Citation NR: 9632554 Decision Date: 11/20/96 Archive Date: 12/02/96 DOCKET NO. 94-21 850 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for residuals of an insect bite on the right elbow. 2. Entitlement to service connection for a lower back disorder. REPRESENTATION Appellant represented by: Texas Veterans Commission WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD L. Spear Ethridge, Associate Counsel INTRODUCTION The veteran had active duty from September 1988 to July 1992. At a personal hearing in July 1996 before a member of the traveling section of the Board of Veterans’ Appeals (Board), the veteran withdrew his claims for service connection for residuals of a right ankle injury and service connection for residuals of a left shoulder injury. At that time the veteran also raised the issue of service connection for residuals of a right knee injury. That matter is referred to the Regional Office (RO) for appropriate development. The issue of service connection for residuals of a back disorder will be discussed in the remand that follows this decision. CONTENTIONS OF APPELLANT ON APPEAL Essentially, the veteran contends that he was bitten by a spider in service and that he currently has residuals of the bite, as manifested by pain and a scar on the right elbow. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1995), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the evidence supports the claim of service connection for residuals of an insect bite on the right elbow. FINDING OF FACT The veteran received an insect bite in service; current medical evidence shows status post brown recluse spider bite right elbow, with mildly symptomatic audible popping. CONCLUSION OF LAW Residuals of an insect bite on the right elbow were incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.303 (1995). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board notes that the provisions of 38 U.S.C.A. § 5107 have been met, in that the claim for service connection for an insect bite is well grounded and adequately developed. No further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). Murphy v. Derwinski, 1 Vet.App. 78 (1990). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces. Determinations as to service connection will be based on review of the entire evidence of record, with due consideration to the policy of the Department of Veterans Affairs (VA) to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 C.F.R. § 3.303(a) (1995). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1995). Service medical records reveal that the veteran was normal in pertinent part upon enlistment in November 1987. An August 1989, DD Form 689, Individual Sick Slip, indicates that the veteran was seen for redressing of an insect bite. In June 1992, an examiner noted that he veteran had a scar on the right elbow. In July 1992, upon service separation, it was noted that the veteran complained of right elbow pain, and that he gave a history of having indomethacin treatment for the elbow during August 1989. The veteran underwent an VA orthopedic examination in October 1992. By history, the examiner noted that the veteran sustained a bite over the posterior aspect of the right elbow in 1989, and that the bite was caused by a brown recluse spider. Thereafter, he had extensive cellulitis over the posterior aspect of the right elbow and arm, which was treated with injections and indomethacin. The veteran indicated that the wound was healed and that he had no neurovascular injury or compromise. The veteran was able to produce audible popping in the right elbow with forced flexion or extension activities such as weight lifting. Physical examination of the right elbow revealed a small residual scar of the posterior aspect of the right elbow, which measured one cm. The scar was described as nontender. The examiner indicated that there was no olecranon bursitis. Elbow motion was from zero degrees of extension to 150 degrees of flexion. There was an audible crack with forced flexion or extension, and there was no locking of the right elbow. Radiographs of the right elbow were reportedly unremarkable. The diagnosis was status post brown recluse spider bite right elbow, with audible popping-mildly symptomatic. At a personal hearing in July 1996, before a member of the traveling section of the Board, the veteran testified that in he felt something crawling in his sleeve during field exercises in August 1989. Hearing Testimony (T.) at 8. His right arm and elbow became swollen and red, and examiners at that time told him that he had been bitten by a brown recluse spider. Id. He received and injection of Novocain to numb the area, and an incision was made at the site of the bite. Id. Thereafter, he went to sick call for 7 to 10 days for dressing change and packing of the wound. Id. He also wore a sling on his arm. Id. The veteran indicated that there were mild degenerative changes found in the right elbow. T. 8, 10. He stated that he experienced cracking or popping in the elbow since 1989, and that he had loss of strength. T. 8-9. The veteran testified that he was seen again for tenderness in the elbow while in service in July 1992. T. 9. The Board has considered the evidence of record, including the veteran’s sworn testimony, and reports of sick call. The reports of sick call regarding the veteran’s insect bite in August 1989 were not included in the service medical records packet obtained for this appeal. The veteran submitted copies for the record, and the Board finds that the medical records are reliable. Included in the service medical records packet were notations regarding the veteran’s service separation. At that time the veteran complained of right elbow pain, and that he had a right elbow scar with at history of indomethacin treatment. Following service separation, a VA examiner incorporated the veteran’s history of an insect bite into the pertinent diagnosis, and noted that there was mildly symptomatic audible popping associated with the right elbow. The Board determines that the positive evidence of record supports the veteran’s claim for service connection and that the requisite requirements for service connection have been met. Namely, that the veteran’s inservice injury, of an insect bite, is currently manifested by evidence of a one-cm. nontender scar, where an incision was made to drain the insect wound, with objective observation of mildly symptomatic audible popping of the right elbow. Accordingly, service connection for residuals of an insect wound on the right elbow is warranted. ORDER Service connection for residuals of an insect bite on the right elbow is granted. REMAND During the travel board hearing in July 1996, the veteran indicated that he was treated at a private medical facility for physical therapy for his alleged lower back disorder. T. 5, 7. Corresponding treatment records have not been associated with the claims folder, and in order to ensure that VA has met its duty to assist the veteran in developing the facts pertinent to his claim, the case is REMANDED to the RO for the following development: 1. The RO should obtain the names and addresses of all medical care providers who treated the veteran for a lower back disorder since service separation in July 1992. After securing the necessary release(s), the RO should attempt to obtain these records. In particular the RO should attempt to obtain pertinent records from Alvin Medical Center, where the veteran was seen for physical therapy. See T. at 5, 7. 2. After the development requested above has been completed to the extent possible, the RO should again review the record, and determine if any further development is warranted. If any benefit sought on appeal, for which a notice of disagreement has been filed, remains denied, the veteran and his representative should be furnished a supplemental statement of the case and given the opportunity to respond thereto. Thereafter, the case should be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The veteran need take no action until otherwise notified. V. L. JORDAN 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. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1995), a decision of the Board of Veterans’ Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans’ Judicial Review Act, Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The date that appears on the face of this decision constitutes the date of mailing and the copy of this decision that you have received is your notice of the action taken on your appeal by the Board of Veterans’ Appeals. Appellate rights do not attach to those issues addressed in the remand portion of the Board’s decision, because a 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). - 2 -