BVA9504432 DOCKET NO. 93-06 252 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in No. Little Rock, Arkansas THE ISSUE 1. Entitlement to service connection for tendonitis of the right shoulder. 2. Entitlement to service connection for strain of the right neck. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J.R. King, Associate Counsel INTRODUCTION The appellant served on active duty from June 1968 to June 1972. The appellant served on active duty for training from May 26, 1990, to June 9, 1990. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 1991 rating determination of the Department of Veterans Affairs (VA) Regional Office (RO) located in North Little Rock, Arkansas. REMAND This matter has been the subject of lengthy inquiry with regard to the issues of medical causation and chronicity of the injuries claimed. In brief outline, the case was to be referred to a Medical Adviser to the Board in April 1994. Subsequently, the United States Court of Veterans Appeals (Court) held, in the case of Austin v. Brown, 6 Vet.App. 547 (1994), that the request for and use of medical adviser's opinions violates fair process principles and did not allow a claimant an opportunity to respond. Thereafter, in accordance with another procedure, the Board attempted to refer the pertinent medical issues for an opinion from the Veterans Health Administration. Before such an opinion could be obtained, this program was suspended. At this time, the claim remains in such a posture so as to require that additional factual development take place with respect to issues of material fact involving the application of medical expertise. In order to provide competent medical evidence on these issues, this case must now be REMANDED to the RO for the following actions: 1. The appellant should be requested to provide the names addresses and dates of treatment for any medical care providers who have rendered treatment for any disability of the neck, shoulders or cervical spine. The appellant is advised that this information is important in establishing his claim as it reflects both upon the continuity of symptoms and resolution of diagnostic questions. He should be provided with the appropriate release of information forms in order to obtain copies of these records. The RO should then take appropriate action to secure copies of any records identified by the appellant that are not already of record. 2. Following the above, the appellant should be afforded a VA examination so that a VA board-certified orthopedist may review the entire claims folder and examine the appellant. The claims folder and a copy of this REMAND should be provided to the examiner in conjunction with the examination. The purpose of the examination and the review of the record is to resolve questions concerning the appropriate diagnosis, if any, of any current right shoulder and neck pathology, and to assess the etiological relationship between any current pathology and the veteran's period's of service. All tests indicated should be performed. A detailed clinical and occupational history should be elicited, to include findings pertaining to pain and functional impairment of the appellant's right shoulder and neck. The examiner is respectfully requested to comment specifically on the following questions: (a) What is the correct diagnosis of any current right shoulder or neck pathology? (b) What is the most probable diagnosis, if any, of the symptoms presented by the appellant as reflected in May 1990 service medical records? In this regard the examiner is requested to address the question of what is the likelihood that the appellant's May 1990 injury of the right shoulder could be correctly classified as a myofascial injury, and what relationship, if any, would such an injury have to any subsequently diagnosed traumatic arthritis? What are the most common etiological causes of nerve impingement? (c) The examiner should state the degree of medical probability that the appellant's in service right shoulder discomfort could have resulted in nerve impingement with degenerative joint disease. The examiner should also assess, in light of the September 1991 VA clinical findings, whether the appellant's right shoulder disability can be properly characterized as tendinitis? Should the examiner be of the opinion that further review by other specialists is indicated, the claims file should be referred for such a review. The complete rationale for any opinion(s) expressed should be provided. Thereafter, the RO should reevaluate the claim. If the benefit sought is not granted, a supplemental statement of the case should be issued and the appellant and his representative should be provided an opportunity for response. The case should then be returned to the Board for further consideration, if otherwise in order. By this REMAND, the Board intimates no opinion as to any final outcome warranted. No action is required of the appellant until he is so notified by the RO. RICHARD B. FRANK 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).