BVA9500887 DOCKET NO. 93-10 293 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to an increased evaluation for a service connected back disorder, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: AMVETS ATTORNEY FOR THE BOARD P. M. Lynch, Associate Counsel INTRODUCTION The veteran's active military service extended from August 1978 to September 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 1992 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. That rating decision, in part, denied entitlement to an increased rating for the veteran's service connected back disorder, rated as 10 percent disabling. The RO denied service connection for a nervous disorder in December 1992. The informal hearing presentation dated in June 1993 indicates that the veteran disagrees with this decision. However, since this issue is not currently on appeal it is referred to the RO for action deemed appropriate. REMAND In July 1983, the veteran was granted service connection for a fractured coccyx with residual arthritis of the lumbar spine, rated as 10 percent disabling. He subsequently submitted medical evidence in support of a claim for an increased evaluation for his back disorder. In December 1990, the Board denied his claim of entitlement to an increased rating. The veteran filed a reopened claim for an increased rating in August 1992. In support of his claim, he provided outpatient treatment notes dated from October 1991 to August 1992 from the VA Medical Center in Nashville, Tennessee and a hospitalization discharge summary dated from October to December 1991 from the VA Medical Center in Murfreesboro, Tennessee. On the basis of the findings in these records, in December 1992 the RO denied his claim for an increased rating for his service connected back disorder. In his Notice of Disagreement received by the RO in January 1993, the veteran stated that the current evidence of record was not adequate for the purpose of evaluating his disability. In reviewing the two examinations, it is noted that no range of motion measurements were reported. Degenerative arthritis is evaluated on the basis of limitation of motion. The United States Court of Veterans Appeals (Court) has held that range of motion studies should be reported in detail under the provisions of the Physician's Guide for Disability Evaluation Examinations, IB 11-56, March 1, 1985. See Littke v. Derwinski, 1 Vet.App. 90 (1990). It is not sufficient to merely state that there was a "limited range of motion" or "full range of motion". The veteran also requested that he be afforded a VA examination. The RO failed to arrange for such an examination. VA's duty to assist includes the duty to conduct a thorough and contemporaneous medical examination. 38 C.F.R. § 3.326 (1993); See Green v. Derwinski, 1 Vet.App. 121 (1991). A claim that a condition has become more severe is well grounded where the condition was previously service connected and rated, and the claimant subsequently asserts that a higher rating is justified due to an increase in severity since the original rating. See Proscelle v. Derwinski, 2 Vet.App. 629 (1992). To ensure that VA has met its duty to assist the claimant in developing the facts pertinent to the claim and to ensure full compliance with due process requirements, the case is REMANDED to the RO for the following development: 1. The RO should contact the veteran and request that he provide the names and addresses of all health care providers that have treated him for a back disorder since December 1990. 2. After obtaining the necessary releases, the RO should make arrangements to obtain all treatment records not already on file. If these records are unavailable, that fact should be annotated in the claims folder. 3. Following the above, the veteran should be afforded VA examinations by specialists in orthopaedics and neurology. Each specialist should conduct a separate examination. The reports of examination should include a detailed account of all manifestations of back pathology found to be present. All necessary tests and X-rays should be conducted and the examiners should review the results of any testing prior to completion of the reports. Special attention should be given to the presence or absence of pain, any limitation of motion, instability and weakness. The veteran has reported that he experiences back pain which radiates into his legs and up into his neck. The neurological examiner is requested to describe the nature and extent of any lower extremity or cervical neurological deficits and should express an opinion as to whether any such deficits are caused by the service-connected coccyx injury. A copy of this remand and the claims folder must be made available to and reviewed by the examiners prior to the examinations. The reports should be comprehensive and the examiners should provide complete rationale for all conclusions reached. 4. The RO should review the examination reports and determine if they are adequate for rating purposes and in full compliance with this remand. If not, the reports should be returned to the examiners for corrective action. Following completion of these actions and, if the decision remains unfavorable, the veteran and his representative should be provided with a supplemental statement of the case and afforded a reasonable period of time in which to respond. Thereafter, in accordance with the current appellate procedures, the case should be returned to the Board for completion of appellate review. No action is required of the veteran until further notice is issued. JOAQUIN AGUAYO-PERELES 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) (1993).