BVA9507446 
DOCKET NO.  93-13 093     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Milwaukee,
Wisconsin

THE ISSUE

Entitlement for service connection for right foot disorder,
characterized as status post-operative residuals of bunionectomy
of the right foot and osteotomy of the first metacarpal bone of
the right great toe for metatarsus primus varus with hallux
valgus and a bunion.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

Lisa A. Samorajczyk, Associate Counsel

REMAND

The veteran had over 20 years of active service, including
verified service from September 1975 to September 1992 and
unverified active service from June 1971 to May 1974.

The veteran contends that he is entitled to service connection
for residuals of a bunionectomy and an osteotomy for metatarsus
primus varus with hallux valgus and  bunion either based upon
aggravation of preservice right foot disability or onset during
service of additional acquired right foot disorders, including
degenerative arthritic changes of the right big toe.  Although
the veteran admits that he had a preexisting foot condition prior
to his entrance into military service, he contends that the
surgery that he had during military service aggravated the
disability.

A review of the evidence reflects that the veteran underwent an
osteotomy of the first metatarsal and bunionectomy prior to
service.  He was seen for right foot pain on several occasions
during his first period of service.  It was determined that his
disability was not of such severity as to warrant a medical
board; however, he was cross-trained for a position which would
not require prolonged standing.  X-rays as early as 1972
reflected arthritis change.  There were no pertinent findings for
a number of years.  In October 1991, he underwent a second
bunionectomy and osteotomy.

On the initial VA examination in December 1992, it was reported
that the veteran had surgical repair of a bunion on the right
foot at age 15; that the bunion recurred and grew again while in
military service; and that in October 1991, he had a second
bunionectomy and osteotomy.  Since then, the first metatarsal
phalangeal joint had been stiff but no longer painful.  An X-ray
of the right foot revealed articular changes of the first
metatarsophalangeal joint and asymmetry due to the previous
bunionectomy.  A wire suture was shown, as was a portion of a
threaded pin in the tarsal navicular.  The pertinent diagnosis
was postoperative status bunionectomy of the right foot along
with osteotomy of the first metacarpal bone.

The record contains private medical records pre-dating service
and service medical records dated throughout the veteran's active
service that confirm the historical observations recounted at the
December 1992 examination.  However, the available records do not
provide sufficient information regarding the status of the
veteran's foot disability subsequent to the 1991 surgery.  In
particular, there is only an inpatient clinical cover sheet and a
few clinical records covering the veteran's hospitalization at
Womack Army Hospital in October and November 1991.  Further,
although the record reflects that the veteran was scheduled for a
retirement physical examination in January 1992, no report of
final retirement physical examination in service, if undertaken,
is present in the record.  Moreover, the veteran has not been
afforded an examination by an orthopedist to determine the
current level of disability.

To ensure that the Department of Veterans Affairs (VA) has met
its duty to assist the claimant in developing the facts pertinent
to the claim and to ensure full compliance with due process
requirements, the case is REMANDED to the regional office (RO)
for the following development:

1.  The RO should contact the service
department to verify the veteran's periods
of active military service and obtain any
available outstanding service medical
records, including the narrative summary of
the veteran's hospitalization at the Womack
Army Hospital in October and November 1991
and the 1992 retirement examination.

2.  The RO should obtain the names and
addresses of all medical care providers who
have treated the veteran for a right foot
condition since September 1992.  After
securing the necessary release(s), the RO
should obtain these records.

3.  Thereafter, the veteran should be
afforded a VA orthopedic examination of his
right foot to determine the nature and
extent of any disability present.  All
indicated tests and studies should be
accomplished.  The claims folder and a copy
of this remand should be made available to
the examiner for review before the
examination.  The examiner should ascertain
and comment on the level of disability
present on service entrance in 1971 and the
current level of disability.  In addition,
the examiner be asked to provide an opinion
as to whether the veteran's surgery in 1991
represented an increase in the level of his
disability associated with his right foot.
If so, the examiner should further address
the issue of whether any such increase is
due to intervening stress or trauma or the
natural progress of his preexisting foot
disability.  If the evidence is not
sufficient to permit the examiner to answer
any question posed, he/she should so state
in the  report of the examination.

When this development has been completed, the claim should be
reviewed by the RO.  If any benefit sought on appeal is not
granted, the appellant and his representative should be given a
supplemental statement of the case with regard to the additional
development and should also be afforded an opportunity to respond.
The record should be returned to the Board for further appellate
consideration, if in order.

Thereafter, the case should be returned to the Board, if in
order.  The Board intimates no opinion as to the ultimate outcome
of this case.  The appellant need take no action unless otherwise
notified.

          V. L. JORDAN
          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) (1994).