BVA9507280 DOCKET NO. 92-10 003 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUES 1. Entitlement to service connection for coronary artery disease, hypertension, and the residuals of myocardial infarction, secondary to service connected disorders. 2. Entitlement to a total rating for compensation purposes based on individual unemployabilty. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J. A. McDonald, Associate Counsel INTRODUCTION The veteran served on active military duty from March 1943 to September 1945. This case comes before the Board of Veterans' Appeals (hereinafter Board) on appeal from the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania (hereinafter RO). REMAND This case was previously before the Board in May 1993. At that time the case was remanded to the RO for further development of the evidence to include VA cardiology, gastroenterology, and surgical examinations. The Department of Veterans Affairs (hereinafter VA) has a duty to assist the veteran in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1994). The United States Court of Veterans Appeals (hereinafter Court) has held that the "fulfillment of the statutory duty to assist . . . includes the conduct of a thorough and contemporaneous medical examination . . . so that the evaluation of the claimed disability will be a fully informed one." Green v. Derwinski, 1 Vet.App. 121, 124 (1991). Moreover, this duty includes an additional VA examination by a specialist, when necessary. Hyder v. Derwinski, 1 Vet.App. 221 (1991). In response to the Board's remand, the veteran was afforded a general examination, but not by the specialists requested. Furthermore, the Board finds that the examination conducted in August 1993 is inadequate for the purposes of deciding the issues now on appeal as pertinent symptomatology and findings were not reported in detail. The Board therefore concludes that VA cardiology, gastroenterology, and orthopedic (rather than surgical) examinations would provide a record upon which a fair, equitable, and procedurally correct decision on the veteran's claims on appeal, can be made. Additionally, in a statement dated February 1995, the veteran's representative raised the issue of clear and unmistakable error of a rating decision in March 1950 by failing to rate muscle injuries to the left hip and low back area. The service records do make reference to a compound comminuted fracture of the ilium. The Court has held that all issues "inextricably intertwined" with the issues certified for appeal, are to be identified and developed prior to appellate review. Harris v. Derwinski, 1 Vet.App. 180 (1991). As these issues are "intertwined" with the issue of entitlement to a total rating for compensation purposes based upon individual unemployability, and was not addressed by the RO, the case is remanded to the RO in accordance with the holding in Harris for development. Under the circumstances of this case, the Board is of the opinion that additional assistance is required to ensure that necessary development of the issues on appeal is accomplished by the RO and that the veteran is afforded due process under the law. Accordingly, this case is REMANDED to the RO for the following actions: 1. Any VA and private medical records subsequent to August 1993, should be obtained by the RO and incorporated with the claims file. 2. The veteran should be afforded VA cardiology, gastroenterology, and orthopedic examinations, in order to determine the severity and extent of his service-connected disabilities and cardiovascular disease. The examinations should be performed in accordance with the VA's PHYSICIAN'S GUIDE FOR DISABILITY EVALUATION EXAMINATIONS. All pertinent symptomatology and findings should be reported in detail. The cardiovascular examiner should be requested to offer an opinion based on the reported findings as to whether the veteran's service-connected disorders played any role in the development of cardiovascular disease. All indicated studies should be performed. The claims folder must be made available to the examiners, prior to the examinations, for use in the study of the veteran's case. The orthopedic examiner is requested to review the history of the gunshot wounds and express an opinion as to the track of the veteran's missile wounds. An X-ray study of the pelvis should be accomplished to determine whether there is evidence of an old fracture of the ilium. 3. The RO should adjudicate the issue of clear and unmistakable error in the March 1950 rating decision in failing to rate injuries associated with damage in the area of the ilium and the low back region. Following completion of these actions, the RO should review the evidence and determine whether the veteran's claims may now be granted. If not, the RO should provide the veteran and his representative with an appropriate supplemental statement of the case, with all pertinent laws and regulations, and a discussion of the evidence as it applies to the issues on appeal. The veteran and his representative should be afforded a reasonable opportunity to respond. The case should then be returned to the Board for further appellate consideration. E. W. SEERY 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).