BVA9500178 
DOCKET NO.  93-09 626     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Waco, Texas

THE ISSUES

1.  Entitlement to an increased evaluation for residuals of a
gunshot wound with amputation of the lower third of the right
leg, currently evaluated as 40% disabling,

2.  Entitlement to a total disability rating based on individual
unemployability due to service-connected disabilities.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

John J. Crowley, Associate Counsel

INTRODUCTION

The veteran performed active military duty from December 1942 to
December 1945.

This matter is currently before the Board of Veterans' Appeals
(Board) on appeal from 1991 rating decisions of the Department of
Veterans Affairs (VA) Regional Office (RO) in Waco, Texas.

REMAND

In a December 1992 statement, the veteran's representative
requested that his service connected hearing loss be revaluated.
This issue is inextricably intertwined with the issue of
entitlement to a total disability rating based on unemployability
due to service-connected disabilities and should be adjudicated by
the RO.  As to the matter of adjudication of the claim for a total
disability rating, it is noted that a report of May 1993 VA
audiological evaluation and consultation report were furnished for
the record during the 90-day time limit, immediately following
notification to the veteran of certification of his appeal to the
Board.  This pertinent evidence must be referred back to the RO
for their consideration.  38 C.F.R.§ 20.1304(c) (1993).

The veteran is seeking an increased evaluation for the residuals
of a gunshot wound with amputation of the lower third of the right
leg.  Under 38 C.F.R. § 4.71a, Diagnostic Code 5164 (1993), an
amputation of the lower extremity not improvable by a prosthesis,
controlled by natural knee action, warrants a 60 percent
evaluation.  At a June 1992 VA examination, the examiner concluded
that the veteran would need surgical revision before he would be
able to use his BK (below the knee) prosthesis on a regular basis.
At that time, the examiner questioned whether the veteran could
undergo such surgery due to the nature of his diabetes mellitus
and cardiovascular disease.  Until such surgery is performed, the
examiner concluded that he would not be able to use his
prosthesis.  On the basis of a review of the veteran's claims
folder, it is unclear if the veteran has as yet undergone this
surgical procedure.

With these considerations in mind, based on the current medical
evidence of record, the Board in unable to determine if the
veteran is unemployable as a direct result of his service
connected disabilities.  The VA has a duty to assist the veteran
in the development of facts pertinent to his well-grounded claim.
38 U.S.C.A. § 5107(a) (West 1991).  The Court has held that the
duty to assist a veteran includes conducting a thorough and
contemporaneous medical examination so that the evaluation of a
claimed disability will be a fully informed one.  Green v.
Derwinski, 1 Vet.App. 121, 124 (1991); See 38 C.F.R.§ 4.2.

To ensure that the VA has met its duty to assist the claimant in
developing the facts pertinent to the claim, the case is REMANDED
for the following:

1.  The RO should request the veteran to
identify the names, addresses, and
approximate dates of treatment for all
health care providers who have recently
treated him.  With any necessary
authorization from the veteran, the RO
should attempt to obtain copies of those
treatment records, identified by the
veteran not already of record, to include
any more recent VA inpatient or outpatient
records or any private medical records
relating to a recent surgical revision of
his right lower extremity.

2.  The veteran should be afforded a VA
social and industrial survey to assess his
employment history and the effects his
service-connected disabilities have had on
his employment status and day-to-day
functioning.  Interviews with the veteran's
neighbors and disinterested aquaintances
should be accomplished, if possible,
concerning his daily activities.  A written
copy of the VA social worker's report
should be associated with the claims
folder.

3.  The veteran should be afforded a VA
orthopedic examination in order to determine
the current nature and severity of the
residuals of a gunshot wound with amputation
of the lower third of the right leg.  The
claims folder should be provided to the
examiner in conjunction with the
examination.  All tests indicated should be
performed.  Any functional impairment
attributable to the right leg should be
described, to include a full description of
the stump, its location, and the effects of
the disability upon his ordinary activity.
Further, the examiner should review the
veteran's medical record and offer an
opinion as to whether his amputation is
improvable by prosthesis and whether it may
be worn on a regular basis.

4.  The RO should also schedule the veteran
for a VA general medical examination to
determine the nature and extent of his
physical condition.  All disabilities found
present should identified (e.g., diabetes,
coronary artery disease, osteoarthritis,
diabetic neuropathy and/or retinopathy,
etc.), and the examiner(s) should specify
their impact on the veteran's ability to
gain or retain employment.  The examiner(s)
should assess the veteran's industrial
impairment due solely to his service-
connected right leg amputation residuals and
hearing loss, mindful of the nonservice-
connected disability shown of record.

5.  Thereafter, the RO should review the
veteran's claims as stated on the title page
of this decision.  The rating decision
should reflect that consideration was given
to the provisions of 38 C.F.R. §§ 3.321,
4.40, 4.45 (1993).  The RO should also
adjudicate the issue of entitlement to an
increased evaluation for hearing loss.  The
veteran is advised that the claim for
hearing loss will not be before the Board
unless the determination of the RO is
unfavorable, and the veteran files a notice
of disagreement and completes all procedural
steps necessary to appeal a claim to the
Board in accordance with 38 U.S.C.A. § 7105
(West 1991).

If the benefits sought on appeal is not granted to the veteran's
satisfaction, the RO should issue a supplemental statement of the
case, and he and his representative should be provided an
opportunity to respond.  The case should then be returned to the
Board for further appellate consideration, if otherwise in order.

In taking this action, the Board implies no conclusion, either
legal or factual, as to any ultimate outcome warranted.  No
action is required of the veteran until he is notified by the RO.

          J.F. GOUGH
          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).