Citation Nr: 9828828	
Decision Date: 09/28/98    Archive Date: 10/01/98

DOCKET NO.  95-41 652	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in St. 
Petersburg, Florida


THE ISSUES

1.  Entitlement to service connection for multiple sclerosis.  

2.  Entitlement to service connection for hypertension.  

3.  Entitlement to service connection for residuals of a 
cervical spine injury.  


REPRESENTATION

Appellant represented by:	Paralyzed Veterans of America, 
Inc.


WITNESS AT HEARING ON APPEAL

Appellant


ATTORNEY FOR THE BOARD

C. S. Freret, Counsel


INTRODUCTION

The appellant had active military service from August 1968 to 
June 1969.  

This appeal comes before the Board of Veterans' Appeals 
(Board) from a rating decision by the Department of Veterans 
Affairs (VA) St. Petersburg, Florida, Regional Office (RO).  

In a March 1997 statement, the appellant elected to withdraw 
a claim of entitlement to service connection for diabetes 
mellitus.  


REMAND

The appellant asserts that he has multiple sclerosis that 
began in service and that the evidence demonstrates symptoms 
of the disease in service or within the first seven years 
following his separation from service in June 1969.  He 
argues that blood pressure readings within the first year 
after service establish that he had hypertension which had 
its origin in service.  He also claims that he has residuals 
of a cervical spine injury that resulted from a fall 
attributable to his multiple sclerosis.  

In support of his claim for service connection for multiple 
sclerosis, the appellant points to an April 1994 medical 
statement from a VA physical therapist which indicated that 
studies were positive for multiple sclerosis.  He has also 
submitted three private medical statements from G. Colon, 
M.D., an endocrinologist, dated in July 1996, January 1997, 
and March 1997, which analyze the medical evidence in the 
claims file and conclude that the appellant demonstrated 
symptoms of multiple sclerosis during the first seven years 
after service, and an August 1998 private medical statement 
from C. N. Bash, M.D., a neuroradiologist, and physician for 
the appellant’s representative, who opined that the earliest 
symptoms of multiple sclerosis were most likely shown in 
November 1968 service medical records that described “ankle 
clonus and difficulty walking.”  

However, the Board finds that the medical evidence is not 
clear as to whether the appellant has multiple sclerosis, 
and, if so, whether the evidence demonstrates that it was 
clinically manifested prior to June 1976.  The neurologic 
evidence does not include MRI findings suggesting multiple 
sclerosis, and there is no neurological diagnosis of multiple 
sclerosis.  The Board also notes that the November 1968 
service medical records indicate that there was “unsustained 
clonus in the ankles” and “no patellar reflexes.”  

Concerning his claim for service connection for hypertension, 
the appellant submitted Dr. Colon’s statements in which she 
contends that blood pressure readings taken between July 31, 
1969 and June 1, 1971, demonstrated manifestation of 
hypertension to a compensable degree within the first year 
after service.  In her March 1997 statement, Dr. Colon opined 
that because seven of eight readings between July 31, 1969 
and May 28, 1970, were in the hypertensive category during 
the year following the appellant’s separation from service, 
hypertension had been manifested to a 10 percent degree 
during the presumptive period.  Dr. Colon also stated in her 
January 1997 statement that the fact that the appellant was 
still hypertensive in spite of correcting his 
hyperthyroidism” goes in favor of essential hypertension not 
related to his Graves’ Disease.”  Dr. Bash’s August 1998 
medical statement diagnosed essential hypertension, as a 
secondary condition directly associated with the appellant’s 
service-connected Graves’ Disease.  

However, the medical evidence revealed no elevated blood 
pressure readings in service, and blood pressure readings 
taken during the first year after service all had diastolic 
readings below 100.  The Board notes that the more common 
signs of hyperthyroidism include tachycardia and widened 
pulse pressure.  Additionally, Dorland’s Medical Dictionary 
defines essential hypertension as occurring without 
discoverable organic cause.  

Dr. Colon and Dr. Bash both indicate that the appellant 
sustained a cervical spine injury and that ambulation 
problems associated with multiple sclerosis can cause falls 
which result in injuries.  

