BVA9500914 
DOCKET NO.  93-10 473     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Hartford,
Connecticut

THE ISSUE

Entitlement to service connection for a left total knee
replacement.

REPRESENTATION

Appellant represented by: Connecticut Department of
Veterans Affairs

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

R. T. Jones, Counsel

INTRODUCTION

The veteran served on active duty from August 1950 to July 1954.

This matter comes to the Board of Veterans' Appeals (Board) from
a September 1991 rating decision by the Department of Veterans
Affairs (VA) Regional Office (RO) in Hartford, Connecticut, which
denied service connection for a total left knee replacement.  The
RO granted service connection for a scar as the residual of white
phosphorous burns on the left knee, rated noncompensable, in
August 1992.

REMAND

The veteran seeks service connection for a total left knee
replacement which he claims is due to traumatic injury to the
left knee joint, which caused arthritis and eventually required a
total left knee replacement.  He states that this injury occurred
at the same time he incurred white phosphorous burns in the left
knee area during combat in the Korean Conflict.

The veteran's service medical records are unavailable, apparently
lost in a fire at the National Personnel Records Center in 1973,
but all available secondary service records have been developed
and show that the veteran was hospitalized for 27 days beginning
in November 1951 as a result of burns (white phosphorous) of the
left leg incurred as a result of action against the enemy.

The veteran has presented a well-grounded (plausible) claim.
38 U.S.C.A. § 5107(a) (West 1991).  In light of the heightened
duty to assist the veteran when his service medical records are
not available and legal presumptions as to proof of service
connection for injuries alleged to have been incurred in combat
(38 U.S.C.A. § 1154(b)), there is a further duty to assist the
veteran in his claim.

The veteran has submitted opinions from H. S. Pasternak, M.D.,
who first saw him in 1989, that the veteran developed traumatic
osteoarthritis as a result of a concussive injury incurred at the
time he sustained the burns of his left knee.  There is no record
of any treatment for arthritis of the left knee prior to the
1980's nor has the veteran identified physicians who have treated
him for such condition prior to the 1980's.  However, he has
testified that a physician prescribed Motrin for his knee pain
many years ago, and that from time to time he had to have fluid
drained from the knee.  Later, he began to see R. H. Safer, M.D.,
but Dr. Safer's response to an inquiry from the RO was more of a
general history and current assessment than a specific history of
the veteran's knee problems.  Finally, since the veteran was
wounded in combat, and in the absence of evidence to the
contrary, I accept his description of the circumstances of the
wound and its treatment, including his testimony that, after the
injury but while he was still in service, "the knee would give
out" (May 1992 hrng. tr., veteran's corrected version, at 10),
and would "pop" (10), and that one of the doctors treating him
told him the injury had involved the cartilage (10).  38 U.S.C.A.
§ 1154(b) (West 1991).

In view of the foregoing, the case is REMANDED for the following
action:

1.  The veteran should be asked to identify
all sources of knee treatment between
service discharge and 1988.  All records of
such treatment should be obtained.

2.  The VA should obtain copies of all
clinical treatment records pertaining to
knee disabilities from Robert H. Safer,
M.D.

3.  The entire record should be referred to
a VA orthopedic physician who should review
the entire record with particular attention
to the initial treatment records from
Dr. Safer and the veteran's account of the
injury he sustained during the Korean
Conflict as set forth in the May 1992
hearing transcript.  The physician should
provide an opinion as to whether it is at
least as likely as not that the arthritis
of the veteran's left knee, which
ultimately required replacement surgery,
was the result of a concussive injury to
the left knee in 1950 during the Korean
Conflict.

Thereafter, the VA should review the claim.  If the claim is
denied, the veteran and his representative should be issued a
supplemental statement of the case and given an opportunity to
respond.  The case should then be returned to the Board.

          J. E. DAY
          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).