BVA9505494 DOCKET NO. 93-09 938 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in San Juan, Puerto Rico THE ISSUES 1. Entitlement to an increased evaluation for arthritis of the lumbar spine with strain, myositis of the lumbar paravertebral muscles and chronic disc disease with radiculopathy at L5-S1, currently rated as 40 percent disabling. 2. Entitlement to an increased evaluation for residuals of bilateral varicose veins of the great saphenous system, with postoperative residuals, currently rated as 30 percent disabling. 3. Entitlement to an increased evaluation for chronic prepyloric ulcer and antritis, status post subtotal gastrectomy and gastrojejunostomy with hiatal hernia, currently rated as 20 percent disabling. 4. Entitlement to an increased evaluation for bilateral impaired hearing, currently rated as 20 percent disabling. 5. Entitlement to an increased evaluation for chronic purulent pansinusitis, currently rated as 10 percent disabling. 6. Entitlement to an increased (compensable) evaluation for arthritis of the cervical spine. 7. Entitlement to an increased (compensable) evaluation for an appendectomy scar. 8. Entitlement to an increased (compensable) evaluation for chronic tonsillitis. 9. Entitlement to an increased (compensable) evaluation for nephrolithiasis and pyelitis. 10. Entitlement to an increased (compensable) evaluation for pterygium. 11. Entitlement to an increased (compensable) evaluation for hemorrhoids. 12. Entitlement to a total rating based on individual unemployability due to service-connected disabilities. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD M. Auer, Counsel REMAND The veteran served on active duty from November 1940 to June 1963. This appeal arises from an October 1991 rating decision of the Department of Veterans Affairs (VA), San Juan, Puerto Rico, Regional Office (RO). In that decision, an increased rating for the disabilities listed on the title page of this decision was denied. Additionally, the RO denied a total rating based on individual unemployability due to service-connected disabilities. A preliminary review of the record discloses that the veteran was afforded a VA examination in October 1990. This examination was limited to examination of the veteran's service-connected varicose veins. Additionally, the veteran was given a VA audiometric examination in July 1991. It was noted that language difficulties made the use of both pure tone average and speech discrimination inappropriate. The claims folder also contains copies of VA outpatient treatment notes, dated from March 1989 to September 1991. A review of this evidence shows that the reported findings are not of sufficient detail and do not clearly identify the degree of functional impairment caused by the veteran's service-connected disabilities or offer an opinion as to the degree of impairment those disabilities cause in the veteran's ability to perform substantially gainful employment. As such, further examination of those disabilities would be beneficial. Lastly, it is apparent from the record that the veteran receives ongoing treatment from the VA so there are undoubtedly more recent VA medical records that should be obtained. Therefore, in order to give the veteran every consideration with respect to the present appeal, it is the Board's opinion that further development of the case is desirable. Accordingly, this case is REMANDED for the following actions: 1. The RO should contact the veteran and ask him to furnish the names and addresses of all medical personnel and facilities from whom he has received treatment since January 1991. After obtaining the necessary authorization from the veteran, the RO should obtain available records from the named sources, to include any available treatment records from the VA hospitals or medical centers where the veteran has received treatment. Care should be taken by the RO so that duplicate records are not placed in the claims folder. 2. The veteran should be afforded an orthopedic examination to ascertain the manifestations and severity of the service- connected disabilities of his cervical and lumbar spine. Any and all indicated evaluations and tests deemed necessary by the examiner should be accomplished, but should include comprehensive range of motion studies. The examiner is specifically requested to offer comments on the degree of functional impairment each disability causes and the degree of functional impairment each disability would cause in the veteran's capacity for performing substantially gainful employment. The claims folder, or copies of all pertinent records, should be made available to the examiner for a review. 