Citation Nr: 0004498 Decision Date: 02/18/00 Archive Date: 02/23/00 DOCKET NO. 94-04 325 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a disorder of the spine, to include the cervical, thoracic, and lumbar segments. 2. Entitlement to service connection for a disorder of the knees. 3. Entitlement to service connection for a disorder of the ankles. 4. Entitlement to service connection for a disability of the arms, to include the hands and shoulders, with incomplete paralysis of the upper radicular group of nerves. 5. Entitlement to service connection for residuals of toxic poisoning. 6. Entitlement to service connection for a skin disorder. 7. Entitlement to service connection for hypertension. 8. Entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD). 9. Entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for additional disability of the sinuses, including nosebleeds, difficulty in breathing and major discomfort, as a result of treatment by the Department of Veterans Affairs. 10. Entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for additional cardiovascular disability as a result of treatment by the Department of Veterans Affairs. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. WITNESS AT HEARING ON APPEAL The appellant ATTORNEY FOR THE BOARD James A. Frost, Counsel INTRODUCTION The veteran served on active duty from January 1942 to October 1945. This appeal to the Board of Veterans' Appeals (Board) arises from rating decisions in September 1993 and February 1995 by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. In September 1988, the Board denied entitlement to service connection for a back disability. In 1993 and thereafter, the veteran submitted additional evidence in an attempt to reopen the claim. The RO found that the additional evidence was not new and material, and the current appeal on that issue ensued. In a decision of August 8, 1996, the Board denied the veteran's claims. The veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals before March 1, 1999) (Court), which, upon a joint motion by the Secretary of Veterans Affairs and the veteran-appellant, vacated the Board's decision and remanded the case to the Board for the purpose of affording the veteran a personal hearing. [citation redacted]. The Board notes that, in December 1998, the veteran withdrew in writing a claim of entitlement to service connection for diabetes mellitus. FINDINGS OF FACT 1. In September 1988, the Board denied entitlement to service connection for a back disorder. 2. Additional evidence submitted since September 1988 is so significant that it must be considered in order to fairly decide the merits of the claim for service connection for a back disorder. 3. A private physician has related a current spinal disorder to an injury during the veteran's period of active service. 4. There is no competent medical evidence to support claims of entitlement to service connection for disorders of the knees, ankles and arms, to include the hands and shoulders, with incomplete paralysis of the upper radicular nerves, residuals of toxic poisoning, a skin disorder, and hypertension. 5. The veteran has PTSD related to events in service. 6. There is no competent medical evidence to support claims of entitlement to compensation for additional disabilities of the sinuses or cardiovascular system as the result of VA treatment. CONCLUSIONS OF LAW 1. The decision of the Board of Veterans' Appeals in September 1988, denying entitlement to service connection for a back disability, is final. 38 U.S.C.A. § 7104(b) (West 1991). 2. Evidence received since the Board denied entitlement to service connection for a back or spine disability in 1988 is new and material and the veteran's claim for that benefit is reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1999). 3. The claim of entitlement to service connection for a spine disability is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 4. Claims of entitlement to service connection for disorders of the knees, ankles, arms, to include the hands and shoulders, with incomplete paralysis of the upper radicular nerves, and skin, as well as residuals of toxic poisoning and hypertension, are not well grounded. 38 U.S.C.A. § 5107(a). 5. PTSD was incurred in service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.304(f) (1999). 6. Claims of entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for additional disabilities of the sinuses and cardiovascular system are not well grounded. 38 U.S.C.A. § 5107(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. The Spine Service connection may be granted for disability resulting from injury or disease incurred in or aggravated by service. 38 U.S.C.A. § 1110. The law provides that, except as provided in § 5108, when a claim is disallowed by the Board, the claim may not thereafter be reopened and allowed and a claim based upon the same factual basis may not be considered. 38 U.S.C.A. § 7104(b). If new and material evidence is presented or secured with respect to a claim which has been disallowed, the claim shall be reopened and the former disposition of the claim shall be reviewed. 