Citation Nr: 0006471 Decision Date: 04/06/00 Archive Date: 09/08/00 DOCKET NO. 94-46 299 DATE APR 06, 2000 On appeal from the Department of Veterans Affairs Regional Office in Huntington, West Virginia ORDER The following corrections are made in a decision issued by the Board in this case on March 10, 2000: The applicable correction is made to the ORDER of the Board's March 2000 Board decision (pg. 1-4) and reflects the proper effective date: An increased schedular rating to 100 percent for pulmonary fibrosis and emphysema is granted, effective from October 7, 1996, subject to the law and regulations governing the payment of monetary benefits. C.W. Symanski Member, Board of Veterans' Appeals Citation Nr: 0006471 Decision Date: 03/10/00 Archive Date: 03/17/00 DOCKET NO. 94-46 299 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUES 1. Entitlement to a rating in excess of 10 percent for pulmonary fibrosis and emphysema prior to October 7, 1996. 2. Entitlement to a rating in excess of 30 percent for pulmonary fibrosis and emphysema prior to November 24, 1998. 3. Entitlement to a rating in excess of 60 percent for pulmonary fibrosis and emphysema from November 24, 1998. 4. Entitlement to an effective date earlier than August 10, 1993, for a 10 percent rating for chronic sinusitis with associated headaches. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD A. Shawkey, Counsel INTRODUCTION The veteran served on active duty from May 1951 to May 1954 and from August 1956 to September 1959. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a March 1994 rating decision of the Department of Veterans Affairs (VA) regional office (RO) in Huntington, West Virginia, that continued the veteran's 10 percent rating for his service-connected lung disability and continued a noncompensable rating for his service-connected sinus disability with associated headaches. These issues were previously before the Board in March 1997 and August 1998. In the March 1997 decision, the Board remanded the issues for additional development. Thereafter, in April 1998, the RO assigned the veteran a 30 percent rating for his service- connected pulmonary fibrosis and emphysema effective on October 7, 1996. The RO also at that time increased the veteran's service-connected chronic sinusitis with associated headaches to 10 percent also effective on October 7, 1996. In the August 1998 Board decision, the Board assigned the veteran a 10 percent rating for chronic sinusitis with associated headaches prior to October 7, 1996, and denied a greater than 10 percent rating for this disability after October 7, 1996. Because the Board decided the issue of increased ratings for chronic sinusitis with associated headaches, both prior to and subsequent to October 7, 1996, this issue is final. See 38 C.F.R. § 20.1100 (1999). As to the issue of increased ratings for the veteran's service- connected pulmonary fibrosis and emphysema, the Board remanded this issue for further development in August 1998. Thereafter, in June 1999, the RO increased the veteran's service-connected pulmonary fibrosis to 60 percent disabling, effective November 24, 1988. This appeal also stems from an August 1998 RO rating decision that assigned an effective date of August 10, 1993, for the 10 percent rating for the veteran's chronic sinusitis with associated headaches prior to October 7, 1996. The issue of an increased rating in excess of 10 percent for pulmonary fibrosis and emphysema prior to October 7, 1996 is deferred pending the completion of the development being sought in the remand order below. FINDINGS OF FACT 1. Pulmonary function tests performed by VA in September 1997 revealed DLCO-SB of 39.7 percent predicted. 2. On March 29, 1993, the veteran filed a claim for an increased rating for service-connected chronic sinusitis with associated headaches; this claim was denied by the RO in July 1993 and was followed by a timely Notice of Disagreement. 3. Service-connected chronic sinusitis with associated headaches did not increase to its current 10 percent level on any date within the year preceding March 29, 1993. CONCLUSIONS OF LAW 1. The schedular criteria for a 100 percent rating from October 7, 1996, for service-connected pulmonary fibrosis and emphysema have been met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.3, 4.7, 4.97, Diagnostic Code 6802 (1999). 2. The proper effective date for the assignment of a 10 percent rating for service-connected chronic sinusitis with associated headaches is March 29, 1993, being the date of VA's receipt of the claim for an increased rating. 