Citation NR: 9728184 Decision Date: 08/13/97 Archive Date: 08/19/97 DOCKET NO. 94-35 804 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for ischemic heart disease, peripheral vascular disease, hypertension, a neurological disorder (including peripheral neuropathy), impotence, sinusitis, and left-sided hearing loss, each claimed as due to exposure to Agent Orange. 2. Entitlement to an increased (compensable) rating for a skin disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD William L. Pine, Counsel INTRODUCTION The appellant had active service from June 1966 to June 1969. This appeal is from May 1993 and June 1994 rating decisions of the Department of Veterans Affairs (VA) Montgomery, Alabama, Regional Office (RO). The former decision denied direct service connection (i.e., in this context, incurrence or aggravation of the claimed disabilities without application of certain regulatory presumptions regarding exposure to certain herbicide agents) for each of the claims at issue and denied increased rating for a service-connected skin condition. The latter, a decision by letter, notified the appellant of specific findings and continued denial in his case after review to determine applicability of newly promulgated regulations pertaining to diseases associated with exposure to certain herbicide agents (commonly collectively known as Agent Orange). The appellant stated emphatically in the March 1994 notice of disagreement that all of his claimed disabilities result from exposure to Agent Orange, and VA should not consider his claims on any other basis. The appellant’s August 1994 substantive appeal and January 1997 hearing testimony likewise argued that each of his claimed disabilities resulted from exposure to Agent Orange. The Board of Veterans’ Appeals (Board) therefore construes the appeal from the denials of service connection as limited to the question whether the claimed disabilities resulted from exposure to Agent Orange. In a May 1988 decision, the Board denied service connection for unspecified residuals of Agent Orange. The decision was predicated on a since-repealed regulation, 38 C.F.R. § 3.311a(d), held invalid in the case of Nehmer, et al. v. United States Veterans’ Administration, et al., 712 F. Supp. 1404 (N.D. Cal. 1989). Pursuant to the order in Nehmer, 712 F. Supp. at 1423, that Board decision is void and therefore cannot be final as regards any claim at issue in the instant appeal. Whereas there is not an appeal from the denial on a direct basis of service connection for any of the disorders at issue in the instant appeal, the Board need not consider the jurisdictional and procedural effect of another May 1988 Board decision that denied service connection on a direct basis for certain of the claims now at issue. The veteran testified at a hearing before the undersigned in January 1997. In his hearing testimony, the appellant stated he has an intermittent skin condition affecting parts of his body other than the hands and feet, which he believes are due to exposure to Agent Orange, or, alternatively, that his service-connected skin disorder is more extensive than is recognized. To the extent that the testimony can be construed as a claim of entitlement to service connection for a skin disorder due to exposure to Agent Orange and other than that currently service connected, the matter is referred to the RO for appropriate action. For reasons set forth in the REMAND appended to this decision, the Board defers review of the merits of the claim for an increased disability rating for a service-connected dermatophytosis of the hands and feet. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that he has ischemic heart disease, peripheral vascular disease, hypertension, a neurological disorder (specifically peripheral neuropathy), impotence, sinusitis, and hearing loss which all result from exposure in service to Agent Orange. He avers that peripheral neuropathy, impotence, and sinusitis began while in Vietnam. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1997), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the appellant has not met the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that any claim at issue predicated on exposure to Agent Orange is well grounded. FINDINGS OF FACT 1. The Board of Veterans’ Appeals denied service connection for residuals of exposure to Agent Orange pursuant to 38 C.F.R. § 3.311a(d) (1987) in May 1988. 2. The case of Nehmer, et al. v. United States Veterans’ Administration, et al., 712 F. Supp. 1404 (N.D. Cal. 1989), ruled void all VA benefits decisions pursuant to 38 C.F.R. § 3.311a(d). 3. The appellant has not submitted competent medical evidence of a current disability of impotence or peripheral neuropathy. 