BVA9504204 DOCKET NO. 92-15 236 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado THE ISSUES 1. Entitlement to an increased evaluation for bladder impairment due to multiple sclerosis, currently rated as 40 percent disabling. 2. Entitlement to an increased evaluation for bowel impairment due to multiple sclerosis, currently rated as 30 percent disabling. 3. Entitlement to a higher rate of special monthly compensation based on a higher level of aid and attendance under 38 U.S.C.A. § 1114(r)(1) (West 1991). REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. ATTORNEY FOR THE BOARD W. H. Wetmore, Counsel INTRODUCTION The veteran served on active duty from December 1974 to June 1982. The Board of Veterans' Appeals (Board) initially received this case on appeal from an October 1991 RO rating decision. An RO rating decision of June 1992 raised the rating assigned the veteran's bladder impairment due to multiple sclerosis from 20 to 40 percent. The Board remanded this case in March 1993. REMAND The Board's March 1993 remand requested that the veteran be accorded examinations by appropriate medical specialists in order to determine if she had "loss of either bladder or anal sphincter control." The clinic director of the VA medical center requested clarification from the RO, noting that the veteran had undergone a compensation examination in May 1992, and that he knew of no specific tests that could be afforded the veteran, in light of the already established diagnoses of neurogenic bladder and bowel. In evaluating the veteran's claim for increased compensation, VA regulations provide for the assignment of ratings based on the level of disability demonstrated. Often these determinations require specific findings and actual medical opinion as to the degree or level of disability present. Thus, it is necessary, in order to fully evaluate the veteran's claim in this case, that another examination be conducted and that certain medical opinions be obtained. The performance of further testing is not necessarily indicated and is left to the discretion of the examiners. Recent changes in the rating schedule also require additional study by the RO. Under 38 C.F.R. § 4.115b, Diagnostic Code 7512 (1994), the veteran's condition is rated for voiding dysfunction. A 40 percent evaluation may be assigned under voiding dysfunction when it requires the wearing of absorbent materials that must be changed 2 to 4 times per day and a 60 percent evaluation (the highest contemplated by this portion of 38 C.F.R. § 4.115a (1994)) may be assigned when it requires the use of an appliance or the wearing of absorbent materials that must be changed more than four times per day. 38 C.F.R. § 4.115a. (Interestingly, if consideration is given to the portion of § 4.115a devoted to urinary frequency, the highest evaluation is 40 percent, warranted when there is daytime voiding at intervals of less than one hour or awakening to void five or more times per night. The veteran has contended that she attempts to empty her bladder 12 to 15 times per day.) Under these circumstances, the Board concludes that further development of the medical evidence is desirable. Accordingly, this case is REMANDED for the following: 1. The RO should take appropriate steps to obtain copies of complete treatment records for the veteran since July 1993 and associate them with the claims file. 2. The veteran should be examined by a proctologist to determine the impairment of sphincter control in assessing the degree of rectum and anus impairment due to multiple sclerosis. Any additional studies deemed appropriate may be undertaken in order to assist the examiner. A full clinical history should be elicited from the veteran and recorded in order to determine the full extent of bowel impairment, such as the extent and frequency of any leakage or the extent of any incontinence, the requirement for absorbent pads and other impairment of bowel function. Based on her/his review, the examiner should offer an opinion as to the degree of loss of anal sphincter control as produced by the multiple sclerosis. 3. The veteran should be examined by a urologist to determine the extent of voiding dysfunction due to multiple sclerosis. Any additional studies deemed appropriate may be undertaken in order to determine the extent of bladder function. A full clinical history should be elicited from the veteran and recorded for the purpose of describing the extent of actual bladder impairment, such as the requirement for absorbent pads and the frequency with which they need to be changed. Based on her/his review, the examiner should offer an opinion as to the degree of loss of bladder control as produced by the multiple sclerosis. 4. The RO should take adjudicatory action based on the evidence obtained pursuant to the development sought above, including consideration of the current regulatory criteria for evaluating bladder impairment due to multiple sclerosis. See 38 C.F.R. § 4.115a (1994). If the benefit sought by the veteran is not granted, a supplemental statement of the case should be prepared. After the veteran and her representative have been given an opportunity to respond to the supplemental statement of the case, the claims folder should be returned to this Board for further appellate review, if in order. No action is required by the veteran until she receives further notice. The purpose of the remand is to procure clarifying data and to comply with governing adjudicative procedures. The Board intimates no opinion, either legal or factual, as to the ultimate disposition of this appeal. STEPHEN L. WILKINS 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).