BVA9505533 DOCKET NO. 93-02 279 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in San Diego, California THE ISSUES 1. Entitlement to service connection for disability manifested by multiple joint pain. 2. Entitlement to service connection for asthma. 3. Entitlement to service connection for left ulnar nerve compression syndrome. 4. Entitlement to service connection for a right knee disability. 5. Entitlement to an increased evaluation for right carpal tunnel syndrome, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARINGS ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD John J. Crowley, Associate Counsel INTRODUCTION The veteran served on active duty from April 1965 to November 1987. This matter is currently before the Board of Veterans' Appeals (Board or BVA) on appeal from a September 1990 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In November 1994, the Board obtained the medical opinion from the Chief of Orthopedic Surgery at the Boston VA Medical Center concerning the veteran's claims of service connection for left ulnar nerve compression syndrome and a right knee disability. At a hearing held before a hearing officer at the RO in June 1992, the veteran raised the issue of entitlement to an increased evaluation for hypertension. This claim has not been adjudicated by the RO and is not before the Board at this time. It is referred to the RO for appropriate action. In view of development required with regard to the issues of entitlement to service connection for asthma and disability manifested by multiple joint pain, the Board's decision with regard to all issues except for the issue of entitlement to service connection for a right knee disability will be deferred. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his right knee disability was caused by injuries which he sustained during his active military service. 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 files (two volumes). 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 evidence supports the veteran's claim of entitlement to service connection for a right knee disability. FINDING OF FACT The veteran's right knee disability cannot be disassociated from his active service. CONCLUSION OF LAW The veteran's right knee disability was incurred in service. 38 U.S.C.A. §§ 1110, 5107 (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION Service medical records revealed that the veteran strained his right knee in June 1982. Tenderness was noted on the medial joint line. In October 1985, he again injured his right knee. Tenderness was noted in the medial aspect of the right knee. The examiner's impression was right knee strain. At an April 1990 VA examination the veteran stated that he fell on his right knee two years ago and had had intermittent pain in it since that time. In August 1991 the veteran testified at a hearing at the RO that during military service he fell on his right knee and that ever since then he had had problems with his knee. In January 1992, while the veteran was hospitalized for depression, he was referred for orthopedic consultation for long- standing right knee pain. Right patellofemoral degenerative disc disease was diagnosed and the veteran was to be followed by orthopedics as an outpatient. VA outpatient treatment records reflect that the veteran was seen in April 1992 for complaints of right knee pain since 1985 when he fell onto the knee. A May 1992 magnetic resonance imaging study (MRI) revealed osteochondritis dissecans of the right medial femoral condyle. In order to determine the etiology of the osteochondritis dissecans of the medial femoral condyle of the veteran's right knee, the Board, in October 1994, sent this case for a medical expert opinion. In November 1994, the Board received a statement from John Mc A. Harris III, M.D., Chief of the Orthopedic Section of the Boston VA Medical Center. Dr. Harris stated that the MRI study of 1992 revealed a change in the marrow space which could only have occurred had the condition been present for many years. Similarly, the changes described could not have occurred without several years of chronicity. While such physical defects could not, of themselves, establish the original point in time that the knee was injured, it was Dr. Harris's belief that this does establish a chronicity of at least several years. For this reason, it was Dr. Harris's opinion that the veteran's right knee disability was the result of his active service. The undersigned has reviewed the opinion of Dr. Harris with regard to the right knee disorder and finds it to be persuasive. In the Board's opinion, the etiology of the veteran's right knee disability cannot be reasonably disassociated from the veteran's active service, including the right knee injuries incurred during his active service. Consequently, service connection for a right knee disability is warranted. ORDER Entitlement to service connection for a right knee disability is granted. REMAND While the issue of entitlement to service connection for asthma has been developed and certified on appeal, the veteran indicated at a hearing in June 1992 that he may never have had asthma. The service medical records show that in October 1982 the veteran had a chest X-ray which