4. The appellant has not submitted competent evidence that ischemic heart disease, peripheral vascular disease, hypertension, sinusitis, or left-sided hearing loss, claimed as resulting from exposure to Agent Orange, is related to such exposure. CONCLUSIONS OF LAW 1. The May 1988 decision of the Board of Veterans’ Appeal that denied service connection for residuals of exposure to Agent Orange is void. Nehmer, et al. v. United States Veterans’ Administration, et al., 712 F. Supp. 1404, 1423 (N.D. Cal. 1989). 2. No claim at issue alleging a disability due to exposure to Agent Orange is well grounded, and VA has no duty to assist the appellant to develop those claims. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service medical history and examination on entrance into service were negative for any relevant disorder. Blood pressure was measured as 138/88. Hearing was within normal limits. The genitourinary system was normal. There were no complaints, treatment, or diagnoses of impotence in service. The appellant was seen in July 1966 for “sinus”; in November 1966, with complaint of chest cold (no assessment recorded); in May 1967, with cough and sputum production insignificant (no assessment recorded); in July 1967, assessed as acute tonsillitis and with allergic rhinitis; in August 1968, assessed with tracheobronchitis, then with complaints of cough, headache, and vomiting (no assessment recorded); in October 1968 (repeatedly), with complaints of upset stomach assessed as URI (upper respiratory infection), next with cough for several days and not feeling well since return from Vietnam, assessed as probable flu, next with notation of eight month history of frequent URI symptoms, assessed probable sinusitis, next with URI, and again, URI with pharyngitis-viral most likely; in December 1968, assessed as acute URI/rule out pneumonia. Also, the appellant was assessed in August 1968 with dyshidrosis of the right middle finger. Laboratory throat cultures of November 1966 and October 1968 were normal, and beta streptococci-not group A, respectively. A chest x-ray of October 1968 done after complaints of chest pain to rule out pneumonia showed a normal cardiovascular silhouette. Blood pressure measurement in October 1968 was 130/88, the heart had regular sinus rhythm. In May 1969, on separation medical history, the appellant reported history of ear, nose, and throat trouble and sinusitis. He did not endorse any other listed symptom. The medical examination was negative for all body systems and parts. Blood pressure was measured as 120/80. Hearing was within normal limits. In June 1969, the appellant was thrown from a motorcycle, hitting his left shoulder and head against the curb. He complained of left parietal and frontal [head] pain; skull x-ray was negative. Subsequently in June 1969, the appellant executed a statement certifying that he had had no change of medical condition since his separation examination of more than three days previously. An August 1971 application for VA disability compensation sought benefits for chest, head, and skin conditions. On VA examination in August 1971, the appellant reported a skin condition and treatment in service for chest pain. He complained of a sinus condition of four years duration, with a stuffed nose in the morning, but no headaches, and no history of related surgery. Cardiovascular, respiratory, and neurologic system were negative to clinical examination. Blood pressure was 120/80. A left deviated septum was identified. Sinus x-ray study was negative. Chest x-ray showed normal lungs, heart, and great vessels. The only diagnosis was dermatophytosis of the feet. A December 1972 statement reveals the appellant requested treatment at Northport VA Medical Center (VAMC) for left shoulder problems. A December 1972 VA treatment record shows the appellant was seen at a VA clinic for complaints of recent increase in left shoulder pain that had persisted since a motorcycle accident in 1969. A VA employee health record shows that the appellant was seen at a VA medical center for common cold versus/influenza in February 1976. In November 1976, at the same facility, he complained of nasal stuffiness for several days. Blood pressure on the two visits was 156/104 and 130/100, respectively. A June 1976 treatment note of unidentified provenance showed a report of blood pressure of 156/104 at work, normotensive on examination with regular sinus rhythm of the heart. A September 1979 VA outpatient treatment record shows blood pressure was 130/90. The appellant received emergency treatment in January, February, and December 1985 at the University of Alabama Medical Center for chest pain associated with bronchitis and