BVA9500767 
DOCKET NO.  93-11 343     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Nashville,
Tennessee

THE ISSUE

1.  Entitlement to an increased rating for a right knee disorder,
currently evaluated as 10 percent disabling.

2.  Entitlement to an increased rating for a left knee disorder,
currently evaluated as 10 percent disabling.

REPRESENTATION

Appellant represented by: Disabled American Veterans

WITNESS AT HEARING ON APPEAL

The appellant

ATTORNEY FOR THE BOARD

Jeffrey A. Pisaro, Counsel

INTRODUCTION

The veteran had active service from December 1974 to June 1978.
This appeal arises from a June 1992 rating decision of the
Nashville, Tennessee, Regional Office (RO).

REMAND

The Department of Veterans Affairs (VA) has a duty to assist the
veteran in the development of facts pertaining to his claim.  38
U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1993).  The
Court has held that the duty to assist includes obtaining
available records which are relevant to the claimant's appeal.
The duty to assist is neither optional nor discretionary.  Littke
v. Derwinski, 1 Vet.App. 90 (1990).  The veteran testified at an
October 1992 personal hearing that he had injured his right knee
at work in September 1992.  Following the injury, he indicated
that he favored his right knee which placed further strain on the
left knee resulting in increased left knee disability.  He
currently complains of pain, locking, instability, and weakness
of the knees for which he was recently issued a brace and
scheduled for arthroscopic surgery.  Complete medical treatment
records should be obtained from the Nashville VA medical center
pertaining to the disabilities at issue.

The duty to assist also includes, when appropriate, the duty to
conduct a thorough and contemporaneous examination of the veteran
that takes into account the records of prior medical treatment.
Green v. Derwinski, 1 Vet.App. 121 (1991).  This is to ensure
that the evaluation of a disability is a fully informed one.
Following the gathering of all available records, the veteran
should be afforded VA orthopedic and neurology examinations to
determine the nature and extent of all disability of the knees.

Under the circumstances of this case, the Board finds that
further assistance is required.  Accordingly, the case is
REMANDED to the RO for the following actions:

1.  The RO should contact the veteran and
obtain the names and addresses of all
health care providers where he has received
treatment for his knees in recent years.
Thereafter, the RO should obtain legible
copies of all records which have not
already been obtained to include those from
the Nashville VA medical center from
November 1992 to the present.  Once
obtained, all records must be associated
with the claims folder.

2.  Following completion of above
development, the veteran should be afforded
VA orthopedic and neurology examinations to
determine the nature and extent of all
disability of the knees.  All indicated
tests, to include x-rays, should be
accomplished.  It is imperative that the
physicians review the entire claims folder
prior to the examinations.  All disability
should be evaluated in relation to its
history, with emphasis upon the limitation
of activity, to include employability,
imposed by the disabling conditions in
light of the whole recorded history.  The
orthopedic examination report should
include complete range of motion studies
for both knees, and indicate whether there
is evidence of recurrent subluxation or
lateral instability, or frequent episodes
of locking, pain and effusion of the knee
joints.

3.  When the above developments have been
completed, the case should be reviewed by
the RO.  If the decision remains adverse to
the veteran in any way, he and his
representative should be furnished with a
supplemental statement of the case.  They
should then be afforded a reasonable
opportunity 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.

          ALBERT D. TUTERA
          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) (1993).