Citation Nr: 1317940 Decision Date: 06/03/13 Archive Date: 06/11/13 DOCKET NO. 10-02 156 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUE Entitlement to service connection for bilateral hand disability, to include as secondary to a service connected bilateral foot disorder. REPRESENTATION Veteran represented by: The American Legion WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD Megan C. Kral, Associate Counsel INTRODUCTION The appellant is a Veteran who served on active duty from May 1988 to September 1989. This matter is before the Board of Veterans' Appeals (Board) on appeal from an August 2009 rating decision of the Columbia, South Carolina Department of Veterans Affairs (VA) Regional Office (RO). The Veteran's claims file is now in the jurisdiction of the Philadelphia, Pennsylvania RO. In November 2012, a Travel Board hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran's claims file. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the Veteran if further action on her part is required. REMAND The Veterans Claims Assistance Act of 2000 (VCAA), in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The VCAA applies to the instant claim. While the notice provisions of the VCAA appear to be satisfied, the Board finds that further development of the record is necessary to comply with VA's duty to assist the Veteran in the development of facts pertinent to her claim. The Veteran asserts that her bilateral hand disability is part of a systemic disability which is also responsible for her service-connected bilateral foot disability (bilateral flat feet with plantar fasciitis and tarsal tunnel syndrome). She asserts that the foot disability was an early/initial manifestation of a rheumatoid arthritis that has since been diagnosed. At the November 2012 Travel Board hearing, the Veteran testified that she has received treatment from R. D., D.P.M., who diagnosed rheumatoid arthritis. She testified that Dr. R. D conducted X-ray studies which showed the arthritic changes. At her request the record was held in abeyance sixty days to afford her the opportunity to submit the complete treatment records from podiatrist R. D. A single record dated in December 2012 has been received; it states that she was seen for reevaluation for systemic rheumatoid arthritis (there is no mention of X-rays). Regardless, this record suggests that there are outstanding private treatment records that are likely to contain pertinent information, and must be sought. Whether or not the Veteran actually has rheumatoid arthritis also requires additional development (as there is conflicting medical evidence in the matter). Dr. R. D.'s statement suggests that the Veteran has a well-established diagnosis of such disability; while an August 2012 VA examiner found that she does not have such disability. Given the proposed theory of entitlement development to resolve this question is necessary. Accordingly, the case is REMANDED for the following: 1. The RO should ask the Veteran to provide the authorization necessary for VA to obtain the complete records of the Veteran's treatment by R.D., D.P.M. The RO should secure such records for association with the record on appeal. If the records suggest other avenues of development (i.e., identify other providers whose records would have bearing on the nature and etiology of the claimed disability or regarding whether or not she has rheumatoid arthritis), the RO should arrange for such development. 2. After the development sought above is completed, the RO should arrange for the Veteran to be examined by a rheumatologist to secure an advisory medical opinion regarding the Veteran's asserted theory of entitlement to the benefit sought (service connection for a bilateral hand disability). The Veteran's claims file must be reviewed by the examiner in conjunction with the examination. Any tests or studies indicated should be completed. Based on review of the record and examination of the Veteran the consulting should offer opinions that respond to the following: a. Please identify (by medical diagnosis) each hand disability found. b. Please identify (as to each diagnosed hand disability entity) the most likely etiology for such disability. The explanation of rationale for this response should address the Veteran's expressed theory of entitlement (that her service connected foot and service connection claimed for hand disabilities are manifestations of a rheumatoid arthritis that was initially manifested as foot complaints in service). c. Please indicate whether or not the Veteran has rheumatoid arthritis (citing to the clinical data that support or refute such diagnosis). The examiner is asked to explain the rationale for all opinions. 3. The RO should then review the record and readjudicate the Veteran's claim. If it remains denied, the RO should issue an appropriate supplemental statement of the case and afford the Veteran and her representative the opportunity to respond. The case should then be returned to the Board, if in order, for further review. The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ George R. Senyk 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) (2012).