BVA9502381 
DOCKET NO.  93-09 750     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Waco, Texas

THE ISSUE

Entitlement to an increased evaluation for service-connected
postoperative residuals of an ulnar nerve injury of the left arm,
currently rated as 20 percent disabling.

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

Alan S. Peevy, Associate Counsel

INTRODUCTION

The veteran had a period of active military service from April
1979 to May 1992.

This case is before the Board of Veterans' Appeals (Board) on
appeal from an October 1992 rating decision by the Waco, Texas,
Regional Office (RO).  A notice of disagreement addressing only
the issue of entitlement to an increased rating for left arm
disability was received in January 1993, and a statement of the
case was issued in early April 1993.  In late April 1993, the
veteran appeared at a personal hearing before a member of the
Board sitting at the RO.  The transcript of this hearing has been
accepted as the veteran's substantive appeal.

The veteran is not represented in connection with this appeal.

REMAND

As has been noted by the United States Court of Veterans Appeals
(Court), to provide an appellant with an adequate examination, it
is necessary to take into account the entire medical history.
Roberts v. Derwinski, 2 Vet.App. 387 (1992).  Preliminary review
of the record reveals that the claims file was apparently not
available to the examiners who conducted the Department of
Veterans Affairs (VA) medical examination in September 1992.  In
this regard, the Board notes that the report of the general
medical examination as well as the report of the orthopedic
examination contain language to the effect that the veteran's
medical records were not available.  In view of the holdings of
the Court, the September 1992 examination must be viewed as
inadequate for rating purposes.

Further, the Board notes that the service-connected disability at
issue in the present case involves a nerve injury.  Although a
special neurological examination was apparently scheduled for
July 1992, the record reflects that the veteran did not report
for that examination.  However, although both a general medical
examination and an orthopedic examination were conducted by the
VA in September 1992, no neurological examination was
accomplished at that time.  In view of the nature of the
veteran's disability, the Board believes that a special
neurological examination is necessary.

As noted in the introduction, the only issue currently certified
on appeal is entitlement to an increased evaluation for service-
connected postoperative residuals of an ulnar nerve injury of the
left arm, currently rated as 20 percent disabling.  However, the
October 1992 rating decision which is the basis for this appeal
also denied entitlement to increased (compensable) ratings for
postoperative scars of the left arm and donor site scars of both
legs.  The Board notes that these two additional issues were
cited at the beginning of the April 1993 hearing and that
testimony pertinent to these additional issues was presented at
that hearing.  Under the circumstances, the Board believes that
the transcript of the April 1993 hearing must also be viewed as a
notice of disagreement on the two additional increased rating
issues.  Appropriate action by the RO pursuant to 38 C.F.R.
§ 19.26 (1993) is therefore necessary so as to provide the
veteran the opportunity to perfect an appeal as to these issues.

Finally, the claims file contains a Certificate of Release or
Discharge from Active Duty (DD Form 214) which documents the
veteran's active military service from April 1979 to May 1992.
However, although this document also refers to an additional 4
years, 9 months, 21 days of active service, there is no
verification of this reported additional service in the claims
file.  In light of the need for further development as outlined
above, the Board believes it appropriate to clarify the dates of
the veteran's reported additional active service.

For the reasons outlined above, the case is hereby REMANDED to
the RO for the following actions:

1.  The RO should obtain verification
from the service department as to the
dates of all of the veteran's active
military service.

2.  The veteran should be scheduled for
special VA surgical and neurological
examinations for the purpose of
ascertaining the current severity of
the veteran's residuals of nerve injury
of the left arm, postoperative scars of
the left arm and donor site scars of
both legs.  It is imperative that the
claims file be made available to and be
reviewed by the examiners in connection
with the examinations, and the reports
of the examinations should clearly
document this review.  The examinations
should be conducted according to the
guidelines set forth in the VA's
Physicians Guide for Disability
Evaluation Examinations, including
those set forth in paragraph 11.20 of
that publication as pertains to scars.
All appropriate tests, including
radiological studies (if deemed
appropriate) and color photographs of
all scar sites should be accomplished.

3.  After completion of the above, the
RO should review the claims file and
determine whether the veteran's claim
as to the increased rating for nerve
injury of the left arm issue can be
granted.  The RO should also consider
whether entitlement to increased
(compensable) ratings for postoperative
scars of the left arm and for donor
site scars of the legs can be granted.
If the RO's determination as to any
issue is adverse to the veteran, then
the veteran should be furnished a
supplemental statement of the case
addressing each such issue.  The
supplemental statement of the case
should set forth a summary of the
evidence, a citation to and discussion
of all applicable laws and regulations
(including all applicable diagnostic
codes), and a detailed analysis of the
reasons for the RO's decision(s).  With
regard to the issues involving
increased ratings for scars, the
veteran should be clearly advised of
the necessity of filing a timely
substantive appeal if he wishes to
perfect an appeal as to either or both
of these issues.  After affording the
veteran a period of 60 days to respond,
the case should be returned to the
Board for further appellate review of
all issues properly in appellate
status.

The purpose of this decision is to comply with the holdings of
the Court, to assist the veteran, and to clarify the record.  The
Board intimates no opinions as to the eventual determinations to
be made in this case.

          EUGENE A. O 'NEILL
          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 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) (1993).