BVA9500019 
DOCKET NO.  93-09 822     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in No. Little
Rock, Arkansas

THE ISSUES

1.  Entitlement to an increased disability evaluation for
service-connected residuals of frostbite of both lower
extremities, currently rated as 10 percent disabling.

2.  Entitlement to an increased disability evaluation for
service-connected residuals of shell fragment wounds to the right
lower extremity, right arm and face, currently rated as 10
percent disabling.

REPRESENTATION

Appellant represented by: The American Legion

ATTORNEY FOR THE BOARD

Alan S. Peevy, Associate Counsel

INTRODUCTION

The veteran had active military service from January 1943 to
November 1946.

This case is before the Board of Veterans' Appeals (Board) on
appeal from a June 1992 rating decision by the North Little Rock,
Arkansas, Regional Office (RO).  A notice of disagreement was
received in July 1992.  A statement of the case was furnished to
the veteran and his representative in August 1992, and a
substantive appeal was received that same month.  Supplemental
statements of the case were issued in October 1992 and December
1992.

The veteran is represented by The American Legion.

REMAND

The veteran's representative contends that the RO has discounted
certain symptomatology associated with the veteran's lower
extremities based on an erroneous belief that it is attributable
to nonservice-connected phlebitis.  In effect, it is maintained
that the medical record is inadequate to allow for such
differentiation of symptomatology.  Questions of differential
diagnosis involve diagnostic skills and must be made by medical
experts.  Espiritu v. Derwinski, 2 Vet.App. 492 (1992).  The
Board also notes that it has been over three years since the last
VA examination.  Under the circumstances of this case, the Board
agrees that another special VA examination should be afforded the
veteran.

Accordingly, the case is hereby REMANDED to the RO for the
following actions:

1.  The RO should obtain and associate
with the claims file all relevant
private and VA medical records
subsequent to 1991.

2.  The veteran should be scheduled for
a special VA examination by a
specialist in peripheral vascular
disease (and by such other
specialist(s) as may be deemed
appropriate) for the following
purposes:  i) to ascertain the nature
and severity of the veteran's residuals
of frostbite of the lower extremities;
ii) to ascertain the severity of the
residuals of shell fragment wounds to
the right lower extremity, right arm
and face; and iii) to differentiate, if
medically possible, between
symptomatology attributable to the
veteran's service-connected
disabilities of the lower extremities
and from that attributable to any other
etiologically unrelated disorder of the
lower extremities found to be present.
It is imperative that the claims file
be made available to and be reviewed by
the examiner prior to the examination,
and the examination report should
clearly document this review.  All
indicated tests, including color
photographs of the veteran's lower
extremities, right arm and face, are to
be accomplished.  The examiner should
be asked to clearly indicate all
symptomatology associated with
residuals of frostbite of the lower
extremities.  If any other disorder of
the lower extremities, such as
thrombophlebitis, is found to be
present, the examiner should state an
opinion as to whether any such disorder
is etiologically related to the
residuals of frostbite.

3.  After completion of the above, the
RO should review the expanded record
and determine if the veteran's claims
can be granted.  If the RO's
determination as to either or both
issues remains adverse to the veteran,
the veteran and his representative
should be furnished a supplemental
statement of the case setting forth a
summary of the evidence, a citation to
and discussion of applicable laws and
regulations, and a detailed analysis of
the reasons for the RO's decision(s).
After affording the veteran and his
representative a reasonable opportunity
to respond, the case should be returned
to the Board for further appellate
review.

The purpose of this decision is to ensure an adequate medical
record for appellate review.  The Board intimates no opinion(s)
as to the ultimate determination(s) to be made in this case.

          ALBERT D, TUTERA
          Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(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 action has been taken in
accordance with the Veterans' Benefits Improvements Act of 1994,
Pub. L. No. 103-446, § 303, 108 Stat. 4645, ___ (1994), and 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) (1993).