costochondritis, chest x-ray normal; and for dizziness diagnosed as hypertension. He was also seen at Baptist Medical Center-Princeton (BMC-Princeton) in December 1985 for hypertension with a long history. Dr. B. McLean treated the appellant from December 1985 to December 1986 for hypertension, noted as present since the mid 1970s, with additional history of sinusitis and excessive alcohol and tobacco use. A December 1985 electrocardiogram (ECG) was abnormal. January 1986 records show concern that hypertension and laboratory abnormalities may be related to alcohol abuse. In July 1986 he was treated for acute sinusitis. In December 1986, on follow-up for hypertension, the appellant reported some pain in both thumbs and expressed concern it could be related to exposure to “Asian [sic] Orange,” which the doctor assured him was unlikely. On VA examination in June 1987, the appellant reported definite exposure to Agent Orange in Vietnam in 1967. Diagnoses included history of Agent Orange exposure with no apparent residuals. The appellant questioned whether sinusitis and stiffness of the finger joints were residuals of Agent Orange exposure. He reported sinusitis since Vietnam, with current active drainage and nasal stuffiness noted. Cardiovascular examination was normal. An impression of no active sinusitis was corroborated by negative sinus x- ray. June 1987 VA outpatient notes show treatment for hypertension. A September 1987 audiogram showed left-sided hearing loss. The appellant reported current sinusitis and a feeling of stuffiness in the left ear. The audiology results were thought possibly related to the sinusitis. Other September 1987 outpatient records show treatment for complaints of sinus and ear infection, tinnitus, hearing loss and sensation of pressure in the ears, assessed as possible acute sinusitis. In December 1987, he obtained an impression of chronic sinusitis from the otolaryngology clinic, which also noted a positive Rinne test and a Weber test lateralized to the right. A September 1987 letter from Department of Health and Human Services, Centers for Disease Control (CDC) responded to an inquiry by the appellant, described some of the epidemiological research done by the CDC and thanked the appellant for his participation in a health status interview to study Vietnam Veterans’ health. It stated his participation was probably in the Vietnam Experience component of the study. The letter stated that to date CDC had attempted to use military records to determine herbicide exposure levels to then permit the selection of a population to study to determine the health effects of a certain level of exposure. “The findings of the study, reported in the July 24, 1987, Morbidity and Mortality Weekly Report, (enclosed) confirmed conclusively that neither military records nor veterans’ personal perception of their exposure to Agent Orange can be used to identify enough exposed veterans to allow us to conduct a scientifically valid study.” The cited report is of record. Primarily private medical records from March 1989 to November 1992 from Baptist Medical Centers, Dr. Dickenson, Dr. Navari, and St. Vincent’s Hospital reflect treatment of multiple peripheral arterial stenoses and occlusions, two vessel coronary artery disease and segmental left ventricular dysfunction. The veteran underwent multiple arteriograms, catheterizations, and angioplasties. A VA ECG of November 1992 was abnormal. An April 1994 statement from D. Sibley, M.D., reported that the doctor was then treating the appellant for coronary artery disease, status post quadruple coronary artery bypass graft in April 1994 with a history of inferior myocardial infarction and peripheral vascular disease. Also, in July 1989, the appellant had a circumcision as treatment for a mild phimosis. There was no mention of impotence. A letter of July 10, 1996, from the appellant to the appellant’s local representative, Disabled American Veterans (DAV), informed DAV that he had accidentally obtained sensitive information, and that the information was in a secure place he was sure was known to the Government, because he assumed he was under Government surveillance and phone tap. The appellant wrote a letter to the Vice-Chairman, Board of Veterans’ Appeals, dated July 22, 1996, mailed U.S. Postal Service Express Mail to the Vice-Chairman and received July 23, 1996, informing the Board of the existence of a book entitled Veterans and Agent Orange. He stated he bought the book from the National Academy of Sciences National Academy Press for his personal use, but he had become concerned that the book contained information that was not supposed to leave government control, and he was concerned that he should find a way to deliver