BVA9504745 DOCKET NO. 93-06 517 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUES 1. Entitlement to an increased rating for a shell fragment wound of the back, currently evaluated as 10 percent disabling. 2. Entitlement to service connection for a bilateral knee disorder. 3. Entitlement to service connection for a neck and head injury. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD P. M. Lynch, Associate Counsel INTRODUCTION The veteran had active military service from August 1963 to June 1969 which was honorable. He also had active military service from June 1969 to January 1972 which was terminated under conditions other than honorable. This matter comes before the Board of Veterans' Appeals (Board) on appeal from October 1990 and subsequent rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana which assigned a 10 percent rating for a service connected shell fragment wound of the back. A June 1991 rating decision also denied entitlement to service connection for head and neck injury and a bilateral knee disorder. It is noted that the veteran submitted a statement to the effect that he wishes to pursue his previously denied claim for non- service connected pension. He has also submitted statements indicating increased symptomatology in his service connected post traumatic stress syndrome (PTSD) and claims for educational benefits, vocational rehabilitation, and an earlier effective date for his service connected disabilities. Matters related to these issues have not been developed for appellate consideration and are referred to the RO for appropriate action. REMAND The veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, he has presented a claim which is plausible. However, for the reasons that follow, it appears that the statutory duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a) has not yet been fully met. The veteran contends that the RO erred in denying his claim for an increased rating for a shell fragment wound to the back. He argues that his disability is more severely disabling than currently evaluated. At the veteran's most recent VA examination in June 1992 it was noted that he had significant atrophy of the right lower extremity. X-rays revealed calcifications in the region of the right sacroiliac joint and just below the sacroiliac joint. The examiner commented that this finding was significant in that the right lower extremity was atrophied. In accordance with the doctor's recommendation, a computed tomography (CT) scan of the pelvis was conducted which revealed small metallic flecks in the right lower quadrant in or immediately adjacent to the wall of the sigmoid colon and distal small bowel. Vascular calcifications were also present. There is no medical opinion of record discussing whether the shrapnel fragments in the veteran's pelvis caused the atrophy of the right lower extremity. The Board must consider only the evidence of record rather than provide its own medical judgment. See Colvin v. Derwinski, 1 Vet.App. 171 (1991). Therefore, the veteran should be afforded a VA neurological examination in order to determine the etiology of the right lower extremity atrophy. Moreover, the RO has not adjudicated the question of whether the veteran's right lower extremity atrophy is part of or in any way associated with the service connected shell fragment wound. The United States Court of Veterans Appeals has held that it would not review appeals in a piecemeal fashion, and that a decision on a given claim for an increased rating is not a final order when an "inextricably intertwined" question remains undecided and pending. See Harris v. Derwinski, 1 Vet.App. 180 (1991). It is evident that the resolution of the issue of service connection for the veteran's atrophy of the right lower extremity could have a significant impact on the disability evaluation to be assigned for his service connected shell fragment wound to the back. Therefore, the question needs to be adjudicated prior to further review on appeal. A review of the record also reveals that the veteran has received treatment for his condition from the VA Medical Center in Evansville, Indiana as early as 1985 and from private physicians, including a Dr. Monar. However, these complete medical records are not currently associated with the claims folder. The duty to assist requires that VA obtain the veteran's complete medical records. See Ferraro v. Derwinski, 1 Vet.App. 326 (1991). Therefore, the RO should make arrangements to obtain the veteran's complete medical records and associate them with the claims folder. To ensure that VA has met its duty to assist the claimant in developing the facts pertinent to the claim and to ensure full compliance with due process requirements, the case is REMANDED to the RO for the following development: 1. The RO should contact the veteran and request that he provide the names and addresses of all health care providers which have treated him for the residuals of his shell fragment wound to the back since his discharge from service. The Board is particularly interested in obtaining the records of any treatment that the veteran received at the VA Medical Center in Evansville, Indiana since 1985 and from Dr. Monar. 2. After securing the necessary releases, the RO should obtain all treatment reports and hospital treatment folders from all private health care providers listed by the veteran that are not already on file, including those from Dr. Monar. The RO should also obtain all treatment records pertaining to the veteran's condition from the VA Medical Center in Evansville, Indiana. If any records are not available, that fact and the reason(s) should be annotated in the claims folder. 3. Following the above, the veteran should be afforded an examination by a VA neurologist. The report of examination should include a detailed account of all manifestations of residuals of a shell fragment wound to the back found to be present. All necessary tests should be conducted and the examiner should review the results of any testing prior to completion of the report. The examiner should specifically furnish an opinion as to whether the changes seen on X-ray represent residuals of a shell fragment wound and whether any right lower extremity atrophy is caused by or part of the service connected shell fragment wound, including any metallic fragments in the right lower quadrant or in the region of the right sacroiliac joint. The claims folder must be made available to and reviewed by the examiner prior to the examination. The specialist should provide complete rationale for all conclusions reached. 5. The RO should review the examination report and determine if it is adequate for rating purposes and in full compliance with this remand. If not, the report should be returned to the examiner for corrective action. 6. Finally, the RO should formally adjudicate whether service connection is warranted for any right lower extremity atrophy found on examination. The RO should then review the issue originally certified for appeal. The issues of entitlement to service connection for a head and neck injury and a bilateral knee disorder are deferred pending the above development. Once the foregoing has been accomplished, and if the benefits are not granted to the satisfaction of the veteran, both the veteran and his representative should be furnished a supplemental statement of the case covering all the pertinent evidence, law and regulatory criteria. They should be afforded a reasonable period of time in which to respond. Thereafter, the case should be returned to the Board for further appellate consideration. The veteran need to take no action until so informed. The purpose of this REMAND is assist the veteran and to obtain clarifying information. JAN DONSBACH 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).