BVA9507874 DOCKET NO. 93-17 094 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE An increased disability rating for degenerative joint disease of the cervical spine, left hand, right shoulder, both knees, left wrist, and both feet, currently evaluated as 20 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Barry F. Bohan, Counsel INTRODUCTION The appellant served on active duty in the United States Navy from October 1956 to October 1960 and from October 1963 to April 1987. In a March 1988 rating decision, service connection was granted for degenerative joint disease of the cervical spine and right shoulder, and a 10 percent disability rating was assigned. In a February 1989 rating decision, the appellant's service-connected disability was amended to include arthritis of both knees. A 20 percent disability rating was assigned. In a February 1992 rating decision, the service-connection disability was again expanded, to include arthritis of the distal interphalangeal joint, left middle finger and carpometacarpal joint, left wrist. The assigned disability rating remained at 20 percent. This appeal arose from a July 1992 rating decision of the Department of Veterans Affairs regional Office in Waco, Texas (VARO) which added osteoarthritis of both feet to the service- connected disorder and kept the assigned disability rating at 20 percent. The Board notes that in March 1993, the appellant filed a claim for an increased disability rating for service-connected bronchitis and service connection for Hunner's ulcer. That claim was denied in a July 1993 VARO rating decision. In August 1993, when the appellant's claims folders were forwarded to the Board with respect to this appeal, he had not filed a Notice of Disagreement as to the issues of an increased rating for bronchitis and service connection for Hunner's ulcer. Accordingly, those issues may not be considered by the Board at this time. REMAND The appellant is seeking an increased disability rating for service-connected arthritis of multiple joints. In essence, he contends that his service-connected arthritis has gotten worse over the years and that he experiences pain and limitation of motion in numerous joints. In a May 1994 informal presentation, the appellant's accredited representative called into question the adequacy of a February 1993 VA examination of the appellant's joints, which is the most recent medical evidence on record. During that examination, the examiner reported full ranges of motion of all affected joints. The representative pointed out that the examiner evidently failed to use a goniometer. In addition, the representative contended that the many groups of joints now covered by the appellant's service-connected disability should be separately rated. As noted above, the appellant is currently rated as 20 percent disabling for arthritis of multiple joints under 38 C.F.R. § 4.71a, Diagnostic Code 5003 (1994). Under that section, degenerative arthritis is ordinarily rated on the basis of limitation of motion of the joint or joints involved. In the absence of objectively confirmed limitation of motion, a 20 percent disability rating may be assigned for degenerative arthritis of multiple joints. It is further noted that VA regulations specifically call for multiple disabilities arising from a single disease entity, "e.g. arthritis", to be rated separately. 38 C.F.R. § 4.25(b) (1994). See also Esteban v. Brown, 6 Vet.App. 259, 261-2 (1993). With respect to the claimed inadequacy of the most recent VA examination, the Board notes that a VA examination of a joint which does not provide the range of motion in degrees is deemed by VA to be inadequate. M21-1, Part VI, par. 1.03 (March 23, 1993). The Board believes that further development is necessary in this case. The case is therefore REMANDED to VARO for the following action: The appellant should be scheduled for an orthopedic examination. The appellant's claims folder should be made available to the examiner for review prior to the examination. The examiner should specifically render objective clinical findings concerning the severity and extent of service-connected arthritis of each of the appellant's joints. Any laboratory studies or special testing should be done as deemed appropriate by the examiner. The report of the examination should be associated with the appellant's claims folder. After the above development has been completed, VARO should readjudicate the appellant's claim, applying all pertinent law, regulations and Court decisions. If the claim remains denied, in whole or in part, the case should be returned to the Board after compliance with all requisite appellate procedure. The purpose of this REMAND is to procure clarifying data and to satisfy due process requirements. The Board intimates no opinion as to the ultimate conclusion warranted, pending completion of the requested development. No action is necessary on the appellant's part until he receives further notice. C.P. RUSSELL 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) (1994).