BVA9500524 DOCKET NO. 93-05 112 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUE Entitlement to a compensable evaluation for an allergic reaction manifested by painful edema of the ankles and feet, and urticaria. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL The appellant and his wife ATTORNEY FOR THE BOARD Raymond F. Ferner, Counsel INTRODUCTION This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from an October 1990 rating decision of the Department of Veterans Affairs (VA) Regional Office in Phoenix, Arizona, (RO) which denied the benefit sought on appeal. The veteran, who had active service from July 1944 to December 1944, from August 1946 to February 1948, and from July 1948 to July 1949, appealed that decision to the BVA, and the case was received at the Board in March 1993. REMAND A preliminary review of the record discloses that the medical evidence indicates that the veteran has been diagnosed as having several disorders of his lower extremities. A VA outpatient treatment record dated in April 1990 contains assessment of peripheral neuropathy of an unknown etiology, probably diabetes, and peripheral vascular disease. A VA outpatient treatment record dated in May 1990 contains an impression of plantar fasciitis secondary to tight calf muscle, and a June 1990 outpatient treatment record contains an assessment of "asteototic" eczematous dermatitis of the feet. A private physician, Stanton J. Cohen, D.P.M., offered an opinion in a letter dated in February 1991 that it was his impression that the veteran had peripheral neuritis, most likely due to a Steven-Johnson type syndrome to an allergic reaction to penicillin and that nerve damage from the original allergic reaction was permanent. A VA dermatology consultation dated in March 1992 concluded with an assessment of normal skin on the lower extremities, and the examiner commented that he saw nothing from a dermatology standpoint of a chronic persistent condition related to the skin. VA rating examinations performed in March 1992 concluded with impressions of a chronic rash of the lower extremities involving the ankles and feet and neuropathy of the lower extremities from the midleg to the toes, following examination of the veteran's skin; and bilateral peripheral neuropathy, following examination of the peripheral nerves. The opinion of the veteran's podiatrist notwithstanding, it is not clear that any current neurological or vascular problems are attributable to the veteran's service-connected disability. In this regard, the Board would note that the veteran's podiatrist apparently did not have access to, or the benefit of a review of, medical records contained in the veteran's claims file, particularly service medical records pertaining to the veteran's hospitalization in July 1949 for treatment associated with his allergic reaction. Those records reflect that the veteran's allergic reaction was manifested by painful edema of the ankles and feet and generalized urticaria and do not appear to refer to any neurological or vascular manifestations. The Board believes that it would be premature to attempt to evaluate the severity of the veteran's service-connected disability without first obtaining a more detailed and comprehensive review of the veteran's medical records and an opinion as to what symptomatology and manifestations can reasonably be attributed to the veteran's service-connected disability. As indicated in a VA examination request of March 1992, this would best be accomplished by having the veteran examined and an opinion rendered by a board of specialists in the fields pertinent to the claim. To date, however, such request has not been fulfilled. The Board would also note that the veteran recently submitted a record pertaining to nerve conduction velocity and latency studies he underwent at a VA medical facility in May 1993 and indicated in the letter which accompanied the submission of that evidence to the Board that he was scheduled for vascular testing later in that year. No doubt the evidence submitted to the Board and any additional testing the veteran may have subsequently underwent would be useful in attempting to delineate symptomatology attributable to the various disorders of the lower extremities the veteran has been diagnosed as having. Therefore, in order to give the veteran every consideration with respect to the present appeal, it is the Board's opinion that further development of the case is desirable. Accordingly, this case is REMANDED for the following actions: 1. The RO should obtain and associate with the claims file VA medical records pertaining to the veteran dated from 1990 to the present date from the VA Medical Centers in Phoenix, Arizona, and Portland, Oregon. 2. The veteran should be afforded an examination by a board consisting of specialists in neurology and dermatology to ascertain the nature, severity, and etiology of any and all disorders of the lower extremities which may be present. Any and all indicated evaluations, studies, and tests deemed necessary by the board of specialists, including evaluation by a podiatrist, if appropriate, should be accomplished. The purpose of the examination is to determine which symptomatology, manifestations, and disorders which may be present can reasonably be attributed to the veteran's service-connected allergic reaction. The board is specifically requested to attempt to ascribe an etiology to all disorders which may be identified, offer an opinion as to the accuracy of the original diagnosis ascribed to the service-connected disability, and to comment on the accuracy of the February 1991 statement from Yuma Podiatry Associates. The complete rationale for each opinion expressed should be set forth. Since it is imperative "that each disability be viewed in relation its history[,]" 38 C.F.R. § 4.1 (1993), copies of all pertinent medical records in the veteran's claims file or, in the alternative, the claims file, must be made available to the board for review prior to, and during, the examination. When the requested evelopment has been completed, the case should again be reviewed by the RO on the basis of the additional evidence. If the benefit sought is not granted, the veteran and his representative should be furnished a supplemental statement of the case, and afforded the applicable time period to respond before the record is returned to the Board for further review. The purpose of this REMAND is to obtain additional development, and the Board does not intimate any opinion as to the merits of the case, either favorable or unfavorable, at this time. The veteran is free, of course, to submit any additional evidence he desires to have considered in connection with his current appeal. No action is required of the veteran until he is notified. 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) (1993).