BVA9507223 DOCKET NO. 93-10 428 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for subacromial bursitis of the left shoulder. 2. Entitlement to service connection for basal cell carcinoma of the nose. 3. Entitlement to an increased (compensable) rating for postoperative residuals of a left inguinal hernia. 4. Entitlement to an increased (compensable) rating for bilateral high frequency hearing loss. 5. Entitlement to an increased (compensable) rating for residuals of removal of a basal cell carcinoma of the scalp. 6. Entitlement to an increased (compensable) rating for Dupuytren's contracture of the right hand. 7. Entitlement to an increased (compensable) rating for hemorrhoids. 8. Entitlement to an increased (compensable) rating for residuals of a shell fragment wound of the right wrist. 9. Entitlement to an increased (compensable) rating for residuals of a shell fragment wound of the right forearm. 10. Entitlement to an increased (compensable) rating for residuals of a shell fragment wound of the right hip/flank. REPRESENTATION Appellant represented by: Florida Department of Veterans Affairs ATTORNEY FOR THE BOARD John R. Pagano, Counsel REMAND The veteran had active military service from September 1961 to June 1991. As a preliminary matter, the Board of Veterans' Appeals (Board) observes that the veteran has submitted well-grounded claims; that is, they are plausible and capable of substantiation. As such, the Department of Veterans Affairs (VA) has a duty to assist him in their development. See 38 U.S.C.A. § 5107(a) (West 1991). The Board finds that this duty has not yet been met for the reasons that follow. During the pendency of this appeal, the veteran indicated that he had been treated for bursitis of the left shoulder while still on active duty; at various times he has referred to early 1990 and early 1991 as the dates of such treatment. He further indicated that the copies of his service medical records which he submitted in conjunction with his claim for benefits were incomplete. The RO subsequently contacted the appropriate service department, and was furnished copies of the veteran's service medical records maintained on microfiche. The record indicates that the latter were duplicates of those previously submitted by the veteran. The question arises regarding whether the record as now constituted reflects all treatment received by the veteran during military service. The duty to assist includes aiding a claimant in developing pertinent facts, from whatever source; this duty is neither optional nor discretionary, and where the record before the Board is otherwise inadequate, remand is mandatory rather than permissive. See Littke v. Derwinski, 1 Vet.App. 90, 92 (1990). The veteran has indicated that he was treated for bursitis of the left shoulder at Regimental 8th Marines, Camp Lejeune, North Carolina. The Board believes that an attempt should be made to obtain copies of any such treatment prior to appellate disposition to ensure that the veteran is accorded due process of law. The veteran was afforded a VA general medical examination in December 1991. The report of examination indicates that the veteran experiences pain over the lateral epicondyle of the right elbow during flexion against resistance; also indicated is that the veteran experiences discomfort upon pronation and supination of the right forearm. The examination report, however, does not indicate whether the pain experienced by the veteran results in decreased range of motion of the right elbow. Pursuant to the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5213 (1994), limitation of motion is an integral part in determining the level of impairment attributable to the elbow. Given this, the examination of the veteran's right elbow conducted in conjunction with his current claim is inadequate for evaluation purposes. See 38 C.F.R. § 4.2 (1994). Further orthopedic examination of the veteran's right elbow, therefore, is necessary prior to appellate disposition. See Littke, 1 Vet.App. at 92. In a similar vein, current clinical findings associated with the veteran's service-connected hemorrhoids are limited to outpatient treatment received during 1992. The treating physicians did not describe symptomatology observed in terms of VA's Schedule for Rating Disabilities, 38 C.F.R. § 4.114, Diagnostic Code 7336. As such, those records alone are inadequate for rating purposes. See 38 C.F.R. § 4.1 (1994). This is particularly true given that the veteran was observed to have an anal fissure during treatment administered in February 1983. The persistence of such symptomatology is a significant factor in the overall evaluation to be assigned under the foregoing diagnostic code. As such, the Board finds that further examination in this regard is necessary to ensure that it is a position to render an informed opinion with regard to the veteran's appeal regarding the evaluation to be assigned for his service-connected hemorrhoids. In view of the foregoing, action on all issues on appeal is deferred, and this case is REMANDED to the RO for the following: 1. The RO should attempt to obtain copies of any additional records of the veteran's medical treatment, subsequent to January 1990, at Regimental 8th Marines, Camp Lejeune, North Carolina. All information received in conjunction therewith should be made a permanent part of the appellate record. 2. The veteran should be requested to undergo further VA orthopedic examination regarding epicondylitis of the right arm. The claims folder must be available to, and be reviewed by, the examining physician prior thereto. All necessary special studies or tests, to include range of motion testing, should be accomplished. The examiner should report all findings and manifestations of pathology observed in detail. 3. The veteran should be requested to undergo a special proctologic examination. Again, the claims folder must be available to, and be reviewed by, the examining physician prior thereto. All studies indicated should be accomplished. The examiner should set forth all findings in detail. This should include his observations regarding the location, size and reducibility of all hemorrhoids observed. The examiner also should indicate whether any fissures are present. 4. The RO should review the examination reports, and determine if they are in compliance with this remand. Any that is not should be returned for corrective action. 5. Once the foregoing has been accomplished, the RO should again review the claims. If the benefits sought on appeal are not granted, both the veteran and his representative should be furnished a supplemental statement of the case. They should also be given the applicable time period in which to respond. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further consideration. The veteran need take no action until so informed. The purpose of this REMAND is both to obtain clarifying information and to accord the appellant due process of law. No inference should be drawn regarding the final disposition of the claims. JACQUELINE E. MONROE 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).