BVA9503457 
DOCKET NO.  93-12 090     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in St. Petersburg,
Florida

THE ISSUE

Entitlement to an evaluation in excess of 10 percent for
residuals of a shrapnel wound of the left calf.

REPRESENTATION

Appellant represented by: Disabled American Veterans

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

Melissa F. Marquez, Associate Counsel

INTRODUCTION

The appellant had active service from July 1944 to April 1946,
and from September 1950 to October 1951.  This matter came before
the Board of Veterans' Appeals (hereinafter Board) on appeal from
a February 1992 rating decision of the St. Petersburg, Florida,
Regional Office (hereinafter RO), of the Department of Veterans
Affairs (hereinafter VA).

REMAND

Service medical records indicate the appellant sustained what was
characterized as a slight penetrating shell fragment wound to the
posterior left calf in April 1945.  The day after the injury he
had surgery to remove the foreign body and debridement of the
wound.  In May 1945, the appellant's wound was reportedly healed,
though considerably bound down to the underlying muscle.  He was
released to active duty.  On separation examination from the
first period of service no related residuals were noted.

The evidentiary record reflects the appellant filed an
application requesting entitlement to service connection for
residuals of the 1945 gunshot wound in April 1946.  By a rating
decision dated in May 1946, service connection was granted for a
moderate gunshot wound to muscle group XII, left, with a 10
percent evaluation assigned therewith.  Such 10 percent
evaluation was confirmed in a January 1947 rating decision, but
with a correction to Muscle Group XI properly made.  These are
the posterior and lateral crural muscles of the leg.  The 10
percent rating was continued in rating decisions dated in
September 1947, November 1948, January 1956, and September 1974.
In September 1991, the appellant reopened his claim, and an
increased rating was denied in a February 1992 rating decision.
The appellant expressed disagreement with that rating decision
the following month.

During VA examinations dated in October 1991 and January 1992,
the appellant reported increased weakness and pain in his left
calf.  Upon examination in October, the examiner provided only
objective range of motion studies of the cervical spine,
shoulders, elbows, forearms, back, hips, and knees, with no other
objective findings indicated on such report.  Accompanying x-rays
indicated mild degenerative changes of the lumbosacral spine and
the left knee.  Subsequently, during a January 1992 VA
examination scheduled to evaluate related residuals attributable
to the appellant's right foot, the appellant again complained of
increased pain and weakness of his left calf, as well as frequent
collapsing of his left leg.  Upon examination, the examiner noted
normal range of motion of the cervical spine, with a markedly
decreased metatarsal right arch, and spur formation on the right
calcaneus.  Objective range of motion studies of the feet
indicated normal dorsiflexion from 0 to 10 degrees, and plantar
flexion 0 to 45 degrees.

VA outpatient treatment (OPT) reports dated from September 1990
to September 1992 revealed complaints and intermittent treatment
for left knee pain, instability, and swelling, as well as left
hip, right foot, right leg, right hip, and back pain.  Such
records also contained several reports of the appellant's left
leg collapsing, with both an anti locking knee brace and a cane
prescribed for instability.  Significantly, the appellant is
noted to have a halted gait in June 1992.  Upon a request by the
orthopedic department for a neurologic consultation in June 1992,
the neurological clinic refused to evaluate based upon a finding
that the appellant's chart revealed a purely mechanical
orthopedic problem.

During a July 1992 personal hearing, the appellant testified that
he currently experiences a constant dull pain in his left calf
and knee, with accompanying weakness, muscle spasms, and
swelling.  As a result, the appellant stated that his left knee
collapses daily which has caused him to fall, and that he
currently uses a knee brace and cane prescribed by the VA for
instability.

October 1992 private medical records from Robert Vollbracht,
M.D., including EMG and nerve conduction studies, indicated some
decreased amplitude of the left posterior tibial proximal to
stimulation, with a number of motor units decreased in the left
medical head of the gastroc.  Sensory and motor testing revealed
some degree of weakness of the left leg on eversion, with
decreased pinprick of the left calf area, particularly in and
about the scar areas.  He concluded with an impression of status
post left leg injury with probable component of left posterior
tibia neuropathy, possibly due to infection of the nerve fibers
in the left posterior tibial nerve around the wound scar.

