BVA9501296 
DOCKET NO.  91-12 149     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Waco, Texas

THE ISSUES

Entitlement to service connection for vertigo.

Entitlement to a rating in excess of 10 percent for lumbar spine
strain with degenerative disc disease.

Entitlement to an increased (compensable) evaluation for
arthritis of the lower thoracic spine.

Entitlement to an increased (compensable) evaluation for
defective hearing in the left ear.

Entitlement to an increased (compensable) evaluation for chronic
sinusitis.

REPRESENTATION

Appellant represented by: AMVETS

ATTORNEY FOR THE BOARD

P. Gutstein, Counsel

INTRODUCTION

The veteran served on active duty from September 1964 to May
1990.

This matter came before the Board of Veterans' Appeals (Board) on
an appeal from the October 1990 rating decision of the Department
of Veterans Affairs (VA), Waco, Texas, Regional Office (RO) which
granted service connection and assigned a 10 percent evaluation
for right orchiectomy, granted service connection and established
noncompensable evaluations for arthritic changes of the lower
thoracic spine, residuals of injury to the left fifth finger
(minor), residuals, sprain, lumbar spine, residuals, fracture,
left little toe, hearing loss, left ear and chronic sinus
infections.  That rating decision also denied service connection
for a right knee disability, a right foot disability, residuals
of injury to the right ring finger, exotropia, hearing loss of
the right ear, residuals of viral vertigo and hemorrhoids.  The
veteran was also awarded special monthly compensation on account
of loss of use of a creative organ.  A notice of disagreement was
filed by the veteran in November 1990 as to the denial of service
connection for vertigo, cellulitis of the right foot, hemorrhoids
and injury to the right ring finger; and as to the assignment of
the ratings for service-connected arthritic changes of the lower
thoracic spine, sprain of the lumbar spine, hearing loss of the
left ear and sinus infection.  He was furnished a statement of
the case in November 1990 and he filed a substantive appeal in
January 1991.

In a decision of June 1992, the Board granted service connection
for a right foot scar and for a disability of the right ring
finger as a result of an injury.  The case was remanded on the
other issues.  By rating decision of September 1992, the RO
assigned a 10 percent for residuals of injury to the right ring
finger with degenerative joint disease (major) and assigned a
noncompensable evaluation for scar, residuals, cellulitis of the
right foot.  The veteran did not appeal the evaluations assigned
in the September 1992 rating action.  In a February 1993 rating
action, the RO increased the evaluation for lumbar spine strain
with degenerative disc disease to 10 percent.

By decision of February 1994, the Board granted service
connection for chronic hemorrhoids and remanded the other issues
in appellate status.  The veteran has not filed a notice of
disagreement to the evaluation assigned for hemorrhoids and that
issue is not in appellate status.  Service connection was also
granted in the May 1994 rating action for degenerative disc
disease of the lumbar spine and it was rated together with the
lumbar strain, a 10 percent evaluation being assigned for that
disability from June 1990.  Service connection was denied for
exotropia, and the VA Form 1-646 of the veteran's representative
filed in August 1994 constituted a notice of disagreement from
that determination.  However, there is a final October 1990
rating action denying service connection for exotropia.
Therefore, the issue should be whether new and material evidence
has been submitted to reopen the veteran's claim for service
connection for exotropia and, if so, whether all the evidence,
both old and new, warrants service connection.  Thus the veteran
should be furnished a statement of the case on that issue and
furnished notice regarding the necessity of filing a substantive
appeal.  This matter is referred to the RO for appropriate
action.

The veteran is represented in his appeal by AMVETS, which has
submitted written argument in his behalf.

REMAND

In his September 1994 written argument, the veteran's
representative has taken exception to the development undertaken
by the RO pursuant to instructions of the Board's February 1994
remand.  Although VA examinations were conducted in March 1994,
pursuant to the Board's instruction, the findings by the
specialists in otolaryngology and in ophthalmology were not
coordinated in order to determine a possible etiology for the
veteran's claimed vertigo.  The Board also notes that in the
March 1994 report of the ear, nose and throat specialist, he
advised, "Consider ENG, doubt Menieres but this is possible."
Therefore, it will have to be determined by the examining
specialists whether there are additional tests that should be
conducted in conjunction with the examination.

The veteran's representative noted that range of motion studies
of the lumbar and thoracic spine were not reported.  He also
objected to the quality of the examination to evaluate the
sinusitis as not having been done by a specialist.

The veteran's representative has also raised the issue of
entitlement to service connection for degenerative disc disease
of the cervical spine as secondary to service-connected
disabilities of the lumbar and thoracic spine.  The veteran is
therefore entitled to an adjudication on that issue.

In order to comply with the provisions of 38 U.S.C.A. § 5107(a)
(West 1991), which mandate that we assist the veteran in the
development of his claim, appellate action is again deferred and
the case is REMANDED for the following action:

          1.  Treatment records of the veteran
subsequent to December 1991 should be
requested by the RO from the Carswell Air
Force Base, Texas.

          2.  The RO should have the veteran examined
by a panel consisting of a specialist in
otolaryngology and a specialist in
ophthalmology for the purpose of determining
a possible etiology for the veteran's
claimed vertigo.  The specialist in
otolaryngology should also determine the
extent of the veteran's sinusitis.  The
claims file should be made available to the
specialists who should obtain any necessary
tests indicated.  In this regard, their
attention is directed to the March 30, 1994,
report of a VA ear, nose and throat
specialist.

          3.  The RO should schedule the veteran for
an examination by an orthopedist to
determine the extent and severity of the
veteran's disabilities of the thoracic and
lumbar spine.  The claims file should be
made available to the examiner in connection
with the study of the case, and the
examination report should contain range of
motion findings by degrees.  Any indicated
tests should be conducted in connection with
this  examination.

          4.  The RO should review the case and an
adjudication should be made on the issue of
entitlement to service connection for
degenerative disc disease of the cervical
spine as secondary to service-connected
disability and the veteran should be
notified of the results and if the results
are adverse he should be furnished his
appellate rights.

          5.  The RO should review the issues shown on
the front page of this remand and if the
decision(s) is adverse the veteran and his
representative should be furnished a
supplemental statement of the case on any
issues on which  adverse action is taken or
continued, and they should be given an
opportunity to respond thereto.

The case should then be returned to the Board for final appellate
review on all issues in appellate status plus any additional
issues which conform to the provisions of 38 U.S.C.A. § 7105
(West 1991).  The Board intimates no opinion at this time, nor is
any action required of the veteran until he is notified.

          E. M. KRENZER
          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).