BVA9505192 DOCKET NO. 93-08 891 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Anchorage, Alaska THE ISSUES 1. Entitlement to service connection for cervical disc disease. 2. Entitlement to service connection for low back disability. 3. Entitlement to service connection for chronic sinusitis. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Alan S. Peevy, Associate Counsel INTRODUCTION The veteran had active military service from February 1977 to July 1988. This case is before the Board of Veterans' Appeals (Board) on appeal from a February 1992 rating decision by the Anchorage, Alaska, Regional Office (RO). A notice of disagreement was received in April 1992, and a statement of the case was issued in June 1992. The veteran appeared at a personal hearing at the RO in August 1992, and his substantive appeal was received in January 1993. The veteran is represented by the Disabled American Veterans. The Board notes that the veteran's notice of disagreement also initiated an appeal on the issue of entitlement to service connection for an ingrown toenail. However, the veteran withdrew this issue at the time of the August 1992 personal hearing, and that issue is therefore not in appellate status. The Board further observes that the veteran indicated in his April 1992 notice of disagreement that he wished to amend his claim to include "chronic headaches," and testimony offered at the August 1992 included references to migraine headaches. This additional issue is not intertwined with the issues currently certified on appeal. Harris v. Derwinski, 1 Vet.App. 180 (1991). Accordingly, the issue of entitlement to service connection for migraine headaches is referred to the RO for appropriate development and adjudication. REMAND A review of the veteran's service medical records reveals that the veteran was seen for complaints of low back pain in 1981, sinus related complaints in 1982, and complaints related to a stiff neck in 1984. The veteran's service connection claims related to these disabilities have been denied based on the RO's finding that the inservice complaints were acute and transitory in nature as shown by the lack of continuity of pertinent symptomatology since service. Department of Veterans Affairs (VA) medical examinations in October 1991 resulted in reported impressions of degenerative disc disease of the cervical spine, chronic rhinitis and sinusitis and history of intermittent back pain, exact etiology uncertain. At the August 1992 personal hearing, the veteran offered sworn testimony to the effect that he continued having symptoms related to all three disorders during service, but that he was hesitant to seek medical attention since he felt it was frowned on by his superiors. During the course of the hearing, the veteran's representative requested a special examination for the purpose of ascertaining the etiology of the claimed disorders. The VA is charged with the statutory duty to assist the veteran with the development of evidence in connection with his claim. 38 U.S.C.A. § 5107(a) (West 1991). The United States Court of Veterans Appeals (Court) has held that this duty includes adequate VA medical examinations. Littke v. Derwinski, 1 Vet.App. 90 (1990). Additionally, although the appellant may testify as to symptoms he perceives to be manifestations of disability, the question of whether a chronic disability exists is one which requires skill in diagnosis, and questions involving diagnostic skills must be made by medical experts. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). The Board believes it significant in the present case that the veteran filed his application for service connection for certain of the disabilities at issue just one month after his discharge from service. He has testified that he has suffered symptomatology related to the claimed disorders since their onset during service, and post-service VA medical examinations suggest that he may suffer from certain of the claimed chronic disabilities. Under the circumstances, the Board believes that medical clarification regarding the nature and etiology of the disabilities at issue is necessary in order to meet the duty to assist the veteran and to comply with the Court's jurisprudence. Accordingly, the case is hereby REMANDED to the RO for the following actions: 1. The veteran should be scheduled for a VA medical examination by an orthopedic specialist and an ear, nose and throat specialist for the purpose of ascertaining the nature and etiology of any low back disability, cervical spine disability and sinus disability. It is imperative that the claims file be made available to the examiners for review in connection with the examination. All indicated tests, including radiological studies if deemed medically appropriate, should be accomplished. The orthopedic examiner should clearly indicate whether or not the veteran suffers from any chronic disorders of the cervical spine and low back and, if so, the orthopedic examiner should state an opinion as to whether any current cervical spine and low back disabilities are related to the low back and cervical spine complaints noted in service. A detailed rationale should be provided for the examiner's opinion(s). The ear, nose and throat examiner should clearly indicate whether the veteran suffers from sinus disability and, if so, the examiner should state an opinion as to whether it is related to any sinus complaints noted during service. A detailed rationale should also be provided for this examiner's opinion(s). 2. After completion of the above, the RO should review the augmented claims file and determine whether the benefits sought by the veteran can be granted. If the RO's determination as to any issue remains adverse to the veteran, then the veteran and his representative should be furnished a supplemental statement of the case setting forth a summary of the evidence, a citation to and discussion of applicable laws and regulations, and a detailed analysis of the reasons for the RO's determination(s). After affording the veteran and his representative a reasonable opportunity to respond, the case should be returned to the Board for further appellate review. The purpose of this decision is to assist the veteran and to ensure an adequate medical record for appellate review. The Board intimates no opinions as to the eventual determinations to be made in this case. 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) (1994).