BVA9503810 DOCKET NO. 93-08 099 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to service connection for a heart disorder with peripheral vascular disease and hypertension. 2. Entitlement to service connection for arthritis of the knees. 3. Entitlement to service connection for arthritis of the legs. 4. Entitlement to service connection for arthritis of the feet. 5. Entitlement to an increased evaluation for degenerative joint disease of the thoracic spine at T7, T8, and T9, currently rated 10 percent disabling. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD M. Auer, Counsel REMAND The veteran served on active duty from April 1943 to October 1964. This appeal arises from an August 1992 rating decision of the Department of Veterans Affairs (VA) Los Angeles, California, Regional Office (RO). In that decision, service connection for degenerative joint disease of the thoracic spine at T7, T8, and T9 was granted and a 10 percent rating was assigned; service connection for arthritis of the knees, legs, and feet, and for a heart disorder with peripheral vascular disease and hypertension was denied. In the veteran's original claim for VA compensation, received by the RO in October 1991, his complaints included arthritis of the back. A review of the service medical records shows that cervical osteoarthritis was diagnosed in service. An X-ray examination of the lumbar spine showed mild osteoarthritic changes. Additional development regarding this evidence and the veteran's claim regarding service connection for a back disorder should be accomplished by the RO. Service medical records dated in April l964 also showed a 50-degree anterior wedging of the vertebral bodies of T7 and T8 and a 30-degree anterior wedging of T9 on X-ray examination of the thoracic spine. The Board of Veterans' Appeals (Board) has reviewed the report of the VA examination provided to the veteran in April 1992, and finds that it is deficient in that it contains limited clinical findings and is less than comprehensive and complete. For example, an X-ray examination of the veteran's spine was not accomplished and range of motion studies were not performed or at least not reported. On VA examination in April 1992, it was reported that the veteran had known hypertension since 1964. Additionally, the Board has reviewed the veteran's service medical records and it appears that they may not be complete. Additional evidence may be available in association with the veteran's claim regarding hypertension. The United States Court of Veterans Appeals has held that, when an examination report is inadequate, it is part of the VA's duty to assist the veteran to order another examination. See Perez v. Derwinski, 2 Vet.App. 562, 564 (1992). The Board finds that the actions ordered below are warranted. Accordingly, the claim is REMANDED for the following actions: 1. The RO should attempt to obtain any additional original or copies of the veteran's service medical records not already in the claims file and attach them. 2. The RO should request, from the veteran, a comprehensive statement containing as much detail as possible regarding all of the disabilities at issue. The veteran should identify all sources of medical treatment received for the disabilities at issue, from October 1964 forward, and should furnish signed authorizations for release to the VA of private medical records in connection with each non-VA medical source he identifies. Copies of the medical records from all sources he identifies (not already in the claims folder) should then be requested. All records obtained should be added to the claims folder. This request should also include copies of VA treatment notes from April 1992 forward. 3. A VA orthopedic examination should be arranged to determine the extent and severity of all orthopedic disorders. The examination should be conducted in accordance with the VA Physician's Guide for Disability Evaluation Examinations (1985). Based upon complaints, symptoms and findings, the orthopedist should determine whether referral for neurologic examination is warranted and the need for nerve conduction studies, etc. X-rays of the entire spine, knees, and feet should be made. The examiner should set forth detailed findings regarding limitation of motion and any other functional loss caused by the identified disorders. Range of motion, in terms of degrees, with a comparison of the opposite side should also be reported. The presence or absence of painful motion must be reported. The examiner should also describe any functional loss the veteran may experience as a result of pain, weakness, or fatigability. The claims folder, or copies of all pertinent records, should be made available to the examiner for a review. 4. The veteran should be afforded a cardiac examination. The examination should be conducted in accordance with Chapter 6 of the VA Physician's Guide for Disability Evaluation Examinations (1985). A comprehensive examination, including all necessary studies, should be performed and all findings should be reported in detail, with attention given to the veteran's history. In this connection, the examiner is specifically requested to undertake an in-depth review of the veteran's service and post-service medical records and give an opinion as to the probable time of onset of the veteran's current diagnosis(es), if any. The claims file must be made available to the examiner for review prior to, during, and after the examination in order to accomplish all requested development. 5. When the development requested above has been completed, the case should again be reviewed by the RO. The issue of entitlement to service connection for osteoarthritis of the cervical spine and osteoarthritis of the lumbar spine should be adjudicated separately. Consideration should also be given to entitlement to an additional l0 percent rating for demonstrable deformity, i.e., wedging of a vertebral body under applicable schedular criteria. The RO should then review the veteran's claims in light of all the evidence and applicable criteria. If his claims remain 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).