BVA9500744 DOCKET NO. 93- 04 046 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to a permanent and total disability rating for pension purposes. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Nancy S. Kettelle, Counsel INTRODUCTION The veteran served on active duty from January 1953 to December 1954. This matter came to the Board of Veterans' Appeals (Board) on appeal from a March 1992 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. REMAND The veteran is seeking a permanent and total rating for pension purposes. Diabetes is among the disabilities rated by the RO in evaluating the veteran's claim. At the most recent VA general medical examination, which was conducted in June 1992, the physician noted that the veteran reported he had polydipsia and polyuria by day and voided five to six times at night. He also said he was definitely more thirsty than usual. In the examination report, the physician stated that the status of the veteran's alleged diabetes mellitus was unknown and that the veteran needed to return for a fasting blood sugar. There is no indication in the record that this was done. The Board also notes that the diagnosis following a June 1992 VA orthopedic examination was osteoarthritis and degenerative disc disease at all levels of the cervical spine, treated by surgical foraminotomy with fairly satisfactory results in relieving some degree of pain in the veteran's left upper extremity. The physician also stated that the veteran had significant weakness and atrophy in the shoulder musculature and that there was moderate impairment of the left upper extremity function as well as significant neck pain. The Board is of the opinion that a current examination should be performed and that the RO should explicitly address the extent of pain experienced by the veteran and its effect on his employability. See Fanning v. Brown, 4 Vet. App. 225, 229-30 (1993). On his VA Form 21-526, received in October 1991, the veteran reported that he had completed 4 years of college and had last worked in 1987, whereas on a VA Form 21-527, received in March 1989, the veteran reported that he had completed 2 years of college and last worked in 1976. In view of the conflicting information, and potentially lengthy time since the veteran has been gainfully employed, the Board is of the opinion that a VA social and industrial survey would facilitate its decision. Accordingly, the case is REMANDED to the RO for the following actions: 1. The RO should obtain and associate with the claims file all VA outpatient and hospital records for the veteran, dated from June 1992 to the present. 2. The RO should contact the veteran and request that he identify the names, addresses, and approximate dates of treatment for all health care providers from whom he has recently received treatment for any disability he believes contributes to his claimed unemployability. With any necessary authorization from the veteran, the RO should attempt to obtain copies of all medical records identified which have not been obtained previously. 3. The RO should arrange for a VA social and industrial survey to evaluate the veteran's current social and industrial adaptability. 4. Then, the RO should arrange for VA orthopedic and neurology examinations of the veteran by board certified specialists, if available, to determine the nature and extent of disabilities of the cervical spine, left shoulder and left upper extremity and any disability of the right upper extremity. All indicated studies should be performed and the physicians should be specifically requested to identify any objective evidence of pain, painful motion, of functional loss due to pain. The veteran's claims folder should be made available to the physicians prior to the examinations. 5. In addition, the RO should arrange for a VA general medical examination of the veteran to identify the nature and severity of each of the veteran's chronic medical disorders. Studies should include those necessary to identify the extent of diabetes mellitus. In addition, any other indicated studies and any recommended special examinations should be performed. It is noted that the veteran has a clear history of hypertension, but no rating was assigned thereto in September 1992. The claims folder should be made available to the physician prior to the examination. 6. Then, the RO should evaluate the veteran's disabilities and assign a percentage evaluation to each. Those which can be combined should be, pursuant to 38 C.F.R. § 4.25 (1993). 7. Thereafter, in light of all the evidence of record including the evidence obtained pursuant to the requested development, the RO should readjudicate the claim of entitlement to a permanent and total disability rating for pension purposes, with consideration of the impact of pain on the veteran's employability and consideration of the provisions of 38 U.S.C.A. § 1502(a)(1) (West 1991) and 38 C.F.R. §§ 3.321(b)(2), 4.15, 4.16 and 4.17 (1993), as well as the "average person" standard, 38 C.F.R. § 3.340(a) (1993). If the benefit sought on appeal is not granted to the veteran's satisfaction, the RO should issue a Supplemental Statement of the Case, and the veteran and his representative should be provided an opportunity to respond. The case should then be returned to the Board for further appellate consideration, if otherwise in order. By this REMAND, the Board intimates no opinion as to the final outcome warranted. No action is required of the veteran until he is notified by the RO. J. J. SCHULE Member, Board of Veterans' Appeals (CONTINUED ON NEXT PAGE) 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) (1993).