BVA9500115 DOCKET NO. 93-08 926 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUES 1. Entitlement to service connection for bilateral hearing loss. 2. Entitlement to service connection for diabetes mellitus. 3. Whether new and material evidence has been received to reopen a claim for service connection for pilonidal cyst. 4. Whether new and material evidence has been received to reopen a claim for service connection for hypertension. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD M. G. Mazzucchelli, Associate Counsel INTRODUCTION The veteran served on active duty from January 1952 to December 1953. This appeal arises from a December 1991 rating decision of the Lincoln, Nebraska, regional office (RO). That rating decision denied the veteran's claims for service connection for bilateral hearing loss and diabetes mellitus, and held that new and material evidence had not been submitted to reopen the claims for service connection for pilonidal cyst and hypertension. REMAND The veteran contends in part that he has submitted new and material evidence to reopen a claim for service connection for pilonidal cyst. The RO denied service connection for pilonidal cyst in November 1955 in part because the veteran's pilonidal cyst was a constitutional or developmental abnormality and not otherwise a disability under the law. The basis for the RO's denial of service connection for a pilonidal cyst in November 1955 was consistent with prevailing medical opinion in effect then and for some years later. S. O. Moschella, D. M. Pillsbury, H. J. Hurley, Dermatology, 522 (1975). A pilonidal cyst is a congenital lesion in the midline of the sacral region overlying the junction of the coccyx with the sacrum and it either remains undetected or produces no symptoms until later in life, usually between the ages of 17 and 35, when secondary infection occurs. Id. at 522. More recent medical opinion is split on the issue of the nature of pilonidal cyst, and the Board has granted service connection for that disability under certain circumstances. The Board also notes the opinion of the General Counsel (OGC) Precedent No. 67-90 which holds that service connection may be granted for a hereditary disease which either first was manifested during service or which pre-existed service and progressed at an abnormally high rate during service. The service medical records show that the veteran was treated for pilonidal cyst in 1953. It does not appear that surgery was performed, and no residuals were noted on the separation examination. However, since one of the bases upon which the RO's 1955 decision was made has changed, it is necessary to further develop the evidentiary record. An examination by a VA physician should be conducted to determine whether the veteran currently has any pilonidal cyst pathology or residuals, including any scarring. Additionally, the veteran's complete VA outpatient records should be obtained. The veteran also contends that he has submitted new and material evidence to reopen a claim for service connection for hypertension. The RO denied service connection for hypertension in November 1955. The veteran's service separation examination showed a diagnosis of benign labile hypertension. His blood pressure has appeared elevated throughout the medical record. It is necessary to obtain the complete records of all the veteran's VA hospitalizations in order to determine whether the blood pressure readings have been consistently elevated since service. Additionally, a VA cardiovascular examination should be conducted to determine if the veteran currently has hypertension and if so, its relationship to the labile hypertension in service. VA has a duty to assist the veteran in the development of his claim. 38 U.S.C.A. § 5107(a) (West 1991). This remand does not constitute a decision on the question of whether the veteran's claims have been effectively reopened. In view of the foregoing, the case is REMANDED to the RO for the following: 1. The veteran should be requested to provide a list of all treatment received after service for his pilonidal cyst and hypertension, whether private or VA. The RO should make arrangements to obtain any and all records of any private treatment reported by the veteran. 2. The RO should obtain copies of the complete VA folders for all the veteran's VA hospitalizations since service, and the complete outpatient records of the veteran since service. The records should be associated with the claims folder. 3. Following the above, the veteran should be examined by a VA physician to determine the nature and extent of any current pilonidal cyst, as well as to determine the nature of any residuals of the pilonidal cyst noted in service. The report of examination should include a detailed account of all manifestations of pathology found to be present, including any scarring. The examiner must be requested to review all the entries in the service medical records referring to pilonidal cyst, and express an opinion as to whether any current pathology is related to the inservice pilonidal cyst. The examiner must provide complete rationale for all opinions expressed. The claims folder and a copy of this remand must be made available to and reviewed by the examiner prior to the examination. The examiner's report should be comprehensive. 4. The RO should schedule the veteran for an examination by a VA cardiovascular specialist to determine the nature and extent of any current hypertension. The entire claims folder, including all the veteran's VA and service medical records, must be made available to and reviewed by the examiner prior to the examination. All indicated tests and studies should be accomplished. The report of examination should contain a detailed account of all manifestations of hypertension found to be present. The examiner should specifically note the veteran's blood pressure readings. The examiner should also express an opinion as to the relationship, if any, between any current hypertension and the labile hypertension noted at the veteran's separation from service. The specialist should comment on the blood pressure reading of 150/90 reported at the time of induction and discuss, if hypertension was present in service, whether it began prior to service, increased in severity beyond its normal course during service, or began in service. The report of examination should include a complete rationale for all conclusions reached. 5. The RO should review the examination reports to determine if they are adequate for rating purposes and in full compliance with this Remand. If not, the report(s) should be returned to the examiner(s) for corrective action. Following completion of these actions, the RO should review the evidence and determine whether the veteran's claims may now be granted. If not, the veteran and his representative should be provided with an appropriate supplemental statement of the case. Thereafter, the case should be returned to the Board for further appellate consideration. No action is required by the veteran until he receives further notice. Adjudication of the issues of service connection for hearing loss and diabetes mellitus is hereby deferred. JAN DONSBACH 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).