BVA9507278 DOCKET NO. 93-12 956 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Buffalo, New York THE ISSUE Entitlement to an increased evaluation for service-connected residuals of a gunshot wound of the chest, with retained foreign body over the 9th rib, partial sensory paralysis of the right diaphragm, and mild pulmonary insufficiency, currently evaluated 20 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD R. T. Jones, Counsel INTRODUCTION The veteran served on active duty from April 1943 to June 1945 This matter comes to the Board of Veterans' Appeals (Board) from an October 1992 decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Buffalo, New York, which denied an increase in a 20 percent rating for residuals of a gunshot wound of the chest. Other residuals of the gunshot wound sustained during service include a left abdominal injury with adhesions and gastritis (50 percent), residuals of a ventral hernia repair (zero percent), and an abdominal scar (zero percent). Service connection is also in effect for an anxiety reaction (30 percent), and his combined rating is 70 percent. An issue of entitlement to increased compensation for disabilities of the lungs based on the provisions of 38 C.F.R. § 3.383 (1994) was developed and certified for appellate review. This issue will be addressed as an argument for increased compensation for his service-connected gunshot wound of the chest rather than as a separate issue, following completion of the development requested on remand. REMAND The veteran's claim for an increased evaluation for service- connected residuals of a gunshot wound of the chest is well grounded, meaning not inherently implausible, and the file indicates there is a further VA duty to assist him in developing the facts pertinent to that claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. §§ 3.103(a), 3.159 (1994); Murphy v. Derwinski, 1 Vet.App. 78 (1990); Littke v. Derwinski, 1 Vet.App. 90 (1990); Murincsak v. Derwinski, 2 Vet.App. 363 (1992). While serving in combat in France in 1944, the veteran sustained a through and through gunshot wound entering the left lower chest in the mid axilla and exiting in the right epigastrium. As a result of the injury, he sustained a massive left pneumothorax and perforation of the stomach. His past medical history includes treatment for serofibrinous pleurisy at a VA hospital in October-November 1951 and a left thoracotomy for a "spot on the lung," first reported on a VA examination in December 1983. The veteran has not had a pulmonary function study (PFT) done as part of his VA compensation examination in connection with his current claim, and although there is evidence that one may have been performed at Erie County Medical Center in 1991, no recent PFTs were available at the time of the VA pulmonary examination in February 1992. In the judgment of the Board, a current medical examination is warranted. Weggenmann v. Brown, 5 Vet.App. 281 (1993), Caffrey v. Brown, 6 Vet.App. 377 (1994). To ensure that VA has met its duty to assist the veteran in developing the facts pertinent to his claim, the case is REMANDED to the RO for the following development: 1. The RO should secure all the veteran's medical treatment records, since March 1991, from the VA Medical Center in Buffalo. The RO should obtain the names and addresses of all medical care providers who have treated the veteran for respiratory disorders since 1991. The RO should then directly contact the medical providers and obtain copies of all records not already on file, following the procedures of 38 C.F.R. § 3.159. This includes, but is not limited to, the Erie County Medical Center in 1991, listed on the March 1993 VA Form 21-4142 which was previously submitted by the veteran. 2. The veteran should be afforded a VA pulmonary examination. All necessary diagnostic studies, including a PFT and an exercise tolerance test, should be performed. The examiner should identify all respiratory disabilities and state whether each is part of, or related to, the service-connected residuals of the pleural cavity injury. It should further be indicated whether the veteran's service- connected residuals of a pleural cavity injury are productive of moderate disability with pain or discomfort on exertion, scattered rales, or some limitation of excursion of diaphragm or of lower chest expansion; or whether they are productive of moderately severe disability. For moderately severe residuals of a pleural cavity injury, symptoms would include findings such as pain in the chest, dyspnea on moderate exertion (exercise tolerance test), adhesions of diaphragm with excursions restricted, moderate myocardial deficiency, and one or more of the following: thickened pleura, restricted expansion of lower chest, compensating contralateral emphysema, deformity of chest, scoliosis, and hemoptysis at intervals. It is essential that the veteran be examined both before and after exertion, controlled with fluoroscopic and proper blood pressure determination. Exercise tolerance tests should have regard both to dyspnea on exertion and to continued acceleration of pulse rate beyond physiological limits. See Diagnostic Code 6818 and Note (2). The claims folder and all current treatment records must be made available to the examiner for review before the examination so a proper assessment of the current insulin dosage and degree of functional impairment can be made. Thereafter, the case should be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The veteran need take no action until otherwise notified. J. E. DAY 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).