BVA9503298 DOCKET NO. 90-48 278 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Albuquerque, New Mexico THE ISSUES 1. Entitlement to an evaluation in excess of 20 percent for traumatic arthritis of the cervical spine, C-6, with C-7 vertebral abnormality, prior to February 8, 1993. 2. Entitlement to an evaluation in excess of 30 percent for traumatic arthritis of the cervical spine, C-6, with C-7 vertebral abnormality, beginning February 8, 1993. 3. Entitlement to service connection for carpal tunnel syndrome, claimed secondary to a service-connected cervical spine disability. 4. Entitlement to service connection for a low back disability, claimed secondary to a service-connected cervical spine disability. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD K. Hudson, Associate Counsel REMAND The veteran had active service from September 1969 to August 1973. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a regional office (RO) rating decision of April 1990, which denied entitlement to an evaluation in excess of 20 percent for the veteran's cervical spine disability. This determination was upheld by the Board by decision dated in February 1991. The veteran appealed the Board's decision to the United States Court of Veterans Appeals (Court). By a subsequent Memorandum Decision, [citation redacted], the Court vacated the Board decision and remanded the case to the Board for further action in accordance with the Court's decision. In response thereto, the Board remanded the case to the RO for additional development in February 1993. In the course of the requested development, by rating action of October 1994, the RO granted a 30 percent rating for the cervical spine disability, and denied service connection for carpal tunnel syndrome and for a low back disorder, both claimed secondary to the service-connected cervical spine disability. The supplemental statement of the case, although briefly touching upon the carpal tunnel syndrome issue, did not provide the pertinent laws and regulations or discuss the low back disorder. In subsequent correspondence, received in December 1994 and January 1995, both the veteran and his representative have presented contentions regarding these issues which must be construed as an intention to incorporate these additional issues into the appeal. Accordingly, the veteran must be furnished a supplemental statement of the case which addresses both of these issues. Further, the RO obtained an opinion from a neurologist who examined the veteran in October 1994, evidently without benefit of the claims folder, to determine, in part, whether previously diagnosed carpal tunnel syndrome was etiologically related to the service-connected cervical spine disability. However, the examiner found no evidence of carpal tunnel syndrome on physical examination, and therefore did not render such an opinion. On an orthopedic examination later that month, there is reference to "EMG of the upper extremities showed normal electrodiagnostic studies of both upper extremities and neck." In contrast, the February 1990 EMG studies which resulted in a finding of carpal tunnel syndrome were described in detail. Consequently, based upon the current record, we are unable to reconcile these seemingly conflicting opinions, or determine whether carpal tunnel syndrome, if present, is related to the service-connected cervical spine disorder. Further, neither examination satisfactorily addressed whether there is a low back disability present which is secondary to the service-connected cervical spine disability. In addition, the veteran also claims that he experiences headaches and blackouts secondary to the cervical spine disability; this matter has not been addressed by the RO. Accordingly, this case is REMANDED for the following: 1. The RO should obtain the veteran's treatment records subsequent to June 1994, including the complete reports of any diagnostic studies conducted, such as EMG, nerve conduction velocities, X-ray, magnetic resonance imaging (MRI), and/or computerized tomography (CT) scans, regarding his cervical spine disability and/or carpal tunnel syndrome, low back disorder, headaches and blackouts he claims on a secondary basis. Such records should specifically include a detailed summary of the EMG report mentioned in the October 1994 VA orthopedic examination. 2. Thereafter, the veteran should be scheduled for a neurological examination, preferably by an examiner who has not previously examined him, to determine the current manifestations and severity of his service-connected cervical spine disability, including claimed secondary disabilities. Manifestations of pain shall be noted, and the examiner is requested to comment on the role of pain with respect to the cervical spine disorder, particularly with respect to its impact on normal functioning. The claims folder must be reviewed by the examiner prior to the examination, in particular, the reports of the October 1994 examinations, as well as all diagnostic studies previously conducted, such as EMG, nerve conduction velocities, magnetic resonance imaging (MRI), and/or computerized tomography (CT) scans. Regarding the EMG findings of February 1990 and October 1994, the examiner should explain the significance of any discrepancies noted on these tests, and attempt to reconcile same. The examiner should also render an opinion as to whether carpal tunnel syndrome is present, with supporting reasons. If carpal tunnel syndrome is present, the examiner should express an opinion as to whether it is etiologically related to the service-connected cervical spine disability. The examination should also address whether there is a separate low back disability etiologically related to the cervical spine disability, and, if not, whether there is symptomatology in the low back which is due to the cervical spine disability. In addition, whether, and if so, to what extent, headaches or blackouts are a manifestation of the cervical spine disability should be reported. 3. Thereafter, the RO should adjudicate the issue of the veteran's current rating, as well as whether carpal tunnel syndrome, a low back disability, headaches, or blackouts are secondary thereto. If the decision regarding any issue remains adverse to the veteran, he should be furnished a supplemental statement of the case addressing the issue, and, if applicable, furnished citation to the regulations pertaining to secondary service connection. After completion of the requested development, if the decision remains adverse to the veteran, he and his representative should be afforded an opportunity to respond. Thereafter, the case should be returned to the Board for appellate consideration, if otherwise in order. ________________________ JACK W. BLASINGAME 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).