BVA9507435 DOCKET NO. 93-02 911 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUES 1. Entitlement to service connection for residuals of a cervical spine strain. 2. Entitlement to service connection for residuals of a lumbar spine strain. 3. Entitlement to service connection for residuals of mononucleosis. 4. Entitlement to service connection for residuals of a Coxsackie virus infection. 5. Entitlement to service connection for peptic ulcer disease. 6. Entitlement to service connection for a rectocele. 7. Entitlement to service connection for a cystocele. 8. Entitlement to service connection for residuals of an ovarian cyst. 9. Entitlement to service connection for headaches. 10. Entitlement to service connection for residuals of a right shoulder injury. 11. Entitlement to service connection for residuals of a right middle finger injury. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD C. R. Olson, Counsel INTRODUCTION The veteran's active military service extended from October 1974 to March 1981. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 1992 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana. That rating decision, in part, denied service connection for residuals of a cervical spine strain, residuals of a lumbar spine strain, residuals of mononucleosis, residuals of a Coxsackie virus infection, peptic ulcer disease, a rectocele, a cystocele, residuals of an ovarian cyst, headaches, residuals of a right shoulder injury and residuals of a right middle finger injury. REMAND The veteran's appeal was certified to the Board in February 1993. The Board received additional evidence in February and March 1993. Such evidence must be referred to the RO for review and preparation of a supplemental statement of the case, unless this procedural right is waived in writing or at a hearing. 38 C.F.R. § 20.1304(c) (1994). No waiver is of record. Therefore, the case must be returned to the RO so it can consider the new evidence. The veteran asserts that all of her service medical records have not been obtained. The Board notes that the veteran served under two other names. The RO should ask the records center to conduct a special search under both names. The veteran reports pertinent treatment by private physicians. The RO should obtain complete copies of their treatment notes. The veteran also reports treatment at a military base hospital. In February 1992, the facility stated that the records could not be found. The veteran avers that these records cover a continuity of post service symptomatology. The RO should ask the hospital if the records have been found. The veteran contends that she has an Epstein-Barr virus infection and other residuals as results of mononucleosis and Coxsackie virus infections. Copies of the alleged medical findings should be obtained and the veteran should be examined for any residuals. A service medical record shows that a laparotomy was performed in service for an ovarian cyst. The nature and extent of any residuals should be determined. In as much as this requires the examination of the veteran, she can also be examined again to determine if there are any current residuals of the rectocele or cystocele. As VA must base its decisions on medical evidence, current examinations are desirable to determine if there are any residuals of the gastric and headache complaints during service. Similarly, the service medical records show neck, back and shoulder injuries. A medical opinion as to whether there are residuals of these injuries should be obtained. On the February 1992 VA examination, degenerative joint disease of the cervical spine was diagnosed and the examiner noted that he was requesting x-rays. The x-rays showed kyphosis without evidence of degenerative changes. The examiner should review the results of all requested studies before completing his report and making a final diagnosis. To ensure that VA has met its duty to assist the claimant in developing the facts pertinent to the claim and to ensure full compliance with due process requirements, the case is REMANDED to the RO for the following development: 1. The RO should ask the records center or appropriate depository of records to conduct a special search for additional service medical records pertaining to this veteran. The RO should provide them with the two previous names that the veteran used during service. 2. The RO should request from the veteran the names and addresses of all medical care providers who have treated her for the disorders at issue since service. After securing the necessary releases, the RO should obtain these records. The records of Kekoomaram Kokomo, M.D., and Jeffery A Penman, Ph.D., M.D., should particularly be requested. 3. The RO should ask the 305th Strategic Clinic (SAC) Grissom Air Force Base, Indiana 46971-5300, to make another search for the veteran's clinical records and forward a complete copy of all available records to the RO. 4. Following the above, the veteran should be accorded an examination by a VA orthopedist. The report of the examination should include a detailed account of all manifestations of joint pathology found to be present. All necessary tests and X-rays should be conducted and the examiner should review the results of any testing prior to completion of the report. Special attention should be given to the presence or absence of pain, any limitation of motion, instability and weakness. The examiner should express an opinion as to what if any residuals the veteran currently has from the neck, shoulder and back injuries during service. A copy of this Remand and the claims folder must be made available to and be reviewed by the examiner prior to the examination. The orthopedist should provide a complete rationale for all conclusions reached. 5. The veteran should be accorded an examination by a VA neurologist. A copy of this Remand and the claims folder must be made available to and be reviewed by the examiner prior to the examination. All necessary tests should be conducted and the examiner should review the results of any testing prior to completion of the report. The report of examination should include a detailed account of all neurologic residuals of neck, shoulder and back injuries found to be present. The specialist should express an opinion as to whether there are any current headaches or other residuals of the headaches and injuries reported in the service medical records. The specialist should provide a complete rationale for all conclusions reached. 6. The veteran should be accorded an examination by a gynecologist. A copy of this Remand and the claims folder must be made available to and be reviewed by the examiner prior to the examination. All necessary tests should be conducted and the examiner should review the results of any testing prior to completion of the report. The specialist should express an opinion as to whether there are any current residuals of the ovarian cyst surgery, rectocele or cystocele performed during service. Any current residuals should be described in detail. The specialist should provide a complete rationale for all conclusions reached. 7. The veteran should be accorded an examination by a specialist in infectious diseases. A copy of this Remand and the claims folder must be made available to and be reviewed by the examiner prior to the examination. All necessary tests should be conducted and the examiner should review the results of any testing prior to completion of the report. The examiner should express an opinion as to whether the veteran has the Epstein-Barr virus or any other residuals of mononucleosis or the Coxsackie virus. Any residuals should be described in detail. The specialist should provide complete rationale for all conclusions reached. 8. The veteran should be accorded an examination by a gastroenterologist. A copy of this Remand and the claims folder must be made available to and be reviewed by the examiner prior to the examination. All necessary tests, including a series of upper gastrointestinal x-rays studies, should be conducted and the examiner should review the results of any testing prior to completion of the report. The report of examination should include a detailed account of all manifestations of gastrointestinal disease found to be present. The specialist should express an opinion as to whether there are any current residuals of the gastrointestinal symptoms manifested during service. Any such residuals should be described in detail. The specialist should provide complete rationale for all conclusions reached. 9. The RO should review the examination reports and determine if they are adequate for rating purposes and in compliance with this Remand. Any reports which are not adequate should be returned for corrective action. Following completion of these actions the RO should review the veteran's claims. If the decision remains unfavorable, the veteran and her representative should be provided with a supplemental statement of the case and afforded a reasonable period of time in which to respond. Thereafter, in accordance with the current appellate procedures, the case should be returned to the Board for completion of appellate review. The Board intimates no opinion as to the ultimate outcome of this case. No action is required of the veteran until further notice is issued. Pending the above development, the Board defers action on the issue of entitlement to service connection for residuals of a right middle finger injury. JOAQUIN AGUAYO-PERELES 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).