BVA9506226 DOCKET NO. 93-12 578 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for a stomach disorder. 2. Entitlement to service connection for a back disorder. 3. Entitlement to service connection for a neck disorder. 4. Entitlement to service connection for a psychiatric disorder. 5. Entitlement to service connection for a heart disorder. 6. Entitlement to service connection for fibrocystic disease of the breasts. 7. Entitlement to an increased rating for vaginitis, currently assigned a 10 percent evaluation. 8. Entitlement to an increased rating for chondromalacia of both knees, currently assigned a 10 percent evaluation. 9. Entitlement to an increased (compensable) rating for right Achilles tendinitis. 10. Entitlement to an increased (compensable) rating for allergic rhinitis. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Stephen F. Sylvester, Counsel INTRODUCTION The veteran had active service from October 1987 to January 1990, with additional service in the United States Army Reserve. This appeal to the Board of Veterans' Appeals (Board) arises from a September 1991 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. REMAND A review of the record in this case raises some question as to the exact nature and etiology of the disabilities for which service connection is presently sought, and the current severity of the veteran's service-connected vaginitis, chondromalacia, Achilles tendinitis, and allergic rhinitis. In that regard, we note that there is no service separation examination report of record. This is particularly puzzling in view of service clinical entries dated January 23 and 25, 1990, a mere matter of days prior to the veteran's discharge. On those occasions, an attempt was made by the family practice clinic to contact the veteran, with no success. There is no additional information as to whether the veteran did, in fact, undergo a separation examination, and, if so, whether the results of that examination are available. The Board further observes that, during service, the veteran received treatment for what was at that time described as a "nervous stomach", noted in conjunction with a complaint of harassment by her superiors and a death in the veteran's family. On VA medical examination in July 1991, the veteran, once again, received a diagnosis of a "nervous stomach", described as "helped" by nerve medication, and stabilized at present. Such findings raise some question as to whether the veteran does, in fact, suffer from a chronic disorder of the stomach or whether the disorder currently diagnosed represents an acute and transitory condition. Turning to the issue of service connection for a back disorder, the Board notes that, during service, the veteran received treatment for various back-related complaints, culminating in a diagnosis of low back pain. While on VA medical examination in July 1991 the veteran voiced continued complaints of back pain, she was not examined for this. An orthopedic examination is needed for proper development of this claim. Regarding the issue of service connection for a psychiatric disorder, we observe that, in July 1989, while in service, the veteran received a diagnosis of uncomplicated bereavement with associated psychological factors affecting physical condition, reported in conjunction with the aforementioned incidents of harassment and a death in her family. On VA psychiatric examination in July 1991, adjustment disorder with anxious mood was diagnosed. It was not indicated whether or not this represented a chronic acquired psychiatric disorder. In October 1991, the veteran was seen in an outpatient psychiatry clinic. She described harassment by her superiors in service and the denial of leave to attend the funeral of a family member. The diagnosis was dyssomnia. Consequently, there is some question as to whether the veteran has a chronic acquired psychiatric disorder for which service connection might potentially be granted. The RO denied service connection for fibrocystic disease of the breasts on the basis that such disease preexisted entry upon active service, and was not aggravated thereby. In a statement of October 1976, the veteran's private physician wrote that, in November 1970 (well in advance of the veteran's entry upon active duty), she underwent a bilateral breast biopsy, resulting in a pathological diagnosis of benign fibroadenoma of both breasts. Clearly, then, the veteran's fibrocystic breast disease predated her entry upon active service. However, a review of the record discloses that, on a number of occasions during service, the veteran received treatment for problems associated with fibrocystic breast disease. At the present time, no medical opinion has been rendered as to whether the veteran's preexisting breast disease increased in severity during her period of active service. Such an opinion is vital to a proper adjudication of the veteran's claim. Concerning the issue of service connection for a heart disorder, we note that service medical records are negative for evidence of any such disability. However, on VA examination in July 1991, there was noted the presence of mitral valve prolapse. The RO based its denial of this benefit on a judgment that the mitral valve prolapse noted on VA examination is congenital or developmental in nature, and, as such, an inappropriate subject for a grant of service connection. However, there is no medical opinion of record to whether that is, in fact, the case. Finally, turning to the issues of increased ratings for service- connected vaginitis, chondromalacia patellae, right Achilles tendinitis, and allergic rhinitis, the Board notes that, during the period from January 1991 to October 1992, the veteran voiced continued complaints of knee pain, and of vaginitis and "nose problems". A review of the record discloses that the most recent VA medical examination for compensation purposes was conducted in July 1991, almost four years ago. VA outpatient treatment records currently on file do not present findings in sufficient detail to enable us to thoroughly evaluate the current extent of the disorders at issue. Accordingly, additional development is needed. We note that the VA has a duty to assist the veteran in the development of all facts pertinent to her claims. 38 C.F.R. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1994). The United States Court of Veterans Appeals (Court) has held that this duty to assist the veteran in obtaining and developing available facts and evidence to support her claim includes obtaining adequate VA examinations, including examination by a specialist, when necessary. Littke v. Derwinski, 1 Vet.App. 90 (1990); See also Hyder v. Derwinski, 1 Vet.App. 221 (1991). Accordingly, the case is REMANDED to the RO for the following actions: 1. The RO should arrange for an exhaustive search for the veteran's separation examination report. They should contact the National Personnel Records Center and the appropriate service department as well as the veteran, herself, in this regard. The search for the separation examination report should also specifically encompass contacts with all Reserve records depositories and a review of the veteran's service personnel file. If the separation examinaton report is unavailable because it is lost, it should be so certified. 2. Any pertinent VA or other inpatient or outpatient treatment records, subsequent to October 1992, should be obtained and incorporated in the veteran's claims folder. The veteran should be requested to identify all sources of treatment and to sign the necessary forms for release of any private medical records to the VA. 3. The veteran should then be afforded additional VA examinations, by appropriate specialists if necessary, to determine the presence, nature, and etiology of her claimed stomach, back, psychiatric, and heart disorders, and fibrocystic disease of the breasts. All pertinent symptomatology and findings should be reported in detail. The examiner or examiners should specifically comment as to whether the veteran currently exhibits chronic stomach, back, acquired psychiatric, or heart disorders. As to the veteran's claimed heart disease, a cardiologist should provide an opinion whether the mitral valve prolapse identified on VA examination in July 1991 is a congenital and/or developmental disability. As to fibrocystic disease of the breasts, an appropriate specialist should review the veteran's service medical records and provide an opinion whether fibrocystic disease present at the time of the veteran's service entrance underwent a clinically significant increase in severity during the veteran's period of active service. Finally, it is requested that appropriate examinations be undertaken to determine the current severity of the veteran's service-connected vaginitis, chondromalacia patellae, right Achilles tendinitis, and allergic rhinitis. All pertinent symptomatology and findings should be reported in detail. The veteran's claims folder must be furnished to the examining physicians prior to their evaluations in order to facilitate the study of the case. Following completion of the above actions, the RO should review the evidence and determine whether the veteran's claims may be granted. If not, the veteran and her representative should be provided with an appropriate supplemental statement of the case and given an ample opportunity to respond. The case should then be returned to the Board for further appellate consideration. In this REMAND of the claim for further development, the Board does not intimate any opinion as to the ultimate determination warranted. No action is required of the appellant until she receives further notice. GEORGE R. SENYK 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).