VA has a duty to assist the appellant in the development of 
facts pertinent to his claims.  38 U.S.C.A. § 5107(a); 
38 C.F.R. § 3.103(a).  The United States Court of Veterans 
Appeals (Court) has held that when the Board believes the 
medical evidence of record is insufficient it may supplement 
the record by ordering a medical examination.  Colvin v. 
Derwinski, 1 Vet.App. 171 (1991).  Because the Board believes 
that additional medical evidence would be helpful in 
resolving questions concerning the appellant’s claims, the 
Board finds that, in order to obtain additional medical 
evidence and to insure that the appellant receives his 
procedural due process rights and fair process rights, the 
claims must be remanded for the following actions:  

1.  The RO should schedule the appellant for 
examination by a specialist in neurology in 
order to ascertain whether the appellant has 
multiple sclerosis and when the disease, if 
present, was initial manifested.  The claims 
folder and a copy of this remand must be made 
available to and reviewed by the examiner prior 
to the examination.  He should be requested to 
express an opinion as to whether it is as 
likely as not that the appellant has multiple 
sclerosis that was manifested in service or 
within the first seven years after service.  
The examiner should provide complete rationale 
for all conclusions reached, and he should 
discuss any differences between his conclusions 
and those of Drs. Colon and Bash.  

2.  The RO should schedule the appellant for 
examination by a specialist in internal 
medicine for the purpose of ascertaining by 
appropriate diagnostic procedures whether the 
appellant currently has hypertension 
(hypertensive cardiovascular disease).  The 
claims folder and a copy of this remand must be 
made available to and reviewed by the examiner 
prior to the examination.  He should be 
requested to identify the initial manifestation 
of any hypertensive vascular disease currently 
found and to express an opinion as to whether 
it is as likely as not that the appellant has 
hypertensive vascular disease which had its 
origin in service, or whether it is as likely 
as not that the medical evidence shows that 
postservice blood pressure readings, including 
those from December 1969 to June 1971, 
represented blood pressure increases due to 
tachycardia, which is considered a common sign 
of hyperthyroidism.  The examiner should 
provide complete rationale for all conclusions 
reached, and he should discuss any differences 
between his conclusions and those of Drs. Colon 
and Bash.  

3.  Following completion of the above 
examinations, the RO should schedule the 
appellant for examination by an orthopedic 
specialist in order to determine the nature and 
extent of all cervical spine disabilities.  The 
claims folder and a copy of this remand must be 
made available to and reviewed by the examiner 
prior to the examination.  He should be 
requested to identify all current cervical 
spine disorders and to express an opinion as to 
whether it is as likely as not that the 
appellant has a cervical spine disorder that is 
related to a fall caused by multiple sclerosis.  
The examiner should provide complete rationale 
for all conclusions reached, and he should 
discuss any differences between his conclusions 
and those of Drs. Colon and Bash.  

3.  The appellant should be advised of the 
provisions set forth at 38 C.F.R. § 3.655(b) 
regarding failure to report for scheduled VA 
examinations.  

4.  The RO should review the claims folder and 
ensure that all of the development action has 
been conducted and completed in full.  The 
Court has held that, if the requested 
examination does not include adequate responses 
to the specific opinions requested, the report 
must be returned for corrective action.  
38 C.F.R. § 4.2 (“if the [examination] report 
does not contain sufficient detail, it is 
incumbent upon the rating board to return the 
report as inadequate for evaluation purposes  
Ardison v. Brown, 6 Vet.App. 405, 407 (1994).  

The Board expresses its appreciation in advance to the RO for 
its assistance in developing the requested evidence and 
trusts that this development will be attended to in an 
expeditious manner.  

After the above requested actions have been completed, the RO 
should review the appellant's claims.  If the benefits sought 
on appeal remain denied, a supplemental statement of the case 
should be furnished to the appellant and his representative, 
and they should be afforded the appropriate period of time to 
respond.  Thereafter, the case should be returned to the 
Board for further appellate consideration.  

The purpose of this REMAND is to obtain addition medical 
evidence and to ensure that the appellant receives his due 
process and fair process rights.  No opinion, either legal or 
factual, is intimated by this REMAND as to the merits of the 
appellant's claims.  No additional action is required by the 
appellant until he receives further notification from VA.  



		
	M. W. GREENSTREET
	Member, Board of Veterans' Appeals


NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. § 7266, 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 that 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 
(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.  Appellate rights do not 
attach to those issues addressed in the remand portion of a 
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).  
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