BVA9505933 DOCKET NO. 93-14 956 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to an increased rating for service-connected bilateral varicose veins, currently evaluated as 30 percent disabling. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD Richard E. Coppola, Associate Counsel INTRODUCTION The veteran served on active duty from March 1941 to April 1945. This matter came before the Board of Veterans' Appeals (Board) on appeal from a rating decision of September 1991 from the St. Petersburg, Florida, Department of Veterans Affairs (VA) Regional Office (RO), which denied a rating in excess of 30 percent for service-connected bilateral varicose veins. The RO also denied increased ratings for service-connected valvular heart disease, acne of the face and trunk, post-operative hemorrhoids and residuals of a gunshot wound of the right knee. The veteran did not appeal these latter determinations. REMAND The veteran underwent VA examination of his service-connected disabilities in August 1991. The physician indicated that the veteran had post-operative residuals of varicose vein surgery in the lower extremities. The physician reported that the lower extremities revealed extensive dependent edema in both legs with 2+ edema involving the lower half of each leg, ankle and foot. It was also reported that the lower extremities revealed marked changes including pigmentation and skin thickening but no evidence of ulceration. The physician did not indicate whether these marked changes included distortion or sacculation, or whether the veteran's medical history included episodes of ulceration. The physician also reported the presence of dilated varicose veins in the greater saphenous distribution, bilaterally, but did not indicate the diameter of these veins. At a personal hearing in August 1992, the veteran testified that the residual symptoms associated with his service-connected varicose veins had increased in severity. The veteran's representative argues that the veteran should be afforded a contemporaneous VA examination to determine the current severity of his service-connected bilateral varicose veins. Under the present circumstances, the Board finds that additional development of the evidence is necessary. Accordingly, the case is REMANDED for the following actions: 1. The veteran should identify the names and addresses of any medical care providers, VA or otherwise, who have treated him for residuals of varicose veins or other symptoms involving the lower extremities during 1992 and thereafter. After obtaining any needed authorization from the veteran, the RO should obtain copies of all these record. 2. The veteran should undergo a VA examination in order to determine the current manifestations and severity of his service-connected bilateral varicose veins that are consistent with the veteran's complaints and symptoms. The examination should be conducted in accordance with VA's Physician's Guide for Disability Evaluation Examinations, and should include any indicated testing. The examiner should specifically determine whether the veteran's residuals involve superficial veins above and below the knee, with varicosities of the long saphenous, ranging over 2 cm. in diameter, whether marked distortion and sacculation with edema and episodes of ulceration are present, and whether there is secondary involvement of the deep circulation as demonstrated by Trendelenburg's and Perthe's tests. The claims folder must be made available to the physician prior to the examination. 3. When the above development has been completed, the case should be reviewed 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 which summarizes the pertinent evidence and reflects detailed reasons and bases for the decision. 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).