BVA9508336 DOCKET NO. 93-17 885 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Reno, Nevada THE ISSUE Entitlement to an increased evaluation for rheumatoid arthritis, currently rated at 20 percent. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD C. M. Flatley, Counsel INTRODUCTION The veteran had active service from October 1952 to September 1954. This case comes before the Board of Veterans' Appeals (Board) on appeal from a February 1992 rating decision of the Reno, Nevada, Department of Veterans Affairs (VA) regional office (RO). In a February 1994 statement from the veteran's representative, it is noted that a July 1993 VA outpatient report which notes that the veteran is 100 percent disabled, should be accepted as an informal claim for a permanent and total disability evaluation for pension purposes. This matter is referred to the RO for appropriate action. REMAND Review of the record indicates that the veteran has submitted a well-grounded claim. 38 U.S.C.A. § 5107(a) (West 1991). The VA therefore has a duty to assist the veteran in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet.App. 78, 81-82 (1990). In this case, the veteran is service-connected for rheumatoid arthritis, rated at 20 percent disabling since the initial grant of service connection by a February 1955 rating decision. On a private examination conducted in June 1993, it was noted that laboratory testing in 1991 failed to reveal evidence of rheumatoid arthritis; the physician indicated that further pertinent testing was arranged. The results of any further private evaluation are not of record. A June 1993 VA rheumatology clinic report reflects that no evidence of rheumatic arthritis was present. It was also noted that the veteran was "...originally misdiagnosed..." with rheumatoid arthritis and that severe degenerative osteoarthritis was present. The basis upon which the examiner reached the former conclusion is unclear. It has been also contended on appeal that the diagnosis of rheumatoid arthritis was erroneous at the time when service connection was granted and that in actuality, the veteran's current disorder, described in a variety of ways in the record, including degenerative joint disease and lumbar stenosis, were present at that time. In support of his argument, the veteran emphasizes that an x-ray study conducted in 1955 revealed pathology such as sacralization of the last lumbar vertebra. In the alternative, it is argued that the veteran's current disorder and rheumatoid arthritis are essentially similar. Lastly, in a July 1993 statement provided by the veteran's representative, it is argued that service connection should be allowed for an "..as yet undiagnosed and unclassified condition..." It appears, therefore, that service connection is sought for the disorder currently present. In this regard, the Board notes that the United States Court of Veterans Appeals (Court) has held that when an issue raised on appeal, but not developed, may impact upon a fully developed issue, further action with regard to the recently raised issue may be appropriate. Harris v. Derwinski, 1 Vet.App. 180 (1991). As development of service connection for a musculoskeletal disorder other than rheumatoid arthritis may impact on the veteran's current claim, additional action is indicated. In light of the veteran's contentions and the evidence of record, the Board is of the opinion that clarification is in order. In order to fully assist the veteran in the development of his case, therefore, and extend to the veteran every equitable consideration, additional development is warranted. As such, this case is REMANDED for the following: 1. After any necessary information and authorization are obtained from the veteran, records of any post-June 1993 treatment, VA or private, inpatient or outpatient, associated with the veteran's musculoskeletal disability, should be obtained by the RO and incorporated into the claims folder. 2. The RO should schedule special VA rheumatology and orthopedic examinations to determine the nature and etiology of the veteran's musculoskeletal disability, for which current diagnoses of degenerative joint disease and lumbar stenosis have been made and for which a diagnosis of rheumatoid arthritis has been made by history and for which service connection is in effect. Any pertinent disorder present should be clearly identified. The examination should be conducted in accordance with the appropriate provisions of the VA's Physician's Guide for Disability Evaluation Examinations. All indicated studies should be conducted. The examination report should include a full description of the veteran's symptoms, clinical findings, and associated functional impairment; attention is directed to the history of the veteran's disability, including the initial identification of rheumatoid arthritis, and subsequent pathology. All findings should be recorded in detail, including range of motion of joints affected by any pathology present, recorded in degrees. The examiners should provide an opinion as to the relationship between the veteran's service-connected rheumatoid arthritis and other musculoskeletal disability identified on examination; an opinion should be rendered as to the propriety of the initial diagnosis of rheumatoid arthritis and the degree of probability, if any, that any current pertinent disorder is related thereto or represents disability which, by history, was mischaracterized as rheumatoid arthritis. A comprehensive report, which represents consideration of the aforementioned factors and which includes the examiners' conclusions and the foundation upon which they are based, should be provided and associated with the veteran's claims folder. The veteran's claims folder should be provided to the examiners and should be reviewed prior to the examinations. 3. The RO should then review the veteran's claim in light of all of the pertinent evidence of record; the issue of service connection for the musculoskeletal disorder other than rheumatoid arthritis, and identified on the aforementioned VA examination, should be addressed. All pertinent law, regulations, and Court decisions should be considered, including Schafrath v. Derwinski, 1 Vet.App. 589 (1991). Each of the arguments advanced on appeal should be addressed. With regard to the newly raised issue, the veteran and his representative should be provided notice of any determination and an opportunity to respond; appropriate procedural development should be undertaken in response. If the veteran's claim otherwise remains in a denied status, he and his representative should be provided with a supplemental statement of the case, which includes any additional pertinent law and regulations and a full discussion of action taken on the veteran's claim, consistent with the Court's instruction in Gilbert v. Derwinski, 1 Vet.App. 49 (1990). The applicable response time should be allowed. The case should then be returned to the Board, if in order, after compliance with customary appellate procedures. No action is required of the veteran until he is so informed. The Board intimates no opinion as to the ultimate decision warranted in this case, pending completion of the requested development. EUGENE A. O'NEILL 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 action has been taken in accordance with the Veterans' Benefits Improvements Act of 1994, Pub. L. No. 133-446, § 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) (1994).