Citation Nr: 0406275 Decision Date: 03/10/04 Archive Date: 03/19/04 DOCKET NO. 02-01 378 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUES 1. Entitlement to service connection for a disorder affecting the elbows and hips, claimed as due to undiagnosed illness. 2. The propriety of a 30 percent initial rating for a cognitive disorder. 3. The propriety of a noncompensable initial rating for hemorrhoids. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD Joseph Michael Horrigan INTRODUCTION The veteran served on active duty from January 1975 to May 1998. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2000 rating action by the Department of Veterans Affairs (VA) Regional Office (RO) in Pittsburgh, Pennsylvania that, among other things, granted service connection for a cognitive disorder which was assigned a 10 percent initial evaluation, effective June 1, 1998, and also granted service connection for hemorrhoids, which was assigned a noncompensable (0 percent) evaluation, effective June 1, 1998. The RO denied service connection for a disorder effecting the elbows and hips, claimed as due to undiagnosed illness. In March 2002 the veteran appeared and gave testimony at an RO hearing before a hearing officer. A transcript of this hearing is of record. In February 2003 the RO increased the evaluation for the veteran's cognitive disorder to 30 percent disabling, effective June 1, 1998. Entitlement to service connection for a disorder of the elbows and hips decision, and entitlement to a compensable rating for hemorrhoids were again denied. In October 2003 the veteran appeared and gave testimony before the undersigned at a hearing held at the RO. A transcript of this hearing is also of record. At this hearing, the veteran indicated that he wished to claim entitlement to an increased rating for service connected irritable bowel syndrome. Since this issue has not been developed and certified for appeal, it is referred to the RO for all appropriate action. Only the issues listed on the title page of this decision are currently before the Board for appellate consideration. REMAND During the veteran's October 2003 hearing, he reported receiving ongoing medical treatment for the disabilities currently at issue from two private physicians. No clinical records documenting this reported treatment are currently in the claims folder and such should be obtained prior to further appellate consideration of the issues before the Board. See 38 U.S.C.A. § 5103A(b)(1) (West 2002) (VA will make reasonable efforts to obtain relevant private records adequately identified by a claimant). In regard to the claims for higher initial ratings for hemorrhoids and cognitive disorder, it is apparent from his testimony at the October 2003 hearing that the veteran has asserted that these disabilities have worsened since the most recent VA examinations in April 2002. The veteran is entitled to a new VA examination where there is evidence that the condition has worsened since the last examination. Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994); VAOPGCPREC 11-95 (1995). In regard to the veteran's claims for service connection for a disorder affecting his hips and elbows, he contends that these disabilities developed in service after he was stationed in Southwest Asia during the Persian Gulf Conflict. The service medical records reflect treatment for right hip and right elbow complaints, which were assessed as due to arthritis. However, VA examinations, including x-rays, of these joints conducted subsequent to service have failed to reveal findings indicative of arthritis. During his recent hearing before the undersigned, the veteran stated that a private physician had opined that his elbow and hip complaints were due to early arthritis. In the Board's opinion, the veteran should be afforded another VA orthopedic examination to determine the nature and etiology of his elbow and hip symptomatology. In view of the above, this case is REMANDED to the RO for the following actions. 1 . The RO ensure that all notice obligations, including those imposed by 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2003) have been satisfied. 2. The RO should take the necessary steps (including obtaining needed information from the veteran) to obtain records of the veteran's treatment by Doctor Roseman and the Sewickley Valley Hospital for hemorrhoids; and by Doctor Park for cognitive disorder, joint complaints, and hemorrhoids. All records obtained should be associated with the claims folder. 3. The veteran should then be afforded an examination to determine the severity of his hemorrhoid disability. The claims folder should be made available to the examiner, and the examiner should state in the examination report (or in an addendum to the report) that the claims folder was reviewed. The examiner should specifically comment as to whether any hemorrhoids noted on the examination are mild, moderate, large or thrombosed and/or irreducible with excessive redundant tissue evidencing frequent recurrence. In addition the examiner should comment as to the presence or absence of persistent bleeding, secondary anemia, or fissures. 4. The veteran should also be afforded an orthopedic examination to determine the nature and etiology severity of any current elbows and hip disability. The claims folder should be made available to the examiner, and the examiner should state in the examination report (or in an addendum to the report) that the claims folder was reviewed. All indicated tests, especially x-rays of the pertinent joints, should be performed and all pertinent clinical findings reported in detail. If an elbow or hip disability is diagnosed, the examiner should express an opinion as to whether it is at least as likely as not (50 percent probability or more) that the diagnosed disabilities are related to the hip and elbow complaints noted in the service medical records. If the examiner is unable to diagnose a current elbow or hip disability, the examiner should render an opinion as to whether it is at least as likely as not that the veteran has objective indications of chronic elbow or hip disability. 5. The veteran should also be afforded a psychiatric examination to determine the severity of his cognitive disorder. The claims folder should be made available to the examiner, and the examiner should state in the examination report (or in an addendum to the report) that the claims folder was reviewed. All indicated tests should be accomplished. The examiner should note the level of psychiatric impairment, social impairment, and occupational impairment (to include a global assessment of functioning (GAF) score) resulting from the veteran's service-connected cognitive disorder. The case should then be returned to the Board, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). 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. 8.43 and 38.02. _________________________________________________ Mark D. Hindin 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) (2003).