38 U.S.C.A. § 5110 (West 1991); 38 C.F.R. § 3.400 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background In October 1959 the veteran filed an original claim of service connection for bronchitis and for sinusitis. In February 1960, the RO granted service connection for chronic bronchitis and assigned a noncompensable evaluation effective September 25, 1959. The RO also granted service connection for chronic sinusitis with associated headaches and assigned a noncompensable evaluation effective the same date. In a March 1960 rating decision, the RO recharacterized the veteran's bronchitis as pulmonary fibrosis and emphysema and increased the rating to 10 percent effective on August 18, 1969. At a VA examination in November 1972, the veteran's chest was found to be slightly emphysematous. He had some exertional dyspnea and had two pillow orthopnea at times. Expiration was 35 inches and inspiration was 37 inches. Breath sounds were diminished with some basal tympany, no rhonchi or rales. The veteran was diagnosed as having pulmonary emphysema and fibrosis, minimal. In September 1975 the veteran filed increased rating claims for sinusitis and pulmonary fibrosis and emphysema asserting that these disabilities had worsened. The RO denied the veteran's claim for increased ratings in October 1975. A private X-ray study of the veteran's chest was performed in April 1979 revealing bilateral chronic changes and no active disease or failure. Another chest X-ray study was performed the following day revealing overexpanded lungs associated with generalized interstitial changes. It was noted that there had been no significant radiographic change in appearance of the chest since the previous day. A private radiology report of the veteran's chest in January 1993 revealed chronic pulmonary changes and emphysema. There were no other abnormalities noted. A private office note dated in February 1993 reflects a diagnosis of probable chronic obstructive pulmonary disease (COPD). In March 1993 the veteran filed a claim for "service connection compensation". He also said that he had developed respiratory symptomatology through the years. An April 1993 private office note reflects diagnoses of COPD likely and chronic smokers' bronchitis. The RO continued the veteran's 10 percent rating for service- connected pulmonary fibrosis and emphysema and 0 percent rating for chronic sinusitis with associated headaches in a July 1993 rating decision. The veteran filed a claim for increased ratings in August 1993 for his "problems" to include chronic sinusitis with associated headaches and pulmonary fibrosis and emphysema. At a VA examination in September 1993, the veteran reported having been told that he had pulmonary fibrosis and emphysema in 1959. He complained of being short of breath and wheezing with activity and at rest. He complained of getting a lot of coughs and colds and of spitting up brown sputum now and then. On examination the veteran did not have cough or expectoration. The chest was symmetrical. Chest mobility was within the normal range. Lungs were clear to percussion and auscultation. X-ray findings revealed emphysema and fibrotic changes of the lower lung fields. The veteran was diagnosed as having pulmonary fibrosis and emphysema, and chronic recurrent sinusitis with headache. In a March 1994 rating decision, the RO continued the veteran's 10 percent rating for his lung disability and also continued a 0 percent rating for his sinus disability with headaches. At a VA medical facility in August 1994, the veteran complained of chest pain and of coughing up black phlegm for several years. He was diagnosed as having atypical chest pain and mild bronchitis. A chest X-ray taken at a VA medical facility in August 1994 revealed COPD with chronic lung changes. There was no active cardiopulmonary process seen. Findings resulting from an October 1994 VA outpatient visit revealed decreased breath sounds, inspiration and expiration wheezes. It was noted that chest X-rays revealed COPD and no active process. The veteran was assessed as having COPD. A June 1995 X-ray report of the veteran's chest revealed no acute cardiopulmonary changes, but chronic changes including findings consistent with COPD. A chest X-ray report dated in January 1997 revealed essentially no changes from the June 1995 X-ray study. There was COPD change. Pulmonary function tests performed in September 1997 revealed moderate airways obstruction; no immediate change with inhaled bronchodilator and forced expiratory volume in liters per second (FEVI) that was lower than during a previous study on September 30, 1993. Specific findings of the standard study revealed FEV1 of 55.7 percent predicted and after bronchodilator of 58.9 percent predicted. DLCO-SB