BVA9503097 DOCKET NO. 93- 10 736 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to an increased evaluation for residuals of injury to the knees with traumatic arthritis, currently rated as 20 percent disabling. 2. Entitlement to service connection for degenerative arthritis of the hips, secondary to service-connected residuals of an injury of the knees with traumatic arthritis. 3. Entitlement to service connection for degenerative arthritis of the back, secondary to service-connected residuals of an injury of the knees with traumatic arthritis. 4. Entitlement to service connection for a gastrointestinal bleeding, secondary to pain medication prescribed for service- connected residuals of an injury of the knees with traumatic arthritis. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD M. Auer, Counsel REMAND The veteran served on active duty from January 1952 to June 1953. This appeal arises from a May 1992 rating decision of the Department of Veterans Affairs (VA), Nashville, Tennessee, Regional Office (RO). In that decision, an increased rating for residuals of injury to the knees with traumatic arthritis was denied. Additionally, service connection for degenerative arthritis of the hips, back, and legs, secondary to the service- connected knee disability was denied, as was service connection for a gastrointestinal bleeding, secondary to medications prescribed for the veteran's service-connected bilateral knee disorder. This case was originally developed to include the issue of entitlement to service connection for degenerative arthritis of the legs. During a hearing at the RO in May 1993 before the undersigned member of the Board of Veterans' Appeals (Board), the veteran and his representative requested that this claim be considered as a claim for an increased rating for residuals of injuries to the knees (Tr. at 2). Accordingly, the issues for appeal are as outlined on the title page of this decision. With regard to the veteran's claim for service connection for gastrointestinal bleeding secondary to pain medication prescribed for his service-connected knee disability, the Board notes that the threshold question is whether the veteran has presented evidence of a well-grounded claim. The United States Court of Veterans Appeals (the Court) has held that a well-grounded claim is one that is plausible, that is meritorious on its own or capable of substantiation. If a claimant has not presented a well-grounded claim, his appeal must fail. 38 U.S.C.A. § 5107(a) (West 1991); Grivois v. Brown, 6 Vet.App. 136, 139 (1994); Murphy v. Derwinski, 1 Vet.App. 78, 82 (1990). Under the law, a claim for benefits need not be conclusive, but it must be accompanied by evidence. Tirpak v. Derwinski, 2 Vet.App. 609, 610 (1992). Where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992). In the recent case of Robinette v. Brown, No. 93-985 (U.S. Vet. App. Sept. 12, 1994), reconsideration granted in part (Oct. 21, 1994) (per curiam), the Court held that even prior to the submission of a well-grounded claim triggering the duty to assist under 38 U.S.C.A. § 5107(a) (West 1991), the VA has an obligation under 38 U.S.C.A. §§ 5103(a), 7722 (West 1991) to advise the appellant of the evidence necessary to complete his application for benefits. In this case, the veteran is hereby notified that preliminary review indicates that the "evidence necessary to complete the application" is medical evidence that current gastrointestinal bleeding is proximately due to or the result medication prescribed for his service-connected knee disability. During the hearing in May 1993, the veteran reported that he had received treatment (aspiration of the knees) for his service- connected bilateral knee disorder at Vanderbilt (Tr. at 4). The claims file contains no medical records from Vanderbilt. The veteran also testified that he had required the draining of his knees on three or four occasions in the previous ten years. He claimed that this procedure had been performed by a local orthopedic person. He also testified that in the course of VA treatment he had been told that arthritis of the hip was from imbalance in walking due to his knee disability (Tr. at 8). It appears that the medical records in the claims file may be incomplete and that other records showing treatment may be available. VA has a duty to assist the veteran in the development of facts pertinent to his claim under 38 C.F.R. § 3.103(a) (1994). The Court has held that fulfillment of VA's duty to assist the veteran includes the procurement and consideration of any relevant medical records. Ferraro v. Derwinski, 1 Vet.App. 326, 334 (1991). The Board also notes that the veteran has not received a VA examination for his service-connected bilateral knee disorder for many years. VA's duty to assist the veteran in the development of facts pertinent to his claim includes providing him with a thorough and contemporaneous medical examination. Littke v. Derwinski, 1 Vet.App. 90, 92 (1990). Therefore, in order to give the veteran every consideration with respect to the present appeal, it is the Board's opinion that further development of the case is desirable. Accordingly, this case is REMANDED for the following actions: 1. The RO should request that the veteran identify all sources of medical treatment received for the orthopedic disabilities at issue, and to furnish signed authorizations for release to the VA of any private medical records. Copies of the medical records from all sources he identifies (not already in the claims folder) should then be requested. All records obtained should be added to the claims folder. 2. With any additional information provided by the veteran, the RO should determine whether he has presented a well- grounded claim with regard to the issue of his gastrointestinal disorder. The veteran should be accorded a VA examination with regard to this issue if the RO determines it is well grounded but may not be granted based on the available evidence. The examiner should be instructed to set forth the history of symptoms as reported by the veteran as well as all pertinent findings. The examiner should express an opinion as to the probability of a relationship between current findings and any service connected disorder or the medications prescribed for any service-connected disorder. The claims folder or copies of all pertinent records should be made available to the examiner for review. 3. A VA orthopedic examination should be arranged to determine the extent and severity of the veteran's residuals of an injury of the knees with traumatic arthritis. The examination should be conducted in accordance with the VA Physician's Guide for Disability Evaluation Examinations (1985). The examiner should set forth detailed findings regarding limitation of motion, painful motion, and any other functional loss as a result of pain, weakness or fatigability caused by the residuals of an injury of the knees. The examiner should comment on the degree of probability of a causal relationship, if any, between the veteran's bilateral knee disability and any bilateral hip or back disability. The claims folder should be made available to the examiner for review. The RO should then review the veteran's claims in light of all the evidence and applicable legal criteria. The veteran and his representative should be provided with a supplemental statement of the case that includes any additional pertinent law and regulations and a full discussion of the evidence in his case. The appropriate response time should be allowed. The case should be returned to the Board, if in order, after compliance with all regulatory appellate procedures. No action is required of the veteran until he is so informed. The Board intimates no opinion as to the ultimate decision warranted in this case, pending completion of the requested development. 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 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).