Citation Nr: 0323406 Decision Date: 09/10/03 Archive Date: 09/23/03 DOCKET NO. 02-15 100 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUE Entitlement to service connection for residuals of cold injury to the hands. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Jessica J. Wills, Law Clerk INTRODUCTION This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a November 2001 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan, that denied the benefit sought on appeal. The veteran, who had active service from August 1950 to March 1952, appealed that decision to the Board, and the case was referred to the Board for appellate review. REMAND Upon a preliminary review of the claims file, the Board finds that additional development is needed in this case before proceeding with appellate review for the reasons set forth below. The veteran indicated in VA Form 9 that a doctor examined and x-rayed his hands in 1985 and found arthritis. Such records may prove to be relevant and probative in the appellant's claim. However, no inquiry has been made of the veteran in order to ascertain whether such records exist. The record also discloses that the veteran was afforded a VA examination in May 2001 in order to determine whether there were residuals of cold injury to his hands. Following the examination, the examiner stated that both hands were normal looking without any discoloration or skin changes. The veteran's hands felt warm to touch, and the radial pulses were palpable. X-rays of both hands were also reportedly normal. The finger joints were not tender. Nor was there any muscle atrophy. Despite these observations and a diagnosis of normal hands, the examiner stated that the veteran's grip strength was only moderate and did not provide a rationale. Furthermore, the veteran's representative stated in VA Form 646 that the physician inadequately examined the veteran's hands without attempt to follow the VA cold injury protocol examination. In particular, the representative indicated an absence of proper neurological, vascular, and nerve conduction studies. The representative further contended that there should have been a rheumatology exam. The veteran has asserted that the May 2001 examination was inadequate and that the examiner only examined the veteran's hands in a cursory manner as he has had pain, numbness and cold sensitivity of his hands in the same distribution as were injured by the cold while he was in Korea. It appears that the May 2001 examiner did conduct the examination following the VA cold injury protocol and the Board notes that certain diagnostic tests such as nerve conduction studies and specialty examinations such as neurology and rheumatology consultations appear to be at the discretion of the examiner as indicated. However, while the clinical examination of the veteran's lower extremities did not yield any apparent abnormal findings, electromyography (EMG) studies of the veteran's lower extremities were conducted and revealed severe denervation of the intrinsic muscles of the feet. This finding, in part, led to a grant of service connection by the RO for cold injury to the feet in a November 2001 rating decision. It is unclear why similar studies of the upper extremities were not conducted, as pointed out by the veteran in his August 2002 correspondence, and the veteran's representative has requested that further examination of the veteran's hands to include such EMG or nerve conduction studies be accomplished in this regard. Based on the foregoing, the Board finds that the veteran should be afforded another VA cold injury protocol examination in which appropriate nerve condition studies or EMG studies of the veteran's upper extremities is accomplished. The Board finds further, that this additional examination is necessary to determine the etiology of the decreased grip strength noted on the VA examination of May 2001. From a review of the record, the Board notes that the May 2001 x-ray report of the veteran's hands are not of record. On remand, the RO should obtain that report. Therefore, in order to give the veteran every consideration with respect to the present appeal, it is the Board's opinion that further development of the case is necessary. Accordingly, this case is REMANDED for the following action: 1. The RO should request that the veteran provide the name and address of the physician who examined the veteran's hands in 1985. After acquiring this information, the RO should obtain and associate these records with the claims file. 2. The RO should obtain the May 2001 x-ray report of the veteran's hands conducted in connection with his VA compensation examination. 3. The RO should afford the veteran a comprehensive VA cold injury protocol examination to determine whether he has cold injury residuals involving the hands from in-service cold exposure. Any and all indicated evaluations, studies, and tests deemed necessary by the cold injury protocol examination worksheet should be conducted. The examiner should ensure that NCS or EMG testing of the upper extremities is accomplished. The examiner is requested to comment on whether the veteran has residuals of a cold injury to his hands, and if so, whether it is at least as likely as not that the cold injury residuals are due to any in- service cold-related injury, or of some other etiology. The examiner is requested to set forth in the report whether any abnormal findings, such as decreased grip strength, are etiologically related to a specific disorder or disease process, and whether such underlying pathology is related to the veteran's military service. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. When the development requested has been completed, the case should be reviewed by the RO on the basis of the additional evidence. If the benefit sought is not granted, the veteran and his representative should be furnished a Supplemental Statement of the Case and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. The purpose of this REMAND is to obtain additional development, and the Board does not intimate any opinion as to the merits of the case, either favorable or unfavorable, at this time. The veteran has the right to submit additional evidence and/or argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). No action is required of the veteran unless he is notified. This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West 2002) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44-8.45 and 38.02-38.03. _________________________________________________ S. L. KENNEDY Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. 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) (2002).