BVA9501740 DOCKET NO. 92-13 189 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUE Entitlement to an increased disability evaluation for service- connected "fascitis/intraspinous ligament," currently rated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Alan S. Peevy, Associate Counsel INTRODUCTION The veteran had active military service from March 1943 to April 1946, and from June 1951 to June 1952. This case is before the Board of Veterans' Appeals (Board) on appeal from an August 1991 rating decision by the Detroit, Michigan, Regional Office (RO). A notice of disagreement was received in February 1992, and a statement of the case was issued in March 1992. A substantive appeal was received in April 1992. A supplemental statement of the case was issued that same month. The case was remanded to the RO by Board decision dated in October 1992, and a supplemental statement of the case was issued in June 1994. The case is now again before the Board for further appellate review. The veteran is represented by the Disabled American Veterans. Pursuant to the Board's October 1992 remand, the RO adjudicated the issue of entitlement to service connection for arthritis of the cervical spine. Entitlement to this benefit was denied by rating decision dated in June 1994. However, it appears that the only notice to the veteran of that adjudicative action was the premature (prior to any notice of disagreement) issuance of a supplemental statement of the case that same month. It appears that the veteran's notice of disagreement as to this issue was not received until July 1994. The Board does not view the service connection for arthritis issue to be intertwined with the increased rating issue currently in appellate status. Therefore, they need not be adjudicated together. Harris v. Derwinski, 1 Vet.App. 180 (1991). However, the Board refers this matter to the RO for the necessary procedural steps, including a reexamination of the claim to determine if additional review or development is warranted and, if the benefit sought is not granted, the issuance of a statement of the case (in its proper sequence after the veteran's notice of disagreement) along with clear notice to the veteran and his representative of the need to file a timely substantive appeal if the veteran wishes to perfect the appeal he has initiated on the service connection for arthritis of the cervical spine issue. 38 U.S.C.A. § 7105 (West 1991); 38 C.F.R. §§ 19.26, 20.200 (1993). CONTENTIONS OF APPELLANT ON APPEAL It is contended by and on behalf of the veteran that the veteran's service-connected fascitis/intraspinous ligament should be rated at least 50 percent disabling. It is maintained that this disability results in attacks of intense pain and greatly limits the veteran's activities. Further, the veteran asserts that his neck cracks and snaps when he moves his head. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), 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 preponderance of the evidence is against entitlement to a disability evaluation in excess of 10 percent for service-connected "fascitis/intraspinous ligament." FINDING OF FACT It was medically determined that the veteran does not suffer from "fascitis/intraspinous ligament." CONCLUSION OF LAW An evaluation in excess of 10 percent for service-connected "fascitis/intraspinous ligament" is not warranted. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321 and Part 4, 3.951 (1993). REASONS AND BASES FOR FINDING AND CONCLUSION Disability evaluations are based upon the average impairment of earning capacity as contemplated by the schedule for rating disabilities. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 3.321 and Part 4 (1993). Separate diagnostic codes identify the various disabilities. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the veteran's condition. Schafrath v. Derwinski, 1 Vet.App. 589, 594 (West 1991). A review of the record discloses that service connection was established for "fascitis/intraspinous ligament" by rating decision dated in August 1952 based on evidence in the veteran's service medical records of treatment for a strain of the upper dorsal and lower thoracic musculature and an inservice diagnosis of "fascitis/intraspinous ligament." In his original 1952 claim, the veteran indicated that the disability was possibly due to a fall suffered during his first period of service. A 10 percent disability rating was assigned at the time of the original grant of service connection in August 1952, and this rating has been in effect since that time. The veteran began seeking medical attention for neck-related complaints in the mid-1980's due to what he claims was an increase in the severity of neck pain and loss of motion. Of record are clinical records documenting treatment by Ronald M. Urban, D.C. from 1985 to 1992 along with a January 1993 letter citing an impression of "advanced degenerative changes in the spine probably due to an earlier trauma, Vertebral Subluxation Syndrome." Also of record are 1992 medical records documenting treatment by Richard E. Tapert, D.O. and a January 1993 letter from this private