was 39.7 percent predicted. At a VA examination in September 1997, the veteran reported having breathing problems since 1952 which had gradually worsened. He said that he coughed up a lot of whitish expectoration especially early in the morning and got frequent hemoptysis. He could not walk more than 100 yards without getting very short of breath and could not even attempt to walk uphill or up steps. On examination the veteran did not have any cough or expectoration. He had a lot of difficulty walking from the waiting room into the examination room which was only a very short distance. His chest was symmetrical. Chest mobility was somewhat diminished. Lungs were clear to percussion and auscultation except for rales and rhonchi scattered all over the lung fields. The examiner stated that a chest X-ray showed essentially no change since June 1995. There was some hyperaeration of the lung fields with flattening of the diaphragms and widening of the anterior mediastinal cleared space compatible with chronic obstructive pulmonary change. The examiner relayed the results of pulmonary function results performed at that time revealing moderate airway obstruction. He said that there had been no immediate change with inhaled bronchodilator. He also said that if VI was lower than during the previous study in 1993, it appeared to be slightly worsened since 1993. He diagnosed the veteran as having chronic obstructive pulmonary disease, moderate, and pulmonary emphysema. In an addendum VA opinion in March 1998, the examiner said that he had reviewed the previous compensation examination performed in September 1997 and that the veteran's symptomatology appeared to be a lot more than what was reflected by the pulmonary function studies. He said that by any standard, FEVI is suppose to be the best reflection of the veteran's disablement. However, he said that in the veteran's case, he witnessed the veteran having shortness of breath by walking from his waiting room to the examination room. He said that he was unable to explain that. He reiterated that FEVI was suppose to be the best reflection of the disablement and that he even consulted a pulmonologist who agreed with him. In an April 1998 rating decision the RO increased the veteran's service-connected pulmonary fibrosis and emphysema to 30 percent disabling, effective October 7, 1996. The RO also increased the veteran's service-connected chronic sinusitis with associated headaches to 10 percent disabling effective October 7, 1996. In a September 1998 rating decision, the RO assigned August 10, 1993, as the effective date for the increased 10 percent rating for service-connected chronic sinusitis with associated headaches, being the date of claim. Pulmonary function tests performed by VA in November 1998 revealed severe obstruction defect, no bronchodilator response. Standard study revealed FEV1 of 48.9 percent predicted and FEV1/FVC ratio of 29.3 percent predicted. Findings after bronchodilator revealed FVC of 73.8 percent predicted and FEV1 of 52.7 percent predicted. FEV1/FVC ratio was .840 percent predicted. A chest X-ray performed by VA in November 1998 revealed a minor abnormality. Findings from a VA examination in November 1998 revealed grossly diminished chest mobility and lungs that were clear to percussion and auscultation. The examiner reviewed the veteran's claims file and pulmonary function tests and diagnosed the veteran as having severe chronic obstructive lung disease in addition to pulmonary fibrosis and emphysema by history. He said that a review of the claims file showed that the pulmonary function test had deteriorated since 1987. In the veteran's Notice of Disagreement in December 1998, the veteran pointed out that because he had been found to be not able to perform military service in part due to his sinus condition, how could he not likewise be found to be in the same condition in civilian life. He requested that he be rated at 60 percent back to 1959. In May 1999 the veteran's claims file was reviewed by a VA examiner who compared the veteran's pulmonary function tests performed in September 1997 with the pulmonary function tests performed in November 1998. He concluded that the veteran's respiratory condition had gotten worse. He also said that FEVI was the most sensitive indicator for emphysema. Later in May 1999 the veteran again underwent pulmonary function tests. The standard study revealed FVC of 77.3 percent predicted and FEV1 of 52.1 predicted. An interpretation was given of moderate severe airway obstruction with no immediate change in bronchodilator. FVC was noted to be better than during the prior study in November 1998. In July 1999 a VA