the information to the “right officials or destroy it in the presence of someone credible to the government.” With the letter in the claims folder is a label, showing receipt at VA on July 23, 1996. The Board returned the July 10 and July 22, 1996, letters to the RO, which then had jurisdiction over the claims folder, and which received them August 5, 1996 as is indicated by the date stamp on the material. No book is currently associated with the claims folder. In VA hearing testimony in January 1997, the appellant testified he mailed the book to the Board in July 1996. A March 1997 internal Board memorandum shows that the Board received the appellant’s claims folder from the RO in October 1996, prior to which any material received by the Board pertinent to the appellant’s claim would have been transferred to the RO in the ordinary course of business, as were the letters of July 10 and 22, 1996. The Board remanded the claims folder to the RO to request the appellant to provide proof of shipment and for the RO to search for the book. A May 7, 1997, memorandum from the RO stated that the book was not found. The appellant stated in May 1997 that he mailed the book to the Vice-Chairman, and he did not have a copy of the mailing receipt, nor did the post office. In addition to the January 1997 testimony regarding the above referenced book, the appellant testified he had neurological pain and numbness in the hands and feet between outbreaks of the skin condition, which he believed was related to the skin condition. He stated, in summary, that sometime about 1992 or 1993 a VA psychiatrist told him, “the optic nerve in my back that goes down my right leg to my feet,” transcript at 12, was involved in a neurologic disorder associated with Agent Orange. He stated the report should be in his VA records from 1992 or 1993. He stated the pain in his hands and feet started in 1968 in Vietnam, that he complained of it prior to discharge, but there was no finding. He stated he received treatment about 1973 or 1974 at the Northport, New York, VA Medical Center, where he worked between 1970 and 1976. He stated he also received private treatment in New York, but he did not remember where. The appellant testified that he was chosen in 1982 for an Agent Orange study in Birmingham, Alabama. He testified that he saw several private doctors who said they could not say his hand and foot pain, heart problems, and other disabilities were or were not caused by Agent Orange. He stated he could not recall the names of or obtain records from the private doctors, but the book he sent to the Vice- Chairman of the Board “had it all in there,” transcript at 22, about all of his claimed disabilities. He testified, when asked if he had a diagnosis of peripheral neuropathy, that he was sure he did, from the VA psychiatrist who said there was no other explanation for his symptoms than exposure to Agent Orange. When asked if he could remember the names of any of the doctors he referred to, he identified Dr. McRea, who he said performed back surgery at St. Vincent’s in September 1994 for his nerve problem. The appellant testified he was first treated for heart disease in 1987, but had had angioplasty of the left leg first. He stated his claim of entitlement to service connection for a vascular disorder pertained to his legs; he first noticed a problem in 1985. He reported that impotence first started in 1968 while in Vietnam, that the medic he told said it was just a phase, and he had no further treatment in service. He said the vascular surgeons related it to his circulatory problems, and that vascular surgery had helped some. He stated the book he submitted had information on impotence. The appellant testified to the onset of sinusitis in 1967, with the first treatment in Vietnam. He stated he may have been treated during the summer after his separation, but he was not sure, referencing treatment records from Northport VAMC from 1973. He stated that he had been treated at Birmingham VAMC for left-sided hearing loss, etiology unknown, but thought probably due to sinusitis, and that he had had audiology examinations in 1986 or 1987 and in service. He stated he was first diagnosed with hypertension in 1971 at the Brooklyn, New York, VAMC, and he had been treated for years. He requested that records be obtained from Northport VAMC and from St. Vincent’s hospital for 1994 in support of his claim regarding peripheral neuropathy. The appellant argued that he is entitled to the benefit of the doubt regarding the question whether his claimed disorders are due to exposure to Agent Orange. The Board borrowed a copy of Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam (National Academy Press 1994) from VA Central