BVA9501462 
DOCKET NO.  93-11 016     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Los Angeles,
California

THE ISSUE

Entitlement to an increased rating for a left knee disorder,
currently evaluated as 10 percent disabling.

REPRESENTATION

Appellant represented by: Disabled American Veterans

WITNESS AT HEARING ON APPEAL

The appellant

ATTORNEY FOR THE BOARD

Jeffrey A. Pisaro, Counsel

INTRODUCTION

The veteran had active service from March 1985 to March 1988 and
from February to October 1991.  This appeal arises from a
November 1991 rating decision of the Los Angeles, California,
Regional Office (RO), which granted service connection for a left
knee disorder and assigned a 10 percent evaluation.

REMAND

The Department of Veterans Affairs (VA) has a duty to assist the
veteran in the development of facts pertaining to his claim.  38
U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1993).  The
Court has held that the duty to assist includes obtaining
available records which are relevant to the claimant's appeal.
The duty to assist is neither optional nor discretionary.  Littke
v. Derwinski, 1 Vet.App. 90 (1990).  The veteran testified at a
November 1992 personal hearing that his left knee disability was
growing progressively worse with swelling, locking, pain and
giving way.  Due to worsening symptomatology, the veteran
testified that he was currently unemployed.  He further testified
that he was receiving continuing treatment at the Long Beach VA
medical center, that surgery had been scheduled in the near
future, and that follow-up surgery would be necessary every two
to three years.  The record shows that left knee surgery was
performed in mid-November 1992 with one subsequent outpatient
notation showing that the incision was healing well.  The veteran
was scheduled to return for follow-up in one month.  Complete
medical treatment records should be obtained from the Long Beach
VA medical center from November 1992 to the present.

The duty to assist also includes, when appropriate, the duty to
conduct a thorough and contemporaneous examination of the veteran
that takes into account the records of prior medical treatment.
Green v. Derwinski, 1 Vet.App. 121 (1991).  This is to ensure
that the evaluation of a disability is a fully informed one.  In
view of the foregoing facts, following the gathering of all
available records, the veteran should be afforded a VA orthopedic
examination to determine the nature and extent of all disability
of the left knee.

Under the circumstances of this case, the Board finds that
further assistance is required.  Accordingly, the case is
REMANDED to the RO for the following actions:

1.  The RO should contact the veteran and
obtain the names and addresses of all
health care providers where he has received
treatment for his left knee in recent
years.  Thereafter, the RO should obtain
legible copies of all records which have
not already been obtained to include those
from the Long Beach VA medical center from
November 1992 to the present.  Once
obtained, all records must be associated
with the claims folder.

2.  Following completion of above
development, the veteran should be afforded
a VA orthopedic examination to determine
the nature and extent of all disability of
the left knee.  All indicated tests, to
include x-rays, should be accomplished.  It
is imperative that the physician reviews
the entire claims folder in connection with
the examination.  The disability should be
evaluated in relation to the veteran's
medical history, with emphasis upon the
limitation of activity, including any time
lost from employment, imposed by the
disabling condition.  The orthopedic
examination report should include complete
range of motion studies for the left knee,
and indicate whether there is evidence of
recurrent subluxation or lateral
instability, or frequent episodes of
locking, pain and effusion into the knee
joint.

3.  When the above developments have been
completed, the case should be reviewed by
the RO.  If the decision remains adverse to
the veteran in any way, he and his
representative should be furnished with a
supplemental statement of the case.  They
should then be afforded the applicable time
to respond.

Thereafter, subject to current appellate procedures, the case
should be returned to the Board for further appellate
consideration, if appropriate.  The veteran need take no action
until he is further informed.  The purpose of this REMAND is to
obtain additional information and to ensure due process of law.
No inference should be drawn regarding the final disposition of
the claim as a result of this action.

          CHARLES E. HOGEBOOM
          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).