Citation Nr: 0003478 Decision Date: 02/10/00 Archive Date: 02/15/00 DOCKET NO. 98-07 957 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Newark, New Jersey THE ISSUES 1. Entitlement to service connection for right knee strain with degenerative joint disease. 2. Entitlement to service connection for right hip strain. 3. Entitlement to an increased rating for lumbosacral strain, currently rated as 20 percent disabling. 4. Entitlement to an increased rating for left knee strain, currently rated as 20 percent disabling. REPRESENTATION Appellant represented by: New Jersey Department of Military and Veterans' Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. Hancock, Counsel INTRODUCTION The veteran served on active duty from June 1975 to June 1978. Review of the record also shows evidence of National Guard service from May to June 1984. The issues currently on appeal come before the Board of Veterans' Appeals (Board) from a July 1997 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) located in Newark, New Jersey. The veteran was afforded a hearing before a local hearing officer at the RO in July 1998. The issues concerning entitlement to increased ratings for lumbosacral strain and left knee strain are addressed in the REMAND section of this decision. FINDINGS OF FACT 1. Service connection is in effect for, in pertinent part, left knee strain, rated as 20 percent disabling. 2. The positive and negative evidence is in relative equipoise as to whether the veteran's diagnosed right knee strain with degenerative arthritis is causally related to his service-connected left knee disability. 3. The veteran has not submitted competent medical evidence to show that right hip strain is related to service. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the veteran's favor, the veteran's right knee strain with degenerative joint disease is proximately due to or the result of a service-connected disease or injury. 38 U.S.C.A. §§ 1131, 5107 (West 1991); 38 C.F.R. §§ 3.102, 3.310 (1999). 2. The claim for entitlement to service connection for right hip strain is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSIONS Service Connection Generally Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury or disease. 38 U.S.C.A. § 1131 (West 1991). Regulations also provide that 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) (1999). Service connection may also be granted for disability which is proximately due to or the result of a service- connected disease or injury. 38 C.F.R. § 3.310(a) (1999). When aggravation of a nonservice-connected condition is proximately due to or the result of a service-connected condition, such veteran shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen v. Brown, 7 Vet. App. 439, 448 (1995). In making a claim for service connection, the appellant has 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) (West 1991). A well grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet App. 78, 81 (1990). In the absence of evidence of a well-grounded claim, there is no duty to assist the veteran in developing the facts pertinent to his claim, and the claim must fail. Epps v. Gober, 126 F.3d 1464, 1467- 68 (Fed. Cir. 1997). A well-grounded claim for service connection generally requires medical evidence of a current disability; evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, a nexus, or link, between the inservice disease or injury and the current disability as provided by competent evidence. Caluza v. Brown, 7 Vet. App. 498 (1995); 38 C.F.R. § 3.303 (1999); Layno v. Brown, 6 Vet. App. 465 (1994); Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Additionally, it is noted that evidence which is simply information recorded by a medical examiner, unenhanced by any additional medical comment by that examiner, does not constitute medical evidence of the required nexus. LeShore v. Brown, 8 Vet. App. 407, 409 (1995). Establishing direct service connection for a disability that was not clearly present in service requires the existence of a current disability and a relationship or connection between that disability and a disease contracted or an injury sustained during service. Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Savage v. Gober, 10 Vet. App. 488 (1997). However, where the claim involves issues of medical fact, such as medical causation or medical diagnoses, competent medical evidence is required. Grottveit, 5 Vet. App. At 93. Accordingly, the necessary causal relationship between a service-connected condition and the secondary service-connected condition complained of also must be provided by competent medical opinion. Libertine v. Brown, 9 Vet. App. 521 (1996). A veteran may also establish a well-grounded claim for service connection under the chronicity provision of 38 C.F.R. § 3.303(b) (1999), which is applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service or during an applicable presumption period, and that the same condition currently exists. Such evidence must be medical unless the condition at issue is a type as to which, under case law, lay observation is considered competent to demonstrate its existence. If the chronicity provision is not applicable, a claim still may be well grounded pursuant to the same regulation if the evidence shows that the condition was observed during service or any applicable presumption period and continuity of symptomatology was demonstrated thereafter, and