BVA9504757 DOCKET NO. 93-10 847 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to service connection for a stomach disorder. 2. Entitlement to an increased disability evaluation for traumatic arthritis of the lumbar spine currently evaluated as 20 percent disabling. 3. Entitlement to an increased disability evaluation for residuals of a fracture of the right ankle with osteochondritis dissecans, currently evaluated as 20 percent disabling. 4. Entitlement to an increased disability evaluation for post operative sebaceous cysts of the neck, face, ears and right leg, currently evaluated as 10 percent disabling. 5. Entitlement to an increased combined disability evaluation pursuant to 38 C.F.R. 4.25 (1994). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J.W. Engle, Counsel INTRODUCTION The appellant served on active duty from February 1982 to February 1988. This matter came before the Board of Veterans Appeals (the Board) on appeal from a decision dated in August 1992 by the Cleveland, Ohio, Department of Veterans Affairs Regional Office (VARO). REMAND The appellant has contended that additional medical development is necessary in this case. In the Informal Presentation dated in September 1993, it was argued that the most recent VA examination conducted in May 1992 was inadequate for rating purposes since the orthopedic examination did not identify the appellant's range of motion in degrees. The appellant further indicated in the Substantive Appeal received at VARO in December 1992, that at the time of the May 1992 VA examination, the examining physician did not have access to the appellant's claims folder. Furthermore, in his Substantive Appeal as well as correspondence received by VARO in March 1993, the appellant raised additional issues including service connection for a right hand disorder, a deviated nasal septum and a testicle tumor. Review of the record reveals that the range of motion studies conducted during VA examination in May 1992 did not identify the appellant's range of motion in degrees as required by the VA Physician's Guide for Disability Evaluation Examinations, Section 2.13, which provides that in order to give uniformity in describing limitation of motion or ankylosis of a joint, the use of a goniometer is required. The Board further notes that the VA examiner indicated in May 1992 that there was no medical chart available at the time of the examination. The United States Court of Veterans Appeals (Court) has held that an adequate examination, in most cases, requires that a disability be viewed in relation to its whole history. See 38 C.F.R.§ 4.1 (1994); Schafrath v. Derwinski, 1 Vet.App. 589 (1991); Tucker v. Derwinski, 2 Vet.App. 201 (1992). Furthermore, where the medical evidence on file is not adequate a remand for further studies is mandatory, not permissive. Littke v. Derwinski, 1 Vet.App. 90, 93 (1990). In addition, the Board notes that the appellant indicated in correspondence received by VARO in May 1992 that he has a stomach disorder due to the multiple medications he takes for his service-connected disabilities. However, there is no medical evidence of record which comments on the presence of a stomach disorder and its relationship, if any, to the medications taken for the service-connected disabilities. In view of the need for additional medical development as indicated above, the Board believes that a gastrointestinal examination would be helpful with respect to this claim. In view of the above, the undersigned concludes that additional development is necessary in this case. Accordingly, this case is REMANDED for the following action: 1. VARO should request that the appellant verify all issues he desires to pursue. All issues identified should be developed and adjudicated. 2. The appellant should be scheduled for VA orthopedic and gastrointestinal examinations in an effort to accurately determine the current nature and extent of his service-connected orthopedic disabilities and to determine whether or not the appellant has a stomach disorder as a result of medication taken for his service-connected disabilities. With respect to the service-connected traumatic arthritis of the lumbar spine, cervical spine and right shoulder as well as residuals of a fracture of the right ankle with osteochondritis dissecans, the appellant should be examined by a specialist in orthopedic medicine. The examination should be conducted in accordance with the VA Physician's Guide for Disability Evaluation Examinations, and all ranges of motion must be identified in degrees as found by use of a goniometer. The examiner should further identify the limitation of activity imposed by the disabling conditions, viewed in relation to the medical history, considered from the point of view of the appellant working or seeking work, with a full description of the effects of disabilities upon the appellant's ordinary activity. 38 C.F.R. §§ 4.1, 4.2, 4.10 (1994). 3. With respect to the gastrointestinal examination, after review of the appellant's claims folder and examination of the appellant, the examiner is requested to comment on the presence of a chronic gastrointestinal disability, if any, and the relationship of any existing chronic gastrointestinal disorder to the medications prescribed for the appellant's service-connected disabilities. 4. The claims folder must be provided to the examiners prior to the examinations for development of the clinical history of the appellant's disabilities. All appropriate tests and/or studies should be conducted. 5. Following completion of the foregoing, VARO must review the claims folder and ensure that all of the foregoing development actions have been conducted and completed in full. If any development is incomplete, including if the requested examination does not include all test reports, special studies or opinions requested, appropriate corrective action is to be implemented. Thereafter, the case should be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The appellant need take no action unless otherwise notified. 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).