BVA9506389 
DOCKET NO.  93-12 990     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Denver,
Colorado

THE ISSUES

1.  Entitlement to increased rating for internal derangement of
the right knee, with quadriceps atrophy with osteoarthritis,
currently evaluated as 30 percent disabling.

2.  Entitlement to increased rating for shell fragment scar with
muscle group XX, lumbar fourth, right.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

Constance C. Hickey, Associate Counsel

INTRODUCTION

The record reflects active service from June 1943 to December
1945, from July 1946 to June 1949, and from October 1950 to
October 1951.

This appeal to the Board of Veterans' Appeals (Board) arises from
rating decisions of the Department of Veterans Affairs (VA)
Regional Office (RO) in Denver, Colorado in November 1991 and
January 1992 which denied increased ratings for the veteran's
right knee disability and shell fragment wound scar.

REMAND

On preliminary review the Board finds that the record respecting
the veteran's right knee and low back disabilities is incomplete.
The most recent VA examination of the veteran's right knee
disability was conducted more than three years ago, in September
1991.  At that time the veteran related that he was scheduled to
be seen by a VA orthopedist in the near future.  It is unclear
whether the RO attempted to obtain clinical records of the
referenced appointment.  In addition, although the record
reflects that the veteran sustained a fracture of his first
lumbar vertebra in October 1962 and underwent spinal fusion of
the L5 to S1 in 1973, the claims folder contains no clinical
records related to that injury or surgery.  In his December 1992
appeal the veteran indicated that he was experiencing
considerable pain on motion and difficulty in bending.  The Board
is mindful that the veteran's statement can be construed to
indicate increased pain and stiffness attributable to either his
right knee disability, his low back disability, or both his
disabilities.  In view of the passage of time since the veteran's
last knee examination, and in order to ensure that VA has met its
obligation to assist the veteran in the development of facts
pertinent to his claim and the record is complete for appellate
review, the Board finds that the case must be remanded for
compilation of all treatment records, and an additional
examination to assess the current status of the veteran's service
connected disabilities.

Accordingly, the case is REMANDED for the following actions:

1.  The RO should contact the veteran and
request that he provide the names and
addresses of all medical care providers, VA
or private, who have evaluated or treated
his right knee and low back disabilities
since separation from service, in addition
to the dates of such treatment or
examinations.  After the necessary releases
have been obtained, the RO should request
copies of all previously unobtained
treatment records.  Specific request should
be made for October 1962 records of
treatment for fracture of the first lumbar
vertebra, by Drs. Studt and Johnson, at
Mesa Memorial Hospital, Grand Junction,
Colorado, and 1973 records of lumbar spinal
fusion at St. Mary's Hospital, Grand
Junction, Colorado.  All records received
should be associated with the veteran's
claims folder.

2.  After the above development is
completed, the RO should schedule the
veteran for a comprehensive examination by
a VA orthopedic specialist, who has not
previously examined or treated the veteran.
This study must be conducted in accordance
with the VA Physician's Guide for
Disability Evaluation Examinations.  All
indicated tests, including X-rays, if
appropriate, should be conducted.  The
claims folder must be made available to,
and thoroughly reviewed by the examiner
prior to the examination.  With respect to
the veteran's right knee disability and his
low back disorder, the examiner's report
should comment on instability, range of
motion, the effect of pain on motion,
coordination, fatigability, weakness,
swelling, deformity, atrophy, and any
additional pertinent findings, which
describe the status of the veteran's
disabilities.  To the extent possible, the
examiner should distinguish between the
symptoms and manifestations attributable to
the veteran's service connected shell
fragment wound and those attributable to
residuals of non-service connected back
injuries.  Additionally the examiner should
comment on the effect, if any, which the
veteran's unequal leg length following knee
replacement has had on his back.  The
examiner's opinions should be supported by
appropriate clinical findings and full
rationale.

3.  Following completion of the foregoing,
the RO must review the claims folder and
ensure that all of the requested
development has been conducted and
completed in full.  If any development is
incomplete, including if the requested
examination does not include all studies
and opinions requested, appropriate
corrective action is to be implemented.

4.  The RO should then review the
veteran's claims for increased evaluation
of his service connected disabilities.  If
action taken remains adverse to the
veteran, the RO should provide the veteran
and his representative with a supplemental
statement of the case containing a
recitation of all relevant evidence, a
citation to the relevant law and
regulations including all applicable
diagnostic criteria pertinent to the
veteran's rated disabilities, and a
statement of the reasons for action taken.
An opportunity should be provided for
response.

Thereafter, the case should be returned to the Board for further
appellate consideration, if otherwise in order.  By this action
the Board intimates no opinion, either factual or legal, as to
the ultimate determination in this case.  No action by the
veteran is required until he receives further notice.

_____________________________
          S. L. COHN
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).