38 U.S.C.A. § 5108. "New and material evidence" means evidence not previously submitted to VA decision makers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant of prior evidence and which, by itself, or in connection with evidence previously assembled, is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a). When a veteran seeks to reopen a final decision based on new and material evidence, a three-step analysis must be applied. See Elkins v. West, 12 Vet. App. 209, 214-5 (1999); Winters v. West, 12 Vet. App. 203, 206-7 (1999); Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). The first step is to determine whether new and material evidence has been received under 38 C.F.R. § 3.156(a). Second, if new and material evidence has been presented, then, immediately upon reopening the veteran's claim, VA must determine whether the claim is well grounded under 38 U.S.C.A. § 5107(a). In making that determination, all of the evidence of record is to be considered and presumed to be credible. See Robinette v. Brown, 8 Vet. App. 69, 75-6 (1995). Third, if the claim is found to be well grounded, then the merits of the claim may be evaluated, after ensuring that the duty to assist under 38 U.S.C.A. § 5107(a) has been met. The evidence of record when the Board considered the issue of service connection for a spinal disability in September 1988 included statements and testimony by the veteran and private medical records. The veteran's service medical records were unavailable. In October 1987, the National Personnel Records Center (NPRC) reported that the service medical records, if present at that facility in 1973, were destroyed by a fire and reports of physical examinations could not be reconstructed. The NPRC requested that National Archives and Records Administration (NARA) Form 13055, Request for Information Needed to Reconstruct Medical Data, be completed. The form was submitted, but no records were forthcoming. In a statement received in October 1987, the veteran stated that: In 1945, at a base in Northern Ireland, he had volunteered and was assigned to assist in the salvage of aircraft; some men were cutting off a wing of an airplane when it exploded; one man was killed and others were wounded. The veteran stated that he managed to get out, but his back was injured; he had someone put tape on his back. He indicated that he did not know if there was an investigation or the name of the organization which was in charge of the aircraft. He stated further that, after separation from service, a private medical insurance company paid for treatments for his back. Records of the Boone County, Missouri, Hospital were submitted, which showed that the veteran was admitted in December 1980 for evaluation of low back pain after he slipped and fell on ice at his workplace. He had a history of an episode of lower back pain in the early 1960s after a fall, which had responded to conservative treatment. X-rays showed spondylolisthesis of L3 on L4 and probably spondylolysis of L3. A lumbar myelogram showed a central epidural defect at L3-4. A neurological examination was negative. Treatment consisted of a lumbosacral corset. In November 1987, D. L. Shroyer, D.C., reported that he had treated the veteran for back problems since 1961. The diagnoses included low back pain at L4-5, sciatica, and radiculitis. At a personal hearing in May 1988, the veteran reiterated his prior statements. He also testified that when the aircraft exploded he "hurt my back pretty bad." He was asked if he wanted to see a doctor, but he declined; a medic taped his back. He testified further that: After the incident, his back bothered him and pain radiated to his left leg; the incident occurred in August 1945, which was the month his wife delivered a baby girl, who died. The veteran stated further that two weeks after his separation from service he saw an osteopathic physician about his back. Thereafter, he "went through a bunch of chiropractors." He said that, in December 1980, he fell on ice at work and was treated at Boone County Hospital. He testified that he was currently seeing Dr. Shroyer. The additional evidence submitted since September 1988 will be summarized below. The veteran submitted a copy of a Department of Defense history from May 1944 to June 1945 of the unit to which he had been assigned, which showed that, on May 26th, 1945, the explosion of a wing of an aircraft killed a sergeant. There was no reference to other service members being injured. A letter dated in April 1988 from the NPRC to a Member of Congress stated that NARA Form 13055 submitted by the veteran had been too general and incomplete to reconstruct any requested information. The unit history of the 328th Service Squadron was submitted, which showed that, in August 1945, a man was killed when a cable which was suspending an airplane above him snapped. In March 1989, the Directorate of Aerospace Safety, United States Air Force, reported having no record of a B-26 aircraft explosion as described by the veteran. A statement by the veteran's wife was received, in which she said