BVA9507394 DOCKET NO. 92-05 606 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for cirrhosis of the liver. 2. Entitlement to service connection for the residuals of a right cerebrovascular accident. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD W. H. Wetmore, Counsel INTRODUCTION The veteran served on active duty from October 1948 to July 1952, from December 1957 to December 1960 and from February 1961 to February 1965. The Board of Veterans' Appeals (Board) initially received this case on appeal from an October 1989 RO rating decision. The issues accepted for appellate jurisdiction, in addition to those set forth on the front page of this determination, were entitlement to service connection for lumbar disc disease with radiculopathy and arthritis, an increased evaluation for low back strain and a total rating based on individual unemployability due to service connected disabilities. These three benefits were granted in a June 1993 RO rating decision, which assigned a 60 percent evaluation for the service-connected back disability to include disc disease and a total rating. Accordingly, appellate consideration is limited to the two issues set forth on the front page of this decision. During the course of the pending appeal, the veteran has raised the issues of service connection for tinnitus and a hernia, the latter under the provisions of 38 U.S.C.A. § 1151 (West 1991). These matters are referred to the RO for action deemed appropriate. REMAND The Board requested, in its December 1992 remand, further development of the record, to include an examination in order to determine if the veteran had residuals of a cerebrovascular accident and an opinion as to whether any such residuals were related to his service-connected hypertensive vascular disease. The examiner in December 1992 is not shown to be a cardiologist, as was requested, although the examination appears to be limited to heart disease. The examiner concluded his report by requesting an echocardiogram, followed by another appointment with the veteran and final comments. The results of a current echocardiogram are not of record, and the "comments" after such an examination have not been associated with the record. While holding a decision with respect to the claim for service connection for cirrhosis of the liver in abeyance, the Board believes that further development of the record with respect to the claim for service connection for the residuals of a cerebrovascular accident is desirable. Accordingly, the case is REMANDED for the following; 1. Complete copies of VA neurologic and cardiovascular treatment records since December 1992 should be associated with the claims files. Also, the complete original clinical records pertaining to VA hospitalization afforded the veteran in January 1988, a period identified by the veteran's representative in a June 1992 statement as the time when the veteran sustained a cerebrovascular accident as an "unnecesary" consequence of the treatment he underwent, should be obtained and associated with the claims files. (This raises an issue of the applicability of 38 U.S.C.A. § 1151 (West 1991)). 2. After completion of the above, the veteran should be scheduled for an examination by a cardiologist who has reviewed the claims files in order to determine if the veteran sustained a cerebrovascular accident. (The Board notes that opinions that such an event occurred are contained in the reports of physicians who examined the veteran in November and December 1990, with the latter opining that the veteran had "signs of left cerebral dysfunction secondary to a right cerebral infarct that he probably sustained postoperatively in 1988....") All indicated studies should be undertaken. The Board notes that an echocardiogram was to be scheduled for the veteran in December 1992, but there is no indication that it was performed. The examiner should offer an opinion as to whether the veteran did sustain a cerebrovascular accident, whether there are any current residuals thereof and, if so, whether they are related to any service-connected disability, including hypertensive cardiovascular disease. Also, the examiner should specifically offer an opinion as to the medical probability that any cerebrovascular accident which may have been sustained in January 1988 during the period of VA hospitalization was certain to result from or an intended consequence of the treatment afforded the veteran during January 1988. Any consultation deemed appropriate should be undertaken to establish the presence or absence of this claimed disability. 2. The veteran should be examined by a neurologist, who has reviewed the claims files, to determine if the falls the veteran complained of are related to any neurologic impairment. Such an examination was requested by the examiner in December 1992. This examiner should correlate the conclusions reached with the cardiologist who examined the veteran, in order to determine the medical probability that the "falls" are due to a separate and distinct neurologic disorder or related to any cardiovascular disorder in any manner. 3. The RO should take adjudicatory action based on the evidence obtained pursuant to the development sought above. The RO should specifically consider the new regulations pertaining to claims under the provisions of 38 U.S.C.A. § 1151 (West 1991), found at 60 Fed. Reg. 14,223 (1995) (to be codified at 38 C.F.R. § 3.358). If the benefits sought by the veteran are not granted, a supplemental statement of the case should be prepared. After the veteran and his representative have been given an opportunity to respond to the supplemental statement of the case, the claims folder should be returned to the Board for further appellate review, if in order. No action is required by the veteran until he receives further notice. The purpose of the remand is to procure clarifying data and to comply with governing adjudicative procedures. The Board intimates no opinion, either legal or factual, as to the ultimate disposition of this appeal. BARBARA B. COPELAND 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).