BVA9500692 DOCKET NO. 93-07 128 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to service connection for a back disorder. 2. Entitlement to service connection for residuals of a right hand fracture. 3. Entitlement to service connection for residuals of a left hand injury. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Kay F. Mayer, Associate Counsel INTRODUCTION The veteran served on active duty from March 1980 to April 1983. This matter came before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the VA Regional Office (RO) of Cleveland, Ohio. The Board has noted that the appellant's representative raised the issue of treatment of the appellant for sinusitis during service in written argument for the captioned claims. That issue has not been developed for appellate review and is not intertwined with the issues before us. As such, it is referred to the RO for appropriate development. Kellar v. Brown, 6 Vet.App. 157 (1994). REMAND The Board has noted that pursuant to his claims for service connection for residuals of a fracture of the right hand, and service connection for residuals of an injury of the left hand, the appellant underwent a VA examination of his hands and X-ray studies of his hands in May 1992. However, the reports of the X- ray studies of the appellant's hands dated in May 1992 are ambiguous. One report of the hand noted it was of the left hand, yet the clinical history on that report discussed the cervical spine and the right hand, and then the report noted no significant abnormality of the bone, joints or adjacent soft tissues. It is unclear from this report whether it refers to the right or left hand. Also, another report of X-ray study of the hand does not indicate to which hand it referred, but indicated the same results as reported above regarding the bones and joints. The examiner, apparently on the basis of the history provided by the veteran diagnosed the residuals of a right hand fracture, but it is unclear what objective residuals were actually identified. In light of these unclear reports, the Board believes the appellant should undergo further X-ray studies of the right and left hands. Moreover, the Board has noted that while the VA examiner accepted the appellant's report of history of injury of the left hand during service following a fall from a truck, and reported objective findings of numbness to pinprick of the left middle finger, crepitus of the metacarpal phalangeal joint on flexion at those joints and weakness of the left hand on grasping of objects, the diagnosis of residuals of left hand injury is ambiguous. The examiner did not indicate whether he found the tendinitis of the left middle finger was a residual of the alleged injury to the appellant's claimed left hand during service. Additionally, the Board has noted the service medical records show a June 1981 injury to the appellant's left arm while wrestling and negative X-ray study of that arm. Then, in August 1982 an X-ray study, without an accompanying clinical examination or history, or treatment record, notes a request for a wrist series of the left navicular, a history of follow-up of a navicular fracture and that the appellant was out of plaster the day before. Then, the report result indicated there was no fracture noted. The Board concludes the appellant should undergo a further VA examination of the left hand so that the examiner can identify the specific residuals of the appellant's claimed August 1982 injury to his left navicular (such as was there a fracture?), and whether any fracture of the left navicular during service, if found, is related the appellant's current tendinitis of the left middle finger. The Board has noted the appellant's lumbosacral spine was not examined pursuant to consideration of his claim for residuals of a back injury, and the Board concludes in light of his testimony that he has back pain that radiates to his legs and feet the appellant should undergo such an examination. The Board has also noted the appellant testified he applied for social security disability benefits for his back. Medical records associated with that application for benefits and any determination should be obtained. Murincsak v. Derwinski, 2 Vet.App. 363 (1992). The Board has considered the representative's request that morning reports for the appellant's unit and any accident report, including a line of duty determination, involving the appellant should be obtained. It is concluded that an attempt should be made to obtain and associate any such records with the claims file. Accordingly, the case is REMANDED to the RO for the following actions: 1. The RO should obtain medical records filed in association with the appellant's claim of Social Security disability benefits for his back along with any final determination made with regard to that claim and associate that information with the claims folder. 2. The RO should attempt to obtain for association with the claims folder service department personnel records and unit morning reports, including any accident reports involving the veteran. 3. The RO should schedule a VA orthopedic examination to determine the specific, identifiable residuals of the claimed right and left hand injuries during service, and if found, whether there is any identifiable medical evidence showing a causal relationship between any such residuals, and the claimed in service injuries. Also, the examiner should evaluate the appellant's lumbosacral spine and offer an opinion as to whether any impairment found could be medically related to the claimed injury in service. All indicated tests and studies should be performed, including radiographic and range of motion studies. The claims folder should be made available to the examiner prior to the examination. The examiner should adequately summarize the relevant medical history and clinical findings and provide detailed reasons for the medical conclusions. The examination should be conducted and reported in accordance with the provisions set forth in the VA Physician's Guide for Disability Evaluation Examinations. When this development has been completed, and if the benefits sought are not granted, the case should be returned to the Board for further appellate consideration, after compliance with appropriate appellate procedures, including issuance of a supplemental statement of the case. It is requested that the statement specifically set forth the reasons and bases for the decision. No action by the appellant is required until he receives further notice. The Board intimates no opinion, either legal or factual, as to the ultimate disposition warranted in this case, pending completion of the requested development. MICHAEL D. LYON 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).