BVA9506144 DOCKET NO. 93-13 283 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to service connection for a bilateral leg disorder characterized by numbness, claimed as secondary to service-connected back disability. 2. Entitlement to an increased evaluation for residuals, lumbosacral spine injury, currently evaluated as 20 percent disabling. 3. Entitlement to an increased evaluation for neurogenic bladder, currently evaluated as 10 percent disabling. 4. Entitlement to an increased evaluation for bowel impairment, currently evaluated as 10 percent disabling. 5. Entitlement to an increased (compensable) evaluation for impotence. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. ATTORNEY FOR THE BOARD Alice A. Booher, Counsel INTRODUCTION The appellant had periods of active and inactive duty for training in the 1980's with the Ohio Army National Guard. He injured his back in a jeep accident in October 1982 while serving on inactive duty for training which was determined to have been in line of duty. A Board of Veterans' Appeals (the Board) decision in July 1990 granted service connection for residuals of a low back injury. Since then, the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio, has granted service connection for additional disabilities secondary to the low back injury to include neurogenic bladder, bowel impairment and impotence. This appeal is taken from rating actions by the RO in May and August 1991, and February 1992. In the most recent presentation by the appellant's representative, Paralyzed Veterans of America, Inc., dated in September 1993, additional issues were raised of entitlement to service connection for an acquired psychiatric disorder and a total rating based on individual unemployability due to service- connected disabilities, neither of which has been developed for appellate review. They are not inextricably intertwined with the other appellate issues, but the attention of the RO is drawn to these issues for appropriate consideration. REMAND Private treatment records are in the file from prior to the Board's grant of service connection for the residuals of back injury. The most recent VA outpatient records in the file appear to be from 1991. The appellant underwent a VA orthopedic evaluation in May 1992 at which time the appellant reported that he had been told that there was nonunion from a 1986 surgical decompression laminectomy and fusion. The examiner noted the appellant's history of radiation into his lower extremities as well as bowel, bladder and alleged sexual dysfunction. The primary clinical records relating to neurogenic bladder and [neurogenic] bowel complaints are dated from 1982-1986 when he was evaluated by various private physicians; they are dated prior to his back surgery. No clinical evidence is of record relating to the impotence. Report of the May 1992 VA neurologic evaluation does not adequately assess the appellant's neurogenic bladder, bowel dysfunction and/or impotence. The appellant's representative reports that additional records are available from Wade Park VA facility where the appellant is seen on a regular basis, including results of Magnetic Resonance Imaging (MRI); and that these are crucial to the appellant's claim and should be acquired and reviewed. It is also noted that while additional clinical records were added to the file in May 1993 which, according to the appellant's representative, reflect care by the appellant's Health Maintenance Organization (HMO), the RO did not review these records in connection with his claim. Based on the evidence of record, the Board finds that additional development is required. The case is REMANDED for the following actions: 1. The appellant's complete, up-to-date VA outpatient and inpatient clinical records from Wade Park, Brecksville, and Cleveland medical facilities since 1991 should be obtained and attached to the claims folder. 2. The appellant should then be given comprehensive VA examination, in accordance with the VA Physician's Guide for Rating Disability Evaluations, to determine the exact nature and extent of the neurogenic bladder, bowel dysfunction and impotence. All necessary laboratory and other tests must be conducted and the results associated with the claims file. The claims folder including all evidence obtained pursuant to this REMAND must be made available to the examiner prior to evaluation of the appellant's case. The examiner should specify the degree of voiding dysfunction and particularly the amount of retention, if any, and the necessity and frequency of catheter usage. 3. The case should then be reviewed by the RO. If the decision remains unsatisfactory, a Supplemental Statement of the Case should be prepared including a discussion of current criteria used in evaluating neurogenic bladder, and the appellant and his representative should be afforded a reasonable opportunity to respond. The case should then be returned to the Board for further appellate review. The appellant need do nothing further until so notified. THOMAS J. DANNAHER 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).