BVA9503041 DOCKET NO. 93- 08 187 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim for entitlement to service connection for rheumatoid arthritis. 2. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for degenerative arthritis of the cervical spine. 3. Entitlement to a compensable evaluation for gouty arthritis. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD L. M. Barnard, Counsel INTRODUCTION The veteran has active duty from September 1955 to March 1976. This appeal arises from a February 1990 rating decision of the Montgomery, Alabama, Department of Veterans Affairs (VA), Regional Office (RO), which denied entitlement to a compensable evaluation for gouty arthritis. This was confirmed and continued by rating actions issued in November 1990 and June 1991. A separate rating action issued in June 1991 found that no new and material evidence had been submitted to reopen a claim for entitlement to service connection for rheumatoid arthritis. An August 1991 rating action continued the denial of a compensable evaluation for gout. A December 1991 rating decision referred to all issues currently on appeal. These denials were confirmed and continued by rating decisions issued in March, April and September 1992. The veteran has requested that his claims for service connection for rheumatoid arthritis and degenerative arthritis be reopened based on the submission of new and material evidence. However, a final determination as to these issues will be deferred pending the outcome of this remand. REMAND The veteran contends, in essence, that his gouty arthritis is more disabling than the current disability evaluation would suggest. He asserts that he has experienced an increase in the occurrence and significance of his attacks. He states that this disease has resulted in excruciating pain and discomfort. The pain manifests primarily in the toes and ankles. He commented that during these attacks it is difficult for him drive a car, walk or stand normally. He also reported losing a great deal of time from work because of these attacks. He notes that medication has helped but has not cured the problem. Therefore, he believes that an increased disability evaluation is warranted. VA has a duty to assist the veteran in the development of all facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1993). This includes the duty to obtain all relevant treatment records, as well as VA examinations which provide an adequate basis upon which to determine entitlement to the benefits sought. Littke v. Derwinski, 1 Vet.App. 90 (1991). Examinations by specialists are recommended in those cases which present a complicated disability picture. Hyder v. Derwinski, 1 Vet.App. 221 (1991). VA has a duty to acknowledge and consider all regulations which are potentially applicable based upon the assertions and issues raised in the record and to explain the reasons used to support the conclusion. Schafrath v. Derwinski, 1 Vet.App. 589 (1991). These regulations include, but are not limited to, 38 C.F.R. § 4.1, that requires that each disability be viewed in relation to its history and that there be an emphasis placed upon the limitation of activity imposed by the disabling condition, and 38 C.F.R. § 4.2 which requires that medical reports be interpreted in light of the whole recorded history, and that each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.10 states that, in cases of functional impairment, evaluations are to be based upon lack of usefulness, and medical examiners must furnish, in addition to etiological, anatomical, pathological, laboratory and prognostic data required for ordinary medical classification, full description of the effects of the disability upon a person's ordinary activity. This evaluation includes functional disability due to pain under the provisions of 38 C.F.R. § 4.40. These requirements for the evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decision based upon a single, incomplete or inaccurate report and to enable VA to make a more precise evaluation of the disability level and any changes in the condition. In the instant case, the veteran has apparently been treated for a long period of time by a private physician for attacks of gout. While there are several letters from the physician in the record, the RO has never made any attempt to obtain copies of the veteran's treatment records. These records would be extremely helpful in evaluating the frequency and severity of his attacks of gout. Moreover, a review of the evidence of record reveals that the veteran's disability has not been evaluated by VA for several years. In fact, the last VA examination of record dates from May 1982. Clearly, this is an insufficient basis upon which to evaluate the current degree of severity of his gouty arthritis. Under the circumstances of this case, it is the finding of the undersigned that additional assistance is necessary, and this case is REMANDED to the RO for the following: 1. The RO should contact the veteran and request that he sign and return a consent form authorizing the release to VA of Dr. Piersma's treatment records. Once this consent has been provided, the RO should contact John D. Piersma, M. D., 111 Rand Avenue, Huntsville, Alabama 35801, and request that he provide copies of the veteran's treatment records developed between January 1990 and the present. 2. Once the above-requested treatment records have been obtained and associated with the claims folder, the RO should afford the veteran examinations by a rheumatologist and an orthopedist in order to ascertain the current nature and degree of severity of his service-connected gouty arthritis. In particular, the examiners should elicit information from the veteran concerning the frequency of his attacks. The effects that this disability has had upon his ability to engage in ordinary activities should be described, as well as the effect of pain. All indicated special studies, to include, but not limited to, range of motion studies and x-rays, should be accomplished. The claims folder must be made available to the examiners prior to the examinations so that the veteran's entire medical history can be taken into consideration. In the event that the veteran's claim remains denied, in whole or in part, he and his representative should be provided with an appropriate supplemental statement of the case, and an opportunity to respond, and the case should be returned to the Board for further appellate consideration if otherwise in order. C. P. RUSSELL 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).