BVA9503079 DOCKET NO. 93-10 213 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Milwaukee, Wisconsin THE ISSUES Entitlement to an increased rating for the residuals of shell fragment wound injury of the muscles of the right thigh, currently evaluated as 40 percent disabling. Entitlement to an increased rating for the residuals of a shell fragment wound injury to the right thigh consisting of neurological damage, currently evaluated as 30 percent disabling. Entitlement to service connection for a back disorder, including as secondary to service-connected disabilities. Entitlement to service connection for transient ischemic attacks as secondary to service-connected disabilities. Entitlement to service connection for neurological defects of both feet. Entitlement to special monthly compensation based on loss of use of the right foot. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J. L. Prichard, Associate Counsel REMAND The veteran had active service from February 1943 to May 1946. The veteran contends that his service-connected disabilities have increased in severity to such a degree as to warrant increased evaluations. He argues that he is able to walk for only a short distance, and that he does not have any feeling in his right foot. He also notes that his right leg is very weak. The veteran contends that he has developed several disorders as a consequence of his service-connected disabilities, including a back disorder and transient ischemic attacks. He argues that his altered gait and poor posture resulting from his service- connected disabilities have caused a low back disorder. He states that he has undergone surgery to correct this disorder on several occasions, but that the symptoms have not been alleviated. He contends that he experiences neurological problems in both feet as a result of a back disability which resulted from a gait disturbance due to his service-connected right thigh disorders. He asserts he has lost use of his right foot either due to the right thigh disorders or due to disc disease which resulted from the thigh disorders. He states that he requires a brace on his right foot. Finally, he contends that he has developed transient ischemic attacks secondary to his service-connected disabilities. The veteran indicated at a January 1990 neurological examination that he was followed at a Department of Veterans' Affairs (VA) facility for his transient ischemic attacks, and that he was told that the problem was neurologic as opposed to vascular. These records are not contained in the claims folder. The veteran is service connected for the residuals of a muscle injury to the right thigh, currently evaluated as 40 percent disabling, and the residuals of a nerve injury to the right thigh, currently evaluated as 30 percent disabling. Those ratings are protected. He seeks service connection for a back disorder which has been diagnosed as spinal stenosis, neurological defects of both feet, and entitlement to special monthly compensation for the loss of use of the right foot. The veteran was afforded a VA examination in October 1992, at which time the examiner offered an opinion as to the etiology of the back disorder and stated: He has a history of a right sciatic nerve injury, which probably affected motor fibers to his right gastrocnemius, accounting for his absent ankle jerk and weakness of this right gastrocnemius. As a sequella *sic* to his change in gait, one could hypothesize mechanical low back pain; however, it seems unlikely that all of the difficulties that he has had with spinal stenosis would be referrable *sic* to his shrapnel injury in 1945. The veteran noted in a letter dated in February 1993 that he was recently fitted with braces for both legs. The records pertaining to this have not been obtained; and it is unclear whether the brace on the right leg is needed for his service- connected disabilities. The VA has a duty to assist the veteran in developing all evidence pertinent to his claim. 38 U.S.C.A. § 5107 (West 1991). This includes obtaining all necessary medical records and affording him adequate medical examinations. Therefore, the Board of Veterans' Appeals (Board) finds it necessary to remand this case for the following development: 1. All VA treatment records pertaining to treatment of the veteran from 1989 until the present should be obtained and associated with the claims folder. 2. The veteran should be asked to provide the names and addresses of all private sources of treatment for his disabilities from 1992 to the present. After obtaining the proper releases from the veteran, those records should be obtained and associated with the claims folder. The RO should especially attempt to obtain the records pertaining to the ordering of the veteran's braces of the right and left leg. 3. The veteran should be afforded VA orthopedic and neurologic examinations of his back and lower extremities to determine the nature and probable etiology of his back disorder and the underlying pathology of any neurological defect of both lower legs. All indicated tests and studies should be conducted. The examination of the right foot should include studies to ascertain all remaining function of the foot. The balance and propulsive abilities of the right foot should be noted, as well as the possible existence of organic changes (e.g., disuse atrophy) which might be evidence of loss of use. The examiners should differentiate, if possible, between those symptoms of the right leg and foot attributable to the service-connected disabilities and those which are attributable to nonservice-connected causes. The disability that has resulted in the use of the brace of the right foot should also be noted. The veteran's claims folder should be made available to, and reviewed by, the examiners in the study of this case. Following completion of these developments, the RO should review the veteran's claims on the basis of the additional evidence. If the decisions remain unfavorable to the veteran, both he and his representative should be issued an appropriate supplemental statement of the case and given opportunity to respond. The case should then be returned to the Board for further appellate review. The purpose of this remand is to assist the veteran in the development of his claim. The Board does not intimate any opinion, either legal or factual, as to the ultimate disposition warranted in this case. _______________________________ GEORGE R. SENYK 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).