BVA9500121 DOCKET NO. 93-11 689 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUE Entitlement to service connection for a left knee condition secondary to a service connected right knee condition. REPRESENTATION Appellant represented by: American Legion ATTORNEY FOR THE BOARD P. M. Lynch, Associate Counsel INTRODUCTION The veteran's active military service extended from February 1954 to February 1957. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 1993 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. That rating decision denied entitlement to service connection for a left knee condition. REMAND The veteran contends that he developed a left knee condition due to the severity of his service connected right knee condition. Specifically, he states that his left knee has undergone additional stress and strain to compensate for his right knee disability, resulting in swelling, locking and significant pain. The veteran has been service connected for a right knee disability since July 1963. In November 1991, he submitted a statement requesting revaluation of his right knee condition due to an increase in severity and consideration of a bilateral knee disability. He underwent a VA examination in November 1991. However, only an examination of his right knee was conducted. In view of his request for consideration of a bilateral disability, the left knee should have also been examined for any abnormalities. VA has the duty to assist the veteran in developing facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991). The Court has held that the duty to assist the veteran in obtaining available facts and evidence to support his claim includes obtaining medical records to which the veteran has referred, adequate VA examinations, records in the possession of the VA, and pertinent evidence that applies to all relevant facts. See Sanders v. Derwinski, 1 Vet.App. 88 (1990); Murphy v. Derwinski, 1 Vet.App. 78 (1990); Littke v. Derwinski, 1 Vet.App 90 (1990); and Seavey v. Derwinski, 2 Vet.App. 262 (1992). Therefore, the veteran should be afforded a special VA orthopedic examination to determine the cause, nature and extent of any left knee disorder. Moreover, the veteran has contended that VA medical records show that he is in need of a left knee replacement. Outpatient treatment notes dated in August 1992 from the Alexandria, Louisiana VA Medical Center reveal that the veteran complained that his left knee "locked up". However, the physician did not make any statements or opinions of record regarding the existence or cause of any left knee disorder. It is possible that additional VA clinical records may provide information on the nature and cause of a left knee disorder. Therefore, the RO should make arrangements to obtain the veteran's complete VA medical records and associate them with the claims folder. In addition, the veteran submitted an evaluation dated in May 1993 from a private physician, John E. Cobb, M.D. Dr. Cobb stated that the veteran has a left knee condition intensified by his right knee condition. Dr. Cobb's complete medical records are not currently associated with the claims folder. Evidence of record also indicates that the veteran was treated by another private physician, Joseph A. Drazek, M.D. Similarly, Dr. Drazek's complete medical records are not associated with the claims folder. The RO should make arrangements to obtain both Dr. Cobb's and Dr. Drazek's complete records on the veteran. To ensure that VA has met its duty to assist the claimant in developing the facts pertinent to the claim and to ensure full compliance with due process requirements, the case is REMANDED to the RO for the following development: 1. The RO should request that the veteran provide the names and addresses of all hospitals and health care providers that have treated him for a left knee condition since his discharge from service. The Board is particularly interested in records from John E. Cobb, M.D., Joseph A. Drazek, M.D. and from all VA medical centers where the veteran received treatment. 2. After securing the necessary releases, the RO should make arrangements to obtain copies of all hospital records folders and treatment records not already on file. If any records are not available, that fact should be annotated in the claims folder. 3. Following the above, the veteran should be accorded an examination by a VA orthopedist. The report of examination should be comprehensive and should include a detailed account of all manifestations of left knee joint pathology found to be present. All necessary tests and X-rays should be conducted and the examiner should review the results of any testing prior to completion of the report. Special attention should be given to the presence or absence of pain, any limitation of motion, instability and weakness. The specialist should specifically furnish an opinion as to whether any left knee pathology is caused by or part of the right knee disorder. In association with this opinion the examiner should comment on the opinion expressed by John E. Cobb, M.D. in May 1993. A copy of this remand and the claims folder must be made available to and reviewed by the examiner prior to the examination. The orthopedist should provide complete rationale for all conclusions reached. 4. The RO should review the examination report and determine if it is adequate for rating purposes and in full compliance with this remand. If not, the report should be returned to the examiner for corrective action. Following completion of these actions the RO should review the veteran's claim. If the decision remains unfavorable, the veteran and his representative should be provided with a supplemental statement of the case and afforded a reasonable period of time in which to respond. Thereafter, in accordance with current appellate procedures, the case should be returned to the Board for completion of appellate review. No action is required of the veteran until further notice is issued. JAN DONSBACH 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).