BVA9502893 
DOCKET NO.  93-13 204     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Boston,
Massachusetts

THE ISSUE

Entitlement to an increased rating for leg knee disability,
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

REMAND

The veteran had active service from January 1967 to February
1970.  This appeal arises from a March 1992 rating decision of
the Boston, Massachusetts, Regional Office (RO).

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).  At the November 1992
personal hearing, the veteran complained of severe pain, locking,
instability, and swelling of the left knee.  The veteran has been
receiving treatment from William Mitchell, M.D., and physical
therapy at Quincy Hospital.  Complete medical records should be
obtained from the referenced sources.

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.  The
veteran's last VA rating examination was conducted in July 1992.
Since that time, the veteran underwent left knee surgery in
October 1993.  A course of physical therapy ensued and the
veteran was issued a knee brace in December 1993.  In view of the
foregoing, following the gathering of all available records, the
veteran should be afforded a VA orthopedic examination to
determine the nature and extent of all disability of the left
knee.

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 left knee in recent
years.  Thereafter, the RO should obtain
legible copies of all records which have
not already been obtained to include those
from the William Mitchell, M.D., and from
Quincy Hospital.  Once obtained, all
records must be associated with the claims
folder.

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

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 the applicable time
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.

          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) (1993).