BVA9504383 
DOCKET NO.  93-09 040     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs (VA) Regional Office (RO)
in San Francisco, California

THE ISSUE

Entitlement to service connection for sleep apnea.

REPRESENTATION

Appellant represented by: AMVETS

ATTORNEY FOR THE BOARD

Ripley P. Schoenberger, Counsel

INTRODUCTION

The veteran had active duty from November 1952 to November 1956.

This appeal arises from a July 1991 rating decision by the
Department of Veterans Affairs (VA) Regional Office (RO) in San
Francisco, California.

In their May 1993 Informal Hearing Presentation the
representative raised the issue of entitlement to service
connection for spinal stenosis.  However, this issue was not
developed and certified for appellate review.  Thus, the Board of
Veterans' Appeals (Board) does not have jurisdiction.  The issue
is referred to the RO for appropriate action.

REMAND

Service connection has been established for the residuals of a
tonsillectomy, evaluated as zero percent disabling.  The veteran
claims that the residuals of the tonsillectomy caused him to
develop sleep apnea.  In December 1990, and November 1991,
letters Vincent P. Zarcone, Jr., M.D., identified as a professor
of psychiatry and VA employee, stated that in his professional
opinion the post operative complication of the tonsillectomy
caused the veteran's seep apnea.  However, following a February
1992 VA Ear Nose and Throat examination, the impression was no
service connection as to the cause of sleep apnea.

Complete copies of Dr. Zarcone's office notes, have not been
associated with the claims folder.  Moreover, it is not clear if
the VA examiner reviewed the claims folder prior to the February
1992 examination.

To ensure that the VA has met its duty to assist the claimant in
developing the facts pertinent to the claim and to ensure full
compliance with due process requirements, the case is REMANDED to
the RO for the following development:

1.  The RO should take appropriate steps to
secure copies of Dr. Zarcone's office
notes.  After copies of the office notes
have been secured, they should be
associated with the claims folder.

2.  The veteran should be afforded a VA Ear
Nose and Throat examination to determine
the ethology of sleep apnea.  Any indicated
testing should be done in this regard.  The
claims folder should be made available to
the examiner for review before the
examination.  Based on the results of the
examination and a review of the claims
folder the examiner is requested to render
an opinion as to the medical probability
that complications from the service
connected residuals of a tonsillectomy
caused the veteran to develop sleep apnea.
The opinion should include a full
explanation for the conclusions reached.

3.  After the development requested above
has been completed the RO should again
review the record.  If the benefit sought
on appeal remains denied, the appellant and
his representative should be furnished a
supplemental statement of the case and
given the opportunity to respond thereto.

Thereafter, the case should be returned to the Board, if in
order.  The Board intimates no opinion as to the ultimate outcome
of this case.  The appellant need take no action unless otherwise
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) (1993).