BVA9507554 DOCKET NO. 93-16 558 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to an increased rating for residuals of fractures of the medial malleolus and the second, third and fourth metacarpals, to include the propriety of the reduction from 20 percent to 10 percent. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL The veteran ATTORNEY FOR THE BOARD Richard E. Coppola, Associate Counsel INTRODUCTION The veteran served on active duty from December 1967 to December 1970. This matter came before the Board of Veterans' Appeals (Board) on appeal from a rating decision of January 1992 from the Cleveland, Ohio, Department of Veterans Affairs (VA) Regional Office (RO). In pertinent part, the RO reduced the veteran's disability evaluation for residuals of fractures of the medial malleolus and the second, third and fourth metacarpals from 20 percent to 10 percent, effective from April 1, 1992. REMAND The claims folder discloses that additional records were recently added to the records assembled for appellate review. This new evidence includes records showing treatment and examination of the left foot and ankle from February 1994 to May 1994. In statements accompanying these records the veteran said that he underwent surgical removal of four bones from the left foot on April 4, 1994, in order to treat his service-connected residuals. The April 1994 VA hospitalization summary shows that an excision of a loose fragment of the left medial malleolus was performed at that time. Follow-up outpatient records indicate removal of osseous fragments from the left medial malleolus, and a short, weight-bearing cast applied to the lower left extremity. The most recent record, dated in May 1994, notes that the veteran did not return for follow-up examination. The veteran also stated that there were plans to fuse the left ankle joint; however, it is unclear whether this was performed. At the personal hearing, the veteran testified regarding his residual symptoms and indicated that the residual pain, swelling and instability of the left ankle and foot has become significantly more disabling. Transcript, pp. 2-4 (Dec. 1992). He testified that he was issued support stockings due to the severity of his left ankle instability. Tr., at 3. He also testified that his symptoms included radiating pain from the left ankle upwards. Tr., at 6. The current nature and severity of the veteran's post-operative residuals are not clear from the evidence of record. The Board finds that a current VA examination should be conducted in order to assist the veteran in accordance with 38 U.S.C.A.. § 5107(a) (West 1991). Under the circumstances, the Board finds that additional development of the evidence is necessary. Accordingly, the case is REMANDED for the following actions: 1. The veteran should identify the names and addresses of any medical care providers, VA or otherwise, who have treated him for residuals of fractures of the medial malleolus and the second, third and fourth metacarpals, including any surgical procedures such as fusion of the left ankle. After obtaining any needed authorization from the veteran, the RO should obtain copies of all these records. 2. The veteran should then be afforded special VA orthopedic examination to determine the nature and extent of all residuals of the service-connected of fractures of the medial malleolus and the second, third and fourth metacarpals. The scope of the examination should be broad enough to cover all residual conditions which are suggested by the veteran's complaints, symptoms or findings. A special neurologic examination should be conducted if deemed warranted in the opinion of the examiner to determine whether any associated neurologic residuals are present. The examination(s) should be conducted in accordance with the Physician's Guide for Disability Evaluation Examinations. The physician(s) must be provided the claims folder for review in connection with the examination(s). The extent of functional loss, including that which is due to pain consistent with the objective findings should be reported. The physician should also indicate the extent of any disability of the left lower extremity which is not caused or aggravated by residuals of the in-service fractures of the medial malleolus and the second, third and fourth metacarpals. If there is a neurologic deficit of the left lower extremity, that physician should provide an opinion as to the etiology of such deficit and the degree of probability, if any, that such deficit is caused or aggravated by the service-connected disability. 3. When the above development has been completed, the case should be reviewed by the RO. The rating decision should reflect consideration of all potentially applicable criteria, to include consideration of the applicability of 38 C.F.R. § 3.321(b)(1). The veteran and his representative should then be furnished with a supplemental statement of the case which summarizes the pertinent evidence, fully cites the applicable legal provisions not previously provided, and reflects detailed reasons and bases for the decision. They should then be afforded the applicable time period 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) (1994).