RO should undertake any other indicated development, and readjudicate the issue of entitlement to service connection for bilateral hearing loss. If the benefit sought on appeal is not granted to the veteran's satisfaction a supplemental statement of the case containing adequate reasons and bases should be issued and the veteran and his representative provided an opportunity to respond. Thereafter, the case should be returned to the Board for further consideration, if otherwise in order. No action is required of the veteran until he is otherwise notified by the RO. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of 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. 1998) (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. RENÉE M. PELLETIER Member, Board of Veterans' Appeals