that she married the veteran in 1945 and was with him in Northern Ireland. She stated that: In August 1945, she delivered a female infant, who died the same day; later that day, the veteran came home and said that he had been working on a plane which exploded, killing one man and severely injuring another; and the veteran had injured his back, which was taped up. The veteran was then sent home and discharged. She joined him in March 1946, and he still had trouble with his back; all the doctors could do was give him something for pain. Sometimes, he had to stay home from work; he then started seeing chiropractors. In November 1993, a statement by [redacted] was submitted. Mr. [redacted] had served with the veteran in 1945 in Northern Ireland. He confirmed that an aircraft had exploded; he had been about 150 feet away. He did not provide any information about an injury to the veteran. An emergency room record of Boone County Hospital showed that the veteran was seen on December 23, 1980. Reportedly, he had fallen at work the previous day. X-rays were interpreted as showing a fracture of L4. A report of a bone scan of the lumbar spine in October 1990 at John Fitzgibbon Memorial Hospital, Marshall, Missouri, showed slightly increased activity compatible with degenerative disease of the lumbar spine. VA X-rays of the lumbosacral spine in June 1993 showed spondylolisthesis of L3 on L4; degenerative disc disease of L4-5 and L3-4; and suspected pars defects of L3. At a VA orthopedic examination in June 1993, the veteran complained of lower back pain and neck pain since an injury in 1945; he stated that he had been told that he had compression fractures in his spine. On examination, all movements of the lumbosacral and lower thoracic spine caused significant pain. X-rays showed compression fractures. The diagnoses included: Multiple compression fractures of T10 through T12 and L1-2; lower back pain secondary to extensive degenerative disc disease involving L4-5 and L3-4, without neurological changes; and neck pain secondary to degenerative joint disease and discogenic disease. In August 1993, the NPRC reported that no records of the Surgeon General's Office pertaining to the veteran were on file. In October 1993, K. T. Papreck, M.D., reported that: My patient, [the veteran] has had significant problems over the years with back pain and has requested the VA to review him for disability related to an accident where there was an explosion in a bomber that he was in on the ground. This occurred May 26, 1945. I have reviewed his history extensively. He has had some other injuries that may account for some of his problems. However, I can find no evidence that the thoracic spine fractures demonstrated on recent X-rays at the VA hospital are from any previous injury and there are no pre-existing normal X-rays that I am aware of, specifically of that area. It is my feeling that, as he has described the blasting injury effects and the bouncing that occurred in the cabin of the aircraft, that he could certainly have sustained injuries to his thoracic spine, specifically the X-rays that the VA showed with compression deformities at T10, 11 and 12. I believe it is reasonable to presume that this many years later he would have significant pain from traumatic arthritis associated with those injuries. I do believe that this is likely service connected and not related to other injuries or problems. At a personal hearing in January 1994, the veteran reiterated his earlier statements and testimony. The Board finds that Dr. Papreck's statement is new and material because it relates a current spinal disorder to the injury to the veteran's back which he claims occurred in service in 1945. Dr. Papreck's statement well grounds the veteran's claim for service connection for a disorder of the spine. That issue will be further addressed in the Remand portion of this decision. II. Service Connection Claims Factual Background With reference to the knees, ankles, and upper extremities, the service medical records, as previously discussed, are unavailable. At a personal hearing in May 1988, the veteran testified that at times his left arm would go numb. In July 1991, at Fitzgibbon Memorial Hospital, X-rays of the knees showed mild degenerative changes, including mild hypertrophic changes involving the bony structures and scattered soft tissue calcification. The veteran was given medication for knee and hip pain. VA X-rays of the left shoulder in June 1993 showed degenerative changes at the acromioclavicular joint. X-rays of the left hand and thumb showed minimal degenerative changes. At a VA orthopedic examination in June 1993, the veteran stated that he had left arm and wrist numbness during the last 3 or 4 years, which was relieved by chiropractic manipulation of his neck. On examination, strength of the upper extremities was normal; range of motion of the hands and wrist was normal, with no swelling or numbness. Disorders of the knees, ankles or upper extremities were not diagnosed. At a personal hearing in January 1994, the veteran offered no testimony concerning his knees, ankles