Office library. No scientifically reliable association between exposure to the studied herbicides was reported for vascular diseases (including ischemic heart disease and hypertension), 699-708; peripheral neuropathy, 662-666; respiratory disorders (no specific mention of sinusitis), 708-714; or hearing loss, 659-650. The extensive index has no listing for impotence. The Board takes notice that in November 1996 VA amended the regulations providing for certain presumptions of service connection and listing diseases associated with Agent Orange exposure, to include acute and subacute peripheral neuropathy, 61 Fed. Reg. 57586-57589 (1996) (to be codified at 38 C.F.R. §§ 3.307 (a)(6)(ii) and 3.309(e)), based on findings published in Veterans and Agent Orange: Update 1996 (National Academy Press 1996). II. Analysis A. Procedural Matters The appellant has not informed VA of the existence of any specific evidence germane to any claim at issue that would complete an incomplete application for compensation, i.e., well ground an otherwise not well-grounded claim, if submitted. Consequently no duty arises in this case to inform the appellant that his application is incomplete or of actions necessary to complete it. Specifically, his testimony about treatment by certain unnamed physicians and alleged medical opinions or diagnoses by these unnamed doctors is too vague to trigger such a duty on VA’s part; it appears records from VAMC Northport are of record. See 38 U.S.C.A. § 5103(a) (West 1991); Beausoleil v. Brown, 8 Vet.App. 459, 465 (1996); Johnson v. Brown, 8 Vet.App. 423, 427 (1995); cf. Robinette v. Brown, 8 Vet.App. 69 (1995) (when a claim is not well grounded and claimant informs VA of the existence of certain evidence that could well ground the claim, VA has duty under 38 U.S.C. § 5103(a) to inform claimant that application for compensation is incomplete and to submit the pertinent evidence). The veteran’s testimony that a VA psychiatrist told him he has peripheral neuropathy due to Agent Orange exposure because there can be no other explanation, and further that it was in “the optic nerve in his back,” is utterly implausible, and the production of a statement to that effect from a medical practitioner would not make it more so, or well ground the claim. Moreover, the appellant’s testimony that Dr. McRae and unnamed others could not rule out Agent Orange as a cause of his problems is a lay recollection of a medical opinion that, if verified, would not well ground his claims, so the testimony cannot well ground the claims. Robinette v. Brown, 8 Vet.App. 69 (1995). The Board has no duty to inform the appellant prior to deciding his appeal of the Board’s intention to rely, in part, on the use of Veterans and Agent Orange, or to provide the appellant an opportunity to submit additional evidence in response, see Thurber v. Brown, 5 Vet.App. 119 (1993), because the appellant has alleged that he is familiar with the work, that he submitted it, and VA lost it. Consequently, there can be no unfair surprise in the Board’s reference to a work with which he testified he is familiar. As a matter of law, the appellant may, in the alternative to a claim predicated upon exposure to Agent Orange, allege that any disorder claimed as due to Agent Orange exposure was otherwise directly incurred in or aggravated by service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). However, in this case, the appellant has explicitly and emphatically disavowed any intention to claim the existence of disability other than as due to exposure to Agent Orange. The Board in this decision intends not to rule or imply any conclusion in any claim the appellant may eventually prosecute for service- connection for disability alleged to be directly incurred in or aggravated by service other than as alleged to be attributable to exposure to Agent Orange. B. Substantive Matters Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated during service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303(a) (1996). In order to establish service connection, either the evidence must show affirmatively that such a disease or injury was incurred in or aggravated by service, or statutory presumptions may be applied. In this case, the appellant has chosen to narrow the basis of his claim by eschewing to claim direct service connection. A veteran who has 90 days or more of wartime service may be entitled to presumptive service connection of “a disease associated with exposure to certain herbicide agents listed in § 3.309(e),” 38 C.F.R. § 3.307(a) (1996), that becomes manifest to a degree of 10 percent or more within the time period specified by regulation. