BVA9505229 DOCKET NO. 93-06 469 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for a back disorder as secondary to service-connected pes planus. 2. Entitlement to an increased evaluation for bilateral pes planus, currently rated as 30 percent disabling. 3. Entitlement to an increased evaluation for bilateral varicose veins, currently rated as 10 percent disabling. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD T. Hal Smith, Counsel INTRODUCTION The veteran served on active duty from April 1942 to June 1945. This appeal arises from rating decisions of the Department of Veterans Affairs (VA) Regional Office in St. Petersburg, Florida. REMAND In addition to the appellant's service medical records, there are post service VA and private records available for review. The service records show that upon discharge examination from service, symptomatic pes planus and bilateral varicose veins were noted. Service connection for these disabilities was established upon rating decision in October 1945 shortly after service separation. The veteran contends that these service-connected disorders have increased in severity and that increased ratings are warranted. Additionally, he argues that post service back problems are secondary to his flat feet. Post service records show that the veteran underwent back surgery in February 1956 for herniated nucleus pulposus at L5, S1. Service connection for a back disorder was denied on a direct incurrence basis by the Board of Veterans' Appeals (Board) in May 1957. Medical records in 1979 show that back diagnoses included rotoscoliosis with straightening of the normal lordotic curve, evidence of moderate osteophyte changes with narrowing of the intervertebral spaces and chronic disc disease between the 4th and 5th lumbar vertebrae and the 5th lumbar vertebra and the 1st sacral segment. Service connection for a back disorder on a direct incurrence basis (failure to submit new and material evidence to reopen the claim) was denied again by the Board in August 1981. Records dated subsequent to 1981 and up to 1990 show treatment for multiple joint complaints, to include the legs, feet and back. As indicated above, it is now asserted that current back problems are secondary to service-connected flat feet. In support of this contention is a February 1990 statement by a private chiropractor, N. Ringel, who reported at that time that he had treated the veteran since January 1989. He stated that the veteran had been diagnosed with a subluxation complex of the cervical and lumbar spine complicated by severe osteoarthritis. He opined that this disorder was a secondary result of the veteran's service-related foot injury. Medical evidence from December 1991 indicates that the veteran was to be fitted for custom molded shoes with tarsal accommodation and scaphoid pads due to foot complaints. Bilateral varicosities were also noted. At a VA personal hearing in March 1992, the veteran testified as to the severity of his service-connected flat feet and varicose veins. He reported foot cramping, and said that he wore special shoes and took medication to relieve his symptoms. As a result of his varicose veins, he experienced swelling and numbness in the legs and wore elastic stockings. He experienced pain in his back and used a cane for ambulation. Upon VA examination in April 1992, the veteran ambulated with somewhat of a "splayed foot" attitude but without any apparent difficulty. In the standing position, he had definite pes planus, grade three plus. He had a valgus position of his longitudinal arches. In the sitting position, with the legs dependent, the veteran had grade 1 or 2 superficial varicosities, mainly in the lateral aspect of the right leg but with some in the left leg. There were none on the calf, and none extending above the knees. On tourniquet test in the sitting position, there was some minimal to moderate reappearance of the superficial vein on the right side. On the left side, the veins disappeared completely. There was no cyanosis in the feet in the dependent position and it was the examiner's opinion that none of these situations were "really marked." Moderate varicose veins of the lower extremities were noted. The examiner's impressions also included status post surgical procedure for removal of herniated disc at L4-5, with X-ray evidence of progressive degenerative joint disease in those areas. In October 1992, a private podiatrist found that there was peripheral vascular insufficiency with claudication and diminished to absent pedal pulses. There was some peripheral diabetic neuropathy possibly related to previous back problems. Additionally, there was hyperkeratosis related to poor foot structure and digital contracture. The veteran was to return for follow up in one month. It is the Board's determination that additional development of the medical record is necessary prior to further appellate consideration of the appealed issues. Some medical records pertinent to the veteran's claims are not of record, and the question of whether the veteran's post service back problems are related to his service-connected pes planus has not been specifically addressed by a VA examiner. The United States Court of Veterans Appeals (Court) has held that the duty to assist extends to obtaining adequate VA examinations, including an opinion from the examining physician as to a possible relationship between a current disability and a disability experienced in service. Wilson v. Derwinski, 2 Vet.App. 16 (1991), Moore v. Derwinski, 1 Vet.App. 401, 405 (1991). Additionally, we note that the veteran's representative has requested that current examinations be conducted to properly evaluate the veteran's service-connected pes planus and varicose veins as they have not been examined by VA for several years. We agree that more current examinations are required. Caffery v. Brown 6 Vet.App. 377 (1994). Accordingly, this case is REMANDED for the following: 1. Any available medical records since May 1992 showing treatment of the veteran, not already of record, from the VA Ambulatory Clinic at 301 Broadway in Riviera Beach, Florida, should be associated with the record. 2. Treatment records dated subsequent to October 7, 1992, should be obtained from Joseph N. Uricchie, D.P.M., at PGA Podiatry at 5602 PGA Boulevard, Suite 101 in Palm Beach Gardens, Florida 33418, or at 3472 Forest Hill Blvd., Suite 2-A in West Palm Beach, Florida 33406. 3. The veteran should be afforded special VA peripheral vascular and orthopedic examinations to ascertain (1) the severity of his flat feet and varicose veins, and (2) whether the veteran has any back disorder which is etiologically related to the service-connected foot disability. On the examination reports, the examiners should provide his or her findings, and the rationale therefor. All indicated studies and tests should be performed. The claims folder and a copy of this remand are to be made available to the examiners prior to these examinations. After completion of the requested development, the case should be reviewed by the RO. If any one of the decisions to be reached remains adverse to the veteran, he and his representative should be furnished a supplemental statement of the case and afforded an opportunity to respond. Thereafter, the case should be returned to the Board for appellate consideration, if otherwise in order. (CONTINUED ON NEXT PAGE) The appellant need take no action until he is informed. The purposes of this REMAND are to obtain additional medical evidence. BRUCE E. HYMAN 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).