or upper extremities. With reference to toxic poisoning and the skin, in a statement of October 1987, the veteran said that, later in the day of the aircraft explosion in 1945, he was working on another plane when someone activated the motor of the hydraulic system, shooting hydraulic fluid into his eyes; he wiped his eyes and then went to see his commanding officer, who gave him another assignment. At the hearing in May 1988, the veteran reiterated his statement. In her statement, the veteran's wife did not mention a hydraulic fluid incident. At the hearing in January 1994, the veteran testified that the hydraulic fluid got into his mouth and ears as well as his eyes. The fluid also soaked his clothes, and five days passed before he could go home and get washed. At a personal hearing in December 1998, the veteran testified that he had sun sensitivity of the skin, which he thought was related to being sprayed with hydraulic fluid in 1945. With reference to hypertension, at the hearing in January 1994, the veteran testified that after he returned from service his father took him to a doctor because his face had swelled up. The doctor gave him some pills for elevated blood pressure, which he took for 30 days; the doctor did not tell him his blood pressure readings. Years later, a different doctor told him that he had high blood pressure. With reference to a psychiatric disorder, at a VA psychiatric examination in May 1993, the veteran recounted his experiences on a day in 1945 when he was injured in a plane explosion and sprayed with hydraulic fluid. He had not at that time received psychiatric treatment or medication. He denied having recurrent memories, dreams or flashbacks of World War II events and he did not avoid activities which would remind him of military service. He had had problems with irritability and angry outbursts since high school. He felt somewhat detached from others. He startled easily and was hypervigilant when driving. A mental status examination was essentially unremarkable. The examiner concluded that the veteran did not meet the diagnostic criteria for a diagnosis of PTSD or any other psychiatric disorder. At the hearing in January 1994, the veteran testified that after he got home from World War II, "I had problems for a while. I couldn't really keep a job too good and I was a little touchy...I never did particularly care to take too much from anybody after that." In May 1998, the veteran was seen by a VA psychologist. He reported various PTSD symptoms, such as poor sleep, nightmares, startle reaction, trouble finishing things, self- isolation, trouble with anger and possible "flashbacks." The veteran got visibly shaky when he talked about the various tragic events which occurred during World War II. The veteran had survivor guilt, because a man he was close to offered to take his place in going over to an assignment in Europe, which turned out to be the Battle of the Bulge; the man was killed. The veteran was easily fatigued, had loss of energy and interest, and poor sleep. The psychologist reported that the veteran would benefit from a psychiatric consultation to consider possible medications, such as antidepressants, or whatever was medically feasible. The psychologist concluded that there was no doubt that the veteran demonstrated very chronic PTSD, for which he had not been treated. In August 1998, a VA psychiatrist also diagnosed PTSD. Analysis Hypertension and paralysis of nerves may be presumed to have been incurred in service when manifested to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an inservice stressor; and credible supporting evidence that the claimed inservice stressor occurred. 38 C.F.R. § 3.304(f) (1999). A person who submits a claim for VA benefits shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107(a). Where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence to the effect that the claim is "plausible" or "possible" is required. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). When there is no medical evidence to link a current disability with events in service, a service connection claim is not well grounded. Grivois v. Brown, 6 Vet. App. 136 (1994). In the veteran's case, no physician has made a finding, based on an accurate history and objective clinical findings, that any of the physical disorders for which the veteran seeks service connection is etiologically related to any incident or manifestation during his period of active service. No physician or health care professional has found that paralysis of the upper radicular group of nerves or hypertension was manifested during the one-year presumptive period after completion of the veteran's service in 1945. Thus, the veteran's service connection claims (other than the claim for service connection for a psychiatric disorder) are not well grounded and must be denied on that basis. 