BVA9502928 DOCKET NO. 93-04 056 ) DATE ) ) On appeal from decisions of the Department of Veterans Affairs Regional Office in St. Paul, Minnesota THE ISSUES 1. Entitlement to an increased evaluation for service-connected pancreatitis with pancreatic pseudocyst, postoperative, cholecystitis with cholecystectomy; duodenal ulcer, currently rated as 30 percent disabling, including the question of whether the duodenal ulcer should be separately rated. 2. Entitlement to an increased evaluation for service-connected diabetes mellitus, currently rated as 20 percent disabling. 3. Entitlement to an increased (compensable) evaluation for service-connected hearing loss of the left ear. 4. Entitlement to an increased (compensable) evaluation for service-connected esophagitis with Mallory-Weiss tear and esophageal peptic stricture. 5. Entitlement to service connection for eye disability. 6. Entitlement to service connection for hepatitis. 7. Entitlement to a temporary total convalescence rating under 38 C.F.R. § 4.30 (1993) prior to January 6, 1992, and subsequent to March 1, 1992. REPRESENTATION Appellant represented by: AMVETS WITNESSES AT HEARING ON APPEAL Veteran and veteran's spouse. ATTORNEY FOR THE BOARD Alan S. Peevy, Associate Counsel INTRODUCTION The veteran had active military service from February 1979 to March 1988. This case is before the Board of Veterans' Appeals (Board) on appeal from decisions of the St. Paul, Minnesota, Regional Office (RO). By rating decision dated in September 1991, the RO denied entitlement to increased ratings for service-connected pancreatitis, diabetes mellitus, and hearing loss of the left ear. In that same decision, the RO also denied entitlement to service connection for eye disability. A notice of disagreement initiating an appeal on these four issues was received in September 1991. The veteran and his spouse testified at a personal hearing at the RO in November 1991. By rating decision dated in May 1992, the RO denied entitlement to service connection for hepatitis and denied entitlement to an increased rating for service-connected esophagitis with Mallory- Weiss tear and esophageal peptic stricture (previously rated together with and under the same Diagnostic Code as the veteran's service-connected pancreatitis disability). In a notice of disagreement received in May 1992, the veteran initiated an appeal as to these issues and also raised the new issue of entitlement to service connection for a duodenal ulcer secondary to his pancreatic disability. In an October 1992 rating decision, the RO denied entitlement to an extension of a temporary total convalescence rating under 38 C.F.R. § 4.30 (1993). The RO also established service connection for the veteran's duodenal ulcer, but determined that regulatory law provided that it be rated with the pancreatitis disability under the same Diagnostic Code. A statement of the case addressing the diabetes, pancreatitis (with duodenal ulcer), eye, hearing loss, hepatitis and esophagitis issues was furnished to the veteran and his representative in October 1992. An Appeal to Board of Veterans Appeals (VA Form 9), received in December 1992, constituted the veteran's substantive appeal on the diabetes, pancreatitis (with duodenal ulcer), eye, hearing loss, hepatitis and esophagitis issues, and also constituted a notice of disagreement on the temporary total convalescence rating issue. A supplemental statement of the case which included the temporary total convalescence rating issue was furnished to the veteran and his representative in December 1992, and a Statement of Accredited Representation in Appealed Case (VA Form 1-646) received from the veteran's representative in February 1993 constituted a substantive appeal on the temporary total convalescence rating issue. The veteran is represented by AMVETS. REMAND Preliminary review of the claims file discloses that the most recent comprehensive Department of Veterans Affairs (VA) examination was conducted in August 1991. The record also reflects that the veteran has received outpatient and hospital treatment for several disorders subsequent to that examination. The veteran's representative has requested another examination for various specific purposes pertinent to the certified issues. The Board notes here that the resolution of certain of these issues will involve questions of differential diagnosis and should be resolved by trained medical experts. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). In view of the medical complexities involved with regard to certain issues in this case and in recognition of the fact that several years have passed since the last comprehensive VA examination, the Board believes that it would be appropriate and helpful to have the veteran examined by appropriate specialists so that a more current medical record can be developed and so that certain medical questions can be resolved. Accordingly, the case is hereby REMANDED to the RO for the following actions: 1. The RO should contact the veteran and his representative and request the dates of treatment together with the names and addresses of all medical care providers, both VA and private, who have treated the veteran for any of the medical disabilities at issue since 1992. After obtaining any necessary consents to the release of medical records, the RO should obtain copies of the reports of any such treatment and associate them with the claims file. 2. (a) The veteran should be scheduled for VA examinations by appropriate specialists for the following purposes: i) to ascertain the current severity of the veteran's service-connected pancreatitis with pancreatic pseudocyst (postoperative), cholecystitis with cholecystectomy and duodenal ulcer; ii) to ascertain the current severity of the veteran's service- connected diabetes mellitus; iii) to ascertain the current severity of the veteran's service- connected hearing loss: iv) to ascertain the current severity of the veteran's service- connected esophagitis with Mallory- Weiss tear and esophageal peptic stricture; v) to ascertain the nature and etiology of any eye disabilities found to be present, including a medical opinion as to whether the veteran suffers from diabetic retinopathy; vi) to ascertain whether the veteran suffered from hepatitis in November and December 1991 and, if so, to ascertain the etiology thereof as well as to document the severity of any residuals; vii) to obtain a medical opinion on what period of time constituted a reasonable period of convalescence for the veteran to recover from his period of hospitalization at a VA facility in January 1992. (b) With regard to each of the special VA examinations, it is imperative that the claims file be made available to and be reviewed by the appropriate examiner prior to each special examination. All of the special examinations should be conducted in accordance with the guidelines set forth in the VA's Physicians' Guide for Disability Evaluation Evaluations, and all indicated special studies and tests are to be accomplished. The eye examiner should be specifically requested to comment on any eye symptomatology attributable to the veteran's diabetes mellitus. The examiner who conducts the examination of the veteran's esophagitis with Mallory-Weiss tear and esophageal peptic stricture should clearly describe the current residuals of this disability and comment on the effects of this disability on the veteran. An opinion should also be requested from the appropriate examiner as to whether the veteran suffered from hepatitis in late 1991. If so, the examiner should be asked to state the most likely etiology of the hepatitis. If possible, one of the VA medical doctors whose name appears on the January 1992 hospital summary should be contacted and asked to review the records of that hospitalization and subsequent follow- up records and offer an opinion as to when the veteran could reasonably be considered to have recovered from this hospitalization. If the physicians who completed the January 1992 hospital summary are unavailable, the RO should request an appropriate examiner to review the hospital summary and subsequent records and offer an opinion as to the dates of the veteran's period of convalescence. 3. After completion of the above, the RO should review the expanded medical record and determine if any of the veteran's claims can be granted. The veteran and his representative should be furnished a supplemental statement of the case addressing each issue for which the full benefit available has not been granted. The supplemental statement of the case should set forth a summary of the evidence, a citation to and discussion of applicable laws and regulations, and a detailed analysis of the reasons for the RO's decision. After affording the veteran and his representative a reasonable opportunity to respond, the case should be returned to the Board for further appellate review of all issues remaining in appellate status. The purpose of this remand is to expand the medical record for eventual appellate review. The Board intimates no opinions as to the eventual determinations to be made in this case. EUGENE A. O'NEILL 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) (1993).