BVA9502542 DOCKET NO. 92-08 177 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Boston, Massachusetts THE ISSUES 1. Entitlement to service connection for left knee disability. 2. Entitlement to an increased rating for bilateral varicose veins, currently assigned a 30 percent disability evaluation. 3. Entitlement to a total disability evaluation by reason of unemployability due to service-connected disabilities. WITNESS AT HEARING ON APPEAL The appellant ATTORNEY FOR THE BOARD P. H. Mathis, Counsel REMAND The veteran had active service from October 1974 to February 1977. This appeal comes before the Board of Veterans' Appeals (Board) on appeal of rating decisions by the Boston, Massachusetts, Regional Office (RO) of the Department of Veterans Affairs (VA). The record reflects that the veteran has been granted disability benefits by the Social Security Administration; however, copies of the records upon which the award was based have not been obtained. Moreover, private and VA treatment records pertinent to the veteran's claims have not been secured. The Board also notes that the report of an August 1993 VA examination of the veteran's left knee reflects that the veteran was scheduled for an X-ray of his knee on the day of the examination, and that further comment was deferred until after review of the X-ray findings. Neither the report of the X-ray nor further comment by the examiner is of record. The report of a VA peripheral vascular examination in September 1993 includes a diagnosis of questionable infection of the feet, but there is no further report of investigation of this. The examiner also reported that he had drawn diagrams to demonstrate the anterior and posterior delineation of the varicose veins, but no diagrams are included with the examination report. The Board further notes that the veteran claims that incisional scars in his groin from surgery for his varicose veins are very tender. The veteran has not been provided a recent VA dermatology examination. Finally, the Board notes that the veteran appears in his correspondence of January 1991 to be raising the issues of entitlement to secondary service connection for headaches and disability manifested by dizziness. These issues have not been addressed by the RO. In view of the foregoing, the Board concludes that further development, as specified below, is warranted. Accordingly, the case is REMANDED to the RO for the following actions: 1. The RO should obtain a copy of the records upon which the veteran's award of Social Security Administration disability benefits was based. The RO should also request a copy of any subsequent decision related to the disability claim. 2. The RO should obtain the complete report of the VA examination on August 26, 1993, including the report of any X-rays and/or subsequent comments by the examiner, if available, and the drawn diagrams reportedly made by the examiner during the examination on September 27, 1993. 3. The RO should contact the veteran and request that he identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who have treated him at any time since service discharge for headaches, left knee disability, or disability manifested by dizziness or have treated him in recent years for any currently service-connected disability. With any necessary authorization from the veteran, the RO should attempt to obtain copies of pertinent treatment records identified by the veteran, which have not been previously secured, and associate them with the claims folder. The records requested should include those of Mark B. Bown, M.D. In any event, the RO should obtain copies of all VA treatment records which have not previously been secured. 4. Then, the RO should arrange for examination of the veteran by a board certified dermatologist, if available, who should determine the nature and extent of any infection of the feet, to include an assessment of whether it is related to the service-connected varicose veins, or is a separate disability. He should also identify and describe the incisional scars from the veteran's vascular surgeries, to specifically include any tenderness, ulceration or other symptom associated with the scars. All indicated studies should be performed. It is imperative that a copy of this Remand and the veteran's claims file be made available to the examiner prior to the examination. 5. The RO should also arrange for VA orthopedic, neurology, and vascular examinations of the veteran by appropriate board certified specialists, if available. The orthopedist should determine the nature and extent of any left knee disability present. The orthopedist should examine the veteran, review the record, and provide an opinion, with complete rationale, as to the etiology of any left knee disability, to include whether it is at least as likely as not that it is etiologically related to the left knee symptoms noted during service or to the service-connected varicose veins with peripheral neuropathy. The vascular specialist should determine the nature and extent of the varicose veins, to include examination of the veteran's deep circulatory system. The neurologist should determine the current nature and extent of the bilateral saphenous and sural neuropathy. All indicated studies should be performed. The examiners are requested to correlate their findings. The neurologist and vascular specialist should comment on the impact of the service- connected disabilities on the veteran's employability. The rationale for all opinions expressed should be explained. It is imperative that a copy of this Remand and the veteran's claims file be made available to the examiners prior to the examinations. 6. Thereafter, the RO should undertake any other indicated development, readjudicate the issues currently certified on appeal and adjudicate the claims for service connection for headaches and disability manifested by dizziness. In readjudicating the increased evaluation issue, the RO should consider Esteban v. Brown, No. 92-693 (U.S. Vet.App. Feb. 25, 1994) and determine whether the incisional scars from the vascular surgeries warrant separate evaluation. If the benefits sought on appeal are not granted to the appellant's satisfaction or if a timely Notice of Disagreement is received with respect to any other matter, a Supplemental Statement of the Case addressing all issues in appellate status should be prepared and furnished to the appellant and his representative. They should be provided an opportunity to respond. Thereafter, in accordance with proper appellate procedures, the case should be returned to the Board for further appellate review, if otherwise in order. All issues properly in appellate status should be returned to the Board at the same time. In taking this action, the Board implies no conclusion, either legal or factual, as to any final outcome warranted. The appellant need take no action until otherwise notified by the RO. _____________________________ SHANE A. DURKIN Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 State. 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) (1993).