BVA9504013 DOCKET NO. 92-53 288 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for a left shoulder disorder. 2. Entitlement to service connection for disabilities of the cervical, thoracic and lumbar spine. 3. Entitlement to service connection for a left hand disorder. 4. Entitlement to service connection for left leg spasms. 5. Entitlement to service connection for abdominal spasms. 6. Entitlement to service connection for residuals of a left chest injury. 7. Entitlement to service connection for enterobiasis. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL The appellant and his wife ATTORNEY FOR THE BOARD William J. Jefferson, Counsel INTRODUCTION The appellant had periods of active duty for training in the Missouri Army National Guard from February 1957 until March 1989. This case comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) St. Louis, Missouri Regional Office (RO). A rating decision dated in July 1990, denied service connection for a disability of the left shoulder, cervical, thoracic and lumbar spine disorders, a left hand condition, a left leg condition, abdominal spasms, and residuals of a left chest injury. A personal hearing was held at the RO in May 1991. At that time, the issue of entitlement to service connection for enterobiasis was raised. Pursuant to the hearing officer's decision, an August 1991 rating decision denied service connection for enterobiasis. In July 1993, the case was remanded for verification of the appellant's National Guard duty and for all National Guard medical records. The appellant was also afforded a physical examination. REMAND The appellant has argued that all of the conditions for which service connection is claimed (except for enterobiasis) were related to an incident which occurred while he was on active duty for training in July 1988. The official record shows that the appellant was awakened with back and leg spasms after loading and unloading equipment at annual training in July 1988. Subsequent medical entries in July 1988 include back pain radiating down the right leg, muscles spasms of the left groin and leg, and muscle spasms radiating down the left leg. In August 1988, the assessment was improving sciatica. X-rays showed moderate spondylosis. There are subsequent medical and chiropractic diagnoses which include fibromyalgia, muscle spasms, degenerative joint disease, cervical disc disease, lumbar disc disease, chest pain apparently musculoskeletal in etiology and chronic muscle spasms-anxiety. It should be noted that the record includes references to low back pain in 1984, to back disability in 1987 and to chiropractic treatment for a condition characterized as thoracic outlet syndrome beginning in 1986. It should also be noted that according to V. Flippen, a chiropractor, the appellant sustained intercurrent injury involving the neck, upper back and lower back in June 1989. The Board is of the opinion that clarification as to the nature and etiology of current neck, low back and upper back pathology is necessary in this case. Additional medical evidence as to the nature of disorders of the left shoulder, left hand, left leg abdomen and left chest is also necessary. In addition, all treatment records from the Potosi Chiropractic Life Center should be obtained. The appellant has been treated at this chiropractic facility for many years. Finally, the appellant should be requested to provide information regarding treatment for his spine prior to July 1988. In consideration of the foregoing, this case is REMANDED to the RO for the following: 1. The RO should contact the veteran so that he may provide information indicating treatment that he has had for his spine prior to July 1988; after obtaining authorization from the veteran, the RO should obtain copies of those records. 2. After obtaining authorization from the veteran, the RO should obtain copies of his complete treatment records from Joseph B. Huck, D.C., Potosi Chiropractic Life Center, 502 North Missouri Street, Potosi, Missouri 63664, and associate those records with the claims folder. 3. The veteran should be afforded a VA orthopedic examination. All appropriate tests and studies should be performed. The examiner is requested to review the file and offer an opinion on the following questions: (1) what is the nature of disorders of the left shoulder, cervical, lumbar and thoracic spine, left hand, left chest and disorder causing left leg spasms and abdominal spasms, if any; (2) is it as likely as not that any of these disorders was caused by the aforementioned incident which occurred while the appellant was on active training in July 1988; and (3) if any of the spine disorders was present prior to July 1988, is it as likely as not that there was increase in severity beyond the natural progress of the particular condition as a result of the lifting incident during active training in July 1988. The reasoning which forms the basis of the opinions should be set forth. The claims folder and a copy of this remand must be made available to the examiner, prior to the examination, for use in the study of the case. When the requested development has been accomplished, if the claim remains in a denied status, the appellant and his representative should be furnished with a supplemental statement of the case and afforded a reasonable opportunity to respond thereto. Thereafter, if necessary, the case and the requested evidentiary data should be returned to the Board of Veterans' Appeals for further appellate disposition. NANCY I. PHILLIPS 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).