includes competent evidence relating the current condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488, 495-98 (1997). With regard to the procedural development of certain issues in this case, the Board notes that, on a VA Form 21-4138, Statement in Support of Claim, dated in October 1996, the veteran raised the issue of service connection for the right knee and right hip disorders "secondary" to his service- connected left knee and back disabilities. The Board notes that the RO, in denying the veteran's claims for service connection in a rating decision dated in July 1997, noted that the veteran had reported during a recent VA examination that he injured his right knee and right hip at the same time as his service-connected left knee and the RO adjudicated the service connection claims on a direct basis, as opposed to secondary to service-connected disorders. In so doing, it was also determined at that time by the RO that the claims were not well-grounded. In the Notice of Disagreement (NOD) dated in December 1997 as well as in the substantive appeal dated in April 1998, the veteran again asserted that his right hip and knee conditions should be service-connected "secondary" to his service- connected back and left knee disorders. The December 1997 Statement of the Case (SOC) shows that the veteran was afforded laws and regulations as to both direct and secondary service connection. Right Knee Strain with Arthritis Initially, the Board finds that the veteran's claim for service connection for right knee strain with degenerative joint disease is well grounded pursuant to 38 U.S.C.A. § 5107 (West 1991) in that his claim is plausible, that is, meritorious on its own or capable of substantiation. Murphy, supra. Once it has been determined that a claim is well grounded, the VA has a statutory duty to assist the appellant in the development of evidence pertinent to that claim. The Board is satisfied that all relevant evidence is of record, and the statutory duty to assist the veteran in the development of evidence pertinent to his claim has been met. Service connection is currently in effect for left knee strain, evaluated as 20 percent disabling, and rated under Diagnostic Code 5257 of VA's Schedule of Rating Disabilities. Under Diagnostic Code 5257, a 20 percent disability evaluation is assignable for moderate recurrent subluxation or lateral instability of the knee. Service medical records show that the Report of Medical Examination at enlistment, dated in June 1975, showed that clinical evaluation of the veteran's right knee was normal. In addition, review of the Report of Medical Examination at the time of separation, dated in May 1978, also showed that the veteran's right knee was clinically evaluated as normal. A Report of Medical Examination, dated in November 1982, showed that clinical evaluation of the veteran's right knee was normal. Additional service treatment records dated in 1984, both during and after the veteran's period of National Guard duty, while showing that the veteran was treated following a fall for left knee problems, showed no complaints or treatment relevant to a right knee disorder. On a VA examination report dated in September 1984, the veteran did not complain of any problems concerning his right knee. Examination of the right knee was described as not remarkable. A right knee disorder was not diagnosed. Reports of Physical Evaluation Board Proceedings, dated in December 1985 and April 1986, showed no complaints or findings relevant to right knee problems. A May 1987 VA examination report showed that the veteran indicated that he had been thrown off of a tractor trailer in 1984 during training. There were no complaints concerning his right knee at this time, and a right knee disorder was not diagnosed. On a VA examination in June 1989, he did not complain of a right knee disorder. His right knee was described as unremarkable, and no diagnosis concerning the right knee was made at that time. The reports of VA examination in August 1991 and October 1993 were also devoid of a diagnosis of a right knee disability. A VA orthopedic examination was conducted in January 1997. The veteran provided a history of having suffered trauma to multiple body parts as a result of being thrown from a tractor trailer while in the service. He added that he injured both of his knees, his right hip, and his lower back as a result. He complained of right knee pain. Right knee strain with degenerative joint disease was diagnosed. A VA outpatient treatment record dated in October 1996 also showed a diagnosis of right knee degenerative joint disease. In a medical opinion, dictated in April 1997, a VA physician indicated that he had consulted with the examining physician who conducted the January 1997 orthopedic examination and that they both had reviewed the examination report. It was noted that the examining physician indicated that the veteran had clearly reported a history of injuring both his knees, his right hip, and lower back all at the same time during his military service. The VA physician opined that the only relationship between the veteran's right knee disorder and the service-connected left knee and lumbosacral strain disorders is that they all occurred at the same time; he added that there was no evidence of any other relationship between the veteran's right knee and his service-connected left knee and back disorders. At the hearing conducted