BVA9505986 DOCKET NO. 93-11 350 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for a thyroid condition. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Anthony D. Dokurno, Associate Counsel INTRODUCTION The veteran performed active military service from August 1955 to September 1974. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which denied service connection for a thyroid disorder. The Board notes that the RO, by its rating decision of October 1991, denied service connection for a thyroid disorder and for rheumatoid arthritis. The veteran was notified of the decision in November 1991. The same month, the veteran filed his Notice of Disagreement with the decision, noting that his disagreement included the denial of service connection for rheumatoid arthritis, and submitted additional documentation. The RO's Confirmed Rating Decision of December 1991 addresses several issues and reaffirms its denial of service connection for the thyroid disorder, but does not address rheumatoid arthritis. The statement of the case also addresses only the thyroid condition. The Board therefore finds that the RO must issue a supplemental statement of the case that will apprise the veteran of the appropriate laws and regulations regarding the claim of entitlement to service connection for a rheumatoid arthritis disorder and the procedural requirements necessary to perfect an appeal on that issue. REMAND The threshold inquiry is whether the veteran's claim is well- grounded. Under the provisions of 38 U.S.C.A. § 5107 (West 1991), a person who submits a claim to the VA has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well-grounded. If the person meets this burden, the VA is obligated to assist in developing facts pertinent to the claim. A well-grounded claim is one that is plausible, that is, meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). The veteran and his representative have submitted documentation demonstrating a December 1981 provisional diagnosis by the VA of a "large multinodular goiter." The veteran and his representative have also submitted documentation dated January 1992 from a private physician indicating that in his opinion the veteran's thyroid disorder, first diagnosed in December 1981, "was present for many years before he was diagnosed," and continues to the present day. Accordingly, the Board finds that this claim is well-grounded. Grottveit v. Brown, 5 Vet.App. 91, 92-93 (1993). However, though the claim is well-grounded, the current record indicates that significant additional medical records may be available, and that the factual question of the disorder's etiology requires development. The December 1981 VA consultation sheet listing the provisional diagnosis of the veteran's disorder also specifically requests a needle biopsy to confirm the diagnosis. An entry in a VA consultation report dated later the same month indicates a plan to take X-rays of the neck's soft tissue. A December 23, 1981, VA progress note states that the X-rays "show mild compression of tracheal airway." It also lists a plan, including, "[Return to clinic] 2 [weeks with] thyroid scan and X-rays." The claims file does not contain the thyroid scan, the radiological report, or the needle biopsy report. The Board is of the opinion that these records would be of use in rendering a decision in this case. The VA has a duty to assist a veteran in the development of facts pertinent to a well-grounded claim. 38 U.S.C.A. § 5107(a). The duty to assist a veteran in obtaining and developing available facts and evidence to support a claim includes obtaining adequate VA examinations. Littke v. Derwinski, 1 Vet.App. 90 (1990). In light of the above, there appear to be additional and potentially relevant medical records available, as well as a medical question regarding the etiology of the veteran's disorder, that would benefit from additional development. Accordingly, the VA's duty under 38 U.S.C.A. § 5107(a) to assist the veteran in the development of facts pertinent to his claim mandates that this case must be REMANDED to the RO for the following actions: 1. The RO should directly contact the VA Medical Center in New York, New York, to determine the existence or location of soft-tissue radiological reports of the veteran's neck, and a report of a needle biopsy, performed at that facility during December 1981 and January 1982. If they exist, the RO should acquire copies of these records and incorporate them into the claims file. 2. The RO should advise the veteran to supply the necessary signed authorizations for the release of his medical information from all private physicians (specifically to include endocrinologists and rheumatologists) from whom he has received treatment since service discharge. After the veteran has submitted written authorizations for the release of any information, the RO should take appropriate action to secure copies of these records. 3. Following the above, the RO should schedule the veteran for examination by a VA endocrinologist in order to determine the nature and severity of any thyroid disorder. All testing deemed necessary should be performed. The claims folder must be made available to the examiner for review in conjunction with his or her examination, along with a copy of this remand. The examiner should also review the January 1992 letter from S. B. Novak, M.D. After reviewing the claims file and conducting the examination, the examiner should state whether it is at least as likely as not that the veteran's current thyroid disorder had its onset during his active military service or was manifested within one year following his separation from active military service. The examiner's report should include a complete rationale for the opinion, with attention to Dr. Novak's letter. The examiner is further requested to comment specifically as to whether an examination by the Armed Forces Institute of Pathology of the pathologic material from 1981, or any later or current pathologic material, would be fruitful in ascertaining the date of onset of the thyroid disorder. 4. The RO should review the above opinion. If the examiner indicates that an evaluation of pathologic material might reasonably be probative of the date of onset of the disorder, the RO should take appropriate action to procure such material and to associate it with the claims folder. 5. Thereafter, in light of any additional evidence obtained, the RO should readjudicate the issue listed on the title page, adjudicate the issue of entitlement to service connection for rheumatoid arthritis, and issue a supplemental statement of the case if the benefits sought on appeal are not granted to the veteran's satisfaction. The supplemental statement of the case is to include the law and regulations regarding the manifestation of chronic diseases, e.g. endocrinopathies, within one year of service discharge. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994). The veteran and his representative should be provided an opportunity to respond. Thereafter, the case should be returned to the Board for further consideration, if otherwise warranted. By this REMAND, the Board intimates no opinion regarding any final outcome. The veteran is not required to perform any action until he is notified by the RO. RICHARD B. FRANK 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).