BVA9501760 DOCKET NO. 93-09 384 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUES 1. Entitlement to an increased rating for anxiety reaction, currently evaluated as 30 percent disabling. 2. Entitlement to an increased rating for duodenal ulcer, currently evaluated as 10 percent disabling. 3. Entitlement to a compensable evaluation for residuals of a fracture of the left index finger. 4. Entitlement to a compensable evaluation for residuals of a hemorrhoidectomy. 5. Entitlement to a total rating based on individual unemployability due to service-connected disability. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD James R. Siegel, Counsel REMAND The veteran served on active duty from May 1942 to June 1944. This matter comes before the Board of Veterans' Appeals (the Board) on appeal from decisions from the Regional Office (RO). By rating action of December 1991, the RO increased the 10 percent evaluation which had been in effect for the veteran's service-connected psychiatric disability to a 30 percent rating. In addition, the RO confirmed and continued the evaluations assigned for the veteran's other service-connected disabilities. In addition, by rating decision of June 1992, the RO denied entitlement to a total rating based on individual unemployability due to service-connected disability. The veteran has filed a timely notice of disagreement with each of these determinations. It is contended that the veteran developed tremors as a result of medication he takes for his service-connected disabilities. He maintains that the tremors are not solely due to his nonservice- connected Parkinson's disease. In this regard, it is noted that during the recent Department of Veterans Affairs (VA) examination, the veteran reported that the medications he was taking included Ativan, Phenobarbital and Vivactil. The Court has held that a claim which is inextricably intertwined with another claim which remains undecided and pending before the VA must be adjudicated prior to a final order on the pending claim. Harris v. Derwinski, 1 Vet.App. 180 (1990). However, the RO has not formally adjudicated the issue of entitlement to service connection for tremors due to medication for his service- connected disabilities. This matter must be disposed of prior to a decision on the issue of entitlement to a total rating based on individual unemployability. In a statement dated in July 1991, David Riesenberger, M.D., stated that the veteran's chronic anxiety syndrome was controlled with medication. He also noted that Parkinson's disease had been diagnosed in 1986 and was controlled with medication. The physician added that the veteran was disabled and would never be able to be employed due to the combination of his illnesses. There is no indication that the RO has attempted to obtain the clinical records from Dr. Riesenberger. In a March 1993 statement, the veteran's representative contended that the RO rating board should submit this case to the Director, Compensation and Pension Service, in accordance with 38 C.F.R. § 4.16(b). In Fisher v. Principi, 4 Vet.App. 57 (1993), the Court held that in a claim for a total rating for compensation purposes based on individual unemployability, where the disability rating did not entitle the appellant to a total disability rating under 38 C.F.R. § 4.16(a), the rating board must also consider the applicability of 38 C.F.R. § 4.16(b), and that the decision (or non-decision) by the RO whether to refer a case to the Director for extra-schedular consideration under § 4.16(b) is an adjudicative decision subject to review by the Board and the Court. 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). The Court has held that the duty to assist the veteran in obtaining and developing available facts and evidence to support his claim includes obtaining adequate VA examination. This duty is neither optional nor discretionary. Littke v. Derwinski, 1 Vet.App. 90 (1990). This duty also includes providing additional VA examinations by a specialist when recommended. Hyder v. Derwinski, 1 Vet.App. 221 (1991). The fulfillment of the statutory duty to assist includes conducting a thorough and contemporaneous medical examination, one which takes into account the records of prior medical treatment, so that the evaluation of the claimed disability will be a fully informed one. Green v. Derwinski, 1 Vet.App. 121, 124 (1991). Under the circumstances of this case, the Board finds that additional development of the record is required. Accordingly, the case is REMANDED to the RO for action as follows: 1. The RO should contact the veteran and request that he furnish the names, addresses, and dates of treatment of all medical providers from whom he has received treatment for his service-connected disabilities since 1992. He should execute the proper authorization forms for release of this information. 2. Thereafter, the RO should seek to obtain copies of all treatment records referred to by the veteran, including those from Dr. Riesenberger, whose address is as follows: 205 South 3rd Street, Girrard, Illinois 62640. 3. The veteran should then be afforded a general medical examination to determine the severity of the duodenal ulcer, the residuals of the left index finger fracture and the residuals of a hemorrhoidectomy. Additionally, the veteran should be examined by specialists in psychi-atry and neurology to determine the nature and extent of his psychiatric disability and the etiology of the tremors. All necessary tests should be performed. The examiners should express an opinion as to whether it is as likely as not that the veteran's tremors are due to the medication he takes for his service- connected disabilities. The claims folder should be made available to the examiners in conjunction with the examinations. 4. The RO should formally adjudicate the issue of entitlement to service connection for tremors on a secondary basis, the issues currently certified on appeal, and, if a total rating is not granted, whether the veteran's case should be referred to the Director for extra-schedular consideration under 38 C.F.R. § 4.16(b). If any issue currently on appeal is not resolved to the veteran's satisfaction, he and his representative should be furnished an appropriate supplemental statement of the case. If any new issue is denied, and the appellant files a notice of disagreement, the RO should develop the new issue in accordance with appellate procedures. Thereafter, the case should be returned to the Board for further appellate consideration. GARY L. GICK 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 deter- mination. 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).