BVA9505437 
DOCKET NO.  93-12 925     )       DATE
          )
          )

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

THE ISSUES

1.  Entitlement to an increased evaluation for osteochondritis of
the left knee with secondary degenerative changes, currently
evaluated as 10 percent disabling.

2.  Entitlement to an increased (compensable) evaluation for
bilateral defective hearing.

REPRESENTATION

Appellant represented by: Texas Veterans Commission

ATTORNEY FOR THE BOARD

Alice A. Booher, Counsel

INTRODUCTION

The veteran had active service from August 1956 to August 1960.

This appeal is from a rating action by the Department of Veterans
Affairs (VA) Regional Office (RO) in Houston, Texas, in July
1990.

At the time of the VA examination in 1989, the veteran was
described as having sensorineural hearing loss with associated
tinnitus.  Based on that diagnosis, there is an inferred claim
for service connection for tinnitus.  That issue is referred to
the RO for initial consideration.

REMAND

The veteran's last formal VA orthopedic examination of record was
in 1983 when he was described as having crepitance, pain,
puffiness and a tendency of the knee to give-way.  X-rays showed
moderate degenerative arthritis with slight narrowing of the
medial joint space.  The examiner diagnosed osteochondritis of
the left knee with secondary degenerative changes, and opined
that "the process appears to be progressive."

The veteran reopened his claim in 1989, indicating that his left
knee had become worse and that he had been seen as a VA
outpatient.

Since the 1983 VA examination, there are only a few outpatient
treatment records pertaining to the veteran's left knee and they
are inadequate to assess the status of his knee disability.  It
is noted, incidentally, that when he was seen in March 1990, the
physician, mistakenly believing that the veteran's knee
disability was "NSC," stated that the veteran would be seen again
in six months, but if he had not lost weight by then he would not
be seen again.

In correspondence received in February 1993, the veteran
indicated that he was not working, having been laid off from
work; it is unclear whether he is alleging that his service-
connected disabilities were involved.  He also stated that he had
been taking prescription medication for his left knee when he
required emergency care for an allergic reaction at a private
facility, (Memorial Hospital, SW), and had been unable to take
pain medicine since then.

Based on the evidence of record, the Board of Veterans' Appeals
(Board) finds that additional development of the evidence is
warranted.  The case is REMANDED for the following actions:

1.  Copies of complete VA outpatient
treatment records since March 1990 from the
Houston VA Medical Center should be
acquired and attached to the claims folder.

2.  The veteran should be requested to
submit or identify evidence of treatment or
evaluation of his left knee or hearing
disorder by private physicians since March
1990, and to clarify and document any
claimed time lost from work or termination
of employment due to service-connected
disabilities.  With the veteran's consent,
the RO should obtain any evidence
identified and the records from the
veteran's care at Memorial Hospital, SW.

3.  Thereafter, but in any event, the
veteran should be examined by a VA
orthopedist who has not previously seen
him, in accordance with the VA Physician's
Guide for Disability Evaluation
Examinations, to determine the nature and
manifestations of his service-connected
left knee disability.  All necessary tests
and studies should be accomplished,
including X-ray studies of the left knee.
The examiner should be aked to delineate
range of left knee motion in degrees of arc
and fully assess any left knee instability.
The claims folder and a separate copy of
this remand must be made available to the
examiner prior to evaluation of the
veteran's case.

4.  Inasmuch as the veteran's hearing
acuity has not been evaluated since 1989,
he should be afforded an audiometric
examination.

5.  The case should then be reviewed by the
RO, with consideration of 38 C.F.R.
§§ 3.321 and 4.7.  If the decision remains
adverse, a Supplemental Statement of the
Case should be issued, and the veteran and
his representative should be afforded a
reasonable opportunity to respond.

Thereafter, the case should be returned to the Board for further
appellate review.  The veteran need do nothing further until he
is so informed.

          JANE E. SHARP
          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).