BVA9504801 DOCKET NO. 93-12 144 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Buffalo, New York THE ISSUES 1. Entitlement to an increased rating for traumatic arthritis of the left wrist, currently rated as 20 percent disabling. 2. Entitlement to special monthly compensation for loss of use of the left hand. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD Richard E. Coppola, Associate Counsel REMAND The veteran served on active duty from February 1941 to September 1945. This matter came before the Board of Veterans' Appeals (Board) on appeal from a rating decision of February 1992 from the Buffalo, New York, Department of Veterans Affairs (VA) Regional Office (RO), which increased the disability rating for traumatic arthritis of the left wrist from 10 percent to 20 percent. The case was received at the Board in June 1993. Subsequently, additional records were added to the records assembled for appellate review. This additional evidence includes VA outpatient examination and treatment records which are dated from January 1992 to December 1993. Several of these records show examination and treatment of the left wrist and hand. These records are new and have not previously been considered by the RO. The veteran has not waived his right to have this new evidence initially considered by the RO. See 38 C.F.R. § 20.1304(c) (1994). At the personal hearing, the veteran testified that the VA compensation examination was inadequate because the physician did not fully address all his complaints and did not provide an X-ray examination of the left wrist. Tr., pp. 1-3. The February 1992 report of VA examination discloses that the examiner ordered X- rays of the left wrist for enclosure with the examination report; however, it does not appear that this was accomplished. A VA hospitalization report, dated from July 1991 to September 1991, shows that the veteran has a history of treatment for insulin-dependent diabetes mellitus and peripheral neuropathy. In fact, the report indicates that he underwent a right great toe amputation due to diabetic ulceration. The recent medical evidence indicates that the veteran has bilateral carpal tunnel syndrome, severe ulnar motor/sensory neuropathy and peripheral polyneuropathy in both lower extremities. The evidence includes a diagnosis of ulnar claw hand and an assessment that the neurologic deficit appears to be permanent and his symptoms could be due to diabetic polyneuropathy or cervical spinal stenosis. It appears that the recent medical evidence has raised questions regarding the symptoms that are attributable to the veteran service-connected arthritis of the left wrist. Under the circumstances, the Board finds that additional development of the evidence is necessary. Accordingly, the claim is REMANDED for the following action: 1. The veteran should identify the names and addresses of any medical care providers, VA or otherwise, who have treated him for symptoms of the left upper extremity since December 1993. After obtaining any needed authorization from the veteran, the RO should obtain copies of all these records. 2. The veteran should then be afforded special VA orthopedic and neurologic examinations to determine the nature and extent of all residuals of the service- connected traumatic arthritis of the left wrist, and its debilitating effects, if any, on the left hand. The scope of the examinations should be broad enough to cover all residual conditions which are suggested by the veteran's complaints, symptoms or findings. The examiners must be provided the claims folder prior to the examinations so that they may review historical data contained therein to obtain a true picture of the progress of any disorders. The examinations should be conducted in accordance with the Physician's Guide for Disability Evaluation Examinations. All necessary tests should be performed. Each physician should identify all diseases, injuries, and residuals conditions which affect the functioning of the left wrist and hand. Motion of the wrist joint should be recorded in degrees of motion remaining. Any portion of the arcs of motion which are painful should be so designated. Each physician should specify the nature and severity of all impairment which is attributable to the service-connected arthritis of the left wrist, versus the impairment that is attributable to other conditions. The remaining functional ability of the left wrist and hand should be described. 3. When the above development has been completed, the case should be readjudicated by the RO. The rating decision should reflect consideration of all potentially applicable criteria, to include consideration of the applicability of 38 C.F.R. § 3.321(b)(1). If the decision remains adverse to the veteran in any way, he and his representative should be furnished with a supplemental statement of the case. They should then be afforded the applicable time period to respond. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration, if appropriate. The veteran need take no action until he is further informed. The purpose of this REMAND is to obtain additional information and to ensure due process of law. No inference should be drawn regarding the final disposition of the claim as a result of this action. GARY L. GICK 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 deter- mination. 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 action has been taken in accordance with the Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 303, 108 Stat. 4645, ___ (1994), and 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).