BVA9500532 DOCKET NO. 93-06 445 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in North Little Rock, Arkansas THE ISSUES 1. Entitlement to an increased rating for sinusitis, currently assigned a 10 percent evaluation. 2. Entitlement to an increased (compensable) rating for bilateral defective hearing. 3. Entitlement to an increased (compensable) rating for an epigastric (ventral) hernia. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL The appellant and his spouse ATTORNEY FOR THE BOARD Stephen F. Sylvester, Counsel INTRODUCTION The veteran in this case had active service from September 1952 to August 1954. This appeal to the Board of Veterans' Appeals (Board) arises from an October 1991 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in North Little Rock, Arkansas. REMAND A review of the record in this case raises some question as to the current severity of the veteran's service-connected epigastric (ventral) hernia. In that regard, the majority of the evidence currently on file is to the effect that the veteran's current gastrointestinal symptomatology is for the most part the result of a nonservice-connected hiatal hernia, as opposed to his service-connected epigastric hernia. At the time of a VA medical examination in September 1991, the veteran gave a history of abdominal bloating and distention, said to be the result of an esophageal-gastric hiatal hernia. According to the veteran, he had been placed on medication, and given instructions to eat smaller meals, with the result that, over the past year, he had experienced considerably less difficulty. Physical examination revealed only a possible diastasis recti with mild protrusion of the upper part of the abdomen. There were no abdominal masses, and no abdominal tenderness was in evidence. However, in a statement of September 1992, the veteran's private physician wrote that the veteran did, in fact, have an umbilical (that is, epigastric) hernia, for the control of which he utilized an umbilical hernia prosthesis (belt). Based on the aforementioned, it is clear that there currently exists a certain ambiguity as to the existence of an epigastric hernia. More specifically, VA examination findings, in conjunction with the results of recently performed upper gastrointestinal series, would appear to indicate that the veteran currently has no epigastric hernia. However, according to the veteran's private physician, the veteran does, indeed, have an epigastric hernia, for which he utilizes a prosthesis. At the hearing on appeal in August 1992, the veteran also testified that he could not hear well; that he had worn a hearing aid for the past three years; that he had difficulty breathing; and that his sinuses were obstructed. The veteran was last examined by the VA in 1991. In consideration of the holding of the United States Court of Veterans Appeals (Court) in Caffrey v. Brown, 6 Vet.App. 377 (1994), an updated examination should be conducted to determine the current status of the veteran's service-connected disabilities. In the Caffrey case, the Court determined that an examination conducted approximately two years before the Board decision was too remote to be contemporaneous. We note that the VA has a duty to assist the veteran in the development of all facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1993). The Court has held that this duty to assist the veteran in obtaining and developing available facts and evidence to support his claim includes obtaining adequate VA examinations, including examination by a specialist, when necessary. Littke v. Derwinski, 1 Vet.App. 90 (1990); Hyder v. Derwinski, 1 Vet.App. 221 (1991). Accordingly, in light of the aforementioned, the case is REMANDED to the RO for the following actions: 1. Any pertinent VA or other inpatient or outpatient treatment records, subsequent to September 1992, should be obtained and incorporated in the claims folder. This includes any records of treatment for the veteran's sinusitis, defective hearing, or epigastric hernia. The veteran should be requested to sign the necessary forms for release of any private medical records to the VA. 2. The veteran should then be afforded an additional VA medical examination, by a gastrointestinal specialist, if necessary, in order to more accurately determine the current severity of his service-connected epigastric (ventral) hernia. All pertinent symptoma- tology and findings should be reported in detail. The examiner should specifically comment as to the presence or absence of an epigastric hernia, and, if present, what if any symptomatology is attributable to that hernia, as opposed to the veteran's nonservice-connected hiatal hernia. The claims folder should be furnished to the examining physician prior to his evaluation in order to facilitate the study of the case. 3. The veteran should also be afforded an appropriate medical examination to determine the current status of his sinusitis. All indicated tests and studies should be accomplished. The veteran's claims folder should be made available to the examiner for study in the case. 4. The veteran should also be afforded an audiological examination to determine the current status of his defective hearing. All indicated tests and studies should be accomplished. The veteran's claims folder should be made available to the examiner for study in the case. Following completion of the above actions, the RO should review the evidence and determine whether the veteran's claim may now be granted. If not, the veteran and his representative should be provided with an appropriate supplemental statement of the case, and given an ample opportunity to respond. The case should then be returned to the Board for further appellate consideration. In this REMAND of the claim for further development, the Board does not intimate any opinion as to the ultimate determination warranted. No action is required of the appellant until he receives further notice. 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).