BVA9505692 DOCKET NO. 91- 46 866 ) DATE ) RECONSIDERATION ) ) On appeal from a decision of the Department of Veterans Affairs Regional Office in Manila, Philippines THE ISSUE Entitlement to an increased evaluation for residuals of a shell fragment wound of the left knee, currently evaluated as 10 percent disabling.. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Sheila A. Lawson, Associate Counsel REMAND The veteran had recognized Philippine guerrilla service from March 1945 to November 1945. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 1991 decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Manila, Philippines. When the case was before the Board in May 1994, it was remanded to the RO for further clinical development. In June 1994, pursuant to the Board's May 1994 remand instructions, the veteran underwent a VA examination, during which he complained of left knee pain. The examiner noted that the veteran's most recent VA examination was in March 1992, and that he indicated that he did not take regular medication. The examiner reported that the veteran walked with a limp but did not appear to be in any distress. Examination of the veteran's left knee was negative for any findings of swelling, deformity, subluxation or crepitus. The examiner noted that the veteran had smooth knee movements, and was able to flex his knee while seated during the interview. The examiner also noted, however, that upon examination, the veteran was unable to flex his knee. The examiner found that the veteran had full extension of the left knee and flexion to 140 degrees. The examiner described the veteran's left knee scar as stellate, well healed and approximately 4.5 centimeters in length. Examination of the scar was negative for any keloid formation, adherence, herniation, inflammation, swelling, depression, vascular complications or ulceration. The examiner also indicated that the veteran's left knee scar was not tender or painful on objective demonstration and did not result in any functional limitation of his left knee. X-ray studies of the veteran's left knee revealed minimal degenerative osteoarthritis of the knee joint. At the conclusion of the examination, the veteran was diagnosed as having minimal degenerative osteoarthritis of the left knee, and well-healed residuals of a shell fragment wound of the left knee. In correspondence dated in July 1994, the veteran expressed his dissatisfaction with the VA examination. In September 1994, the Board received an affidavit from the veteran's private physician, Ponciano N. Lloren. Dr. Lloren reported that he had treated the veteran on numerous occasions since 1946 for residuals of a shell fragment wound of the left knee. He reported that such residuals included recurrent and continuous pain of the left knee joint, swelling and fetid discharge. Dr. Lloren stated that he had prescribed and administered various medications and vitamins to the veteran. Dr. Lloren also reported that he recently diagnosed the veteran as having post-traumatic arthritis, and opined that this condition was a residual of his service-connected shell fragment wound. Dr. Lloren's findings with respect to the range of motion of the veteran's left knee were less than 45 degrees flexion and less than 15 degrees extension due to pain. In light of Dr. Lloren's opinion that the veteran's arthritis is a residual of his service-connected shell fragment wound, and the inconsistencies in his September 1994 affidavit and the July 1994 VA examination report regarding the range of motion of his left knee and the nature of his left knee scar, the Board finds that further clinical data are needed to evaluate the residuals of the veteran's left knee shell fragment wound. The Board also notes that the veteran appears to be raising issues of entitlement to service connection, on a secondary basis, for disabilities resulting from the residuals of his left knee shell fragment wound. In light of the foregoing circumstances, the Board concludes that a remand is required. Accordingly, the case will be REMANDED to the RO for the following actions: 1. The RO should contact the veteran, through his representative, and request that he clarify whether he is seeking service connection for any disabilities as secondary to his service-connected residuals of a shell fragment wound. If the veteran responds in the affirmative, the RO should undertake any indicated development. 2. The RO should also request that the veteran identify specific names, addresses, and approximate dates of treatment for all health care providers from whom he has received treatment in recent years for his service-connected residuals of a shell fragment wound. With any necessary authorization, the RO should attempt to obtain the treatment records identified by the veteran that have not been secured previously. 3. Then, the RO should arrange for a VA orthopedic examination, by a board certified orthopedist who has not examined him previously, to identify the extent of current impairment resulting from the residuals of a shell fragment wound of the left knee. The orthopedist should specifically identify the extent of any associated functional impairment present, to include any muscle impairment present. The examiner should specifically indicate whether the associated scarring is tender, painful, ulcerated, depressed or adherent. All indicated studies should be performed. The examiner should be requested to express an opinion, supported by complete rationale, as to the etiology of the veteran's osteoarthritis of the left knee. The veteran's claims folder should be made available to the examiner prior to the examination. 4. Thereafter, the RO should adjudicate any additional issues specified by the veteran, adjudicate the issue of service connection for arthritis of the left knee and readjudicate the veteran's claim of entitlement to an evaluation higher than 10 percent for residuals of a shell fragment wound of the left knee. If the benefits sought on appeal are not granted to the veteran's satisfaction, or if a Notice of Disagreement is received with respect to any other matter, the RO should issue a Supplemental Statement of the Case for all issues in appellate status, and the veteran and his representative should be provided an opportunity to respond. The case should then be returned to the Board for further appellate consideration, if otherwise in order. In taking this action, the Board implies no conclusion, either legal or factual, as to any ultimate outcome warranted. No action is required of the veteran until he is notified by the RO. J. J. SCHULE SHANE A. DURKIN ROBERT E. SULLIVAN STEPHEN L. WILKINS JOHN E.ORMOND F. JUDGE FLOWERS 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) (1994).