38 U.S.C.A. § 5107(a). Although the Board considered and decided these issues on a ground different from that of the RO, which denied the claims on the merits, the appellant has not been prejudiced by the Board's decision because, in assuming that the claims were well grounded, the RO accorded the claimant greater consideration than his claims in fact warranted under the circumstances. Bernard v. Brown, 4 Vet. App. 384, 392-4 (1993). To remand this case to the RO for consideration of the issue of whether the claims are well grounded would be pointless, and, in light of the laws cited above, would not result in a determination favorable to him. VAOPGCPREC 16-92, 57 Fed. Reg. 49747 (1992). With reference to PTSD, there are, as discussed, diagnoses of that disorder by a VA psychologist and a VA psychiatrist, who have linked the veteran's current PTSD symptomatology to the plane explosion in 1945. The credible supporting evidence that the claimed inservice stressor occurred is the service record that a member was killed in May 1945 in an explosion of a wing section of an aircraft. That record essentially corroborates the veteran's account that such an incident occurred. The Board recognizes that the veteran has testified that the explosion occurred in August 1945 and told Dr. Papreck that the incident occurred in May 1945, and the Board notes that his representative has described the veteran as a poor historian. Nevertheless, the veteran has vigorously asserted for many years that he was injured in the explosion of the aircraft. The Board will resolve the doubt on that issue in the veteran's favor. 38 U.S.C.A. § 5107(b). The elements necessary to establish service connection for PTSD have thus been established. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.304(f). III. Claims under 38 U.S.C.A. § 1151 Title 38, United States Code, § 1151 provides that, where a veteran suffers an injury or an aggravation of an injury resulting in additional disability by reason of VA hospitalization, or medical or surgical treatment, compensation shall be awarded in the same manner as if such disability were service connected. Amendments to 38 U.S.C.A. § 1151 made by Public Law 104-204 require a showing not only that the VA treatment in question resulted in additional disability, but also that the proximate cause of the additional disability was carelessness, negligence, lack of proper skill, error in judgment, or a similar instance of fault on VA's part in furnishing the medical or surgical treatment, or that the proximate cause of additional disability was an event which was not reasonably foreseeable. Those amendments, however, apply only to claims for compensation under 38 U.S.C.A. § 1151 which were filed on or after October 1, 1997. VAOPGCPREC 40-97, 63 Fed. Reg. 31263 (1998). Therefore, because the veteran filed his claims prior to October 1, 1997, the only issue before the Board is whether he suffered additional disability as a result of VA treatment. There are three requirements to establish a well-grounded claim under the provisions of 38 U.S.C.A. § 1151. First, there must be medical evidence of a current disability. Second, there must be medical evidence or, in certain circumstances, lay evidence, of incurrence of an injury or aggravation of an injury as the result of VA hospitalization or medical or surgical treatment. Third, there must be medical evidence of a nexus or link between that asserted injury or disease and the current disability. Jones v. West, 12 Vet. App. 460, 464 (1999). Records of Boone County Hospital at Columbia, Missouri, disclose that the veteran underwent surgery in June 1965 for multiple benign nasal polyps. Records of the VA Medical Center, Columbia, Missouri, disclose that, in May 1977, the veteran was admitted for a cardiac evaluation. Four months earlier, he had suffered an inferior wall myocardial infarction. An exercise stress test showed cardiac function to be within normal limits. The diagnosis was atherosclerotic cardiovascular disease. The veteran was admitted to a VA medical center in August 1987 with chronic bilateral posterior ethmoiditis, with polypoid degeneration and chronic post nasal drip. He had previously undergone partial bilateral inferior turbinectomy and left middle turbinectomy by a private physician. His past medical history was significant for three myocardial infarctions in 1974, 1976 and 1977; he currently had stable angina. He also gave a history of adult-onset diabetes since March 1987 and a history of hypertension for many years. At admission, an examination of his nose revealed edematous mucosa, and the throat showed post-nasal drip in the hypopharynx. The veteran underwent a left ethmoidectomy, infundibulotomy and nasofrontal duct exploration, as well as a right partial middle turbinectomy and infundibulotomy; there were no surgical complications. Postoperatively, he was monitored with cardiac telemetry on recommendation of the cardiology service. He experienced no cardiac problems or arrhythmias. He denied any chest pain during his entire hospital stay. He was released from the hospital in stable condition. The discharge diagnosis was chronic sinusitis with polypoid degeneration. In September 1987, at a VA ear, nose and throat (ENT) clinic, the veteran complained of continued nasal obstruction with mild post-nasal drip. A small amount