BVA9500252 
DOCKET NO.  90-02 422     )       DATE
          )
          )

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

THE ISSUE

Entitlement to special monthly compensation based on loss of use
of one foot.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

R. L. Shaw, Counsel

INTRODUCTION

The veteran had active military service from February 1942 to
April 1946.

This matter was previously before the Board of Veterans' Appeals
(the Board) on appeal from a September 11, 1989, rating decision
by the St. Petersburg, Florida, Regional Office (RO) of the
Department of Veterans Affairs (VA).  By a decision dated
July 30, 1990, the Board upheld the denial of a rating higher
than 30 percent for residuals of a gunshot wound to the right
thigh.  The veteran appealed these determinations to the United
States Court of Veterans Appeals (the Court).  In an order issued
on August 26, 1992 ([citation redacted]), the Court granted the
appellee's motion, and the matter was remanded to the Board for
additional adjudication.

On October 2, 1992, consistent with the order of the Court, the
Board remanded the claim to the RO to obtain additional records
and for the scheduling of an orthopedic examination of the
veteran.  The Board assumed jurisdiction, as an inextricably
intertwined issue, the matter of entitlement to special monthly
compensation based on loss of use of the right foot.  Harris v.
Derwinski, 1 Vet.App. 180 (1991).  After additional clinical
studies, the rating for residuals of a gunshot wound to the right
thigh involving Muscle Group XII, with traumatic arthritis of the
right knee, was raised to 50 percent from April 28, 1989.  The
veteran has indicated through his representative that he
considers the increased rating issue to be resolved.  By a rating
decision of November 1993, the claim for special monthly
compensation based on loss of use of the right foot was denied.

REMAND

The actions requested by the Board in the October 2, 1992, remand
included a medical examination to ascertain how much of the
veteran's right lower extremity impairment is due to the service-
connected gunshot wound residuals alone, without regard to the
disabling effects of a 1984 cerebrovascular accident which
resulted in a partial right hemiparesis.  The examiner was asked
to determine whether loss of use of the right lower extremity was
present or absent and to differentiate the loss of function
caused by the wound residuals from that due to the nonservice-
connected stroke.  However, the report of an orthopedic
examination performed in October 1992 contained no indication as
to whether loss of use was present.  At the request of the
veteran's representative, the RO referred the case back for
further review by the examiner in light of the questions posed by
the Board.  In a supplemental report dated in October 1993, the
examiner expressed an inability to determine, without having
examined the veteran before his stroke, how much of the current
impairment resulted from wound residuals.

The question of whether the wound residuals are productive of
loss of use within the meaning of VA regulations is a medical
determination which must be made from the record, without resort
to independent medical judgment by the Board.  Colvin v.
Derwinski, 1 Vet.App. 171 (1991).  Without an adequate factual
record, the Board is unable to satisfy the statutory requirement
that it articulate adequate reasons and bases for its decisions.
See Gilbert v. Derwinski, 1 Vet.App. 49 (1990).  Where the record
before the Board is inadequate, a remand is required.  Green v.
Derwinski, 1 Vet.App. 171 (1991).  Where a medical opinion
requested by the Board has not been rendered, the claim must be
remanded.  Smith v. Brown, 5 Vet.App. 335 (1993).

While the Board understands the difficulty cited by the examiner
in differentiating the effects of one disability from those of
another, an examination report which does not answer the
questions raised is of no evidentiary value in deciding the
appeal.  See Perman v. Brown, 5 Vet.App. 237 (1993).  The Board
is not persuaded that, in the circumstances of the present case,
a useful opinion cannot be obtained.  The medical review
performed pursuant to the remand is clearly deficient since it
was limited to a description of the veteran's current physical
status and omitted consideration of the prior documentary record,
which includes medical reports describing both the original thigh
wound and the residuals of the injury before the stroke.  It
would appear that information concerning the status of the
extremity before the stroke would be highly relevant, even though
the examiner might not find a records review to be a fully
adequate substitute for having personally examined the veteran
before 1984.

In view of the foregoing, the case is REMANDED to the RO for the
following action:

The claims file should be referred to (if
feasible) a board-certified or board-
qualified orthopedist who has not
previously examined the veteran or the file
for a comprehensive review of all medical
evidence of record, beginning with the
World War II combat wound to the veteran's
right thigh, and for a medical opinion
based on such review.  If considered
warranted by the examiner, in his or her
discretion, an actual physical examination
of the veteran may be ordered; any
examination performed should conform to the
requirements of the VA Physician's Guide
for Disability Evaluation Examinations (IB
11-56, March 1, 1985), and all findings
should be reported in detail.  On the basis
of this review of the record including, if
deemed necessary, the report of any current
physical examination performed, the
examiner should state a conclusion as to
the medical probability that the service-
connected thigh and knee wound residuals,
considered separately from the residuals of
the postservice stroke, are of such degree
that "no effective function remains other
than that which would be equally well
served by an amputation stump at the site
of election below...knee with use of a
suitable prosthetic appliance."  The
examiner also should state an opinion as to
the likelihood that the service-connected
gunshot wound residuals resulted in
extremely unfavorable ankylosis of the knee
or shortening of the lower extremity by
3½ inches or more or complete paralysis of
external popliteal nerve (common peroneal).
38 C.F.R. § 4.63 (1993).  The basis for the
conclusions should be stated in full.

When the foregoing development has been completed, the claim
should be reviewed by the RO.  If the decision remains adverse to
the veteran, a supplemental statement of the case should be
prepared and the veteran and his representative should be given a
reasonable period of time for reply.  Thereafter, the claim
should be returned to the Board for further review, if in order.
No action is required of the veteran unless he is so notified.
The purpose of this REMAND is to obtain additional information.
The Board does not intimate any factual or legal conclusions
regarding the outcome ultimately warranted in this appeal.

          STEPHEN L. WILKINS
          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).