examiner reviewed the old and new criteria for rating respiratory disorders, in conjunction with the veteran's medical history and claims file. He reported the results of pulmonary function testing in September 1997, November 1998 and May 1999, and concluded that under the old criteria, the veteran would fit into the "60%" category in that he had exertional dyspnea sufficient to prevent climbing one flight of steps or walking one block without stopping, ventilatory impairment of severe degree confirmed by pulmonary function tests with marked impairment of health. He also concluded that under the new criteria, the veteran would also fit into the "60%" category with an FEV1 of 40 to 55%, with actual FEV1 being 50 percent of predicted before dilators and 52.1% after bronchodilators. He also said that it appeared by the current test that the veteran's pulmonary function tests had not deteriorated, but that his symptoms had gotten worse. At a VA outpatient appointment in July 1999, the veteran complained of an increase in the amount of his chronic cough with sputum production. It was noted that he continued to smoke a pack of cigarettes a day and was interested in joining a smoking cessation program. He was examined and given an impression of severe chronic pulmonary disease and pulmonary cachexia. II. Legal Analysis Entitlement to an Increased Rating for Pulmonary Fibrosis and Emphysema Rated at 30 Percent Prior to November 24, 1998, and 60 Percent From November 24, 1998 The veteran's claim for an increased rating prior to and from November 24, 1998, for service-connected pulmonary fibrosis and emphysema is well grounded, meaning not inherently implausible. All relevant facts have been properly developed and VA has fulfilled its duty to assist the veteran. 38 U.S.C.A. § 5107(a). Disability evaluations 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; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. When rating the veteran's service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). During the course of the veteran's appeal, the regulations pertaining to respiratory disabilities were revised. Under the old criteria, the veteran's service-connected pulmonary fibrosis with emphysema was rated analogous to pneumoconiosis under Diagnostic Code 6802. Under that code, a 10 percent evaluation is warranted if the veteran's disability is definitely symptomatic with pulmonary fibrosis and moderate dyspnea on extended exertion. A 30 percent evaluation is warranted if the disorder is moderate with considerable pulmonary fibrosis and moderate dyspnea on slight exertion, confirmed by pulmonary function tests. In order to warrant a 60 percent evaluation, the disorder must be severe, with extensive fibrosis and severe dyspnea on slight exertion with corresponding ventilatory deficit confirmed by pulmonary function tests with marked impairment of health. A 100 percent rating requires that the condition be pronounced, with extent of lesion comparable to far advanced pulmonary tuberculosis or pulmonary function tests confirming a markedly severe degree of ventilatory deficit; with dyspnea at rest and other evidence of severe impairment of bodily vigor producing total incapacity. 38 C.F.R. § 4.97, Diagnostic Code 6802 (1996). Under the new criteria, which were made effective October 7, 1996, the veteran's service-connected pulmonary fibrosis with emphysema is rated under Diagnostic Code 6603. Under that code, a 10 percent evaluation is warranted if the FEV-1 results were 71 to 80 percent predicted, or; the FEV-1/FVC results were 71 to 80 percent, or; DLCO (SB) was 66 to 80 percent predicted. A 30 percent evaluation will be assigned if FEV-1 results were 56 to 70 percent predicted, or; the FEV-1/FVC results were 56 to 70 percent, or; DLCO (SB) was 56 to 65 percent predicted. A 60 percent evaluation is warranted if FEV-1 results were 40 to 55 percent predicted, or; the FEV-1/FVC results were 40 to 55 percent, or; Diffusion Capacity of the lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) was 40 to 55 percent predicted, or, maximum oxygen consumption was 15 to 20 ml/kg/min (with cardiorespiratory limit). For a 100 percent evaluation, FEV-1 must be less than 40 percent of predicted value, or; the ration of FEV-1/FVC less than 40 percent, or; DLCO (SB) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption, or; cor pulmonale, or; right ventricular hypertrophy, or; pulmonary hypertension, or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy. The RO determined in June 1999 that the evidence prior to November 24, 1998, did not support a higher than 30 percent rating. The Board disagrees with this determination and in fact finds that the evidence prior to November 1998 supports a 100 percent rating. This is so based on findings from a September 1997 VA pulmonary function test report which shows that DLCO-SB was 39.7 percent predicted. Under the new criteria for rating emphysema, pulmonary, a 100 percent rating is warranted if DLCO-SB is less than 40-percent predicted. The veteran's 39.7 predicted falls under 40 percent thus satisfying the criteria for a 100 percent rating. 