medical care provider documenting treatment of the veteran since 1986. In this letter, Dr. Tapert reported that the veteran suffered from pain and limited motion of the cervical spine and that his condition included degenerative arthritis of the cervical spine. Dr. Tapert also commented that it was his opinion that the veteran's "present state of pain and disability is related to the injuries which he sustained while serving in the U.S. Navy." VA outpatient reports in the early 1990's show treatment for degenerative joint disease of the cervical spine. A VA examination in 1991 resulted in a diagnosis of degenerative joint disease of the cervical spine. Pursuant to the Board's October 1992 remand, the veteran underwent VA orthopedic examination in June 1993. The examiner reported subjective complaints of decreased range of motion of the neck with cracking, popping and occasional pain with movement of the neck. Examination of the cervical spine revealed some limitation of motion with no muscle spasm. Radiological studies of the cervical spine were interpreted as showing generalized minor degenerative changes without disc disease or instability. The examiner's orthopedic opinion was that the veteran had "generalized spinal problems, very minor degenerative disc disease as well as degenerative arthritis of aging." A follow-up examination was conducted in July 1993 for the purpose of clarifying the nature of the veteran's disability and residuals related thereto. The same examiner conducted the examination and reported that the veteran had decreased range of motion with discomfort secondary to arthritis in his neck, but with no change since the June 1993 examination. The RO requested further review and explanation and, in an October 1993 statement, the Chief of the Administrative Medicine Section of the VA medical facility reported that the examiner had again reviewed his findings and had indicated that there was no such diagnosis of "fascitis/intraspinous ligament" and that therefore no list of findings could be related to this non- existent diagnosis. The RO once again requested clarification, and in a December 1993 statement, the examiner reported that it was his opinion that there were no residuals of "fascitis/intraspinous ligament" noted on examination. He further indicated that there was no indication that this problem ever existed. It appears that the underlying problem in the present case is that there is no persuasive evidence to relate the veteran's current neck symptomatology to the disability for which service connection has been established. Although the veteran may relate symptoms which he perceives to be manifestations of that disability, the question of whether those symptoms are in fact attributable to his service-connected disability involves a question of differential diagnosis. The Board believes that such a question calls for application of diagnostic skills and therefore must be made by medical experts. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). A trained medical doctor has reported that the veteran does not suffer any residuals of "fascitis/intraspinous ligament." It appears that the veteran's neck symptomatology is related to degenerative changes for which service connection has not been established. Under the circumstances, the Board is unable to find that any symptomatology attributable to the veteran's service-connected "fascitis/intraspinous ligament" is present to warrant an increased disability evaluation. A review of the private medical reports and statements does not change this outcome. The statement from Ronald M. Urban, D.C. to the effect that the veteran's condition was probably due to earlier trauma does not link the veteran's current neck symptoms to his service-connected "fascitis/intraspinous ligament." It only refers to an earlier trauma. The January 1993 statement by Dr. Tapert which is to the effect that the veteran's condition includes degenerative arthritis of the cervical spine and that the veteran's symptoms are related to injuries sustained in service does not show that the veteran suffers from "fascitis/intraspinous ligament," but that he suffers from arthritis. While Dr. Tapert's statement may be probative on the question of whether the veteran's arthritis is related to his service, the issue of entitlement to service connection for arthritis of the cervical spine is not before the Board since an appeal has not yet been perfected. The Board therefore does not have jurisdiction to review that issue. In sum, the evidence does not show that the veteran currently suffers any symptomatology associated with his service-connected "fascitis/intraspinous ligament." Accordingly, there is no basis for granting his claim for an increased rating. The current 10 percent evaluation is protected, however, and therefore is to be continued. 38 C.F.R. § 3.951(b) (1993). ORDER The appeal is denied. E. M. KRENZER 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. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), 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 which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.