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1112, 1113, 1137 (West 1991 & Supp. 1997); 38 C.F.R. § 3.307 (1996). The diseases recognized as associated with exposure to certain herbicide agents and subject to this presumption are prescribed by regulation. 38 C.F.R. § 3.309(e) (1996). Only those listed at 38 C.F.R. § 3.309(e) will be presumed to have been incurred in service due to exposure to Agent Orange. 38 C.F.R. § 3.307(a) (1996). "[A] person who submits a claim for benefits under a law administered by the Secretary [of Veterans Affairs] 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) (West 1991). “[I]n order for a claim to be well grounded, there must be competent evidence of a current disability (a medical diagnosis); of incurrence or aggravation of a disease or injury in service (lay or medical evidence); and of a nexus between the in-service disease or injury and the current disability (medical evidence).” Caluza v. Brown, 7 Vet.App. 498, 506 (1995)(citations omitted) aff’d 78 F.3d 604 (Fed. Cir. 1996) (Table); see Grottveit v. Brown, 5 Vet.App. 91 (1993) (characterizing the type of evidence, lay versus medical, necessary to well ground a claim as dependent on the nature of the matter to be proven); see also Espiritu v. Derwinski, 2 Vet.App. 492 (1992) (lay individuals are competent to testify about matters of common experience, but expert qualification is necessary for VA to take cognizance of testimony that is rendered reliable only by expertise pertinent to object of inquiry). Truthfulness of the evidence is presumed in determining whether a claim is well- grounded. Caluza, 7 Vet.App. at 504. None of the disabilities at issue is included in 38 C.F.R. § 3.309(e) as associated with exposure to Agent Orange, thus none of his claims may be well grounded by operation of a statutory presumption. The appellant has submitted no competent evidence to show an association between exposure to Agent Orange and any of his claimed disabilities. The literature he submitted is not competent medical or other expert evidence for his purposes, see Espiritu, 2 Vet.App. 492, because it is at best epidemiologic, and is uninformative about his circumstances. Moreover, both Veterans and Agent Orange and the statement and article from the CDC are either adverse to his claims or, as to sinusitis and impotence, utterly uninformative. Neither supports the proposition that any of his claimed disabilities are associated with exposure to Agent Orange. A claim cannot be well grounded on adverse evidence. Cf. Villalobos v. Principi, 3 Vet.App. 450 (1992) (evidence adverse to a claim cannot be new and material). The testimony about the statement of Dr. McRae and other unnamed physicians’ opinions cannot well ground the appellant’s claims. On its face, the testimony does no more that assert the referenced doctors were uncertain whether there existed a relationship between various of the appellant’s disorders and exposure to Agent Orange. The appellant’s lay recollection of medical opinions does not afford the degree of reliability required of medical opinion evidence to well ground a claim. Robinette, 8 Vet.App. 69. The appellant emphatically insists his claim be adjudicated on no other basis than exposure to Agent Orange, and none of his claims either benefits from a statutory presumption or is supported by competent expert evidence that exposure to Agent Orange caused the onset of a claimed disorder. Thus, as to each claimed disability, the claim fails of the most basic criteria of well groundedness, as none is either plausible or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78 (1990). In short, none of the appellant’s claims for any of the disabilities the alleged to be due to Agent Orange exposure can be well grounded on that basis, and thus, within the context of his claim, none is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). Additional comments are warranted regarding the claims of entitlement to service connection for impotence and peripheral neuropathy. With respect to impotence, the veteran has not presented any medical evidence that he suffers from such a disability. His lay testimony is not sufficient to provide a diagnosis, and he has stated that he has never had treatment for the alleged condition. Accordingly, without competent evidence of a current disability, that claim cannot be well grounded. With respect to peripheral neuropathy, although the appellant alleges he has a neurological disorder, even proof of chronic peripheral neuropathy would leave him in the position of seeking service connection for a disability alleged to be due to exposure to Agent Orange that does not enjoy a statutory presumption of such incurrence. Acute or subacute peripheral neuropathy is subject to presumptive service connection. 