BVA9507343 DOCKET NO. 92-54 532 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUES Entitlement to service connection for bilateral defective hearing. Entitlement to service connection for essential (chronic) hypertension. Entitlement to service connection for residuals of an injury to the nose, claimed as a deviated nasal septum. Entitlement to an increased rating for post-operative residuals of brachial plexopathy of the left upper extremity with traumatic arthritis of the left shoulder, currently rated as 60 percent disabling. Entitlement to an increased rating for acne of the face and neck, currently rated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD R. K. ErkenBrack, Counsel INTRODUCTION The veteran served on active duty from October 1974 to September 1989. This appeal arises from a rating decision in April 1990 of the Department of Veterans Affairs (VA) Regional Office (RO) at Huntington, West Virginia. The veteran's files were transferred to the Winston-Salem, North Carolina, RO shortly thereafter. The Board REMANDED the case in May 1992 for a dermatology examination in order to ascertain the severity of acne. Service connection is in effect for additional disability of postoperative scars of the left shoulder and left upper back, rated as 10 percent disabling. A total compensation rating based on individual unemployability and special monthly compensation on account of loss of use of the left hand have been in effect since March 1992. The veteran also has received a certificate of eligibility for financial assistance in the purchase of an automobile or van with special adaptive equipment. REMAND The available service medical records show blood pressure readings in the same range as those on which a diagnosis of mild hypertension was based on a VA examination in March 1990, but the veteran apparently was not on antihypertensive medication at that time. A more recent clinical evaluation of hypertension is indicated in order to assist the veteran in the preparation of his claim. The current criteria, in effect since April 1990, for service connection for bilateral hearing loss have not been applied in this case. While the VA examination in March 1990 found no hearing loss in the conversational ranges, some sensorineural high frequency hearing loss was indicated. This could have worsened, but there is no clinical evidence whether such has occurred. A current examination and then adjudicative consideration with application of 38 C.F.R. § 3.385 (1994) is in order. It is not clear from the available clinical evidence what linkage exists between a deviated nasal septum and epistaxis (nose bleeding), the latter symptom apparently having arisen in service. The veteran has associated the two conditions together in his claim for service connection. Additional clinical development of these conditions and competent evidence or medical comment on the relationship, if any, between the two conditions is needed. In addition to left brachial plexopathy, traumatic arthritis has been service-connected as a postoperative residual of inservice left shoulder dislocation. The available clinical evidence indicates that the left shoulder is fused, that no glenohumeral motion is present, that pain is constant and severe, and that there is a frozen, fixed, ankylosed condition of the left shoulder. Remaining functional motion is at the left elbow. This is the minor extremity, of record. It has been rated as for severe, incomplete paralysis of the left upper extremity radicular groups of nerves, but apparently separate and distinct left shoulder joint dysfunction has not been rated, by application of Codes 5200-5203. Another examination to determine the current level of such dysfunction and to measure whether the nerve dysfunction has advanced since the last examination appear to be in order. To ensure that VA has met its duty to assist the veteran in developing the facts pertinent to the claim and to ensure full compliance with due process requirements, the case is REMANDED to the RO for the following development: 1. The RO should obtain copies of the complete VA hospital and outpatient treatment records since October 1993 from the Winston-Salem VA satellite outpatient clinic and the VA Medical Center, Salisbury, North Carolina. 2. The veteran should be afforded VA vascular, audiometric (to show the values mandated by 38 C.F.R. § 3.385), nose, orthopedic, neurologic and surgical examinations to ascertain the current severity and treatment of essential hypertension, bilateral hearing loss, epistaxis, a deviated nasal septum, and left upper extremity dysfunction for rating purposes. All indicated tests should be accomplished and detailed findings should be reported. The claims folder must be made available to the examiners for review before the examinations, respectively. It is requested that the appropriate examiner render an opinion as to the etiology, onset and initial manifestations of essential hypertension; the etiology of a deviated nasal septum and any epistaxis and any relationship between them; and the current extent of nerve dysfunction of the left upper extremity and left shoulder ankylosis. 3. After the development requested above has been completed to the extent possible, the RO should again review the record. If any benefit sought on appeal, for which a notice of disagreement has been filed, remains denied, the veteran and his representative should be furnished a supplemental statement of the case, to include the criteria of 38 C.F.R. § 3.385, and given the opportunity to respond thereto. 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 veteran need take no action unless otherwise notified. SAMUEL W. WARNER 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) (1993).