BVA9504406 DOCKET NO. 93-12 411 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Paul, Minnesota THE ISSUE Entitlement to an increased disability evaluation for symptomatic bilateral varicose veins, currently evaluated as 30 percent disabling. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Theresa M. Catino, Associate Counsel REMAND The veteran served on active military duty from July 1942 to October 1945 and from February 1948 to January 1950. The veteran contends that his service-connected bilateral varicose vein disability has worsened and that the VA examination conducted in September 1992 inadequately evaluated this disorder. In an October 1993 statement, the veteran's representative expressed support for these contentions and specifically requested that the case be remanded to accorded the veteran an opportunity to have a thorough and complete VA examination of his bilateral varicose veins. Upon review of the September 1992 VA examination report, the Board of Veterans' Appeals (Board) concludes that this prior examination provided an incomplete description of the veteran's bilateral varicose veins. Accordingly, he should be given an evaluation of this service-connected disability which is in accordance with the guidelines set forth in the VA Physician's Guide for Disability Evaluation Examinations. VA has a duty to assist the veteran in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1991). This duty to assist includes the duty to develop facts when the record before the Board is clearly inadequate. EF v. Derwinski, 1 Vet.App. 324 (1991); Littke v. Derwinski, 1 Vet.App. 90 (1990). The development of facts includes a "thorough and contemporaneous medical examination, one which takes into account the records of prior medical treatment, so that the evaluation of the claimed disability will be a fully informed one." Green v. Derwinski, 1 Vet.App. 121, 124 (1991). The Board concludes that further assistance to the veteran is required. Accordingly, the case is REMANDED to the RO for the following: 1. The veteran should be contacted and requested to furnish a complete list of all medical personnel and facilities from which he has received treatment for his service-connected bilateral varicose vein disability since 1990. The Board is particularly interested in records of any treatment that the veteran may have received for his varicose veins from the Twin Ports Outpatient Clinic and the VA Medical Center in Minneapolis, Minnesota. After obtaining the appropriate releases from the veteran where necessary, the health care providers should be contacted and requested to provide copies of all treatment records in their possession pertaining to the veteran. If these records are unavailable, or are duplicates of those already on file, those facts should be annotated in the claims folder. Any available records should be associated with the claims folder. 2. Following the above, the veteran should be accorded a VA examination for veins for the purpose of determining the nature and extent of his bilateral varicose vein disability. The report of examination should include a detailed account of all manifestations of the disorder found to be present. All necessary tests, including Trendelenburg's and Perthe's tests, should be conducted, and the examiner should review the results of any testing prior to completion of the report. The examination should be conducted in accordance with the diagnostic procedures outlined in the VA Physician's Guide for Disability Evaluation Examinations. The examiner must comment on whether either of the veteran's legs have ulceration, pigmentation, distortion, sacculation, edema, induration, ankle or leg swelling, or involvement of the deep or superficial venous system secondary to varicose veins. Varicosities should be measured, and the examiner should state whether they are found above or below the knees, or both. The claims folder should be made available to and reviewed by the examiner prior to the examination. A complete history should be obtained; the specialist should provide complete rationale for all conclusions reached; and a comprehensive typed or neatly printed report should be furnished. 3. After the above-requested action has been completed, the RO should review the examination report and determine if it is adequate for rating purposes and in compliance with this Remand. If not, it should be returned for corrective action. 4. Thereafter, the RO should review the issue of entitlement to an increased rating for symptomatic bilateral varicose veins. If the decision remains unfavorable, the veteran and his representative should be provided with a supplemental statement of the case and afforded a reasonable period of time in which to respond. Thereafter, the case, in accordance with the current appellate procedures, should be returned to the Board for completion of appellate review. The purpose of this REMAND is to obtain clarifying evidence. No action is required of the veteran until further notice is issued. V. L. JORDAN 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) (1993).