Citation Nr: 0115510 Decision Date: 06/05/01 Archive Date: 06/13/01 DOCKET NO. 93-07 736 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston- Salem, North Carolina THE ISSUES 1. Entitlement to an increased disability evaluation for the veteran's right thigh shell fragment wound residuals including Muscle Group XIV injury and post-operative femoral artery repair residuals, currently evaluated as 30 percent disabling. 2. Entitlement to a compensable disability evaluation for the veteran's left thigh shell fragment wound residuals. 3. Entitlement to a compensable disability evaluation for the veteran's left calf shell fragment wound residuals. WITNESSES AT HEARINGS ON APPEAL The veteran and the veteran's wife ATTORNEY FOR THE BOARD J. T. Hutcheson, Counsel INTRODUCTION The veteran had active service from July 1963 to August 1967. This matter came before the Board of Veterans' Appeals (Board) on appeal from a July 1989 rating decision of the Winston-Salem, North Carolina, Regional Office (RO) which denied increased disability evaluations for the veteran's service-connected right thigh shell fragment wound residuals, left thigh shell fragment wound residuals, and left calf shell fragment wound residuals. In May 1990, the RO, in pertinent part, recharacterized the veteran's right shell fragment wound residuals as right thigh shell fragment wound residuals including Muscle Group XIV injury and post-operative femoral artery severance repair residuals evaluated as 30 percent disabling. In November 1990, the veteran was afforded a hearing before a Department of Veterans Affairs (VA) hearing officer. In May 1991, the RO determined that the 30 percent evaluation of the veteran's right thigh shell fragment wound residuals encompassed both his post-operative right femoral artery injury and right knee impairment and denied separate evaluations for those disabilities. In September 1991, the RO denied service connection for right shoulder and right arm shell fragment wound residuals. In June 1993, the veteran was afforded a hearing before a Member of the Board. In April 1994, the Board remanded the veteran's claims to the RO for additional development of the record. In February 1996, the veteran was afforded a hearing before the undersigned Member of the Board. In July 1996, the Board remanded the veteran's claims to the RO for additional development of the record. In May 1998, the Board again remanded the veteran's claims to the RO for additional development of the record. In January 2001, the RO granted service connection for right (major) deltoid area shell fragment wound neurological residuals; assigned a 10 percent evaluation for that disability; granted service connection for both right (major) deltoid area shell fragment wound scar residuals and right (major) forearm shell fragment wound residuals; assigned noncompensable evaluations for those disabilities; granted a separate 10 percent evaluation for right thigh shell fragment wound neurological residuals under the provisions of 38 C.F.R. § 4.124a, Diagnostic Code 8526 (2000); and recharacterized the veteran's left calf shell fragment wound residuals as left calf shell fragment wound neurological residuals evaluated as 10 percent disabling under the provisions of 38 C.F.R. § 4.124a, Diagnostic Code 8525 (2000) and left calf shell fragment wound scar residuals evaluated as noncompensable under the provisions of 38 C.F.R. § 4.118, Diagnostic Code 7805 (2000). The veteran has not appealed the 10 percent rating assigned for the neurological residuals resulting from the right thigh wound and that issue is not in proper appellate status. The issue of the veteran's entitlement to an increased evaluation for his left calf shell fragment wound residuals is addressed below in the Remand portion of this decision. FINDINGS OF FACT 1. The veteran's right thigh shell fragment wound residuals have been shown to be manifested by no more than moderately severe Muscle Group XIV injury; mild incomplete femoral nerve paralysis; post-operative femoral artery repair residuals including graft insertion; and non-tender, well-healed, and essentially asymptomatic scars. 2. The version of 38 C.F.R. § 4.104, Diagnostic Code 7111 in effect prior to January 12, 1998 is more favorable to the veteran's claim than amended version of the regulation. 3. The veteran's left thigh shell fragment wound residuals have been shown to be manifested by no more than moderate Muscle Group XIV injury and a non-tender, well-healed, and essentially asymptomatic scar. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 30 percent for the veteran's right thigh shell fragment wound residuals including Muscle Group XIV injury and post-operative femoral artery repair residuals under the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5314 have not been met. 38 U.S.C.A. § 1155 (West 1991); Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 4, 114 Stat. 2096, 2098-2099 (2000) (to be codified as amended at 38 U.S.C. § 5107); 38 C.F.R. §§ 4.10, 4.40, 4.55(a), 4.56, 4.71a, Diagnostic Code 5314 (2000). 2. The criteria for a separate 20 percent evaluation for the veteran's post-operative right femoral artery repair residuals under the provisions of 38 C.F.R. § 4.104, Diagnostic Code 7111 (1997) have been met. 38 U.S.C.A. § 1155 (West 1991); Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 4, 114 Stat. 2096, 2098-2099 (2000) (to be codified as amended at 38 U.S.C. § 5107); 38 C.F.R. § 4.104, Diagnostic Code 7111 (1997); 38 C.F.R. § 4.20 (2000). 