BVA9501010 DOCKET NO. 91-17 528 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUES 1. Entitlement to service connection for right hip and neck pain secondary to Ehlers-Danlos syndrome. 2. Entitlement to service connection for sinusitis. 3. Entitlement to an increased rating for mechanical low back pain secondary to Ehlers-Danlos syndrome, currently rated as 20 percent disabling. 4. Entitlement to an increased (compensable) rating for left hip pain secondary to Ehlers-Danlos syndrome. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Michael P. VanderMeer, Associate Counsel INTRODUCTION The veteran served on active duty from December 1987 to April 1989. This case is before the Board of Veterans' Appeals (Board) on appeal from a September 1989 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. This case was last before the Board in January 1994, at which time it was remanded for further development. The appeal was returned to and redocketed at the Board in April 1994. REMAND On review of the file it is noted that a hearing officer's decision dated in August 1992, pertaining to a hearing held in April 1992, reflects that the veteran had, in conjunction with her personal hearing, submitted reports reflecting treatment rendered her from August 24, 1990, to April 21, 1992, at Barksdale Air Force Base Hospital as well as a lumbar spine magnetic resonance imaging report, which was noted by the hearing officer to have been indicative of lumbar disc herniation, from Willis-Knighton Medical Center dated April 20, 1992. While the transcript of the veteran's April 1992 hearing, at which she indicated having received treatment at the Barksdale facility for a sinus condition and which treatment is of possible implication for her current claim for service connection for sinusitis, was obtained and associated with the claims folder pursuant to the Board's January 1994 remand, neither the above-addressed Barksdale records nor the magnetic resonance imaging report from the Willis-Knighton facility, which latter report may bear on the veteran's current claim for an increased rating for mechanical low back pain, are shown to be of record. Further development in this regard is specified below. At her personal hearing, with respect to her claim for an increased rating for mechanical low back pain, the veteran's complaints relative to her low back included diminished ability to flex forward as well as experiencing back spasms. Given the veteran's recent hearing testimony, and inasmuch as her low back has not been X-rayed by VA since August 1990, the Board is of the opinion that a current VA examination should be performed before an appellate adjudication of the veteran's claim for an increased rating for mechanical low back pain is rendered. The Board is similarly of the opinion that a current VA examination in conjunction with the veteran's claim for an increased rating for her service-connected left hip pain should be performed before a related decision on appeal is made. Accordingly, the case is REMANDED for the following: 1. The RO should contact the veteran and request her to identify the names, addresses, and approximate dates of treatment for any health care provider(s) to include any VA medical facility other than the VA Medical Center in Shreveport, Louisiana, as well as possible treatment rendered the veteran subsequent to April 21, 1992, at Barksdale Air Force Base Hospital, who may possess additional records pertinent to her claims. Thereafter, in light of the response received and after obtaining any necessary authorization, the RO should take appropriate action to obtain copies of any clinical records indicated. In any event, the RO should obtain copies of all clinical records reflecting treatment rendered the veteran since April 1992 at the VA Medical Center in Shreveport, Louisiana; and, after obtaining any necessary authorization, the RO should obtain and/or associate with the claims folder a lumbar spine magnetic resonance imaging report from Willis- Knighton Medical Center dated April 20, 1992, as well as all clinical reports pertaining to treatment rendered the veteran from August 24, 1990, to April 21, 1992, at Barksdale Air Force Base Hospital. 2. Thereafter, the RO should arrange for the veteran to undergo a VA examination by a board certified orthopedist, if available, to determine the current severity of her service-connected mechanical low back pain and service- connected left hip pain. Findings pertaining to range of motion of the veteran's lumbar spine and left hip are essential. Any special diagnostic studies deemed necessary should be performed, and the claims folder must be made available to the examiner for review prior to the examination. 3. The RO should then review the report pertaining to the VA examination performed in response to the previous directive to ascertain whether such examination is in compliance with the Board's examination instructions. 4. Then, after undertaking any development deemed necessary in addition to that specified above, the RO should readjudicate the issues on appeal. 5. If the benefits sought on appeal are not granted to the veteran's satisfaction, the veteran and her representative should be provided a Supplemental Statement of the Case on all issues in appellate status. The veteran should be provided appropriate notice of the requirements to perfect an appeal with respect to any issue addressed therein, which does not appear on the title page of this decision. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. In taking this action, the Board implies no conclusions, either legal or factual, as to any ultimate outcome warranted. No action is required of the veteran until she is notified. ROBERT E. SULLIVAN 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).