38 C.F.R. § 3.309(e) (as amended, 1996) (emphasis added). Acute or subacute peripheral neuropathy is defined as “transient peripheral neuropathy that appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset. 38 C.F.R. § 3.309(e) note 2 (1996); see Supplementary Information 61 Fed. Reg. 57587 (1996) (distinguishing between chronic peripheral neuropathy and acute or subacute peripheral neuropathy for presumptive purposes). Therefore, his testimony that he has peripheral neuropathy 30 years after his last service in Vietnam precludes the application of the regulatory presumption to that disorder. Moreover, he has not submitted competent medical evidence he has even chronic peripheral neuropathy. For that reason alone, this is a claim for a disorder the appellant is not shown to have, and the claim cannot be well grounded. See Rabideau v. Derwinski, 2 Vet.App. 141 (1992). The presumption of incurrence in service of acute or subacute peripheral neuropathy was added to the regulation by amendment post-dating the last RO review of his case. See 61 Fed. Reg. 57589 (1996) (to be codified at 38 C.F.R. § 3.309(e)). Whereas the claim is not well grounded, both for lack of evidence of the existence of any peripheral neuropathy, and because acute and subacute peripheral neuropathy by definition are impossible claims for this claimant, the Board will not remand the claim for adjudication by the RO. Finally, where no claim at issue is well grounded, VA has no duty to assist the appellant to develop the facts in support of any claim of which this decision disposes. 38 U.S.C.A. § 5107(a) West 1991). Each of the claims must be denied. Edenfield v. Brown, 8 Vet.App. 384 (1995). ORDER Entitlement to service connection based on exposure to Agent Orange for ischemic heart disease, peripheral vascular disease, a neurological disorder including peripheral neuropathy, impotence, sinusitis, hearing loss, and hypertension is denied. REMAND The appellant contends that his service-connected skin disorder is more severe than when last evaluated for compensation purposes. He avers that dermatological symptoms involving more of his body than his hands and his feet are part of the service-connected disability. He has not had a VA examination of the skin for compensation purposes since December 1987. He should have a contemporaneous examination in conjunction with his claim for an increased rating. Littke v. Derwinski, 1 Vet.App. 90 (1990). 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) and 38 U.S.C.A. § 5101 (West 1991 and Supp. 1997)(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 by the Court. See M21-1, Part IV, paras. 8.44- 8.45 and 38.02-38.03. Accordingly, the case is REMANDED for the following action: 1. Schedule the appellant for a VA dermatology examination to determine the current severity of service-connected dermatophytosis of his hands and feet, and to diagnose any other dermatological condition on his body. Provide the examiner with the claims folder. The examiner should note the biopsy reports of December 1991 and October 1992. The examiner should state an opinion whether any other findings constitute an increase in severity or evolution of the service- connected dermatophytosis of the hands and feet. 2. Readjudicate the claim for increased rating for dermatophytosis of the hands and feet, and provide the appellant and his representative with supplemental statement of the case and afford them an appropriate amount of time to respond. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration, if appropriate. The appellant need take no further action until he is further informed. The appellant and his representative are free to furnish additional evidence and argument while the case is in remand status. Booth v. Brown, 8 Vet.App. 109 (1995); Quarles v. Derwinski, 3 Vet.App. 129, 141 (1992). The purpose of this REMAND is to obtain additional information and to accord due process. No inference should be drawn regarding the final disposition of the claim as a result of this action. J. SHERMAN Member, Board of Veterans' Appeals 38 U.S.C.A. § 7102 (West Supp. 1997) permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1997), a decision of the Board of Veterans’ Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans’ Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date that appears on the face of this decision constitutes the date of mailing and the copy of this decision that you have received is your notice of the action taken on your appeal by the Board of Veterans’ Appeals. Appellate rights do not attach to those issues addressed in the remand portion of the Board’s decision, because a remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1996). - 2 -