BVA9508460 DOCKET NO. 93-09 332 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Baltimore, Maryland THE ISSUE Entitlement to service connection for a low back disorder. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD R. E. Smith, Counsel INTRODUCTION The veteran had active military service from June 1969 to April 1973. This matter came before the Board of Veterans' Appeals (Board) on appeal from rating decision of the Baltimore, Maryland, Regional Office (RO) of the Department of Veterans Affairs (VA). By a rating action of August 1992, the RO denied the veteran's claim, in pertinent part, seeking entitlement to service connection for a back condition. Service connection for PTSD was denied by the RO in a rating action dated in December 1992. With respect to the issue of service connection for PTSD, the veteran's representative in her informal hearing presentation dated in September 1993 correctly observed that this issue was not developed or certified for appeal by the RO although disagreement with the December 1992 determination by the RO had been expressed by the veteran. While not currently in appellate status, it is clear that appellate consideration of this issue is desired. The Board directs the attention of the RO to this matter. In a statement received in December 1992, the veteran reported that he was exposed to chemicals as a research volunteer in service. The RO's attention is directed to this statement for any developmental action deemed appropriate as well as to a May 1985 letter signed by a private attorney which suggests that the veteran may desire to assert a claim for residuals of Agent Orange exposure. REMAND It is contended, by and on behalf of the veteran, that his current back disorder is directly related to a back injury sustained from a fall during basic training. Review of the record reflects that the veteran presented to a service department medical facility with complaints of chronic low back pain with onset in basic training on two occasions in October 1969 and, thereafter, in April 1970. Clinical evaluations on all occasions, as well as, an X-ray of the lumbar spine in April 1970 were essentially unremarkable. On examination in September 1972, the veteran specifically denied recurrent back pain. Clinical examination was negative. The veteran, thereafter, reported a clinical history of recurrent back pain in connection with his medical examination for separation from service in April 1973; however examination was again negative. The post service clinical data reveals that the veteran had documented complaints of recurrent low back pain following an automobile accident in September 1988. A VA X-ray of the veteran's lumbosacral spine in January 1991 was interpreted to reveal minor degenerative hypertrophic changes in the body of L4 - L5 and suspicious disc space narrowing of L5 - S1. A private magnetic resonance imaging of the lumbar spine in March 1992 was interpreted to reveal disc degeneration at L4 - L5 and L3 - L4 disc levels. Chronic low back pain with degenerative disc disease most likely was diagnosed on a VA examination provided to the veteran in July 1992. The current record before the Board, in sum, reveals that the veteran had recurring complaints of low back pain in service and, after a 15-year gap, had further recurrent complaints of low back pain following a motor vehicle accident in September 1988 with clinical indications, thereafter, of underlying disc pathology. We also note that the private clinical data reveals the veteran was also involved in a head-on motor vehicle accident in January 1984. The Board observes that additional clinical data may be available which could be helpful to the veteran's claim that his current back disorder stems from service. The veteran indicated on his VA Form 21-526, Application for Compensation or Pension, that he received treatment for recurrent low back pain from a Dr. Doukus at the Dairyland Medical Center in Red Lion, Pennsylvania, between the years 1973 and 1990. It does not appear that any of these records, which are potentially highly probative of the issue currently on appeal, are on file or that any attempt to obtain them by the RO has been undertaken. The medical evidence is unclear as to the relationship, if any, between the back complaints noted in service and the veteran's current back disorder. Consequently, the Board finds that additional development is warranted. Accordingly, this case is REMANDED for the following actions: 1. The RO should request that the veteran provide the names, addresses and appropriate dates of treatment for all VA and non-VA health care providers who have treated him since his discharge from service for a low back disorder. In addition, the veteran should be asked to provide information about the motor vehicle accidents he has been involved in subsequent to service including the details of any relevant treatment for low back injuries related thereto and any settlement reached. He should furnish information regarding any back injuries for which he filed a claim for workers' compensation benefits. With any necessary authorization, the RO should attempt to obtain copies of these treatment and other relevant records identified by the appellant which have not previously been secured. Special attention should be directed to obtaining the reports of treatment provided to the veteran by Dr. Doukus at the Dairyland Medical Center prior to 1988. 2. After such development has been undertaken and only if deemed appropriate by the RO in light of the new evidence received establishing chronicity, the veteran should then be afforded a VA orthopedic examination by an orthopedist who has not previously examined or treated him, to determine the nature, status and etiology of all low back pathology. Prior to the examination, the examiner must be provided the claims folder and a separate copy of this REMAND. After review of the evidence in the claims folder, including the evidence developed in connection with this REMAND action, the physician should express an opinion in response to the following question: What is the medical relationship, if any, between the back complaints noted in service and the veteran's current back disorder. The physician should provide full rationale for such opinion. 3. Thereafter, the case should again be reviewed by the RO and appropriate action taken. If the decision remains adverse to the veteran, both he and his representative should be furnished a supplemental statement of the case, reflecting consideration of any new evidence and be given the opportunity to respond thereto. After the above actions have been accomplished, the case should be returned to the Board for further appellate consideration, if otherwise in order. By this REMAND, the Board intimates no opinion, either legal or factual, as to the ultimate determination warranted in this case. The purpose of this REMAND is to further develop the record. N. R. ROBIN 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).