BVA9500690 
DOCKET NO.  93-10 603     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in St. Petersburg,
Florida

THE ISSUES

1.  Entitlement to a prestabilization rating of 50 percent for a
left knee disability.

2.  Entitlement to an increased rating for a left knee
disability, currently evaluated as 10 percent disabling.

ATTORNEY FOR THE BOARD

Richard F. Williams, Counsel

INTRODUCTION

The veteran served on active duty from August 1988 to August
1992.

This matter comes to the Board of Veterans' Appeals (Board) on
appeal from a January 1993 decision of the Department of Veterans
Affairs (VA), St. Petersburg, Florida, Regional Office (RO),
which granted service connection and assigned a 10 percent rating
for residuals of a left knee dislocation with removal of a spur
from the patella.  The veteran disagreed with the assigned
rating.

In the case of Estaban v. Brown, 6 Vet.App. 259, 261 (1994), the
United States Court of Veterans Appeals addressed the question of
when separate ratings should be assigned for separate and
distinct manifestations stemming from the same injury.  The RO is
requested to address the matter of whether separate ratings
should be assigned for the surgical scar on the veteran's left
knee and other knee pathology, in view of the holding in the
foregoing decision.

REMAND

The veteran contends that her service-connected left knee
disability is more disabling than currently evaluated.  She cites
38 C.F.R. § 4.28 (1993) in support of her claim that a 50 percent
prestabilization rating should have been assigned for her knee
disability for a 12-month period and expresses dissatisfaction
with a recent VA examination, noting that the evaluation was
performed by a general medical physician as opposed to a
specialist in orthopedics and that the examiner did not have an
opportunity to review her service medical records, including the
report of her operation.

It appears that the instant claims are well-grounded, meaning
they are plausible.  The record shows that the veteran sprained
or dislocated her left knee in service, underwent arthroscopic
surgery and a lateral release in service, and has complained of
post-surgical recurring pain in her knee, especially when walking
up and down stairs, lifting heavy weights, or standing on her
left leg.  In short, she appears to assert that she has unhealed
or incompletely healed surgical wounds or left knee injury such
that material impairment of her employability is likely.  The
general medical examination included an evaluation of her knee,
but there is no showing that her service medical records were
reviewed, nor does it appear that the recommended X-ray study of
the left knee was conducted.  VA's duty to assist includes
providing a supplemental examination recommended by its own
physician.  Hyder v. Derwinski, 1 Vet.App. 221, 225 (1991).

Hence, the case is REMANDED to the RO for the following actions:

1.  The RO should ask the veteran to
complete and submit a detailed list of
sources (VA or non-VA) of treatment and
examinations for her service-connected knee
disability since service.  Names and
addresses of the medical providers and
dates of treatment should be reported.
After obtaining any release forms from her,
the RO should directly contact the medical
providers and obtain this information.  38
C.F.R. § 3.159 (1993).

2.  After the above development, the
veteran should be scheduled for a VA
orthopedic examination to determine the
severity of her service-connected knee
disability.  All indicates studies,
including range of motion measured in
degrees, ligamentous testing, and X-ray
study of the left knee joint, should be
performed and all clinical findings
reported in detail.  The examiner should
express an opinion as to the severity of
any restriction of motion, including any
functional limitation due to pain, as well
as assessment of the overall degree of
functional loss caused by the knee
pathology.  The examiner should state
whether the veteran has unhealed or
incompletely healed surgical wounds or
residuals of a left knee injury, and should
support all opinions by discussing medical
principles as applied to specific medical
evidence in this case.  In order to assist
the physician in providing the requested
information, the claims folder must be made
available and reviewed prior to the
examination.

3.  After the above information is
associated with the claims files, the RO
should review the claims and consider
assigning separate ratings for disabilities
due to the service-connected knee injury.

If the veteran is dissatisfied with the RO's decision, an
appropriate supplemental statement of the case should be sent to
her.  She should be afforded an opportunity to respond before the
case is returned to the Board for further appellate
consideration.

          M. CHEEK
          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).