BVA9507714 DOCKET NO. 93-13 148 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE Entitlement to special monthly pension based on the need for the regular aid and attendance of another person or based on housebound status. REPRESENTATION Appellant represented by: Alabama Department of Veterans Affairs ATTORNEY FOR THE BOARD Theresa M. Catino, Associate Counsel INTRODUCTION The veteran served on active military duty from September 1965 to September 1967. REMAND A review of the claims file indicates that, when adjudicating the claim of entitlement to special monthly pension based on the need for the regular aid and attendance of another person or based on housebound status, the regional office (RO) considered three disabilities. These disorders include systemic lupus erythematosus, avascular necrosis of the hip, and residuals of hemorrhoid surgery, for which the veteran was evaluated as 60 percent, 30 percent, and 0 percent disabled, respectively. However, in the substantive appeal, which was received at the RO in November 1992, the veteran asserted that he currently experiences severe headaches, loss of memory, numbness in the face (left side of the head and neck), nervousness, "failing" eyesight, cramps and pain in the fingers, and problems with his right elbow and right leg below the knee down to the toes. The VA outpatient treatment records which were received in December 1992 reflect treatment for most of these complaints. Moreover, in the December 1992 rating decision which confirmed the prior denial of the claim of entitlement to special monthly pension based on the need for the regular aid and attendance of another person or based on housebound status, the RO considered the outpatient treatment records received that month and appeared to conclude that the additional symptoms noted on these medical records were attributable to the veteran's lupus. According to an August 1992 medical record, the examining physician noted that lupus cerebritis may be possible. Significantly, however, this conclusion does not appear to have been confirmed. Furthermore, a review of these outpatient treatment records indicates that lupus nephritis, of which the veteran had a history, was also considered to be a possible diagnosis. Consequently, it is unclear whether the additional symptomatology noted by the veteran in the substantive appeal are attributable to the veteran's lupus or are separate disabilities. Moreover, in the substantive appeal, the veteran maintained that he was scheduled soon for a total hip joint replacement of his left hip and that on November 30, 1992 he was scheduled for an appointment at the orthopedic clinic at the Birmingham VA Medical Center. However, the outpatient treatment records subsequently received at the RO only reflect treatment that the veteran received from July to August 1992. The Board concludes that further assistance to the veteran is required. Accordingly, the case is REMANDED to the RO for the following: 1. The RO should consider the additional symptomatology explained by the veteran in the substantive appeal and should determine whether these symptoms reflect disabilities which are separate from his systemic lupus erythematosus. In developing this issue, the RO should obtain and associate with the claims file any records of treatment that the veteran has received for all of his disabilities since August 1992 (and particularly those treatment sessions at the Birmingham VA Medical Center). In addition, the RO should accord the veteran a VA general medical examination (and any specialized VA examinations deemed necessary) to determine the nature and extent of all of his disabilities. The examination(s) should be conducted in accordance with the diagnostic procedures outlined in the VA Physician's Guide for Disability Evaluation Examinations. 2. If the RO concludes that the veteran has additional disabilities which are separate from his lupus, then the RO should rate such disorder(s) separately and include the disability(ies) on the rating decision. In any event, the RO should re-evaluate the ratings for the systemic lupus erythematosus, the avascular necrosis of the hip, and the residuals of hemorrhoid surgery. 3. Thereafter, the veteran should be accorded an examination to determine housebound status or the need for regular aid and attendance. This examination should be conducted in accordance with the diagnostic procedures outlined in the VA Physician's Guide for Disability Evaluation Examinations (Physician's Guide). In particular, reference is made to §§ 1.2(e) and (f) of the Physician's Guide. All functional impairment should be reported in detail. 4. Following the above, the RO should formally adjudicate the issue of entitlement to special monthly pension based on the need for regular aid and attendance or on being housebound. In adjudicating this claim, the RO should consider all the evidence received since the veteran submitted his claim for this benefit. Following completion of these actions, and, if the decision remains unfavorable, the veteran and his representative should be provided with a supplemental statement of the case and afforded a reasonable period of time in which to respond. Thereafter, the case, in accordance with the current appellate procedures, should be returned to the Board for completion of appellate review. The purpose of this REMAND is to obtain clarifying evidence. No action is required of the veteran until further notice is issued. JOHN E. ORMOND, 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).