38 C.F.R. § 4.97, Diagnostic Code 6603 (1999). It is noteworthy to point out that the elements listed under the new criteria of Code 6603 are listed in the disjunctive, meaning that the veteran need only satisfy one element in each rating disability category. The fact that the veteran's FEV-1 output reading in 1997 satisfies one of the elements for a 60 percent rating under the new rating schedule is not determinative of this issue in view of his 1997 DLCO-SB reading which satisfies one of the elements for a 100 percent rating. VA regulation specifies that where there is a question as to which of two 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 (1999). Furthermore, any reasonable doubt that arises in assigning a rating disability will always be resolved in the veteran's favor. 38 C.F.R. § 4.3 (1999). Subsequent pulmonary function tests performed by VA in November 1998 and May 1999 do not contain a DLCO-SB reading. Notwithstanding the absence of this test, the veteran's 100 percent rating will not be reduced absent a showing of physical improvement on reexamination. 38 C.F.R. § 3.344 (1999). Not only do these recent examination reports not show an improvement in the veteran's respiratory disability, they in fact show a worsening. In this regard, results of the pulmonary function tests performed in 1997 revealed moderate airways obstruction whereas results of the November 1998 tests revealed severe obstruction defect. Moreover, a VA examiner who reviewed the veteran's claims file in May 1999 stated that a comparison of the veteran's pulmonary function tests (performed in September 1997 and November 1998) showed that his condition had gotten worse. Similarly, a VA examiner in July 1999 said that it appeared that the veteran's symptoms had worsened. For the foregoing reasons, the weight of evidence supports a 100 percent schedular rating for the veteran's pulmonary fibrosis and emphysema from October 7, 1996. Entitlement to an Effective Date Earlier Than August 10, 1993, for a 10 percent Rating for Chronic Sinusitis with Associated Headaches The veteran's claim for an effective date earlier than August 10, 1993, for a 10 percent rating for his service-connected sinusitis with associated headaches is well grounded, meaning not inherently implausible. All relevant facts have been properly developed and VA has fulfilled its duty to assist the veteran. 38 U.S.C.A. § 5107(a). The regulation governing the assignment of effective dates states that unless provided otherwise in the chapter, the effective date of a claim for an increased rating "shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefore." 38 U.S.C.A. § 5110(a). Section 5110(b)(2) provides otherwise by stating that the effective date of an increased rating "shall be the earlier date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year from such date." See also 38 C.F.R. § 3.400(o)(2) (1999) (to the same effect). The provisions of 38 U.S.C.A. § 5110(b)(2) (West 1991) refer to the date an "application" is received." 'Application' is not defined in the statute. However, in regulations, 'claim' and 'application' are considered equivalent and are defined broadly to include 'a formal or informal communication in writing requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit." Servello v. Derwinski, 3 Vet. App. 196, 198 (1992) (citing 38 C.F.R. § 3.1(p) (1991)). In March 1993 the veteran submitted a statement applying for "service connected compensation" and asserting problems over the years that included respiratory symptomatology. The RO construed this as a claim for an increased (compensable) rating for the veteran's service-connected chronic sinusitis with associated headaches. Thereafter, in July 1993, the RO issued a rating decision denying the veteran's claim for a compensable rating for his service-connected chronic sinusitis with associated headaches. The veteran was advised of the RO's determination in July 1993. The following month, on August 10, 1993, the RO received a statement from the veteran (which he signed in May 1993) contending a worsening of his sinus disability. The RO treated this August 1993 claim as a new claim for an increased rating, but erred by not treating it as a