BVA9502968 DOCKET NO. 93-02 822 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUES 1. Entitlement to service connection for removal of the gallbladder secondary to service-connected residuals of a stellate liver laceration with exploratory laparotomy. 2. Entitlement to an increased evaluation for residuals of a right lateral tibial plateau fracture, currently evaluated as 10 percent disabling. 3. Entitlement to an increased (compensable) evaluation for bilateral subcondylar fractures of the mandible. 4. Entitlement to an increased (compensable) evaluation for residuals of stellate liver laceration with exploratory laparotomy. 5. Entitlement to an increased (compensable) evaluation for scars from a head injury. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Julia M. Kurtz, Associate Counsel REMAND The veteran served on active duty from October 1977 to October 1980. This appeal arises from an August 1991 rating decision of the Phoenix, Arizona, Regional Office (RO) which, in pertinent part, established service connection for status post right lateral tibial plateau fracture, status post bilateral subcondylar fractures of the mandible, stellate liver laceration with exploratory laparotomy, scars from head injury, and assigned a noncompensable evaluation for each disability. The RO also denied service connection for removal of the gallbladder. The veteran testified before a hearing officer at the RO in April 1992. In July 1992, the RO increased the evaluation for residuals of a right lateral tibial plateau fracture to 10 percent, effective from December 4, 1990. The veteran is unrepresented in his appeal. The veteran asserts on appeal that the RO erred in denying service connection for removal of the gallbladder secondary to his service-connected liver disability. In that regard, he asserts that his private physician told him that his gallbladder problems which necessitated the removal were a direct result of the prior serious trauma to his liver in service. He also asserts that he is entitled to increased evaluations for his right tibial plateau fracture, liver disability, fractures of the mandible, and head scars. In reviewing the claims file, the Board observes that the veteran advanced in his January 1992 substantive appeal that he presently suffers from arthritis and degenerative joint disease of the right knee due to his service-connected right tibial plateau fracture, headaches due to head injuries in service, and that he also broke 4 front teeth when he fell onto the pier. These issues have neither been developed nor certified for review on appeal. Any determination as to the issues of service connection for arthritis and degenerative joint disease of the right knee would significantly impact upon the ultimate resolution of the veteran's entitlement to an increased disability evaluation for his service-connected residuals of a right lateral tibial plateau fracture as the schedular criteria set forth in 38 C.F.R. Part 4, Diagnostic Codes 5257, 5260, and 5261 (1993) require an accurate assessment of current right lower extremity function. In light of this fact, the Board finds that the issue of service connection for arthritis and degenerative joint disease of the right knee is inextricably intertwined with the certified issue of a increased disability evaluation for residuals of a right lateral tibial plateau fracture. Therefore, the veteran's entitlement to service connection for arthritis and degenerative joint disease of the right knee secondary to his service- connected right lateral tibial plateau fracture must be formally adjudicated prior to appellate consideration of the instant case. Harris v. Derwinski, 1 Vet.App. 180 (1991). The RO should also consider service connection for headaches and broken teeth. The Board also observes that the veteran has repeatedly complained of numbness in the right thigh and hip resulting from the bone graft of the hip. The Board notes that service connection is in effect for residuals of a bone graft from the right hip, presently characterized as scars, right hip. Accordingly, the RO should consider an increased evaluation for this disability. The VA has the duty to assist the veteran in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1993). Massey v. Brown, No. 93-135, slip. op. at 8 (U.S. Vet.App. Dec. 6, 1994). The Court has clarified that the duty to assist the veteran in obtaining and developing available facts and evidence to support his claim includes obtaining adequate VA examinations. Littke v. Derwinski, 1 Vet.App. 90 (1990). Upon review of the March 1992 VA examination, the Board notes that the examiner's conclusion regarding the etiology of the gallbladder removal is ambiguous. Furthermore, although the veteran claimed an increased evaluation for his head scars, the scars on his head were apparently not examined. In light of the foregoing, this case is REMANDED to the RO for the following actions: 1. The RO should schedule the veteran for a VA examination to determine the present nature and severity of his alleged arthritis of the right knee, headaches, and service-connected disabilities. The examination should be conducted in accordance with the Physician's Guide for Disability Evaluation Examinations. All indicated tests and studies should be accomplished and the findings then reported in detail. The examiner should express an opinion as to the relationship between the veteran's service-connected laceration of the liver and subsequent gallbladder removal. The claims folder should be made available to the examiner for review prior to the examination. 2. The RO should then formally evaluate the veteran's entitlement to service connection for arthritis of the right knee secondary to his service-connected right lateral tibial plateau fracture, headaches, broken teeth, and an increased disability evaluation for his service-connected residuals of a bone graft of the hip presently characterized as right hip scar. The RO should also review the issues on appeal. When the requested action has been completed, and if his claim continues to be denied, the veteran should be afforded a reasonable period of time in which to respond to a supplemental statement of the case. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration, if appropriate. The veteran need not take any action unless he is further informed. The purpose of this REMAND is to allow for further development of the record and due process of law. No inference should be drawn from it regarding the final disposition of the veteran's claim. E. W. SEERY 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).