was noted to be compatible with chronic bronchitis. He indicated at a hearing in August 1991 that he had been treated for bronchitis; the record confirms that he had been treated for bronchitis on numerous occasions from 1987 to 1990 and that a history of chronic bronchitis was noted in December 1991. At hearing in August 1991 and June 1992 the veteran testified that he had experienced pain in multiple joints, including pain in his shoulders, right hip and ankles, during service and was placed on medication for arthritis. On physical examination in April 1990, the examiner gave an impression of multiple joint pains and stated that he had ordered a rheumatologic work-up to be sure there was not some type of migratory arthritis, rheumatalgia, or tendinitis. The results of the rheumatologic work-up have not been associated with the claims folder. VA has an obligation under 38 U.S.C.A. §§ 5103(a), 7722 (West 1991) to advise the appellant of the evidence necessary to complete his application for benefits. In this case, the veteran is hereby notified that preliminary review indicates that the claims of entitlement to service connection for asthma and disability manifested by multiple joint pain do not appear to be well grounded inasmuch as the medical data do not establish the presence of the claimed disabilities. However, even though the veteran's claims of entitlement to service connection for asthma and disability manifested by multiple joint pain do not appear to be well grounded at this juncture, once the development below is completed, the record must again be reviewed to determine whether either claim is ultimately well grounded. Under the present circumstances, the Board finds that additional development of the evidence is necessary. Accordingly, the case is REMANDED for the following actions: 1. The RO should request the veteran to clarify the pulmonary disease or diseases for which he is seeking service connection. He should be requested to specifically state whether he is seeking service connection for chronic bronchitis, bronchial asthma, or both. 2. The RO should also request the veteran to identify the names and addresses of any medical care providers who have treated him for the disabilities at issue from May 1992 to the present. After obtaining any needed authorization from the veteran, the RO should obtain copies of all pertinent records identified by the veteran. 3. The RO should request the VA Outpatient Clinic, 2022 Camino Del Rio North, San Diego, California, to conduct a search for the rheumatologic work-up ordered by Dr. R. Ignelzi at the time of a VA examination for disability evaluation purposes in April 1990. If a rheumatologic work-up was not completed, or if records of any such work-up can not be located, the veteran should be scheduled for an examination by an appropriate specialist to rule in or out the presence of some type of migratory arthritis, rheumatoid arthritis, or tendinitis, as suggested by Dr. Ignelzi in April 1990. 4. The RO should arrange for the veteran to be scheduled for an examination to determine the nature and severity of the residuals of the right carpal tunnel surgical release. The claims folder must be made available to the examiner prior to the examination. The scope of the examinations should be broad enough to cover all residual conditions which are suggested by the veteran's complaints, symptoms or findings. All necessary tests should be performed. The examiner should identify all residuals conditions which affect the functioning of the right wrist and hand. Motion of the wrist joint should be recorded in degrees of motion remaining. Any portion of the arcs of motion which are painful should be so designated. The remaining functional ability of the right wrist and hand should be described. 5. When the above development has been completed, the case should be readjudicated by the RO. The rating decision should reflect consideration of all potentially applicable criteria, to include consideration of the applicability of 38 C.F.R. § 3.321(b)(1). If the decision remains adverse to the veteran in any way, he and his representative should be furnished with a supplemental statement of the case (SSOC) which summarizes the pertinent evidence, including the opinion from Dr. Harris, III, M.D., dated November 16, 1994. If applicable, the SSOC should cites applicable legal criteria for a well-grounded claim. The SSOC should, of course, also reflects detailed reasons and bases for the decision. The veteran and his representative should then be afforded the applicable time period to respond. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration, if appropriate. The veteran need take no action until he is further informed. The purpose of this REMAND is to obtain additional information and to ensure due process of law. No inference should be drawn regarding the final disposition of the claim as a result of this action. 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. 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, pro- vided 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. 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. The remand portion of this decision 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).