3. The RO should schedule the veteran for a special vascular examination. The vascular examiner should describe the veteran's varicose veins completely, noting the location, the veins involved and the diameter of the varicosities. The vascular examiner should also list all symptoms of the varicosities and indicate whether there are any symptoms of pain or cramping on exertion, marked distortion or sacculation with edema, episodes of ulceration, or secondary involvement of the deep circulation as demonstrated by Trendelenburg's and Perthe's tests. The examiner should also indicate whether there is swelling of the legs or thighs and if so, note under what circumstances the swelling is increased and under what circumstances it is relieved (is the swelling increased with standing or walking and is it readily relieved by recumbency with elevation). The examiner should also note whether there is discoloration, pigmentation, cyanosis, eczema or ulceration of the legs. The examiner is specifically requested to offer comments on the degree of functional impairment this disability causes and the degree of functional impairment this disability would cause in the veteran's capacity for performing substantially gainful employment. The claims folder, or copies of all pertinent records, should be made available to the examiner for a review. 4. After obtaining the records referred to in paragraph 1, the veteran should be afforded a special VA gastrointestinal examination for the purpose of determining the nature, severity, and etiology of his service connected gastrointestinal disorders. Any and all tests and evaluations deemed necessary by the examiner should be completed, and the examination must be conducted in accordance with the provisions of the VA Physician's Guide for Disability Evaluation Examinations (1985). The examiner is specifically requested to offer comments on the degree of functional impairment each disability causes and the degree of functional impairment each disability would cause in the veteran's capacity for performing substantially gainful employment. Prior to the examination, the RO must provide the examiner with copies of all relevant records contained in the veteran's claims folder or the claims folder itself, as well as a copy of this remand. 5. The veteran should be scheduled for a complete audiometric evaluation to determine the current severity of his hearing loss. The evaluation should be in accordance with the criteria delineated in 38 C.F.R. § 3.385 (1994) and should include testing of pure tone criteria at 500, 1,000, 2,000, 3,000 and 4,000 Hertz and speech recognition scores using the Maryland CNC Test. The veteran's service audiometric record, as well as his post-service private and VA audiometric record, should be reviewed by the VA audiologist. The examiner is specifically requested to offer comments on the degree of functional impairment this disability causes and the degree of functional impairment this disability would cause in the veteran's capacity for performing substantially gainful employment. The claims folder, or copies of all pertinent records, should be made available to the examiner for a review. 6. The veteran should be afforded an examination, or special examinations, if considered indicated, of his service- connected chronic purulent pansinusitis, appendectomy scar, chronic tonsillitis, nephrolithiasis and pyelitis and pterygium to ascertain the severity and manifestations of those disabilities. The examiner is specifically requested to offer comments on the degree of functional impairment each disability causes and the degree of functional impairment each disability would cause in the veteran's capacity for performing substantially gainful employment. Since it is important "that each disability be viewed in relation to its history[,]" 38 C.F.R. § 4.1 (1994), all pertinent medical records in the veteran's claims file or, in the alternative, the claims file, must be made available to the examiner for review prior to, and during, the examination. 7. A special examination of the rectum and anus should be arranged. The medical history should include a description of any interference with activities due to hemorrhoids and the frequency of any recurrences. The examination should be conducted in accordance with Chapter 7, Section IV, paragraph 7.31 of the VA Physician's Guide for Disability Evaluation Examinations (1985). The examiner should differentiate between internal, external, interno-external, prolapsing, ulcerated, or thrombotic hemorrhoids. The description should include the location of the hemorrhoids and any complications experienced such as pain, bleeding, or tenesmus. The examiner is specifically requested to offer comments on the degree of functional impairment this disability causes and the degree of functional impairment this disability would cause in the veteran's capacity for performing substantially gainful employment. It is essential that the claims folder be provided to the examiner for review in connection with the examination. The RO should then review the veteran's claims in light of all the evidence and applicable legal criteria. If his claim remains denied, the veteran and his representative should be provided with a supplemental statement of the case that includes any additional pertinent law and regulations and a full discussion of the evidence in his case. The appropriate response time should be allowed. The case should be returned to the Board, if in order, after compliance with all regulatory appellate procedures. No action is required of the veteran until he is so informed. The Board intimates no opinion as to the ultimate decision warranted in this case, pending completion of the requested development. WARREN W. RICE, JR. 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).