BVA9504162 DOCKET NO. 93-08 626 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUES 1. Entitlement to service connection for a cardiovascular disorder. 2. Entitlement to service connection for disability manifested by colon polyps. 3. Entitlement to service connection for sinusitis. 4. Entitlement to an increased (compensable) rating for residuals of pneumonia. 5. Entitlement to an increased rating for a generalized anxiety disorder, currently evaluated as 30 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Milo H. Hawley, Counsel REMAND The veteran had active service from April 1965 to April 1969 and from March 1971 to July 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 1988 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona. It is contended that the veteran has a disability which is manifested by colon polyps. It is asserted that he had polyps removed from his colon both during active service and subsequent to active service. An April 1987 service medical record indicates that the veteran was seen for followup to rule out Peutz-Jeghers. VA outpatient treatment records, dated in April 1988, reflect that the veteran underwent a colonoscopy with four polyps being removed. The report of a November 1988 VA examination states an impression which includes Peutz-Jeghers syndrome. Service medical records dated in April and May 1986 include the impression of sinusitis. The report of a May 1986 X-ray states that there was questionable minimal frontal sinusitis. The report of a July 1992 VA examination states a diagnosis of history of chronic rhinosinusitis and asthma which was probably exacerbated by the conditions the veteran experienced while on active duty. A CAT scan was recommended to more fully evaluate the veteran's sinuses. It noted that no diagnostic clinical tests were available. Service medical records reflect that the veteran was hospitalized in January 1987 with pneumonia. The report of X-rays made at that time states that there was persistent nodular scarring in the right apex. The report of March 1987 service pulmonary function testing revealed a combined restrictive and obstructive defect. Service connection has been granted for residuals of pneumonia with right apical pleural thickening of nodular configuration. An increased evaluation in that disability has been denied on the basis that current pulmonary disability is not related thereto. The report of a July 1992 VA pulmonary examination states a diagnosis of mild obstructive pulmonary disease related in part to cigarette smoking and also probably aggravated by an element of extrinsic asthma with the most specific antigen being that of animal dander. Pulmonary function testing, accomplished in July 1992, indicated minimal obstructive airway disease. The record reflects that the veteran has reported that for the most part he ceased smoking in approximately 1989. The issue of entitlement to service connection for obstructive pulmonary disease is inferred and is inextricably intertwined in rating the veteran's residuals of pneumonia. Akles v. Derwinski, 1 Vet.App. 118 (1991); Harris v. Derwinski, 1 Vet.App. 180 (1991). In light of the above the appeal is REMANDED to the RO for the following: 1. The RO should contact the veteran and inquire as to where he has received mental and medical health care relating to his anxiety disorder, pulmonary disability, sinusitis, or colon polyps from June 1992 until the present. After obtaining appropriate releases the RO should contact the health care provider(s) identified and request copies of all medical records relating to treatment of the veteran's anxiety disorder, pulmonary disability, sinusitis, and colon polyps from June 1992 until the present. 2. Thereafter, the veteran should be scheduled for VA gastrointestinal, ear, nose and throat, pulmonary, and psychiatric examinations to determine the nature and extent of any disability manifested by colon polyps, sinusitis, pulmonary disability, and generalized anxiety disorder. All necessary tests and studies should be accomplished, including a CAT scan for diagnostic purposes of sinusitis if indicated, and all clinical manifestations should be reported in detail. All examinations should be conducted in accordance with the VA Physician's Guide for Disability Evaluation Examinations. It is requested that the physician performing the pulmonary examination set forth an opinion regarding the etiology of any pulmonary disability which is diagnosed. With respect to the psychiatric evaluation all indicated tests, including appropriate psychological studies with applicable subscales, must be conducted. The psychiatric examiner must assign a Global Assessment of Functioning Score consistent with the American Psychiatric Association's DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS (3d ed. rev., 1987), and explain what the assigned score represents. A complete rationale for any opinion expressed must be provided. The claims file must be made available to and reviewed by the examiners prior to the requested examinations. 3. Following completion of the foregoing, the RO must review the claims folder and ensure that all of the foregoing development actions have been conducted and completed in full. If any development is incomplete, including if the requested examinations do not include all test reports, special studies or opinions requested, appropriate corrective action is to be implemented. 4. The RO should adjudicate the issue of entitlement to service connection for obstructive pulmonary disease. If service connection for this disability is granted, it should be considered in rating the veteran's pulmonary disability. If service connection is denied, and a notice of disagreement filed, appropriate appellate development should follow. After completion of the above requested development and adjudication, the claims on appeal should again be considered by the RO. If any remain denied, the veteran and his representative should be furnished with a supplemental statement of the case and be given the appropriate opportunity to respond thereto. Thereafter, the claims file, including the above requested evidence, should be returned to this Board for further appellate review, if in order. No action is required by the veteran until he receives further notice. The purposes of this REMAND are to procure clarifying data and accord due process. The Board intimates no opinion, either legal or factual, as to the ultimate disposition of this appeal. The issue of entitlement to service connection for a cardiovascular disorder is deferred pending completion of this REMAND. JEFF MARTIN 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. (CONTINUED ON NEXT PAGE) 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).