Citation NR: 9606093	
Decision Date: 03/08/96		Archive Date: 03/16/96
DOCKET NO.  94-20 982	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Muskogee, 
Oklahoma


THE ISSUES

1.  Entitlement to service connection for a chronic acquired 
low back disorder.

2.  Entitlement to service connection for gout.

3.  Entitlement to service connection for a chronic acquired 
disorder of the right foot.

4.  Entitlement to service connection for [pcardiovascular 
disease.

5.  Entitlement to an increased evaluation for hypertension, 
currently evaluated as 10 percent disabling.


REPRESENTATION

Appellant represented by:	AMVETS


WITNESS AT HEARING ON APPEAL

Appellant


ATTORNEY FOR THE BOARD

Ronald R. Bosch, Counsel



INTRODUCTION

The veteran served on active duty from July 1965 to July 1971 
and from October 1972 to October 1985.

The claims file contains a report of a rating decision dated 
in December 1987 wherein entitlement to service connection 
for post-traumatic stress disorder was denied.

The current appeal arose from a December 1992 rating decision 
of the Department of Veterans Affairs (VA) Regional Office 
(RO) in Muskogee, Oklahoma.  The RO denied entitlement to 
service connection for a chronic acquired back disorder, 
gout, a chronic acquired disorder of the right foot, heart 
disease, and an increased evaluation for hypertension.

The case has been forwarded to the Board of Veterans’ Appeals 
(Board) for appellate review.

In an April 1995 statement on file the veteran expressed his 
wish to reopen a claim of entitlement to service connection 
for post-traumatic stress disorder, and requested entitlement 
to service connection for a lung disorder secondary to 
exposure to Agent Orange in service.  These issues have 
neither been prepared nor certified for appellate review and 
are referred to the RO for appropriate action.


REMAND

A review of the record discloses that the veteran was treated 
on several occasions in service for recurrent back pain, and 
was noted to have recurrent back pain when examined by VA in 
October 1992.  He was treated for right foot symptomatology 
in service and suspected to have gout while on active duty 
due to elevated uric acid levels.  Gout has been confirmed on 
the basis of medical treatment reports of record dated 
through July 1994.  Although the veteran was noted to have no 
cardiovascular symptoms when examined by VA in October 1992, 
the VA outpatient treatment reports on file dated during the 
early 1990’s show he has been treated for chest pain and 
pressure, dizziness, shortness of breath, diaphoresis, etc.  
An electrocardiographic record disclosed right bundle branch 
block.  

The Board is of the opinion that records of the appellant’s 
treatment at the local VA medical center subsequent to July 
1994, and more comprehensive contemporaneous VA examinations 
with medical opinions as to whether he has gout, 
cardiovascular disease, and chronic acquired disorders of the 
back and right foot, and their respective onsets would 
materially assist in the adjudication of the claimant’s 
appeal.

Therefore, pursuant to VA’s duty to assist the veteran in the 
development of facts pertinent to his claims under 
38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) 
(1994), the Board will not decide the issues certified for 
appellate review pending a REMAND of the case to the RO for 
further development as follows:

1.  The RO should request and associate 
with the claims file copies of the 
complete medical records pertaining to 
the veteran’s treatment at the VA Medical 
Center in Wichita, Kansas, from July 1994 
to the present.

2.  The RO should schedule the veteran 
for examinations by a VA orthopedic 
surgeon and cardiologist for the purpose 
of ascertaining the nature, extent of 
severity, and etiology of any back and 
right foot disorders, gout, and 
cardiovascular disease which may be 
present, and the extent of severity of 
hypertension.  The examinations are to be 
conducted in accordance with the 
diagnostic procedures outlined in the VA 
Physician’s Guide for Disability 
Evaluation Examinations (AMIE Worksheet 
Numbers 0105, 0110, 0115, 1415, 1430, 
1440, and 1450) (located in VBA/ARMS 
electronic database on CD-ROM update 
issued 21 September 1995), and all 
appropriate studies must be conducted.  
The claims file must be made available to 
and reviewed by the examiners prior to 
the examinations.  The orthopedic surgeon 
must be requested to provide an opinion 
as to whether it is at least as likely as 
not that gout and any back and right foot 
disorders found on examination are 
related to service documented findings.  
The cardiologist must be requested to 
specifically rule in or rule out 
cardiovascular disease.  The opinions 
provided must be accompanied by a 
complete rationale.  If any requested 
opinion cannot be provided, the examiners 
must explain why.  The examination 
reports should be typed.

3.  Thereafter, the RO should review the 
examination reports and requested 
opinions to ensure that they are in 
complete compliance with the directives 
of this REMAND and if not, the RO should 
implement corrective procedures.

4.  After undertaking any development 
deemed appropriate in addition to that 
outlined above, the RO should 
readjudicate the issues certified for 
appellate review.

If the benefits requested on appeal are not granted to the 
appellant’s satisfaction, the RO should issue a supplemental 
statement of the case.  A reasonable period of time for a 
response should be afforded.  Thereafter, the case should be 
returned to the Board for final appellate review, if 
otherwise in order.  By this REMAND, the Board intimates no 
opinion as to any final outcome warranted.  No action is 
required of the veteran until he is notified by the RO.



		
	BRUCE KANNEE
	Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures 
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741 
(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) 
(1995).
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