BVA9505890 
DOCKET NO.  93-15 214     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Detroit,
Michigan

THE ISSUES

1.  Entitlement to an increased evaluation for amputation of the
thumb of the left hand (minor), currently evaluated as 30 percent
disabling.

2.  Entitlement to an increased (compensable) evaluation for
residuals of a chest wall wound.

ATTORNEY FOR THE BOARD

Robert E. O'Brien, Counsel

REMAND

The veteran had active service from July 1968 to October 1971.

A review of the evidence of record discloses that when the
veteran was accorded his first rating examination by VA in
December 1971, he stated he was right-handed.  Accordingly, when
service connection was granted for amputation of the left thumb
by rating decision dated in January 1972, notation was made that
the amputation of the thumb of the left hand involved the
veteran's minor extremity.  However, in his substantive appeal
dated in June 1993, the veteran indicated that at the time he was
wounded in service, he was left-handed.  He related that while
hospitalized in service he took classes to become right-handed
because of the difficulty using the left hand with the thumb
missing.

Subsequent to the receipt of the claim at the Board in July 1993,
the veteran submitted a letter and a copy of an August 1994
statement from a physician at the VA Medical Center in Ann Arbor,
Michigan.  In his communication dated that month, he stated that
he was receiving continuous treatment at the VA pain clinic in
Ann Arbor.  The statement from the VA physician reported that the
veteran had reflux sympathetic dystrophy which was causing severe
burning pain in the left arm and hand.  The treatment involved a
nerve block which needed to be done every other day for 10 days.
This evidence was received without a waiver of the veteran's
right to have that evidence initially considered by the RO.  Any
pertinent evidence submitted by the veteran or representative
which is accepted by the Board must be referred to the RO for
review and preparation of a supplemental statement of the case,
unless this procedural right is waived by the appellant.  See
38 C.F.R. § 20.1304(c) (1993).  The veteran has not waived his
procedural rights and, in view of other necessary developments,
this case will be returned to the RO for consideration of the
evidence submitted directly to the Board.

The veteran has not been accorded a rating examination by VA
since January 1992.  The United States Court of Veterans Appeals
has held that fulfillment of the VA's duty to assist the veteran
includes providing him with a thorough and contemporaneous
medical examination.  Littke v. Derwinski, 1 Vet.App. 90, 92
(1990).  In view of the subsequent evidence, the Board is
persuaded that a current examination is warranted in connection
with this appeal.

Under the circumstances, the case is REMANDED for the following
actions:

1.  The RO should contact the veteran and
request that he provide the names and
addresses of all health care providers who
have treated him for left hand and chest
wound residuals in the recent past and
specify the approximate dates of treatment,
if possible.  Then, after any necessary
authorization is obtained from the veteran,
the RO should obtain copies of any
treatment records identified by the
veteran.  The VA medical facility in Ann
Arbor, Michigan, should also be contacted
and asked to provide the complete clinical
records regarding treatment of the veteran
there since 1992.

2.  Thereafter, a VA orthopedic examination
should be arranged to determine the extent
and severity of the veteran's left hand
disability and his residuals of a chest
wound.  The examination should be conducted
in accordance with the VA's Physician's
Guide for Disability Evaluation
Examinations (1985).  The examination
reports should include a medical history
with notation of any time lost from work
due to the disabilities and detailed
findings regarding functional loss caused
by the disabilities, including pain,
weakness, or fatigability.  The claims
folder, or copies of all pertinent records,
should be made available to the examiner
for review.

Thereafter, the RO should readjudicate the claims, including the
veteran's claim for increase based on involvement of the major
extremity.  Unless the benefits sought are granted to the
veteran's satisfaction, he should be issued a supplemental
statement and be provided with the applicable time period in
which to respond.  The case should then be returned to the Board
for further consideration, if otherwise in order.  By this
REMAND, the Board intimates no opinion as to any final outcome
warranted.  No action is required of the veteran until he is
notified by the RO.

          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).