BVA9504925 DOCKET NO. 88-31 527 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in New York, New York THE ISSUE Entitlement to an increased rating for bilateral nephrolithiasis and hypercalcemia with residuals of a parathyroidectomy for hyperparathyroidism, currently rated as 20 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD R. K. ErkenBrack, Counsel INTRODUCTION The veteran had active duty from February 1945 to October 1946. This appeal arises from a rating decision in February 1986 of the Department of Veterans Affairs (VA) Regional Office at New York City, New York. The Board of Veterans' Appeals (Board) REMANDED the case in June 1989 for additional VA clinical records and complete VA rating examinations. The Board REMANDED the case again in April 1992 for additional VA clinical records which were not obtained before, a complete VA rating examination, to include an evaluation for osteoporosis, recurrent nephrolithiasis, and any complications of hyperparathyroidism, and adjudication of the issue newly raised by the veteran, entitlement to a total compensation rating based on individual unemployability. The RO increased the rating from 10 percent to 20 percent by rating action in June 1993 for moderate recurrent nephrolithiasis. This was viewed as virtually the only manifestation of the disability. A total compensation rating based on individual unemployability was denied. However, the veteran was not informed of this decision and apprised of his appellate rights. This action must be undertaken by the RO. The RO must also consider whether the representative's informal hearing presentation of January 1995 constitutes a notice of disagreement with the denial of entitlement to individual unemployability benefits, and take any action deemed appropriate. REMAND During the course of this appeal on the increased rating issue, the veteran appears to have claimed service connection for conditions secondary to the hyperparathyroidism residuals. We refer specifically to his statements of August 1987, January 1988 and November 1989 in which he refers to conditions including ear drainage, hearing loss and psychiatric symptoms. Because it is not clear whether he is arguing that these are temporary side effects of treatment for the service connected condition or are chronic conditions resulting therefrom, we are of the opinion that he should be specifically asked by the RO to identify the all conditions for which he wishes to claim secondary service connection. The RO must then consider these claims. See Harris V. Derwinski, 1 Vet. App. 180 (1991). The veteran shows residual manifestations of hyperthyroidism. The recent rating decisions have been predicated upon findings that the kidney disorder represented the primary aspect of the disability. However, Diagnostic Code 7904, which sets forth the criteria for rating hyperparathyroidism, states that consideration is also to be given to effects on systems including the bones. In the veteran's case, the claim was remanded, in part, so that residual effects on the bones could be identified and considered in assigning a disability evaluation. This has not been done. The VA endocrinologist who examined him in 1992 stated that further testing was necessary to see if he had been losing bone mineral density at a rapid pace. In this regard, we note that a 1989 VA study of bone mineral density was in the low normal range. We are of the opinion that all results of the tests ordered by the 1992 VA examiner should be reviewed and examination performed to identify all manifestations of the residual hyperparathyroidism, and, in particular, those affecting the bones. Any such manifestations should then be considered by the RO in assigning a rating. In addition, the schedular criteria for rating hydronephrosis were changed effective in February 1994. The case should be considered under the new criteria. 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 RO once again for the following development: 1. The RO should obtain copies of the complete VA medical records dated since April 1992 from the VA Medical Center, Bronx, New York, to include the results of all laboratory tests and studies. 2. Next, the RO should schedule the veteran for the necessary VA examinations to identify all residual manifestations of hyperthyroidism, to include bone and kidney manifestations. All indicated tests and studies should be performed. The claims file must be made available for review prior to the examination(s). 3. The RO should ask the veteran to specify any and all disabilities which he believes are secondary to the service connected hyperparathyroidism residuals. The disabilities so identified should then be the subjects of adjudication by the RO, after all necessary development is undertaken.. 4. After the development requested above has been completed to the extent possible, the RO should again review the record, and consider the claim under the new criteria for rating nephrolithiasis. If any benefit sought on appeal, for which a Notice of Disagreement has been filed, remains denied, the veteran and his representative should be furnished an appropriate Supplemental Statement of the Case and given the opportunity to respond thereto. Thereafter, the case should be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The veteran need take no action until otherwise notified. (CONTINUED ON NEXT PAGE) NANCY I. PHILLIPS 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).