BVA9507143 DOCKET NO. 93-13 926 ) 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 hip disabilities. 2. Entitlement to service connection for bilateral feet and great toe disabilities. 3. Entitlement to service connection for left ankle disability. 4. Entitlement to service connection for right wrist disability. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Daniel J. McTavish, Associate Counsel INTRODUCTION The veteran served on active duty from April 1970 to August 1990. This matter came before the Board of Veterans' Appeals (Board) on appeal from rating decisions by the Lincoln, Nebraska Regional Office (RO) of the Department of Veterans Affairs (VA) which denied, in pertinent part, service connection for bilateral hip, left ankle, bilateral feet and great toe, and right wrist disabilities. The Board finds that the current record supports favorable consideration with respect to the issue of entitlement to service connection for a bilateral hip disability. As this will be a full grant of benefits for this disorder, we will proceed with a decision on this issue. As to the remaining issues, the Board finds that further development is necessary. These issues will be addressed in the remand section of this decision. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in substance, that service connection is warranted for bilateral hip disability. He asserts that he fell from a ladder while in service and injured his hips. He maintains that following physical activity, he experiences severe throbbing, aches and pain at night which result in loss of sleep. DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), following review and consideration of all of the evidence and material of record in the veteran's claims file, and for the following reasons and bases, it is the decision of the Board that the evidence supports the veteran's claim of service connection for bilateral hip disability, namely trochanteric bursitis of the hips. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal for service connection for bilateral hip disability has been obtained by the RO. 2. Trochanteric bursitis of the hips was objectively demonstrated as being present in active military service. 3. The veteran has trochanteric bursitis, bilaterally, as a consequence of his active military service. CONCLUSION OF LAW Bilateral trochanteric bursitis was incurred during the veteran's active military service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION We note that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, we find that he has presented a claim which is plausible. We are also satisfied that all relevant facts have been properly developed and no further assistance to the veteran is required to assist him mandated by 38 U.S.C.A. § 5107(a). The veteran has appealed the denial of service connection for bilateral hip disability. Service connection may be established for disability resulting from injury suffered or disease contracted in line of duty. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Service medical records indicate that the veteran reported on his enlistment examination in April 1969 that he had chipped his pelvis prior to entering service, in March 1968. X-ray showed complete healing, and it was described as asymptomatic. On subsequent periodic examination, the history of this injury was described as a fracture of the left hip in 1968 with no complications and no sequelae. On examination in April 1980, it was noted that the veteran had left hip pain for approximately six months. He had no prior treatment for his left hip while in service. In April 1981, he was seen for complaints of low back pain and right hip pain. He reported that his hip felt like it had been dislocated. In February 1990, he underwent a retirement medical examination. It was noted that he had pain with range of motion of the hips, bilaterally, left greater than the right. Diagnosis was left trochanteric bursitis. Rheumatology evaluation in March 1990 noted left trochanteric pain but with full range of motion and no swelling. The impression was left trochanteric bursitis. Trochanteric bursitis was again diagnosed in June 1990. In August 1990, physical examination revealed tender trochanteric bursa, greater on the right side than the left side. The assessment was trochanteric bursae. The veteran was afforded a VA general medical examination in January 1991. He reported that he had fallen during service injuring his hips. Physical examination showed full range of motion in all joints, except for the left shoulder. Diagnosis showed arthralgia of the hips by history. In April 1992, he underwent a VA orthopedic examination as well as a neurologic examination by a private physician. The veteran reported that his bilateral hip pain kept him awake at night despite the fact that he slept in a water bed. In December 1992, the veteran was afforded a VA rheumatology examination . The examiner noted, in pertinent part, bilateral trochanteric pain. The diagnosis was trochanteric bursitis, bilateral. The Board acknowledges that service medical records, together with the report of the most recent VA examination in December 1992, show that bilateral trochanteric bursitis is currently shown and was first objectively demonstrated during service. Accordingly, we find that service connection for bilateral trochanteric bursitis is warranted. ORDER Service connection for bilateral trochanteric bursitis is granted. REMAND Service medical records show that the veteran sustained injuries to his right great toe in September 1974 and again in January 1980. Diagnosis on each occasion was subungual hematoma. In February 1990, the veteran was seen with bilateral arch pain. In June 1990, he complained of pain in the left great toe. It was noted that there was some spurring felt on the first metatarsophalangeal joint of his left foot. There was also some tenderness in the third interspace of his left foot similar to neuroma pain. Service medical records also show that the veteran sustained a sprain of the left ankle in 1987. The diagnoses on VA examination in January 1991 included arthralgia of both feet and left ankle, by history, and arthralgia of the right great toe. Some tenderness involving the left great toe was noted on VA examination in April 1992. The VA rheumatology examination of December 1992 diagnosed bilateral pes anserinus bursitis. The Board finds that additional VA examination should be undertaken, in keeping with VA's duty to assist the veteran in the development of facts pertinent to his claim. Accordingly, this case is REMANDED to the RO for the following: 1. The RO should contact the veteran, through his representative, and ask him to identify any sources of treatment, private or VA, received for the claimed disorders subsequent to his discharge from service. Attempts should then be made to obtain records of any treatment reported by the veteran. 2. The RO should then schedule the veteran for VA orthopedic and podiatry evaluations in order to ascertain the nature and severity of any current foot disorder, and any disorders of the great toes, as well as any current disability of the left ankle. Any current disorder of the right wrist should also be identified. All indicated tests, including X-rays, should be performed and all clinical findings should be set forth in detail. The examiner(s) should be asked to review the veteran's service medical records in conjunction with the current findings and offer an opinion, if possible, as to whether the symptoms of any current disability of the feet or great toes is related to the findings noted in service. Opinions should also be expressed as to whether there is any current left ankle disability which may be attributed to the left ankle injury noted in service, and whether there is any identifiable disorder of the right wrist other than the scar of the dorsum of the right hand which is already service-connected. In accordance with recent Court of Veterans Appeals decisions, the claims folder should be made available to the examining physician for review prior to the examination. 3. After further consideration of the claims, if the decision on any issue remains adverse to the veteran, the RO should issue a supplemental statement of the case summarizing the evidence, and laws and regulations, and explaining the application of the laws and regulations to the evidence. The RO should afford the veteran 60 days to respond to the supplemental statement of the case before the matter is returned to the Board for final adjudication, if otherwise in order. 38 C.F.R. § 20.302(c) (1994). The purpose of this REMAND is to further develop the record and afford the veteran due process of law. D. C. SPICKLER 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).