BVA9504688 DOCKET NO. 91-17 686 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Entitlement to an increased (compensable) rating for scar, right wrist and little finger with deformity. 2. Entitlement to an increased (compensable) rating for scar, right shin. REPRESENTATION Appellant represented by: Theresa W. Hajost, Attorney WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Susan S. Toth, Associate Counsel INTRODUCTION The veteran had active service from August 1943 to January 1946. This matter came to the Board of Veterans' Appeals (Board) on appeal from a May 1990 rating decision, whereby the Regional Office (RO) denied the veteran's claims for increased ratings. A hearing was held on April 3, 1991 at the RO before C..W. Symanski, who chaired the hearing and is the member of the Board rendering the final decision in this claim and who was designated by the Chairman to conduct that hearing pursuant to 38 U.S.C.A. § 7102(b) (West 1991). In March 1992, the Board issued a decision granting service connection for loss of tooth 31 due to trauma, and denying increased ratings for scars of the right wrist, right little finger with deformity, and right shin. On August 13, 1993, the United States Court of Veterans Appeals (Court) issued an order acknowledging that the parties had filed a joint motion to remand this appeal to the Board. The Court granted the motion and vacated the Board's decision as to the denial of increased ratings for scars of the right wrist, right little finger with deformity, and right shin. The case was remanded pursuant to 38 U.S.C.A. § 7252(a) (West 1991) for action in compliance with the instructions in the motion for remand. Copies of the joint motion for remand and the Court order have been placed in the claims folder. The veteran was represented before the Court and currently before the Board by Theresa Hajost, Attorney. Previously, the Paralyzed Veterans of America, Inc., represented the veteran in connection with his appeal. The Board remanded the case in March 1994. Following further development of the evidence, the case was docketed at the Board in February 1995. The Board again notes that the veteran raised the issue of service connection for the loss of teeth in a November 1993 statement. In a statement received in May 1994, he also raised the issue of reimbursement for outpatient dental care by a private dentist. As those issues have not been developed or certified for appeal and as they are not inextricably intertwined with the issues before the Board, they are referred to the RO for appropriate consideration. See Harris v. Derwinski, 1 Vet.App. 180 (1991). The veteran has also implicitly raised the issue of entitlement to nonservice-connected pension benefits by virtue of his service during a period of war and his employment status. See 38 C.F.R. § 3.151(a) (1994). The Board refers this issue to the RO for appropriate consideration, since it also was not developed for appeal and is not inextricably intertwined with the issues presently on appeal. See Kellar v. Brown, 6 Vet.App. 157 (1994). REMAND The VA examination reports of October 1994 are patently insufficient for appellate review purposes. The applicable criteria provide that it is incumbent upon the rating board to return a medical report as inadequate for evaluation purposes if it does not contain sufficient detail. 38 C.F.R. § 4.2 (1994); See Green v. Derwinski, 1 Vet.App. 121, 124 (1991). The Board noted in its remand of March 1994 that an October 1989 VA orthopedic examination report contained diagnoses of post- traumatic arthritis of the right wrist and ulnar claw hand on the right. These diagnoses, along with the veteran's long-standing complaints of pain, raised the inferred issue of whether any additional disability of the right wrist and hand is related to the injury suffered during service. See Akles v. Derwinski, 1 Vet.App. 118 (1991). The Board specifically requested that the VA medical examiners express an opinion as to whether or not there was a relationship between any current disabilities of the right hand and wrist and the veteran's injury during service. See Moore v. Derwinski, 1 Vet.App. 401, 405 (1991) (quoting Witherspoon v. Derwinski, 2 Vet.App. 4, 4-5 (per curiam order, 1991)). The orthopedic examiner provided a diagnosis of status post shrapnel wounds to right wrist with injuries to the common sensory digital nerve at the wrist. The neurological examiner, however, recommended that the veteran undergo an EMG nerve conduction velocity evaluation. He indicated that if such a test was performed in the past and was abnormal, the test should currently be repeated. The Board notes that an EMG nerve conduction velocity evaluation was conducted at the Charleston, South Carolina, VA Medical Center in June 1988. The conclusion was mild generalized peripheral neuropathy. Accordingly, further EMG studies should have been conducted pursuant to the examiner's direction. The examination reports of October 1994 were also deficient because the examiners did not reconcile their failure to diagnose post-traumatic arthritis of the right wrist and ulnar claw hand on the right with the previous diagnoses of arthritis and ulnar claw hand. In sum, additional VA examinations are necessary, in this case, to (1) reconcile the