BVA9501157 DOCKET NO. 91-50 873 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Whether new and material evidence has been submitted to reopen claims for service connection for right ankle and right hip disabilities. 2. Entitlement to service connection for right shoulder and right elbow disabilities. 3. Entitlement to service connection for a left knee disability. 4. Entitlement to service connection for aortic and iliac aneurysms. 5. Entitlement to an increased rating for a right knee disability, rated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant INTRODUCTION The appellant had active service from March 1946 to January 1947. This case arose from a May 1990 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The case was remanded by the Board of Veterans' Appeals (Board) in June 1993. While the case was in remand status, a January 1994 rating decision of the same RO denied service connection for aortic and iliac aneurysms secondary to the right knee disability. The attention of the RO is directed to the application for orthopedic appliance received in August 1993. The attention of the RO is also directed to the appellant's claim for secondary service connection for a lower soine disability received at the Board in November 1994. REMAND The Board is of the opinion that further development of the record is necessary, first, to ensure that the development of the record requested in the June 1993 remand has been completed; second, to sufficiently develop the record with respect to the issue which has been added to the appeal since the case was remanded by the Board (service connection for the aneurysms); and, third, to obtain additional medical evidence with respect to the severity of the right knee disability and the etiology of the left knee disability. In the 1993 remand, the Board requested that all treatment records from the Baton Rouge VA outpatient clinic be obtained, to include an October 14, 1982 record. VA Form 10-7131 received November 1, 1993 states that copies of these records from 1988 to 1992 were retrieved from "FRC" in May 1991 and sent to the RO. The Board is unable identify the outpatient records referred to, which presumably were added to the claims file. In support of the claim for service connection for the aneurysms, the appellant has submitted a statement from Ross G. Stone, M.D., which proposes a relationship between the appellant's falls and the aneurysms. We are of the opinion that all records of medical evaluation and treatment of the aneurysms leading to the surgery in September 1993 should be obtained. The appellant last underwent VA examination of the right knee in 1990. Subsequent evidence refers to right knee instability and pain. In the Board's judgment, he should undergo VA examination to determine the current severity of the knee. In addition, such examination should include opinion as to whether impairment in gait due to the right knee disability caused that of the left. The appellant believes that this is the case as is evidenced by the history he related when he was examined by Dr. Stone in 1993. In view of the foregoing, the case is remanded for the following action: 1. The RO is to ask the appellant to identify all of the health care providers who evaluated and treated him for the aortic and iliac aneurysms prior to surgery. The RO is to take the necessary steps to obtain these records. 2. The RO is to ask the appellant to identify all health care providers, other than VA, who have treated him for any of the disabilities at issue from 1993 to the present time. The RO is to take the necessary steps to obtain these records. 3. The RO is to obtain copies of all of the appellant's treatment records from the VA Medical Center, Miami, and the outpatient clinic, Riviera Beach, which date from late 1993 to the present time, and associate those records with the claims file. 4. The RO is to ensure that all records of the appellant's treatment at the VA outpatient clinic, Baton Rouge, during the 1980's are retrieved from records storage and associated with the claims file. These records should be specifically identified. 5. The RO should schedule the appellant for VA orthopedic examination for the purpose of: (1) determining the nature and severity of the right knee disability; and (2) obtaining opinion from the examining orthopedist as to whether the left knee disability was caused by, or is the result of, functional impairment due to the right knee disability. The examination is to be conducted according to the Physician's Guide. The reasoning which forms the basis of the examiner's opinion should be set forth in necessary detail. The claims file must be made available for the examiner's review prior to the examination, and this fact should be affirmatively indicated in the examination report. 6. The RO should request that the claims file be reviewed by a vascular specialist for an opinion as to whether the aortic and iliac aneurysms were caused by falls allegedly due to the right knee disability. (CONTINUED ON NEXT PAGE) When this development has been completed, the claim should be reviewed by the RO. If the benefits sought are not granted, the case should be returned to the Board. NANCY I. PHILLIPS 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).