of thin mucus and some small polyps were noted. The assessment was a good anatomic result of surgery. In November 1987, the veteran complained of a decreased airway on the left on strong inspiration. He could resolve the problem by retracting his left cheek laterally. An examination showed a good airway, intranasally; nasal valve surgery was not recommended. At the ENT clinic in March 1988, the veteran had a stuffy nose and foul yellow post-nasal drainage. On examination, the ethmoid sinuses were almost completely open and were much better than before the August 1987 surgery. There was moderate congestion of the nose, bilaterally, with crusty yellow mucus in each middle meatus. The impression was continued chronic ethmoid sinusitis, even though the ethmoid sinuses were mostly open. At the VA ENT clinic in June 1993, the veteran complained of nasal drainage and congestion. A nasal endoscopy revealed polyps, bilaterally. The impression was polypoid disease. In November 1993, the veteran could breath well through his nose. At the hearing in December 1998, the veteran testified that VA treatment did not make his heart condition worse. Upon review, the Board finds that the record does not includes any competent medical evidence that VA nasal surgery in August 1987 resulted in any additional disability. In particular, the August 1987 nasal surgery did not result in additional disability of the sinuses or cardiovascular system. Indeed, the record shows that the surgery in question was ameliorative and without complications. Thus, the veteran's claims under the provisions of 38 U.S.C.A. § 1151 are not well grounded and will be denied on that basis. 38 U.S.C.A. § 5107(a). The Board's action in this regard is without prejudice to the veteran. Bernard. ORDER New and material evidence having been submitted, a claim of entitlement to service connection for a disorder of the spine, to include the cervical, thoracic and lumbar segments, is reopened. Service connection for a disorder of the knees is denied. Service connection for a disorder of the ankles is denied. Service connection for a disorder of the arms, to include the hands and shoulders, with incomplete paralysis of the upper radicular group of nerves, is denied. Service connection for residuals of toxic poisoning is denied. Service connection for a skin disorder is denied. Service connection for hypertension is denied. Service connection for post-traumatic stress disorder is granted. Compensation under the provisions of 38 U.S.C.A. § 1151 for additional disability of the sinuses, including nosebleeds, difficulty in breathing and major discomfort, as a result of treatment by the Department of Veterans Affairs is denied. Compensation under the provisions of 38 U.S.C.A. § 1151 for additional cardiovascular disability as the result of treatment by the Department of Veterans Affairs is denied. REMAND With regard to a well-grounded claim for service connection, the duty to assist may require a current medical examination and the Board is always free to supplement the record by seeking an advisory medical opinion. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Under the circumstances of this case, particularly in view of the variously reported diagnoses involving the spine, the Board finds that additional medical development would be helpful. Accordingly, the case is REMANDED to the RO for the following action: The veteran should be afforded a special orthopedic examination of the cervical, thoracic and lumbar spine for the purpose of determining the likelihood that any current spine disability is related to the back injury he has described in service. The examiner should be requested to determine the nature of all disorders of the spine and offer an opinion as to whether it is at least as likely as not (a 50 percent or more likelihood) that any current spine disorder is related to being thrown around inside an airplane in service with special attention to the reported compression deformities of the thoracic spine and arthritis as cited in the October 1993 opinion from Dr. Papreck. A discussion of the rationale for such opinion would be helpful to the Board. The claims file should be made available to the examiner for review in connection with the examination. The RO should then review the evidence and determine whether the veteran's claim for service connection for a spine disability may now be granted. If the decision remains adverse to the veteran, he and his representative should be provided with a supplemental statement of the case and an opportunity to respond thereto. The case should then be returned to the Board for further appellate consideration. The purpose of this REMAND is to obtain clarifying medical information. By this REMAND, the Board intimates no opinion as to the ultimate disposition of the appeal. No action of the veteran is required until he receives further notice. The veteran has the right to submit additional evidence and argument on the matter the Board has remanded to the RO. Kutscherousky v. West, 12 Vet. App. 369 (1999). CHARLES E. HOGEBOOM Member, Board of Veterans' Appeals