in July 1998, the veteran reported injuring his right knee as a result of an accident involving a truck in 1984 during his period of service, raising the issue of direct service connection for his claimed right knee disorder. In a letter to VA dated in August 1997 from a private physician, Dr. Gorin, the doctor indicated that the veteran had been examined in August 1997 and complained of pain in both knees, right hip, and lower back. It was also noted that the veteran was well known to the practice with a history of injury to the low back and left knee as a result of a military-related injury approximately 13 years earlier. It was additionally indicated that the veteran was still bothered by back pain radiating to both hips and down the right leg, as well as by right knee pain and instability. Mild degenerative joint disease of the right knee was diagnosed. Dr. Gorin opined that the veteran suffered from early degenerative joint disease of the right knee as a result of instability of the left knee requiring an abnormal gait. A letter written by one private physician, Dr. Chu, to another, Dr. Papa, is also of record. Dr. Chu indicated in this letter, which is shown to have been printed in April 1998, that she had seen the veteran, Dr. Papa's patient, in March 1998 for an electrodiagnostic examination of both lower extremities. Dr. Chu noted that the veteran had reported being involved in a work-related accident in May 1984 as a result of being thrown off the flat bed area of a tractor trailer assembly site. Since that time, it was additionally noted, the veteran had experienced pain associated with his neck, middle and lower back, both knees, and both hips. The letter also mentioned another work-related injury during the veteran's period of Army duty 14 years earlier when the veteran fell backwards while trying to lift a 300 pound object with three other people, and, as a result, injured his left knee and low back. Findings concerning the right knee were not shown. The report of VA orthopedic examination dated in May 1999, and noted to be the most recent medical evidence on file, shows that the veteran gave a history of being involved in a motor vehicle accident when he was thrown off a flat bed, and, as a result, injuring his back and left knee. He reported no complaints concerning his right knee, and a diagnosis concerning the right knee was not shown to be part of the report. Although the veteran has asserted that he incurred a right knee injury at the same time that he injured his service- connected left knee, no medical documentation is of record to substantiate his claim. In other words, no evidence of an inservice right knee injury is of record. Additionally, while the VA opinion dictated in April 1997 essentially determined that no etiological relationship existed between the veteran's service-connected left knee disability and his right knee, a private medical opinion is of record to the contrary. Specifically, as noted above, Dr. Gorin, a private treating physician of the veteran, rendered an opinion in August 1997, following examination of the veteran's knees, which stated that the veteran suffered from early degenerative joint disease of the right knee as a result of instability in the left knee requiring an abnormal gait. After a careful review of all of the evidence, the Board is of the opinion that the positive and negative evidence is now in relative equipoise, and, as such, the benefit of the doubt is in the veteran's favor. 38 C.F.R. § 3.102 (1999). Under such circumstances, the benefit of the doubt is awarded to the veteran. 38 U.S.C.A. § 5107(b) (West 1991). Accordingly, it is the Board's judgment that service connection for right knee strain with degenerative joint disease is warranted. Right Hip Strain Regarding the claim for service connection for right hip strain, the veteran asserts that the right hip strain is related to his period of service. Service medical records, including the Report of Medical Examination at enlistment, dated in June 1975, and the Report of Medical Examination at the time of separation, dated in May 1978, showed that clinical evaluation of the veteran's right hip was normal. A Report of Medical Examination, dated in November 1982, also showed that clinical evaluation of the veteran's right hip was normal. Other service treatment records dated in 1984, both during and after the veteran's period of National Guard duty, do not show any treatment afforded the veteran for his right hip. A VA examination report dated in September 1984 showed that the veteran did not complain of any problems concerning his right hip. A disorder of the right hip was not diagnosed. Reports of Physical Evaluation Board Proceedings, dated in December 1985 and April 1986, demonstrated no right hip problems. A May 1987 VA examination report showed that the veteran complained of pain in the hips. He reported that he was thrown off of a tractor trailer in 1984 during training. A right hip disorder was not diagnosed. The veteran was afforded a VA examination in June 1989. He did not complain of right hip-related problems. No diagnosis was made as to the right hip. The reports of VA examination in August 1991 and October 1993 were also devoid of a diagnosis concerning a right hip disability. A VA orthopedic examination was conducted in January 1997. The veteran provided a history of having suffered trauma to multiple body parts as a result