BVA9501799 DOCKET NO. 93-09 888 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUE Entitlement to an increased rating for Raynaud's disease of the hands, fingers, and feet, currently evaluated as 40 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Darryl A. Joe, Associate Counsel INTRODUCTION The veteran had active military service from January 1952 to March 1958. This matter comes before the Board of Veterans' Appeals (hereinafter the Board) on appeal from a rating action in June 1992 by the Muskogee, Oklahoma Regional Office (hereinafter RO) of the Department of Veterans Affairs (hereinafter VA) which denied the veteran's claim for a disability rating in excess of 40 percent for Raynaud's disease of the hands, fingers, and feet. At the time of his hearing the veteran offered testimony relating to his inability to work, which could be construed as a claim for a total rating due to individual unemployability due to service- connected disability or to a permanent and total rating for nonservice-connected pension purposes. Neither of these issues has been developed for appellate review and will not be addressed herein; however they are referred to the attention of the RO for appropriate action. REMAND The veteran contends that the 40 percent disability evaluation presently assigned to his service-connected Raynaud's disease does not adequately compensate him for problems he experiences relative to that disorder. In this regard, he maintains that he experiences pain, a cold sensation, and numbness in his hands and feet. He also asserts that the Raynaud's disease-related symptoms hinder his ability to ambulate. Review of the record in this case reflects that the veteran has reported an increase in symptoms, particularly those involving his feet, during the past few years. He has undergone a number of studies as a VA outpatient in order to determine the etiology of these symptoms, including increasing foot pain, which, according to the veteran, has resulted in his use of a wheelchair. Although, as noted on the most recent VA examination in December 1992, the vascular and arterial studies did not suggest significant disease, Nifedipine vasospastic provocation testing revealed findings which were stated to be compatible with the diagnosis of Raynaud's phenomenon. The examiner noted that testing by the VA on an outpatient basis in the vascular clinic had led a physician to suspect that the veteran had reflex sympathetic dystrophy, which was the cause of his current symptoms. The examiner also opined that the symptoms involving the veteran's feet were "atypical" of Raynaud's phenomenon; however the examiner also commented that such disability "may be associated" with the Raynaud's phenomenon. In view of the diagnostic ambiguity which is reflected in the record, the Board finds that further development of the record would be beneficial prior to appellate review, so that all symptoms which may reasonably be associated with the service- connected disorder are considered in the evaluation of the claim. This is particularly true since the last VA examination was conducted in December 1992, more than 3 years ago. The VA has a statutory duty to assist a veteran in the development of facts pertinent to his well-grounded claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. §§ 3.103(a), 3.159 (1993). The United States Court of Veterans Appeals has held that the duty to assist the veteran includes obtaining and developing all facts pertinent to his appeal. Murphy v. Derwinski, 1 Vet.App. 78 (1990). This duty includes additional VA examination by a specialist when needed. Hyder v. Derwinski, 1 Vet.App. 221 (1991). Accordingly, the case is REMANDED for the following actions: 1. The veteran should be contacted and asked whether he has been afforded treatment since December 1992 by a private medical care provider for his service- connected Raynaud's phenomenon. If he has, the RO should obtain the reports of such treatment for inclusion in the claims folder, after securing the necessary releases. 2. All up-to-date VA medical records should be incorporated into the claims folder. 3. After this development has been accomplished, the veteran should be afforded a VA examination by an appropriate specialist, preferably one who has not previously examined him, in order to determine the severity of his service- connected disorder, Raynaud's phenomenon. The examination should be conducted in accordance with VA's Physician's Guide for Disability Evaluation Examinations. All appropriate special studies and tests should be performed. The examiner should thoroughly review the veteran's claims folder prior to the examination. It is specifically requested that the examiner set forth all symptoms, particularly those involving the feet, which may be reasonably attributed to Raynaud's phenomenon. Any foot symptoms which arise from unrelated causes should be distinguished, to the extent possible. The necessity for the veteran's reported use of a wheelchair should be addressed. 4. After the above actions have been accomplished, the RO should again adjudicate the veteran's claim for an increased rating, with consideration to all applicable rating schedule criteria, as well as extraschedular evaluation, in accord with the procedure set forth in 38 C.F.R. § 3.321(b)(1) (1993). In the event that the action taken is adverse to the veteran, both he and his representative should be furnished a supplemental statement of the case, containing a recitation of all new evidence and a citation to the relevant law and regulations and pertinent diagnostic codes. A reasonable period of time should be provided for response. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. The veteran need take no action until she is further notified by the RO. N. R. ROBIN 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).