Notice of Disagreement to the July 1993 denial. See Muehl v. West, No. 98-539 (U.S. Vet. App. Nov. 16, 1999) (holding that a claim for reconsideration which followed an adverse decision by the RO and was received prior to the expiration of the appeal period was appropriately construed by the Board as a Notice of Disagreement). It follows that because the July 1993 rating decision did not become final, it was still pending at the time of the RO's rating decision to grant a 10 percent rating. Thus, March 29, 1993, at which time he requested that he be "compensated for [his] medical disabilities" is the proper date of claim for an increased (compensable) rating for service-connected chronic sinusitis with associated headaches. 38 U.S.C.A. § 5110(a),(b)(2); 38 C.F.R. § 3.400(0). Having decided that the claim for an increased (compensable) rating was filed no sooner than March 29, 1993, consideration must now be given to whether an effective date for a 10 percent rating may be assigned earlier than this date. In order to be entitled to an earlier effective date, the evidence would have to show that the veteran's entitlement to a 10 percent disability rating was factually ascertainable prior to August 10, 1993 (provided that the claim was received within one year of the increase). 38 U.S.C.A. § 5110(b)(2); 3.400(0)(2); Harper v. Brown, 10 Vet. App. 125 (1997). As previously noted, changes were made to the rating schedule regarding respiratory disabilities on September 5, 1996, and made effective on October 7, 1996. A 10 percent rating under the old criteria requires moderate chronic sinusitis manifested by a discharge or crusting or scabbing and infrequent headaches. 38 C.F.R. § 4.97, Part 4, Diagnostic Code 6510-6514 (1996). Keeping in mind the above-noted criteria, the evidence does not show that the veteran's chronic sinusitis with associated headaches was consistent with a 10 percent rating within the year preceding his March 29, 1993 claim for an increase. Private treatment notes during that period make no mention of the veteran's sinus disability and there are no subsequent records which show that he met the criteria for a 10 percent rating during that preceding year. Consequently, the effective date for the veteran's 10 percent rating for chronic sinusitis with associated headaches may be no earlier than the date of VA's receipt of claim, which, for the reasons previously stated, is March 29, 1993. 38 U.S.C.A. § 5110(a); 38 C.F.R. § 3.400(0). ORDER An increased schedular rating to 100 percent for pulmonary fibrosis and emphysema is granted, effective from October 6, 1997, subject to the law and regulations governing the payment of monetary benefits. An earlier effective date of March 29, 1993, for a 10 percent rating for chronic sinusitis with associated headaches is granted. REMAND The claims file contains a faxed copy of a September 1993 VA examination report stating that the results of pulmonary function tests revealed early obstructive pattern. However, the actual pulmonary function tests are not on file. This evidence is essential in rating the veteran's pulmonary fibrosis and emphysema prior to October 7, 1996, in view of the rating criteria which is based in part on pulmonary function test results. Furthermore, since these tests were performed at a VA medical facility, they are considered to be constructively before the Board and must be obtained. See Bell v. Derwinski, 2 Vet. App. 611 (1991). Accordingly, this case is REMANDED to the RO for the following action: 1. The RO should obtain a copy of the September 1993 pulmonary function study report from the Clarksburg VA medical center and associate it with the claims file. 2. Thereafter, the RO should again review the veteran's claim for an increased rating in excess of 10 percent for pulmonary fibrosis and emphysema prior to October 7, 1996. If the claim is not granted, a Supplemental Statement of the Case should be issued. The veteran and his representative should be given an opportunity to respond thereto. After the veteran and his representative have been given an opportunity to respond to the Supplemental Statement of the Case, the claims folder should be returned to this Board for further appellate review. No action is required of the veteran until he receives further notice. The purposes of this remand are to procure clarifying data and to comply with the governing adjudicative procedures. The Board intimates no opinion, either legal or factual, as to the ultimate disposition of this appeal. 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 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. C.W. Symanski Member, Board of Veterans' Appeals