BVA9502935 DOCKET NO. 93-11 573 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Denver, Colorado THE ISSUES 1. Entitlement to service connection for bilateral carpal tunnel syndrome. 2. Entitlement to service connection for a right knee disorder. 3. Entitlement to service connection for a back disorder. 4. Entitlement to an increased (compensable) evaluation for a chondromalacia, left knee. 5. Entitlement to an increased (compensable) evaluation for tendinitis, bursitis, right shoulder. 6. Entitlement to an increased (compensable) evaluation for tendinitis, bursitis, left shoulder. 7. Entitlement to an increased (compensable) evaluation for sinusitis. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Alice A. Booher, Counsel INTRODUCTION The veteran had active service from August 1978 to August 1990. This appeal is from rating actions by the Department of Veterans Affairs (VA) Regional office (RO) in Denver, Colorado, in 1991. In s recent statement, the veteran raised the issue of secondary service connection for back and neck disorders and headaches. This matter is referred to the RO for consideration. REMAND Service medical records show recurrent complaints relating to both knees and the back, with and without apparent trauma. In November and December 1987, after complaints of wrist pain, a diagnosis of carpal tunnel syndrome was made, mild on the left and borderline on the right, reportedly based on an electromyogram (EMG). The veteran indicated at the time of a 1991 VA examination that he had recently received treatment for sinus and bilateral shoulder problems at a military facility; however, the records of treatment are not in the file. The veteran has also argued that he has continued to have the same symptoms since service and that inservice diagnoses have been confirmed since service, including carpal tunnel syndrome by EMG at Fitzsimmons Army Medical Center (AMC). Subsequent to forwarding of the case to the Board of Veterans' Appeals (the Board), the veteran submitted additional medical evidence showing, in part, post-service, work related injuries to his right shoulder. This evidence was forwarded by the RO to the Board. Evidence submitted by the veteran which is accepted by the Board, must be referred to the RO for review and preparation of a supplemental statement of the case unless this procedural right is waived by the veteran. Since such waiver was not executed, this evidence must be referred back to the RO. 38 C.F.R. § 20.1304(c) (1993). The veteran's representative, Disabled American Veterans, has also argued that an additional examination is warranted to include specialized testing. Based on the evidence of record, the case is REMANDED for the following actions: 1. The veteran should be allowed to submit or identify any additional evidence in support of his claim, such as medical evidence of treatment or evaluation of the disabilities at issue. The RO should assist him in obtaining identified evidence. 2. Copies of the veteran's complete medical records, including EMG studies, if any, from Fitzsimmons AMC since separation from service should be acquired and attached to the claims folder. 3. With the veteran's consent, the RO should obtain copies of his medical records from Dr. Y. S. Frantovic, by whom he was seen after an October 1992 work related injury. Any available medical records created prior to and since the injury should be requested. 4. With the veteran's consent, the Porter Memorial Hospital, where the veteran was employed when he sustained one or more work related injuries in October 1992, should be requested to provide copies of any medical records and related documents regarding all on-the-job injuries, including those sustained on October 5, 1992. 5. The veteran should be given a comprehensive VA orthopedic examination, by an orthopedist who has not previously examined him, to determine the status and manifestations of his service-connected bilateral shoulder tendinitis/bursitis and left knee chondromalacia. Range of motion of the joints should be reported in degrees of arc. The examiner should also determine whether the veteran has a back or right knee disorder and, if so, its nature and etiology. A separate copy of this remand and the claims folder must be made available to the examiner prior to the examination. Any indicated diagnostic tests should be accomplished. After reviewing the evidence, including medical evidence of work related right shoulder injuries and the "past history" noted in Dr. Berk's December 4, 1992, examination report, the examiner should express an opinion as to which aspects and manifestations of the overall right shoulder disability are related to the service-connected tendinitis/bursitis and which are the result of post-service, work- related injuries. If a distinction can not be made, the examiner should so state. The examiner should also determine whether the veteran has carpal tunnel syndrome of either upper extremity, and if deemed necessary for a definitive diagnosis, should refer the veteran for a neurologic examination. If indicated, electrodiagnostic testing should be accomplished. The claims folder and a separate copy of this remand must be made available to the examiner prior to the examination. 6. When the veteran was last examined by the VA, he was noted to have a history of generalized joint aches and a question of fibromyalgia rheumatica. At that time, instructions were given that he was to be examined to determine whether he had some type of systemic disease such as rheumatoid arthritis or osteoarthritis. It does not appear that this was done. Consequently, he should be examined by a rheumatologist to determine whether he has a systemic disease affecting his joints and, if so, its nature, manifestations and etiology. The claims folder and a separate copy of this remand must be made available to the rheumatologist prior to the examination. All indicated diagnostic studies should be performed. 7. Finally, the veteran should be examined by an otolaryngologist to determine the status and manifestations of his sinusitis. 8. After completion of the above, the case should be reviewed and readjudicated by the RO based on all of the evidence of record. If there is an issue of entitlement to service connection for a systemic disease manifested by joint problems, that issue should be adjuducated since it could be intertwined with issues on appeal. The veteran should be advised of the need to file a notice of disagreement with any issue not previously adjudicated. If any benefit remains denied, a supplemental statement of the case should be prepared and the veteran and his representative should be afforded the opportunity to respond. The case should then be returned to the Board for further appellate review. The veteran need do nothing further until so notified. JANE E. SHARP 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).