BVA9504716 DOCKET NO. 93-11 806 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Fargo, North Dakota THE ISSUES 1. Entitlement to service connection for a right knee disorder. 2. Entitlement to service connection for a right hip disorder. 3. Entitlement to an increased rating for the postoperative residuals of injury to the left knee, currently assigned a 30 percent evaluation. 4. Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities. REPRESENTATION Appellant represented by: North Dakota Department of Veterans Affairs WITNESS AT HEARING ON APPEAL The appellant ATTORNEY FOR THE BOARD Stephen F. Sylvester, Counsel INTRODUCTION The veteran in this case had active service from December 1954 to March 1956. The Board of Veterans' Appeals (Board) notes upon review of this case that during the hearing on appeal the veteran made reference to rib injuries, which he felt were due to a fall caused by his left knee disability. There is no current claim for service connection for a rib injury. Inasmuch as this particular issue has not been developed or certified for appellate review, it is not for consideration at this time. If the veteran wishes to seek service connection for residuals of any injury, he should contact the RO to file a claim. REMAND A review of the record in this case raises some question as to the exact nature and etiology of the veteran's current right knee and hip disorders. In this regard, it is contended that the veteran's current disabilities of the right knee and hip are proximately due to or the result of his service-connected left knee disorder. The Board also notes that, over the course of a period of years, the veteran has undergone multiple surgeries for his service- connected left knee disorder, culminating in a total knee arthroplasty in November 1990. On recent VA medical examination in April 1992, the veteran complained of difficulty in climbing stairs, which task became impossible without a railing. Physical examination disclosed the presence of tenderness at the lateral aspects of both knees, accompanied by the lateral displacement of a patella-like body on extension of the left knee joint, and some laxity of the right knee joint. When ambulating, the veteran exhibited a favoring of his right leg, and some displacement to the right. The pertinent diagnoses were history of left knee injury with total knee arthroplasty; degenerative joint disease/chondrocalcinosis of the right knee; and right hip pain. The Board observes that, based on a review of the entire evidence of record, no VA physician has ever rendered an opinion as to the causal relationship, if any, between the veteran's service- connected left knee disability, and his current right knee and hip disorders. This is particularly problematic in light of a March 1992 statement from the veteran's private physician (Boyd Addy, M.D.) to the effect that the veteran had developed "symptoms on the right knee" as a result of his favoring of the left knee following total knee replacement. Moreover, as per recent decisions of the United States Court of Veterans Appeals (Court), where an issue of causation has been developed, an adequate record must include an opinion as to any possible relationship involved. Moore v. Derwinski. 1 Vet.App. 401 (1991). Finally, the Board notes that, at the time of a personal hearing in November 1992, a transcript (T.) of which is included in the veteran's file, the veteran's accredited representative made reference to VA records for the period from 1956 to 1990, which, apparently, were not then a part of the veteran's claims folder (T.-1). In that regard, a review of the record discloses that, for the period in question, there are on file a report of a VA medical examination in July 1961, a report of arthroscopic surgery in December 1986, and certain outpatient treatment records for the period from December 1987 to January 1988. Inasmuch as it is at this time somewhat unclear whether there are in existence additional treatment records, an attempt will be made to resolve this matter prior to a final adjudication of the veteran's claims. It is noted that the VA has a duty to assist the veteran in the development of all facts pertinent to his claims. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1994). The Court has held that this duty to assist the veteran in obtaining and developing available facts and evidence to support his claims includes obtaining medical records to which the veteran has referred, in addition to adequate VA examinations, including examination by a specialist, when necessary. Littke v. Derwinski, 1 Vet.App. 90 (1990); Hyder v. Derwinski, 1 Vet.App. 221 (1991). Accordingly, in light of the aforementioned, the case is REMANDED to the RO for the following action: 1. The veteran should be contacted to obtain the names and addresses of all health care providers who have treated him for the claimed disabilities or his service-connected back disability. In addition, any pertinent VA or other inpatient or outpatient treatment records, for the period from 1956 to 1990 with regard to his right knee, and which are not currently a part of the veteran's claims folder, should be obtained and incorporated in the veteran's file. The veteran should be requested to sign the necessary forms for release of any private medical records to the VA. 2. The veteran should then be afforded an additional VA orthopedic examination in order to more accurately determine the exact nature and etiology of his current right knee and hip disorders. All pertinent symptomatology and findings should be reported in detail. The examiner should specifically comment as to whether the veteran's current right knee and hip disorders are, in fact, proximately due to or the result of his service-connected left knee disability; the factors which support his conclusion should be cited. The claims folder should be furnished to the examining physician prior to his evaluation in order to facilitate the study of the case. Following completion of the above actions, the RO should review the evidence, and determine whether the veteran's claims may now be granted. If not, the veteran and his representative should be provided with an appropriate supplemental statement of the case, and given an ample opportunity to respond. The case should then be returned to the Board for further appellate consideration. In this REMAND of the claim for further development, the Board does not intimate any opinion as to the ultimate determination warranted. No action is required of the appellant until he receives further notice. V. L. JORDAN 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).