BVA9505028 DOCKET NO. 93-09 444 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUES 1. Service connection for shell fragment wounds of the back . 2. Service connection for baldness (alopecia areata). 3. An increased disability rating for a left shoulder disability, currently evaluated as 10 percent disabling. 4. An increased (compensable) disability rating for bilateral chondromalacia patella. 5. An increased (compensable) disability rating for bilateral hearing loss. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Barry F. Bohan, Counsel INTRODUCTION The appellant served on active duty in the United States Army during several enlistments from October 1968 to October 1991. The appellant initially filed a claim for service connection for "back trouble" and "loss of hair" in June 1972. He failed to report for a scheduled VA physical examination on August 10, 1972, and the Department of Veterans Affairs Regional Office in Chicago, Illinois (VARO) informed him by letter dated August 16, 1972 that his claim was denied because of his failure to report for the examination. No rating decision was issued. In November 1991, the appellant filed a claim for service connection for a number of disabilities, including a back disorder and loss of hair. This appeal arose from a May 1992 VARO rating decision which granted the appellant service connection for eight (8) disabilities and denied service connection for four (4) claimed disabilities, including shell fragment wounds of the back and baldness (alopecia areata). In August 1992, the appellant amended his claim to include a request for service connection for post-traumatic stress disorder (PTSD). Service connection for PTSD was granted in a March 1993 VARO rating decision. REMAND The appellant is seeking service connection for a back disorder and for baldness, as well as increased disability ratings for three service-connected disabilities. As noted in the Introduction, the appellant first applied for service connection for a back disorder and for loss of hair in 1972. At that time, he submitted a bill from the Shaw Clinic in Quincy, Illinois, which indicated that a series of X-rays of the appellant's spine was taken in February 1972; a "physical, neurological and orthopedic exam" was completed in March 1972; and the appellant was treated for unspecified conditions from March to June 1972. No clinical or treatment records of the Shaw Clinic have been associated with the appellant's claims folder. In an October 1993 informal presentation, the appellant's representative contended that a December 1991 VA orthopedic examination of the appellant was inadequate. The Board notes that during that examination, the appellant alleged that he had back problems due to a fall from a helicopter in Vietnam in 1969. That statement mirrored a statement contained in his original claim in 1972. X-rays revealed only four true lumbar vertebra, most likely due to partial sacralization of the fifth lumbar vertebra. The Board has concluded that, in addition to seeking service connection for residuals of shrapnel wounds of the back, the appellant is also seeking service connection for organic low back pathology. That issue must be addressed by VARO. In the October 1993 informal presentation, the appellant's representative also took exception to VARO's conclusion that the appellant's hair loss pre-existed service and that the condition had not been aggravated beyond its normal course by service. In substance, the representative evidently believed that VARO had not adequately explained its position. Although not cited by the representative, Hensley v. Brown, 5 Vet.App. 155, 161 (1993) stands for the proposition that VARO must provide adequate reasons and bases in support of its conclusion that a pre-existing disorder was aggravated beyond its normal course during military service. The Board believes that further development of the evidence, to include an examination by specialists in orthopedics and dermatology, is necessary in this case. Hyder v. Derwinski, 1 Vet.App. 221 (1991). The case is therefore REMANDED to VARO for the following actions: 1. VARO should contact the Shaw Clinic in Quincy, Illinois and obtain all medical records pertaining to examination and treatment of the appellant, to include X- rays and other laboratory studies. Such medical records should be associated with the appellant's claims folder. 2. The appellant should be scheduled for examinations by specialists in orthopedics and dermatology. The appellant's claims folder should be furnished to the examiners prior to the examinations. The orthopedic examiner should specifically discuss the etiology of any identified back pathology. The dermatological examiner should undertake a longitudinal review of the appellant's medical history and render an opinion as to (1) the etiology of the appellant's diagnosed alopecia areata with history of alopecia universalis and (2) whether such disorder, if it pre-existed service, was aggravated beyond its normal course by military service. The reports of the examinations should be associated with the appellant's claims folder. After the above development has been completed, VARO should readjudicate the appellant's claim. In addition to the issues listed above, the issue of service connection for organic low back disorder should be adjudicated. If the claim remains denied, in whole or in part, the case should be returned to the Board after compliance with all requisite appellate procedure. The purpose of this REMAND is to procure clarifying data. The Board intimates no opinion as to the ultimate conclusion warranted, pending completion of the requested development. No action is necessary on the appellant's part until he receives further notice. C.P. RUSSELL 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).