BVA9503147 
DOCKET NO.  93-13 385     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Seattle,
Washington

THE ISSUE

Entitlement to service connection for disability manifested by
chronic bilateral buttock pain.

REPRESENTATION

Appellant represented by: Washington Department of
Veterans Affairs

ATTORNEY FOR THE BOARD

S. L. Kennedy, Counsel

REMAND

The veteran served on active duty from November 1985 to August
1990.

This appeal arises from an October 1992 rating decision of the
Department of Veterans Affairs (VA), Seattle, Washington,
Regional Office (RO).  In that decision, service connection for a
bilateral hip disorder was denied.

On VA Form 9 (Appeal to Board of Veterans' Appeals) received at
the RO in April 1993, the veteran expressed her dissatisfaction
with an August 1992 VA examination conducted to determine whether
she did, in fact, have a bilateral hip disorder.  She stated that
her problem was not in the hip joints, but rather consisted of
nerve damage to both hips from injections, and that the residuals
included knots, scar tissue and pain.

A review of the August 1992 VA examination reflects that the
examiner did identify chronic bilateral buttock pain, most likely
secondary to injections in this area.  However, a definitive
diagnosis to account for the pain was not given.  A more
comprehensive examination is required to identify the nature,
severity, and etiology of the pain, i.e., to determine whether
the pain is a manifestation of nerve or muscle damage secondary
to injections in this area.  The Court of Veterans Appeals has
held that fulfillment of the VA's duty to assist the veteran
includes providing him or her with a thorough and contemporaneous
medical examination.  Littke v. Derwinski, 1 Vet.App. 90, 92
(1990).  The Board has determined that such an examination is
necessary in this case.

In view of the foregoing, and in order to fully and fairly
adjudicate the veteran's appeal, the case is REMANDED to the RO
for the following action:

1.  The RO should request the veteran to
identify the names and addresses of any
medical care providers, VA and otherwise,
who treated her for buttock pain or other
injection site residuals.  After securing
any necessary release, the RO should obtain
records of any treatment identified by the
veteran.

2.  The veteran should be afforded VA
neurologic examination to determine the
nature and severity of any residuals
secondary to intramuscular injections of
pain medication in the buttocks.  The scope
of the examination should be broad enough
to cover all residual conditions which are
suggested by the veteran's complaints,
symptoms or findings at the time of
examination.  All pertinent complaints or
symptoms having a medical cause should be
covered by a definite diagnosis.  The
examination should be conducted in
accordance with the VA Physician's Guide
for Disability Evaluation Examinations.
All indicated diagnostic tests and
procedures should be accomplished.  The
report should summarize all significant
positive findings, particularly those
relating to limitation of function.  The
examiner should specifically identify
affected muscle groups and nerves, if any.
The claims folder should be made available
to the examiner prior to the examination.

3.  Appropriate adjudicatory action should
be taken by the RO on the issue of service
connection for the residuals of injuries to
the buttocks secondary to intramuscular
pain medication injections.  If the
determination is adverse to the veteran,
she should be provided an appropriate
supplemental statement of the case which
includes a summary of additional evidence
submitted, any additional applicable laws
and regulations, and the reasons for the
decision.  The veteran and her represen-
tative should be afforded the applicable
time to respond.

The case should be returned to the Board for further appellate
review.  The Board intimates no opinion, either factual or legal,
as to the ultimate conclusion warranted in this case.

          GARY L. GICK
          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 deter-
mination.  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).