The Board has a duty to assist the appellant in the development
of facts pertinent to his claim.  38 U.S.C.A. § 5107(a) (West
1991).  This duty includes obtaining medical examinations
relevant to the issue on appeal.  See Murphy v. Derwinski, 1
Vet.App. 78 (1990); Littke v. Derwinski, 1 Vet.App. 90 (1990);
Schafrath v. Derwinski, 1 Vet.App. 589 (1991).  It is unclear
from the medical evidence of record as to the current severity
and related residuals of the appellant's in-service gunshot wound
to the left calf.  Particularly, it is unclear as to the nature
and etiology of the appellant's current neurological
symptomatology initially diagnosed during private 1992 treatment,
as it was not evaluated during 1991 and 1992 VA examinations or
outpatient treatment.

Accordingly, the case is REMANDED for the following developments:

1.  The RO should contact the appellant to
determine the names, addresses, and dates
of treatment of any physicians, hospitals
or treatment centers (private, VA or
military) who provided him with recent
relevant treatment since October 1992 for
residuals of a shrapnel wound to the left
calf.  After obtaining the appropriate
signed authorization for release of
information forms from the appellant, the
RO should contact each physician, hospital,
treatment center, and employer specified by
the appellant to obtain any and all medical
or treatment records or reports relevant to
the above mentioned claim.  All pieces of
correspondence, as well as any medical or
treatment records obtained, should be made
a part of the claims folder.  If private
treatment is reported and those records are
not obtained, the appellant and his
representative should be provided with
information concerning the negative
results, and afforded an opportunity to
obtain the records.  38 C.F.R. § 3.159
(1994).

2.  The RO should schedule the appellant
for a complete VA orthopedic examination in
order to determine the severity of any
residuals of the missile wound to the left
calf currently manifested.  All indicated
tests and studies should be done, including
objective range of motion studies of the
appellant's left foot and knee expressed in
degrees, and appropriate x-rays.  In
particular, the examiner is requested to
differentiate between residuals of the
above mentioned missile wound, and any
other disabilities currently found
affecting the knee or ankle.  The claims
folder and the records received pursuant to
the above paragraphs, should be made
available to the examiner prior to the
examination.  The examination should be
conducted and reported in accordance with
the guidelines set forth in the VA
Physician's Guide for Disability Evaluation
Examinations.

3.  The RO should also schedule the
appellant for a complete VA neurological
examination in order to determine the
severity of any neurological residuals of
the missile wound to the left calf.  In
particular, the examiner is requested to
indicate whether there are nerve changes
associated with the wound, and if so, the
particular nerve involved.  It should be
clarified as to whether nerve damage is a
residual of the wound, as opposed to other
back or spinal disabilities currently
manifested, and whether there is sensory
and/or motor functional impairment.  All
indicated tests and studies should be done,
and all subjective complaints and objective
findings should be reported in detail.  If
these matters cannot be medically
determined without resort to mere
conjuncture, this should be commented on by
the examiner in his report.  The claims
folder and the records received pursuant to
the above paragraphs, should be made
available to the examiner prior to the
examination.  The examination should be
conducted and reported in accordance with
the guidelines set forth in the VA
Physician's Guide for Disability Evaluation
Examinations.

4.  The RO should then readjudicate the
appellant's claim for an increased
evaluation for residuals of a missile wound
to the left calf, with application of the
appropriate diagnostic codes in the
Schedule for Rating Disabilities to
determine the percentage of impairment
caused by such disability.

In order to avoid undue delay in this case, the RO should make
certain that the instructions contained in the REMAND decision,
detailing the requested development, have, in fact, been
substantially complied with.  When these developments have been
completed, and if the benefit sought is not granted, the case
should be returned to the Board for further appellate
consideration, after compliance with appropriate appellate
procedures, including issuance of a supplemental statement of the
case.  It is requested that this statement specifically set forth
the reasons and bases for the decision.  No action by the
appellant is required until he receives further notice.

The Board intimates no opinion, either legal or factual, as to
the ultimate disposition warranted in the claim for entitlement
to an evaluation in excess of 10 percent for residuals of a
gunshot wound to the left calf, pending completion of the
requested development.

          MICHAEL D. LYON
          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).