BVA9503660 DOCKET NO. 93-09 813 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to an increased evaluation for rheumatoid arthritis with postoperative left forefoot deformity, evaluated as 60 percent disabling. 2. Entitlement to a total rating based on individual unemployability due to service-connected disabilities. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Alice A. Booher, Counsel INTRODUCTION The veteran had active service from January 1945 to December 1952. This appeal is from the rating action by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke in April 1991. REMAND Service connection is in effect for rheumatoid arthritis, rated 60 percent disabling, and for defective hearing, right ear, rated as 10 percent disabling. The veteran filed an Application for Increased Compensation Based on Unemployability (VA Form 21-8940) in March 1991. He stated that he had last worked full-time in July 1989. He had work experience as an offset pressman supervisor for a military base in England. At the time of the RO's April 1991 rating action confirming the prior schedular rating, the only additional clinical evidence in the file consisted of a report of the veteran's VA hospitalization in February 1991 after a stroke. After the veteran's representative filed a Notice of Disagreement in September 1991 in which he asked the RO to obtain additional VA treatment records, a Statement of the Case was issued in November 1991 again solely based on the February 1991 post- cerebrovascular accident report. In his VA Form 1-9, Substantive Appeal in November 1991, the veteran pointed out that he had been also treated by the VA for rheumatoid involvement of numerous joints including his ankles, knees, upper and lower spine; that he had developed stomach problems because of the medications for his arthritis; that he was scheduled for a VA orthopedic evaluation in December 1991; and that he could not work because of his disabilities. Some VA outpatient records were obtained for the period prior to January 1992, confirming among other things that the veteran was using Canadian crutches. A February 1992 VA upper gastrointestinal series showed no ulcer or gastrointestinal disorder. A VA examination in February 1992 indicated, in general, that the veteran had involvement of the cervical spine, the lumbosacral spine, and the sacroiliac joints. It is unclear from the record which arthritic impairment is due to rheumatoid arthritis as opposed to other forms of arthritis. The commander of a military base in Louisiana was sent a VA Form 21-4192 regarding the veteran's employment there. There was no response. Rating actions by the RO have not delineated which joints are evaluated at what degree of impairment, but rather the rating has been assigned for years as an aggregate under Code 5002. It is unclear to which joints the 60 percent rating applies or why, and some disabilities have also been designated as nonservice- connected on the basis that they are due to degenerative or traumatic arthritis, but the distinction is unclear. Since certification of the case to the Board of Veterans' Appeals (the Board), information added to the file has included a report of VA hospital admission in January 1993 for eye surgery. Also of record is a statement from the veteran in August 1993, to the effect that he had been hospitalized at least twice in May 1993, records from which are not in the file. Finally, the veteran's has a bilateral hearing loss, which is service-connected only in the right ear. Audiometric testing in March 1992, the results of which were uncertified, showed almost no discernible conversational voice range hearing acuity in either ear, with no response at virtually all frequencies in the right ear, and decibel losses from 80 to more than 100 in the left ear. The veteran has been issued hearing aids. The RO has not considered the veteran's evaluation for service-connected defective hearing in the right ear utilizing any revised provisions of the 38 C.F.R. § 4.85 (Code 6100-6110) (1994), and, if applicable, 38 C.F.R. § 3.383(a) (1994), relating to paired organs. This is clearly significant in the context of a total rating based on individual unemployability. Based on the evidence of record, the Board finds that additional development is required. The case is REMANDED for the following actions: 1. The veteran's complete VA outpatient and inpatient treatment records since May 1992 should be acquired and attached to the claims folder. 2. The veteran should be requested to provide any evidence he believes would be of benefit to his case including records of treatment by private physicians since 1992, and records of treatment for and medical opinions regarding alleged gastrointestinal problems secondary to medications for his arthritis, etc. He should also be requested to provide information concerning employment, i.e. statements from employers who have turned him down for work, jobs from which he has been discharged or not hired because of disability, etc. The RO should assist the veteran in the acquisition of all such records as required. 3. The veteran should be given orthopedic, neurological, rheumatologic and audiometric examinations. The orthopedist, neurologist, and rheumatologist should be requested to identify the joints affected by rheumatoid arthritis and provide the rationale for reaching such conclusions. The examinations must be done in accordance with pertinent regulatory criteria and guidelines. All necessary laboratory and other testing should be accomplished including X-ray studies of all joints in which the veteran alleges arthritic involvement. The audiometric test results should be certified in accordance with appropriate regulatory criteria. The claims folder and all evidence obtained pursuant to this REMAND, as well as a copy of this REMAND must be made available to each of the examiners prior to their examination of the veteran. 4. After completion of the above, the RO should review the case with regard to all evidence and pertinent regulatory criteria. In rating the veteran's service-connected rheumatoid arthritis, the RO must rate each joint involved, consider the nature of all applicable regulatory criteria, clearly indicate the basis for the assignment of the rating, and consider the bilateral factor, as applicable. With regard to the defective hearing question, the RO must review the case with regard to 38 C.F.R. § 4.85, and 38 C.F.R. § 3.383(a), if applicable. With regard to the issue of a total rating based on individual unemployability, all pertinent schedular and extraschedular criteria must be considered. If the decision remains unsatisfactory, a Supplemental Statement of the Case should be prepared, and the veteran and his representative should be afforded a reasonable opportunity to respond. Thereafter, the case should be returned to the Board for further appellate review. The veteran need do nothing further until so notified. RENÉE M. PELLETIER 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 (CONTINUED ON NEXT PAGE) 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).