BVA9507475 DOCKET NO. 93-11 192 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina THE ISSUES 1. Entitlement to an increased rating for the service-connected degenerative arthritis with narrowing of L5-S1, currently evaluated as 20 percent disabling. 2. Entitlement to service connection for residuals of a fracture of the low back REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD K. E. Harrison, Associate Counsel INTRODUCTION The veteran had active military service from July 1951 to July 1955. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 1992 rating decision by the RO. REMAND In January 1953, the veteran reported he developed pain when carrying steel which slipped. He was hospitalized for low back pain in May 1954. Service connection was granted for lumbosacral strain and a noncompensable rating was assigned effective on July 10, 1955. The diagnosis was later changed to degenerative osteoarthritis with narrowing of L5-S1 and an increased rating of 40 percent was assigned, effective from March 9, 1970. The veteran's rating was reduced to 20 percent, effective on February 1, 1986. The evidence of record shows that the veteran has a history of low back pain and in November 1988 the veteran reported that his pain radiated down his right leg. In November 1991 the veteran was hospitalized due to falling approximately 12 feet from a ladder. Upon admission to the hospital, the veteran reported that the fall was caused by his knee buckling and that his knee had been buckling for the past 2 to 3 months. The diagnosis at the time of the veteran's discharge was comminuted compression fracture of L1 vertebra with encroachment on the spinal canal and neurological deficit. In support of his claim for service connection for fracture of the lumbosacral spine, the veteran submitted a November 1992 letter by Leroy Allen, M.D., who stated that: It is also possible that [the veteran's] service connected disability contributed to the severe spinal injury sustained on November 21, 1991. [The veteran] had been having increased back difficulty for about six weeks prior to the November accident. His right leg had been buckling on him, and that could have caused him to fall from the ladder. The evidence in this case raises the question of whether the buckling of the veteran's knee was actually due to his service connected low back condition. The evidence of record is insufficient to decide this issue with any certainty and since the Board cannot exercise its own independent judgment on medical matters, Colvin v. Derwinski, 1 Vet.App. 171 (1991), an orthopedic examination is required, to include an opinion based on review of the entire record. In view of the foregoing, the case is REMANDED to the RO for the following actions: 1. The RO should take appropriate steps to contact the veteran and ask him to identify any other physicians and/or medical facilities (hospitals or clinics) from which he may have received examination or treatment for his low back disorder since 1988. Upon receipt of proper authorization from the veteran, full documentation should be obtained. 2. After completion of the foregoing, the veteran should undergo a special VA examination by an orthopedic specialist to determine the current severity of his service-connected low back disorder. The examination should conform to the requirements of Chapter 2 of the VA Physician's Guide for Disability Evaluation Examinations (IB 11-56, March 1, 1985). All necessary studies should be performed, and all findings should be reported in detail. The claims folder should be made available for review. The examiner should express an opinion as to the medical probability that the veteran's low back degenerative arthritis with narrowing of L5-S1 caused or was a contributory factor in an accident in November 1991 when he claimed that his right knee buckled. The examiner should base her/his opinion on current findings, history reported by the veteran and the claims file. 3. When the foregoing development has been completed, the claim should be reviewed by the RO. If the decision remains adverse to the veteran, a supplemental statement of the case should be prepared and the veteran and his representative should be given a reasonable period of time for reply. Thereafter, the claim should be returned to the Board for further appellate review, if in order. No action is required of the veteran until he receives further notice. The purpose of this REMAND is to obtain additional information. The Board does not intimate any factual or legal conclusions as to the outcome ultimately warranted in this appeal. STEPHEN L. WILKINS 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).