BVA9505378 
DOCKET NO.  93-01 219     )       DATE
          )
          )

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

THE ISSUES

1.  Entitlement to service connection for heart disease.

2.  Entitlement to an increased evaluation for right knee
disability, currently rated as 10 percent disabling.

3.  Entitlement to an increased evaluation for left knee
disability, currently rated as 10 percent disabling.

4.  Entitlement to an increased evaluation for back disability,
currently rated as 10 percent disabling.

REPRESENTATION

Appellant represented by: Disabled American Veterans

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

J. W. Loeb, Counsel

INTRODUCTION

The veteran served on active duty from May 1983 to October 1990.
The Board of Veterans' Appeals (Board) remanded this case to the
Department of Veterans Affairs (VA) Regional Office (RO) in
Detroit, Michigan in August 1993 to attempt to obtain private
records of treatment for heart disease.  Letters were sent to two
private health care providers on behalf of the veteran in May
1994, but no response was received from either provider.

REMAND

A review of the claims file reveals that, as noted on behalf of
the veteran in February 1995, the veteran has not had a VA
compensation examination of her service-connected disabilities
since December 1990, and no clinical evidence dated after August
1992 is on file.  VA outpatient records for January 1991 note
positive straight leg raising, bilaterally, at 30 degrees and
knee limitation of motion, which indicate a possible increase in
disability since December 1990, when straight leg raising was
negative to 90 degrees.  Consequently, the Board agrees with the
contention on behalf of the veteran in February 1995 that a
current examination of the veteran's service-connected
disabilities should be obtained.  Therefore, this case is
REMANDED to the RO for the following development:

1.  The veteran should be permitted to
submit any additional evidence that is
pertinent to the issues on appeal.  She
should also be requested to provide the
names, addresses, and approximate dates of
treatment of all health care providers who
have treated her in recent years for knee,
or back disability or since service for
heart disease.  When the requested
information and any necessary authorization
have been received, the RO should attempt
to obtain copies of all indicated records,
including from those contacted in May 1994,
and associate them with the claims file.

2.  After the above, the veteran should be
afforded special cardiovascular and
orthopedic examinations by board certified
specialists, if available, to determine the
nature and severity of any current heart
disease, including a heart murmur, and the
severity of her service-connected knee and
back disabilities.  All necessary tests and
studies should be conducted, including x-
rays, and all findings should be reported
in detail.  If heart disease is found, the
examiner should offer an opinion as to
whether it is at least as likely as not
that the disease is causally related to the
veteran's cardiac symptoms noted in
service.  The rationale for all opinions
expressed should be fully explained.  The
claims folder must be made available to
each examiner for review before examination
of the veteran.

When the above actions have been completed, the case should again
be reviewed by the RO.  If the benefits sought are not granted to
the veteran's satisfaction, a supplemental statement of the case
should be issued and the veteran and her representative should be
given an opportunity to respond.  The case should then be
returned to the Board.  The veteran need take no action until
notified.

          ROBERT E. SULLIVAN
          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).