diagnoses; (2) evaluate the veteran for the purpose of determining the existence of each of the impairments noted in the record; (3) determine the degree of disability, in terms of ordinary conditions of life, imposed by each impairment, if possible, and its relation to service; and (4) determine the extent to which each impairment contributes to the veteran's employability or unemployability. Shoemaker v. Derwinski, 3 Vet.App. 248, 255 (1992). Since further evaluation of the veteran's service-connected conditions is warranted, recent medical treatment records should be procured. In that regard, the veteran submitted a statement in May 1994, wherein he indicated that treatment was received at the Charleston and Columbia VA Medical Centers. All of his private practitioners had either retired or passed away. The VA has a duty to assist the veteran in the development of facts pertaining to his claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.303(a). The Court has held that the duty to assist includes obtaining available medical records that are relevant to the appeal. Littke v. Derwinski, 1 Vet.App. 90 (1990). In a statement received at the RO in June 1994, the veteran requested that he be scheduled for a personal hearing at the RO. In a statement of the case issued in August 1994, the RO informed him that he would be notified by separate letter as to the time of his personal hearing. Review of the claims folder does not indicate that the veteran was subsequently scheduled for a hearing. This defect should be cured upon remand. Under the circumstances of this case, the Board finds that additional assistance is required. Accordingly, the case is REMANDED to the RO for the following: 1. The RO should schedule the veteran for a hearing to be conducted at the RO. 2. The RO should contact the veteran and obtain the names and addresses of all health care providers where he has received treatment for the disabilities at issue from 1993 to the present. Thereafter, the RO should acquire copies of all available medical records, to include those from the VA Medical Center in Charleston, South Carolina, dated from October 1993 to the present and those from the VA Medical Center in Columbia, South Carolina, dated from January 1986 to the present. Once obtained, all records must be associated with the claims folder. 3. The veteran should be afforded VA special examinations in orthopedics and neurology, as well as a special surgical examination, to determine the extent of his service-connected disabilities. The examiners should review the entire claims file prior to the examinations. All indicated tests, to include X-ray studies and an EMG nerve conduction velocity test, should be conducted. The veteran's service-connected disabilities should be evaluated in relation to their history with emphasis upon the limitation of activity imposed by the disabling conditions in light of the whole recorded history. Each examiner should render an opinion as to what effect the service-connected disabilities have on the veteran's ability to work. In addition, the examiners should specifically address the following: a. With respect to the scars, is either the scar of the right wrist or right shin poorly nourished with repeated ulceration; is either scar tender and painful on objective demonstration; or does either scar cause limitation of motion. b. Based on the entire medical history and the current examinations, is any disability of the right wrist and hand (to include any diagnosed post-traumatic arthritis and ulnar claw hand) related to the veteran's shrapnel fragment wound injury during service. If the examiners feel that the veteran does not have post- traumatic arthritis of the right wrist, ulnar claw hand on the right or any other neurological deficit of the right hand or wrist, that result should be reconciled with the previous diagnoses provided in the claims folder. The bases for all medical opinions expressed should be set forth in the examination reports. 4. When the requested developments have been completed, the RO must review the claims folder and ensure that all of the foregoing development actions have been conducted and completed in full. If any development is incomplete, including if the requested examination does not include all test reports, special studies or opinions requested, appropriate corrective action is to be implemented. After all requested development has been satisfactorily completed, the claims should be reviewed by the RO. In the event that the decision remains adverse to the appellant, a supplemental statement of the case should be prepared and furnished to the appellant and his attorney, who should then be given an opportunity to respond. Thereafter, the case should be returned to the Board in accordance with current appellate procedures. The appellant need take no action until he is further informed. The purpose of this REMAND is to obtain additional information, and no inference should be drawn regarding the final outcome of this claim as a result of this action. C. W. SYMANSKI Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), 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. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This 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) (1994).