BVA9500129 DOCKET NO. 93-08 270 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Wichita, Kansas THE ISSUE Entitlement to service connection for sickle cell anemia disease. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Charles G. Sener, Associate Counsel INTRODUCTION The appellant had active service from July 1960 to January 1963. In a September 1974 rating decision, the Department of Veterans Affairs (VA) Wichita, Kansas, Regional Office (RO) denied entitlement to service connection for sickle cell anemia disease, and that rating decision became final when the appellant failed to file an appeal of the decision within one year following notification of the decision. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 1992 rating decision by the RO, which determined that new and material evidence had been submitted sufficient to reopen a claim of entitlement to service connection for sickle cell anemia disease but denied service connection for the disease. REMAND The appellant asserts that he received treatment for sickle cell anemia disease while in service and that it was caused by the stress of military duty. He argues in the alternative that if his sickle cell anemia disorder preexisted service, then it was aggravated by service. A review of the service medical records reveals that the appellant was examined on numerous occasions for complaints of dyspnea on exertion that dated from boot camp. He reported a history of arthritis, with joint swelling, since childhood. A provisional diagnosis in March 1961 indicated "possible heart disease," and an electrocardiogram was recommended, which was subsequently found to be within normal limits. His symptoms, which occurred during long hikes, included dizziness, followed by cramping in the abdomen, and diarrhea. The physician opined that the appellant had a hyperventilatory component, with several sources of anxiety. A June 1961 service medical record showed that the appellant complained of "painful arms" in both biceps humeri muscle groups and that he reported a history of intermittent pains in those regions since the age of five. X-rays and laboratory studies at that time revealed no abnormalities. A treatment record, dated in November 1961, revealed that the appellant was relieved from a field exercise due to complaints of violent abdominal pains, and the impression was gastroenteritis. The appellant was referred to sick call in May 1962 with complaints of dizziness during running. Concomitant symptoms included abdominal cramps, diarrhea, and vomiting. He stated that since childhood he had experienced a migrating type arthralgia upon exertion, with some reddening of the joint areas. He denied any history of rheumatic fever. In June 1962, a sickle cell work-up was done, and it indicated an impression of a "sickle cell trait." Based on the appellant's description of his symptoms, the physician opined that the appellant's blood "sickles" upon exertion due to decreased oxygen. A separation examination performed in January 1963 showed no defect or diagnosis of sickle cell anemia disease. A January 1981 medical record from E. O. Abanishe, D.O, showed that everyone in the appellant's family, except one relative, had sickle cell anemia. E. O. Abanishe, D.O, indicated in a December 1982 medical statement that he had been treating the appellant for severe sickle cell anemia for the last three years. A statement from M. Kimura, M.D., and B. Skikne, M.D., dated in April 1992, indicated that the appellant was first diagnosed with sickle cell disease in 1979, at the age of 32, when he was a having a "painful crisis." In a July 1992 medical statement, D. J. Stechschulte, M.D., stated that the appellant had bilateral hip pain, that he was status post bilateral hip replacements, and that he was a known sickle cell disease patient who had osteonecrosis of the joints without evidence of inflammatory arthritis. In a September 1992 medical statement, E. O. Abanishe, D.O, reported that the appellant had been born with sickle cell anemia that had worsened during service as a result of his having to perform strenuous exercise, and that it had caused joint discomfort and bilateral degenerative arthritis in the hips. VA has a duty to assist the appellant in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1994). The United States Court of Veterans Appeals (Court) has held that the VA's duty to assist the appellant in obtaining and developing available facts and evidence to support his claim includes obtaining adequate VA medical examinations. Littke v. Derwinski, 1 Vet.App. 90 (1990). The appellant has not been evaluated by the VA for sickle cell anemia disease, and a private physician has opined in a September 1992 medical statement that the disease was aggravated by military service. Therefore, this case is remanded to the RO for the following actions: 1. The appellant should be afforded an examination by a specialist in hemoglobinopathy's in order to allow the RO to ascertain the nature and severity of the appellant's sickle cell anemia disease. All indicated special studies should be conducted, if not medically contraindicated. The examiner should be requested to express an opinion as to the date of onset of the appellant's sickle cell disease, as distinguished from the date of onset of the sickle cell trait, particularly as to whether sickle cell disease was initially manifested before, during, or after the appellant's military service, and as to whether, if present in service, it was aggravated by that service. The examiner should explain the difference between a "sickle cell trait" and "sickle cell anemia disease." The claims folder and a copy of the REMAND should be made available to the examiner for review prior to the examination. 2. The RO should review the examination report to determine if it is adequate for rating purposes and in compliance with this remand. If it is not, it should be returned to the examiner for supplemental action. After the above requested actions have been completed, the RO should review the appellant's claim with regard to the additional evidence obtained. If the benefit sought on appeal remains denied, a supplemental statement of the case should be furnished to the appellant and his representative. They should be afforded a reasonable period of time to respond. Thereafter, the case should be returned to the Board for further appellate consideration. The purpose of this REMAND is to obtain additional medical evidence. No opinion, either legal or factual, is intimated as to the merits of the appellant's claim by this REMAND. He is not required to undertake any additional action until he receives further notification from the VA. JACK W. BLASINGAME 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 so assigned. 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).