BVA9503700 DOCKET NO. 93-05 323 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Whether the application to reopen a claim of entitlement to service connection for right ear deafness is well grounded. 2. Entitlement to service connection for cardiovascular disease including hypertension. 3. Entitlement to service connection for multiple joint arthritis. 4. Entitlement to service connection for gout. 5. Entitlement to service connection for hepatitis with jaundice. 6. Entitlement to service connection for bilateral foot cramps. 7. Entitlement to service connection for cataracts. 8. Entitlement to an increased evaluation for postoperative recurrent dislocation of the left shoulder (minor), currently evaluated as 20 percent disabling. 9. Entitlement to an increased evaluation for chronic fibromyositis of lumbar paravertebral muscles, currently evaluated as 10 percent disabling. 10. Entitlement to an increased (compensable) evaluation for a lacerated wound of the inner canthus of the right eye. 11. Entitlement to an increased (compensable) evaluation for postoperative residuals of an appendectomy. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Ronald R. Bosch, Counsel INTRODUCTION The veteran served on active duty from November 1940 to November 1941 and from May 1942 to May 1961. The claims file contains a report of an April 1984 rating decision denying entitlement to service connection for right ear deafness on the basis of its not having been shown by the evidence of record. The veteran was notified of the foregoing determination and of his right to appeal it within one year by letter dated in April 1984. He did not timely file a notice of disagreement with the determination. The current appeal arose from an October 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The RO determined that new and material evidence had not been submitted to reopen a previously denied claim of entitlement to service connection for right ear deafness; denied entitlement to service connection for cardiovascular disease including hypertension claimed as bad circulation, multiple joint disease, gout, hepatitis with jaundice, bilateral foot cramps, and cataracts; and denied entitlement to increased evaluations for postoperative recurrent dislocation of the left shoulder, chronic fibromyositis of lumbar paravertebral muscles, a lacerated wound of the inner canthus of the right eye, and postoperative residuals of an appendectomy. In a May 1992 letter to the RO, the veteran made references to compensation benefits for an elbow disorder. This issue has neither been prepared nor certified for appellate review. The Board of Veterans' Appeals (Board) is referring this issue to the RO for appropriate action. REMAND A review of the service medical records discloses that when the veteran was examined for release from active duty in August 1959, his blood pressure was reported as 144/96. The heart and vascular system were reported as normal. The March 1961 retirement examination report shows blood pressure was 130/82. The physician's summary and elaboration of all pertinent data shows the veteran had had heart palpitations during the previous two years. He was told he had low blood pressure two weeks previously by a technician. The heart and vascular system were reported as normal. The claims file contains a letter from the veteran dated in July 1975 wherein he reported having received treatment for hypertension for five years, and for more than seven years for arthritis. An October 1975 VA examination conducted at the VA Medical Center in San Juan, Puerto Rico, shows the veteran reported receiving treatment for hypertension for the past two years at that medical facility. The medical records of treatment at this medical facility are not on file. The claims file contains medical records dated from August 1961 to June 1964 pertaining to the veteran's treatment at the Rodriguez United States Army Hospital in Fort Buchanan, Puerto Rico. Treatment reports at this medical facility renamed the United States Naval Hospital, Roosevelt Roads, Puerto Rico, are subsequently dated beginning in September 1974. It is not clear from the record where the veteran was receiving medical treatment during the ten year interval; furthermore, the possibility exists that there are additional treatment reports at this facility which have not been previously secured and associated with the claims file. The appellant was last formally examined by VA in August 1991. The orthopedic part of the examination contains rather limited clinical findings. Additionally, the appellant's appendectomy scar was not examined. The appellant has complained of pain and sensitivity relative to the appendectomy scar. The Board is of the opinion that association with the appellate record of the veteran's treatment reports from the VA Medical Center in San Juan, Puerto Rico, plus any additional reports pertaining to his treatment at the United States Naval Hospital in Roosevelt Roads, Puerto Rico, and contemporaneous examinations would materially assist in the adjudication of the appeal. Pursuant to VA's duty to assist the veteran in the development of facts pertinent to his claim under 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1994), the Board is deferring a final decision pending a REMAND of the case to the RO for further development as follows: 1. The RO should request and associate with the claims file photocopies of the complete records pertaining to the veteran's treatment at the VA Medical Center in San Juan, Puerto Rico; and at the United Stated States Naval Hospital in Roosevelt Roads, Puerto Rico. Attainment of records between 1964 and 1974 should be emphasized in the request for the treatment reports. 2. The RO should schedule the veteran for an orthopedic examination to determine the extent of severity of postoperative recurrent dislocation of the left shoulder, chronic fibromyositis of lumbar paravertebral muscles, and postoperative residuals of an appendectomy. The examination should be conducted in accordance with the diagnostic procedures outlined in Chapter 2 of the VA Physician's Guide for Disability Evaluation Examinations. All indicated studies should be conducted. The claims file must be made available to and reviewed by the examiner prior to the examination. 3. The RO should schedule the veteran for a cardiology examination to determine the nature and extent of any cardiovascular disease which may be present, and its etiology. The examination is to be conducted in accordance with the diagnostic procedures outlined in Chapter 6 of the VA Physician's Guide for Disability Evaluation Examinations. All indicated studies should be conducted. The examiner must be requested to provide an opinion as to the onset of any cardiovascular disease found on examination, and whether it is at least as likely as not that such disease was initially manifested during the veteran's service. Any opinion(s) expressed must be accompanied by a complete rationale. The claims file and obtained evidence must be made available to and reviewed by the examiner prior to the examination. 4. The RO should undertake any development deemed appropriate in addition to that specified above. If the benefits sought on appeal are not granted to the veteran's satisfaction, the RO should issue a supplemental statement of the case. A reasonable period of time for a response should be afforded. Thereafter, the case should be returned to the Board for further appellate review, if in order. By this REMAND, the Board intimates no opinion as to any final outcome warranted. 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).