BVA9506214 DOCKET NO. 93-13 024 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to a compensable rating for hemorrhoids. 2. Entitlement to service connection for a gastrointestinal disorder, to include Crohn's disease. 3. Entitlement to service connection for bilateral hearing loss. 4. Entitlement to service connection for tinnitus. 5. Entitlement to service connection for sinusitis. 6. Entitlement to service connection for bilateral ingrown toenails. 7. Entitlement to service connection for bilateral shin splints. 8. Entitlement to service connection for a right ankle disability. 9. Entitlement to service connection for a psychiatric disorder, to include stress. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Deborah W. Singleton, Counsel INTRODUCTION The veteran served on active duty from October 1986 to May 1992. This appeal arises from a rating decision dated in November 1992 by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. REMAND The veteran in his substantive appeal reports that upon examination for separation he reported a history of problems regarding various aliments for which he received treatment during his period of military service. Specifically, the veteran maintains that he has suffered from recurrent rectal bleeding due to hemorrhoids; that his ingrown toenails continue to become infected; and that his shin splints still give him problems. He has reported that shortly before service discharge he was in physical therapy for his right ankle, that he continues to suffer from this problem, and that a physician has told him that he might have "a cyst or a growth of some sort." The fact the veteran has been treated with physical therapy is corroborated by a report of medical history dated in March 1992. The relevant physical therapy reports, however, are not of record. The record further shows that between May 1987 and December 1988, the veteran related complaints which included diarrhea, rectal bleeding, stomach discomfort, weakness, tenderness, watery stools, and a fever. The veteran was subsequently diagnosed as having thrombosed external hemorrhoids and acute gastroenteritis; there was also some indication of an inflammatory bowel disease noted in January 1988. An air contrast barium enema dated in January 1989 was suggestive of showing early signs of Crohn's disease or early ulcerative colitis, and an impression of pancolonic mucosal abnormality was recorded. Later that month the veteran was seen for follow-up with colonoscopy, the results of which were normal. The assessments were reported as no evidence of significant mucosa abnormality and "suspect prior infectious process resolved." The veteran was advised to follow- up if there were any reoccurrences, but no additional evaluation was scheduled at that time. Thereafter, the record reflects that between the period of November 1989 and February 1992 the veteran was seen with complaints of intermittent rectal bleeding, diarrhea, external thrombosed hemorrhoids, and acute gastroenteritis. With respect to other disabilities the service medical records show that paronychia of the left and right great toes was diagnosed in November 1987 and September 1990, respectively. In July 1991, tinnitus and a questionable decreased hearing acuity were noted. Assessments of bilateral shin splints and a questionable right ankle ganglion were reported in 1989 and 1992, respectively with the veteran reporting in 1992 that he had experienced symptoms off and on over the prior three years. January 1992 x-rays of both lower extremities, including the ankles, showed no evidence of a stress fracture, osteomyelitis, or osteoporosis. X-rays of the right ankle dated in March 1992 were reported as showing early right mediolateral infiltrate. A March 1992 separation examination, although noting several of the above disabilities, yielded essentially normal findings. In June 1992, the veteran filed his claims seeking service connection for the disabilities listed on page one of this decision. By rating decision dated in November 1992, the RO granted service connection for hemorrhoids and assigned a non compensable evaluation, but it denied all of the veteran's other claims for service connection. Significantly, a review of the record does not reflect that the veteran was accorded a contemporaneous VA medical examination prior to the RO's consideration of the claims. VA has a duty to assist the veteran in developing facts pertinent to his claim. See Talley v. Brown, 6 Vet.App. 72, 74 (1993). The United States Court of Veterans Appeals has held that the duty to assist includes securing medical records to which reference has been made, as well as conducting a thorough and contemporaneous examination. See Schafrath v. Derwinski, 1 Vet.App. 589, 593 (1991); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). Under the circumstances of this case, the Board is of the opinion that additional development is necessary to ensure full compliance with the duty to assist requirement. Accordingly, this case is REMANDED to the RO for the following: 1. The RO should request that the National Personnel Records Center (NPRC) initiate an additional search for service medical records to ascertain whether or not any additional service records have since become associated with the veteran's file. In this regard, the NPRC is specifically requested to search for any pertinent records which may be located with the veteran’s unit records. 2. The veteran should be afforded VA gastrointestinal, audiological, podiatric, and orthopedic examinations to determine the nature and extent of the veteran's service-connected hemorrhoids, and any disability diagnosed. These examinations should be conducted in accordance with the VA Physician's Guide for Disability Evaluation Examinations, and all necessary tests and studies should be accomplished, and the clinical manifestations reported in detail. The claims folder, including the service medical records, must be made available to and reviewed by each examiner prior to conducting the requested examinations. The examination report should be typed. The Board defers consideration of the issues of entitlement to service connection for sinusitis, and a psychiatric disorder, to include stress. Following completion of the requested development, the RO should again review the evidence and determine whether the veteran's claims may now be granted. In this regard, the Board observes that the veteran has Persian Gulf War Era service. Accordingly, if the record shows that he served in the Southwest Asia theatre of operations during the Persian Gulf War consideration of the provisions of Persian Gulf War Benefits Act, Title I of Public Law 103-446, and 60 Fed. Reg. 6665 (1995) (to be codified at 38 C.F.R. § 3.317) is warranted. If the RO decision on appeal continues to be adverse to the veteran, he and his representative should be furnished a supplemental statement of the case and be given an opportunity to respond. The case should then be returned to the Board for further administrative consideration. No action on the part of the veteran is required until he receives further notice. The Board intimates no opinion, either legal or factual, as to the ultimate disposition of the issues on appeal. DEREK R. BROWN 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).