BVA9502112 DOCKET NO. 93-04 198 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE 1. Entitlement to service connection for a gastrointestinal disability. 2. Entitlement to an increased evaluation for psychophysiological musculoskeletal reaction, currently evaluated 30 percent disabling. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Mark J. Swiatek, Counsel REMAND The veteran had active service from December 1940 to December 1965. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 1992 decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, which denied service connection for gastrointestinal disability and continued the veteran's 30 percent rating for psychophysiological musculoskeletal reaction. The RO determined that the headaches observed were post-traumatic occipital headaches unrelated to the psychogenic migraine. It is asserted, in essence, that the current manifestations of the veteran's psychophysiological disability clearly meet the criteria for a higher schedular evaluation. The representative has requested that the case be returned to the RO to allow for examination of the veteran since it has been several years since the last evaluation of his service-connected disability. The record confirms that the veteran has not had a comprehensive evaluation of the orthopedic, neurologic and psychiatric components of the psychophysiological disability for rating purposes in several years. The private medical treatment records submitted by Kamel Elzawahry, M.D., and Sylvia M. Thomas, D.C., in connection with the current claim relate principally to the evaluation through 1992 of the veteran's musculoskeletal and neurologic complaints following a motor vehicle accident in 1990. Regarding a gastrointestinal disability, the Board observes that in October 1992, the RO denied service connection for ulcer disease on a direct and/or presumptive basis. However, in communications to the RO in May 1992 and January 1993, the veteran has quite clearly claimed service connection as a result of medication prescribed by the VA for his disabilities. In the latter communication he referred to a hospital evaluation during service for gastrointestinal complaints, which is not shown in the service medical records now on file. The Board observes that the recently received records include a November 1991 hospitalization report showing final impressions of antral ulcer with antral gastritis, small tiny pyloric ulcers and hiatal hernia with esophagitis. These records and those received from Dr. William Chandler do not identifying a definite etiology of the disorders. The Board observes that the RO's de novo review of the record in 1992 in effect reopens a claim of service connection for a gastrointestinal disability that was denied by the RO in March 1966 and not appealed by the veteran after he received timely notice of the determination. The Board is of the opinion that the veteran's statement in a January 1993 communication that he is unable to work on account of his disabilities reasonably raises the issue of entitlement to a total compensation rating based on unemployability, to which the RO has not, as yet, responded. The issues of entitlement to individual unemployability benefits and secondary service connection for gastrointestinal disability require development and adjudication by the RO at this time. EF v. Derwinski, 1 Vet.App. 324 (1991); Harris v. Derwinski, 1 Vet.App. 180 (1991). Where the record before the Board is inadequate to render a fully informed decision on an issue, a remand to the RO is required in order to fulfill the statutory duty to assist. See Ascherl v. Brown, 4 Vet.App. 371, 377 (1993). In light of the foregoing, the Board concludes that further development, as specified below, is required. Accordingly, this appeal is REMANDED to the RO for the following actions: 1. The RO should attempt to obtain complete service medical records for the veteran, to include records for a hospital evaluation reported to have occurred during 1956 at the U.S. Army Hospital, Orleans, France. All efforts to obtain those records should be documented in the claims file. 2. The RO should request that the veteran provide the names, addresses and approximate dates of treatment for all VA and non-VA health care providers who have treated him since his discharge from service for any gastrointestinal disability and recently for headaches, psychiatric symptoms or any cervical spine disability. With any necessary authorization, the RO should attempt to obtain copies of those treatment records identified by the appellant which have not been previously secured. 3. The veteran should then be scheduled for a special gastrointestinal examination by a board certified gastroenterologist, if available, to determine the nature and extent of his gastrointestinal disability. All indicated studies should be performed. The examiner should also be requested to review the claims folder and provide an opinion, with complete rationale, as to the etiology of any gastrointestinal disorder found to be present to include whether it is at least as likely as not that it is etiologically related to the gastrointestinal complaints noted in service and/or the medication the veteran has received for treatment of service- connected disability. 4. The veteran should then be scheduled for VA orthopedic, neurologic and psychiatric examinations by board certified specialists, if available, to determine the current severity of the organic and psychological or psychiatric aspects, respectively, of his psycho- physiological disability entity. All indicated studies should be performed. The orthopedic and neurologic examiners should identify, if possible, the manifestations observed that are attributable to the service-connected disability entity and those attributable to traumatic head and neck injuries sustained by he veteran in 1990 to facilitate the application of the rating provisions under Diagnostic Code 9505 of 38 C.F.R. Part 4 (1993). They should also have the claims folder for their use. 5. The RO should then undertake any other indicated development, adjudicate the issues of entitlement to secondary service connection for gastrointestinal disability and entitlement to a total compensation rating based on unemployability, and readjudicate the issues on appeal. 6. If any benefit sought on appeal is not granted to the appellant's satisfaction, or if a timely Notice of Disagreement is received with respect to denial of either of the other two issues, a Supplemental Statement of the Case addressing all issues in appellate status should be prepared and furnished to the appellant and his representative. They should be provided an opportunity to respond or perfect an appeal, as appropriate. Thereafter, in accordance with the proper appellate procedures, the case should be returned to the Board for further appellate review, if otherwise in order. All issues properly in appellate status should be returned to the Board at the same time. In taking this action, the Board implies no conclusion, either legal or factual, as to any final outcome warranted. No action is required of the appellant until he is notified by the RO. ROBERT E. SULLIVAN Member, Board of Veterans' Appeals (CONTINUED ON NEXT PAGE) 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) (1993).