BVA9501832 DOCKET NO. 93-08 454 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for left knee disability, secondary to right leg disability. 2. Entitlement to service connection for right wrist disability. 3. Entitlement to service connection for a disability manifested by chest pain, secondary to residuals of shell fragment wounds to the left upper extremity. 4. Entitlement to a compensable evaluation for residuals of shell fragment wounds to the left arm, axilla, and hand, with limitation of motion of the left index finger. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD C. S. Freret, Counsel INTRODUCTION The appellant had active military service from September 1965 to October 1968. This appeal comes before the Board of Veterans' Appeals (Board) from an August 1991 rating decision by the Department of Veterans Affairs (VA) Houston, Texas, Regional Office (RO), which denied entitlement to service connection for left knee disability, right wrist disability, and disability manifested by chest pain, and denied a compensable evaluation for residuals of shell fragment wounds to the left upper extremity. This appeal also arises from a rating decision by the RO in November 1992, which denied entitlement to service connection for left knee disability, as secondary to the appellant's service-connected right leg disability. The case was remanded by the Board in July 1994 in order to permit the RO to address three issues raised by the appellant concerning claimed Agent Orange related disabilities. Included in his claim filed in February 1991 (VA Form 21-4138), the appellant appears to raise the issue of entitlement to an increased evaluation for his service-connected residuals of a shell fragment wound to the left thigh, with right knee involvement, currently rated 30 percent disabling. Additionally, he presents argument in a February 1993 statement concerning back disability sustained in service. These claims are not inextricably intertwined with the current claim and have not been developed for appellate consideration by the RO. Therefore, this matter is referred to the RO for appropriate action. REMAND The appellant asserts that he has disability associated with his service-connected residuals of shell fragment wounds to the left arm, axilla, and hand, with limitation of motion of the left index finger, that warrant a compensable evaluation. He reports that he experiences pain, numbness, and stiffness in his left arm, hand, and fingers, which require the use of a TENS unit at work, at home, and when driving. He states that the numbness in his left arm has lasted as long as four hours at a time. He also claims that he has chest pain that is related to his left upper extremity disability, and that the TENS unit helps to alleviate some of the chest pain by stimulating the muscles and nerves connected from the left shoulder/arm area (where he was injured) to his chest. A March 1991 VA medical record indicates that the appellant had complaints of increasing pain and numbness in his left arm. The examiner at a June 1991 VA orthopedic examination stated that the appellant had satisfactory left shoulder abduction, and that there was no evidence of group dysfunction in either muscle group III or muscle group VI. An X-ray of the left shoulder, taken at the June 1991 VA medical examination, showed an oblong metallic foreign body in the medial soft tissues of the proximal middle thirds of the upper arm. VA has a duty to assist the appellant in the development of facts pertinent to his claims. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1994). The Court has held that the VA's duty to assist the appellant in obtaining and developing available facts and evidence to support his claim includes obtaining adequate VA medical examinations. Littke v. Derwinski, 1 Vet.App. 90 (1990). Inasmuch as the evidence appears to indicate that the appellant may have some peripheral neuropathy associated with his service-connected left arm disabilities, and there has been no recent comprehensive neurological evaluation conducted, the Board believes that further medical evaluation would be appropriate prior to appellate consideration of this issue. Accordingly, this case is REMANDED to the RO for the following actions: 1. The RO should contact the appellant and request that he provide the names and addresses of any health care providers who have treated him for his left arm disability since 1991, and, if possible, specify the appropriate dates of treatment. Then, after any necessary authorization is obtained from the appellant, the RO should obtain copies of all treatment records for the appellant from the health care providers identified and place them in the claims file. In any event, copies of any VA treatment records should be obtained and associated with the claims file. 2. The RO should schedule the appellant for examination by a specialist in neurology for the purpose of ascertaining whether the appellant has any peripheral neuropathy associated with his residuals of shell fragment wounds to the left arm, axilla, and hand. All indicated special studies, including range of motion studies and nerve conduction studies, should be performed, if not contraindicated. The examiner should be request to express an opinion as to the etiology of any neuropathy found. The claims file and a copy of the REMAND is to be made available to the examiner prior to the examination. 3. The RO should review the examination report to determine if it is adequate for rating purposes and in compliance with this remand. If it is not, it should be returned to the examiner for supplemental action. After the above requested actions have been completed, the RO should review the appellant's claims with regard to the additional evidence obtained. If any of the benefits sought on appeal remains denied, a supplemental statement of the case should be furnished to the appellant and his representative. They should be afforded a reasonable period of time to respond. Thereafter, the case should be returned to the Board for further appellate consideration. Appellate consideration of the issues of entitlement to service connection for left knee disability, right wrist disability, and a disability manifested by chest pain, secondary to residuals of shell fragment wounds to the left upper extremity is deferred pending completion of the development requested above. The purpose of this REMAND is to obtain addition medical evidence and to ensure that the appellant is afforded due process of law. No opinion, either legal or factual, is intimated as to the merits of the appellant's claims by this REMAND. He is not required to undertake any additional action until he receives further notification from the VA. BETTINA S. CALLAWAY 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 so assigned. 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).