BVA9500108 
DOCKET NO.  92-55 433     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs (VA) Regional Office (RO) in
Wichita, Kansas

THE ISSUES

1.  Entitlement to service connection for a left hip disability.

2.  Entitlement to service connection for a left knee disability.

3.  Entitlement to service connection for defective hearing.

4.  Entitlement to service connection for tinnitus.

REPRESENTATION

Appellant represented by: Veterans of Foreign Wars of the
United States

WITNESSES AT HEARING ON APPEAL

The appellant and his wife

ATTORNEY FOR THE BOARD

W. H. Wetmore, Counsel

INTRODUCTION

The veteran served on active duty from December 1940 to September
1945.

The Board of Veterans' Appeals (Board) remanded this case in
September 1992 and April 1994.

REMAND

The Board sent this case to the RO for further development of the
medical record on two previous occasions.  The Board has asked on
both occasions for a review of the record and an opinion as to
the etiology of the veteran's left knee and left hip
disabilities.  The Board provided, on both occasions, a brief
review of the medical record, emphasizing enumerated opinions and
requesting an assessment after a full review of the record as to
whether those opinions were supported by the medical evidence.

Briefly, S. S. Ellis, M.D., opined in August 1976 that the
veteran's left hip disability was due to a motorcycle accident in
which the veteran was involved in 1945.  J. W. Wilson, M.D.,
opined in November 1989 that the veteran's left knee disability
is due to an injury in March 1945, during a motorcycle accident.
A VA examiner in January 1993 opined that the veteran's left hip
pain may have originated prior to the artificial knee replacement
with a history of trauma to the hip in "1947" motorcycle
accidents.

These three opinions do not appear to be based on a full review
of the medical record.  However, the Board does not have
independent medical expertise and believes that a fully informed
medical opinion, based on a full review of the record, is
desirable before entering an appellate determination with respect
to the claims for service connection for a left knee and left hip
disability.  The Board notes that the veteran's representative
has requested further development of the medical record.  (The
other matters are held in abeyance.)

In light of the forgoing, this case is REMANDED to the RO for the
following:

1.  The RO should insure that the claims
file is reviewed by an orthopedist for VA
in order to render an opinion as to the
nature and etiology, including the time of
onset, of any left knee and left hip
disability.  The examiner should be
specifically directed to consider the
entire record, not merely the synopses
provided by the Board in the two earlier
remands.  The examiner should be aware of
the disabilities that are already service
connected and also should render an opinion
as to the medical probability of any left
knee and left hip disabilities being
related to a service-connected disability.
If the examiner does not agree with the
opinions already of record, the specific
factual bases should be set forth,
including the rationale for disagreement.
Similarly, if the examiner agrees with
those opinions, the specific factual reason
for doing so and a rationale supporting
that agreement should be provided.  The
examiner should review the earlier remands
to make sure that the report is fully
responsive to the medical questions that
have been enunciated.

2.  The RO should take adjudicatory action
based on the evidence obtained pursuant to
the development sought above.  If the
benefits sought by the veteran are not
granted, a supplemental statement of the
case should be prepared.

After the veteran and his representative have been given an
opportunity to respond to the supplemental statement of the case,
the claims folder should be returned to this Board for further
appellate review, if in order.  No action is required by the
veteran until he receives further notice.  The purpose of the
remand is to procure clarifying data and to comply with governing
adjudicative procedures.  The Board intimates no opinion, either
legal or factual, as to the ultimate disposition of this appeal.

BARBARA B. COPELAND
          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).