BVA9503219 DOCKET NO. 92-08 227 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUES 1. Entitlement to an increased disability evaluation for post- operative residuals of a skin graft of the right lower leg, currently evaluated 10 percent disabling. 2. Entitlement to a compensable disability evaluation for a right thigh donor site scar. REPRESENTATION Appellant represented by: AMVETS WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J. F. Gussio, Associate Counsel INTRODUCTION The veteran had active military service from April 1959 to August 1969. This appeal to the Board of Veterans' Appeals (Board) arises from a May 1991 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. The case was remanded to the RO in April 1993 for a VA examination with instructions to determine which extremity (right or left thigh) was the donor site for the skin graft of the right lower leg because service connection had previously been established for a donor site scar of the left leg and the veteran had indicated it was on the right leg. The veteran was examined by the VA in August 1993. In May 1994, the RO granted service connection for a donor site scar of the right thigh and assigned a noncompensable disability rating. The RO did not develop that issue for appellate review. In a letter received at the Board in July 1994, the veteran stated that his skin graft donor site was on the right thigh, not the left thigh. Pictures of the veteran's right leg confirm large donor site scarring of the right upper thigh. Nevertheless the RO has continued to develop for appeal a claim for an increased rating for a left thigh donor site scar and neglected to address a claim for a compensable rating for a right thigh donor site scar, which appears to have been the veteran's claim all along. Even if this were not the case, the veteran's letter of July 1994 clearly constituted a withdrawal in writing ( 38 C.F.R. § 20. 204) of a claim for an increased rating for a left thigh donor site scar. We have recharacterized the second issue stated on the preceding page accordingly. REMAND On VA examination in April 1991, physical examination of the lower extremities revealed extensive deep irregular scarring on the right lower leg with a large graft site involving 50 percent of his upper thigh on the right. There was 1+ pitting edema. The assessment was significant venous stasis, which is probably accentuated by lymphatic eruption due to grafting on the right lower leg with disfiguring graft site scar. On VA examination in August 1993, physical examination of the right leg revealed the grafted area of the lower right leg was dry and scaly but well-healed. The physician noted that there was no evidence of edema, tenderness or muscular difficulty under the graft. There were early dilated venules just distal to the lower end of the grafted area of the leg. The examiner stated they had absolutely no functional or cosmetic significance. The veteran reported he wore a Jobst stocking to control swelling. The pertinent diagnoses were postoperative status of skin grafted area of the right leg and donor site, right thigh, with no complications; well-healed with no functional impairment. The VA has a duty to assist a veteran in the development of facts pertinent to his claims. 38 U.S.C.A. § 5107(a) (West 1991). That duty includes obtaining a medical examination where indicated by the facts and circumstances of the case. Littke v. Derwinski, 1 Vet.App. 90 (1990). Here, the veteran's disability picture is unclear. The 1991 examination revealed extensive deep irregular scarring with 1+ pitting edema and the 1993 examination revealed essentially well-healed scarring with no functional impairment, but a notation that the veteran had to wear a Jobst stocking to control swelling. And the veteran has testified extensively regarding functional impairment from these disabilities. Accordingly, another VA examination is warranted to clarify the veteran's disability picture. To ensure that the VA has met its duty to assist the appellant in developing the facts pertinent to his claims, the case is REMANDED to RO for the following development: The veteran should be scheduled for a VA examination by an appropriate specialist to determine the current severity of his donor site scarring of the right thigh and residuals of the skin graft of the right lower leg. His claims folder should be made available to the examiner for review before the examination. The examiner should describe in detail all pathology and all functional impairment from these two disorders, and comment specifically on the veteran's testimony that he has pain and/or swelling in the skin grafted and donor site areas with prolonged activity and his statements that he has to wear a Jobst stocking to control swelling associated with those disorders. When the above-requested development is completed, the RO should again review the veteran's claims, and specifically readjudicate the claim for an increased rating for a right thigh donor site scar. If the benefits sought remain denied, the veteran and his representative should be furnished an appropriate supplemental statement of the case (specifically encompassing-- if indicated-- a claim of an increased rating for a right thigh donor site scar) and given ample opportunity to respond. The case should then be returned to the Board for appropriate action. The purposes of this REMAND are to obtain clarifying data and to meet due process considerations. GEORGE R. SENYK 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).