of being thrown from a tractor trailer while in the service. He added that he injured both of his knees, his right hip, and his lower back as a result. He complained of right hip pain. The diagnoses included residual right hip strain. In a medical opinion supplied by a VA physician, dictated in April 1997, the physician noted that he had consulted the examining physician who conducted the January 1997 orthopedic examination and that they both had reviewed the examination report. It was noted that the examining physician indicated that the veteran had clearly reported a history of injuring both his knees, his right hip, and lower back all at the same time during his military service. It was further noted that the only relationship between the veteran's right hip strain to the service-connected left knee and lumbosacral strain disorders is that they all occurred at the same time; he added that they had no other relationship to each other. A letter to VA dated in August 1997 from a private physician, Dr. Gorin, stated that the veteran had been examined in August 1997. The veteran was noted to have complained of pain in both knees, right hip, and lower back. The letter noted that the veteran was well known to the practice with a history of injury to the low back and left knee as a result of a military-related injury approximately 13 years earlier. It was noted that the veteran was still bothered by back pain radiating to both hips and down the right leg. A right hip disorder was not diagnosed. In addition, while Dr. Gorin related the veteran's right knee problems to his service- connected left knee disability, he did not provide any nexus, or "link," between the veteran's right hip and left knee. As noted above, the veteran was afforded a hearing in July 1998. He reported injuring his right hip as a result of an accident involving a truck in 1984 during his period of service, and that while he did not receive treatment for his right hip until approximately 1989, he raised the issue of direct service connection for his claimed right hip disorder. In an April 1998 letter written by one private physician, Dr. Chu, to another, Dr. Papa, Dr. Chu indicated that she had seen the veteran, Dr. Papa's patient, in March 1998 for an electrodiagnostic examination of both lower extremities. Dr. Chu noted that the veteran had reported being involved in a work-related accident in May 1984 as a result of being thrown off the flat bed area of a tractor trailer assembly site. Since that time, it was additionally noted, the veteran had experienced pain associated with his neck, middle and lower back, both knees, and both hips. The letter also mentioned of another work-related injury during the veteran's period of Army duty 14 years earlier when the veteran fell backwards while trying to lift a 300 pound object with three other people, and, as a result, injured his left knee and low back. The letter also reported that physical examination had revealed complaints of right hip pain on straight leg raising testing. The report of VA orthopedic examination dated in May 1999, and noted to be the most recent medical evidence on file, shows that the veteran gave a history of being involved in a motor vehicle accident when he was thrown off a flat bed, and, as a result, injured his back and left knee. He reported no complaints concerning his right hip. A diagnosis as to the right hip was not rendered. Beyond the veteran's assertions, there is no evidence of record linking a right hip disorder to his period of active service. He was not treated during his period of service for problems affecting his right hip. While the medical evidence notes that the veteran was diagnosed with residual right hip strain on a VA examination in January 1997, the record does not include any medical evidence to establish a nexus between this claimed disorder and service. In addition, the record is devoid of medical evidence showing a causal relationship between a service-connected condition and the veteran's right hip. The veteran's assertions are insufficient to satisfy the nexus requirement because it is not shown that the veteran has any medical training or expertise to comment on the medical causation for any claimed disorder. Espiritu, supra. As the veteran has not submitted competent medical evidence of a nexus between his claimed right hip disorder and period of active service, his claim must be denied as not well grounded. Epps, 126 F.3d at 1467-68. Although where a claim is not well grounded VA does not have a statutory duty to assist a claimant in developing facts pertinent to the claim, VA may be obligated under 38 U.S.C.A. § 5103(a) (West 1991) to advise a claimant of evidence needed to complete his or her application. This obligation depends on the particular facts of the case and the extent to which the claimant has been advised of the evidence necessary to well ground a claim. See Robinette v. Brown, 8 Vet. App. 69 (1995). Here, nothing in the record suggests the existence of any relevant evidence that is available which might well ground this claim. In this respect, the Board is satisfied that the obligation imposed by 38 U.S.C.A. § 5103(a) (West 1991) has been met. See Franzen v. Brown, 9 Vet. App. 235 (1996) (VA's obligation under sec. 5103(a) to assist claimant in filing his claim pertains to relevant evidence which may exist or could be obtained) and Wood v. Derwinski, 1 Vet. App. 190 (1991) (VA "duty" is just what it states, a duty to assist, not a duty to prove a claim). Accordingly, for the reasons and bases provided above, the Board must deny the veteran's claim of entitlement to service connection for right hip strain as not well grounded. ORDER Service connection for right knee strain with degenerative arthritis is granted. A well-grounded claim not having been submitted, service connection for right hip strain is denied. REMAND Initially, the Board finds that the veteran's claims for increased ratings for his service-connected lumbosacral strain and left knee strain are well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991); that is, he has presented claims that are plausible. A claim that a disorder has become more severe is well grounded where the disorder was previously service-connected and rated, and the claimant subsequently asserts that a higher rating is justified due to an increase in severity since the previous rating. Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). Concerning the claim for an increased rating for lumbosacral strain, it is noted that service connection was initially granted for this disability by the RO as shown on a rating decision dated in June 1987. A 10 percent disability evaluation was assigned at that time. Subsequently, by means of a rating decision dated in September 1989, the RO increased the disability evaluation assigned to the veteran's service-connected back disability to 20 percent. The evidence of record includes a letter written by Dr. Chu, a private physician, to Dr. Papa, another private physician. Dr. Chu indicated in this letter, shown to have been printed in April 1998, that she had seen the veteran, Dr. Papa's patient, in March 1998 for an electrodiagnostic examination of both lower extremities and paraspinal muscles. Dr. Chu noted that the veteran had reported being involved in a work- related accident in May 1984 as a result of being thrown off the flat bed area of a tractor trailer assembly site. Since that time, it was additionally noted, the veteran had experienced pain associated with his middle and lower back. The letter also includes mention of another work-related injury during the veteran's period of Army duty 14 years earlier when the veteran fell backwards while trying to lift a 300 pound object with three other people, and, as a result, injured his low back. Additionally, the letter contains a reference to MRI [magnetic resonance imaging] testing in August 1997 which revealed degenerative disk disease at L5-S1 with mild left-sided facet degenerative changes, and slight curvature of the spine convex to the left. Furthermore, comprehensive and detailed examination findings were reported. The letter included a diagnosis which concluded that EMG [electromyograph] testing was abnormal. It was also noted that these abnormal findings were related to the reported May 1984 work injury and that the veteran's condition had been aggravated by accumulated trauma associated with work. A VA orthopedic examination was conducted in January 1997. As history, the veteran indicated that he suffered trauma to multiple body parts as a result of being thrown from a tractor trailer while in the service. He added that he injured his lower back as a result. He complained of low back pain which had progressively worsened over the years. Prolonged standing, bending, lifting were noted to increase the pain associated with the veteran's back. The veteran also complained that prolonged sitting caused numbness in his legs. Examination showed that the lower back was non-tender, and that range of motion tests were conducted. The diagnoses included chronic, recurrent lumbosacral strain with degenerative joint disease. The report of VA orthopedic examination dated in May 1999, the most recent medical evidence on file, shows that the veteran gave a history of being involved in a motor vehicle accident when he was thrown off a flat bed, and, as a result, injuring his back. He complained of similar symptomatology to that reported on VA examination in January 1997. Examination showed no paraspinal tenderness or evidence of easy fatigability, incoordination, or additional loss of range of motion. The diagnosis concerning the veteran's back was degenerative arthritis of the lumbosacral spine. As noted above, the veteran has been treated for his back disability by private physicians Dr. Chu and Dr. Papa. While it appears that the veteran had been referred for treatment/evaluation to Dr. Chu from Dr. Papa, a review of the record does not show that treatment records associated with treatment afforded the veteran from Dr. Papa have been associated with the record. The Board is of the opinion that obtaining and reviewing any available treatment records may very well be pertinent to the issue of entitlement to an increased rating for lumbosacral strain. Therefore, the Board believes that such records from Dr. Papa are to be obtained prior to resolution of this issue. As for the issue of entitlement to an increased rating for left knee strain, after reviewing the veteran's claims folder, it appears to the Board that his substantive appeal concerning this issue was not timely filed. If this is the case, the Board has no jurisdiction over the appeal and it must be dismissed. See 38 U.S.C.A. § 7105(d)(3) (West 1991 & Supp. 1999); 38 C.F.R. §§ 20.101, 20.200 (1999). Cf. Marsh v. West, 11 Vet. App. 468, 470 (1998) (Board has no jurisdiction to consider merits of an appeal where notice of disagreement (NOD) is untimely). The veteran was notified of the RO's July 1997 rating decision granting an increased rating for his service-connected left knee disability by letter dated July 28, 1997. Testimony presented in the course of the above-mentioned July 1998 personal hearing was taken as the veteran's NOD, and the RO subsequently mailed a Supplemental Statement of the Case (SSOC) to the veteran on September 22, 1998. Further review of the record shows that the next correspondence received from the veteran is shown to be a VA Form 21-4138, which was received by the RO on February 26, 1999. Generally, the substantive appeal must be filed within 60 days from the date that the agency of original jurisdiction (in this case, the RO) mails the SOC, or, in this instance, the SSOC, to the appellant, or within the remainder of the 1- year period from the date of mailing of the notification of the determination being appealed, whichever period ends later. 38 C.F.R. § 20.302(b) (1999). The time for filing may be extended at the veteran's request, for good cause shown, but there is no indication that such an extension was requested. 38 C.F.R. § 20.303 (1999). Filing additional evidence does not extend the time for initiating or completing an appeal. 38 C.F.R. § 20.304 (1999). Given the facts above, the veteran's substantive appeal should have been filed no later than November 20, 1998 (60 days following mailing of the September 1998 SSOC by the RO), for it to be timely. A timely appeal would include an appeal postmarked no later than November 20, 1998. 38 C.F.R. § 20.305 (1999). In the veteran's case, since no correspondence was received by him following the issuance of the SSOC in September 1998 until February 1999, the Board appears to have no jurisdiction to review the veteran's claim. Since the Board has raised the jurisdiction issue sua sponte, however, the veteran has had no opportunity to respond, or to submit argument or evidence on the question. A determination of the timeliness of a substantive appeal is itself an appealable issue, as to which a claimant is entitled to file an NOD and as to which he must then receive a SOC. See 38 U.S.C.A. §§ 7104, 7105 (West 1991); 38 C.F.R. § 19.34 (1999); cf. 38 C.F.R. § 20.203 (1999) (notice required when Board raises issue regarding adequacy of allegations of error of fact or law in substantive appeal). Accordingly, the Board may not decide the issue at this time, if doing so prior to hearing from the veteran would prejudicially deprive him of administrative "fair process." See Marsh, supra, at 471-72; Sutton v. Brown, 9 Vet. App. 553 (1996); Bernard v. Brown, 4 Vet. App. 384 (1993). Since the Board cannot assure itself that the veteran would be unable to provide a basis for finding his appeal timely, additional action concerning this matter must be taken. Therefore, in accordance with the statutory duty to assist the veteran in development of evidence pertinent to his claims, the case is REMANDED to the RO for the following actions: 1. The RO should notify the veteran that, on remand, he may submit additional evidence and argument in support of his claims for increased ratings. Quarles v. Derwinski, 3 Vet. App. 129, 141 (1992). 2. It is requested that the RO furnish the veteran the appropriate release of information forms in order to obtain copies of all VA and private treatment records, to include Dr. Papa, associated with recent treatment received for his service-connected back condition. Specifically, the RO should inform the veteran that treatment records reflecting treatment afforded him by Dr. Papa may very well be pertinent to the issue of his claim for an increased rating for service-connected lumbosacral strain. 3. The RO should notify the veteran of the proposed dismissal of his appeal for an increased rating for left knee strain on the basis that his substantive appeal of that issue was untimely. The veteran should be advised of his right to submit a notice of disagreement as to the issue of timeliness of the substantive appeal, and his obligation to do so if he believes the issue was wrongly decided and wishes to appeal. If a notice of disagreement is filed, the appeal should be further developed in accordance with applicable VA law and regulation. 4. Thereafter, following any additional development deemed appropriate, the RO should readjudicate the issue of entitlement to an increased evaluation for lumbosacral strain. If an increased rating for lumbosacral strain is not granted, the veteran and his representative should be provided with a SSOC, and an opportunity to respond. If an appeal as to the Board's jurisdiction to review the veteran's claim for an increased rating for left knee strain is perfected, the case should be returned to the Board. The case should then be returned to the Board for further appellate consideration. No further action is required of the veteran unless he receives further notice. The purpose of this REMAND is to provide fair process, and the Board does not intimate any opinion as to the merits of the case, either favorable or unfavorable, at this time. No action is required of the veteran until he is notified. The veteran 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 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. KATHLEEN K. GALLAGHER Acting Member, Board of Veterans' Appeals