3. The criteria for a 10 percent evaluation for the veteran's left thigh shell fragment wound residuals have been met. 38 U.S.C.A. § 1155 (West 1991); Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 4, 114 Stat. 2096, 2098-2099 (2000) (to be codified as amended at 38 U.S.C. § 5107); 38 C.F.R. §§ 4.10, 4.40, 4.56, 4.71a, Diagnostic Code 5314 (2000). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In reviewing the veteran's claims of entitlement to increased evaluations for his right thigh shell fragment wound residuals and left thigh shell fragment wound residuals, the Board observes that the VA has secured or attempted to secure all relevant VA and private medical records to the extent possible. There remains no issue as to the substantial completeness of the veteran's claims. Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, 114 Stat. 2096 (2000) (VCAA). The veteran has been advised by the statement of the case and the statements of the case of the evidence that would be necessary for him to substantiate his claims. Multiple VA examinations have been conducted. The resulting written reports have been incorporated into the claims files. The veteran has been afforded multiple hearings before a VA hearing officer and Members of the Board. The hearing transcripts have been incorporated into the claims files. Any duty imposed by VCAA, including the duty to assist and to provide notification, has been met. I. Historical Review The veteran's service medical records indicate that he was struck by enemy mortar fire during combat in February 1966. He sustained right thigh and left thigh shrapnel wounds. A November 1966 naval medical board report states that the veteran's lower extremity wounds encompassed multiple thigh lacerations, a right femoral artery laceration, and multiple retained metallic foreign bodies overlying the right femur. The veteran was taken to a medical facility where his right femoral artery laceration was repaired by primary anastomosis and his wounds were left open. The veteran was subsequently evacuated to the Corpus Christi, Texas, Naval Hospital. A September 1966 orthopedic evaluation notes that impressions of reduced right saphenous nerve sensation with paresthesia and femoral nerve damage with very poor vastus medialis muscle function and right knee instability were advanced. During his hospitalization, the veteran underwent delayed primary closure of his wounds. Upon discharge, the veteran exhibited well-healed scars on his thighs; diminished right lower extremity strength; and right lower extremity pain associated with walking. A June 1967 naval medical board report conveys that the veteran exhibited a well-healed oblique and angulated scar over the medial right thigh; a well-healed vertical scar over the lateral upper right thigh; a full range of motion of the right lower extremity; moderately diminished strength involving the right quadriceps muscles and right foot dorsiflexion; some loss of painful sensation extending from the right knee region over the anteromedial aspect of the lower right leg to the dorsum of the right foot; and a small well-healed scar over the anteromedial aspect of the upper left thigh. A July 1967 naval treatment entry clarifies that the veteran sustained a right thigh through and through shell fragment wound. The report of the veteran's August 1967 physical examination for service separation relates that the veteran exhibited six inch-long scars over the lateral and medial aspects of the right thigh and a one inch-long scar over the medial aspect of the left thigh. The report of an August 1967 VA examination for compensation purposes states that the veteran presented a history of being struck by a piece of shrapnel which passed through the right thigh; lacerated the right femoral artery; and struck the left thigh. On examination, the veteran exhibited a well-healed, non-tender, and non-adherent surgical scar over the lateral aspect of the upper right thigh measuring six inches in length; a slightly tender and well-healed scar over the anteromedial aspect of the right thigh measuring six inches in length; some right Muscle Group XIV damage; moderate right quadriceps muscle weakness; retained metallic fragments over the anterolateral aspect of the right thigh; mildly impaired sensation over the lateral aspect of the right thigh and the right calf; a normal cardiovascular system; normal right lower extremity pulses; no evidence of impaired circulation; and no detectable "significant" left lower leg scar. The veteran was diagnosed with right thigh shell fragment wound residuals including right femoral artery involvement with satisfactory repair and retained metallic foreign bodies and asymptomatic left thigh shell fragment wound residuals. In October 1967, the RO established service connection for right thigh shell fragment wound residuals; assigned a 30 percent evaluation for that disability; established service connection for left thigh shell fragment wound residuals; and assigned a noncompensable evaluation for that disorder. The report of a May 1989 VA examination for compensation purposes relates that the veteran exhibited a well-healed, non-tender, and non-adherent surgical scar over the lateral right thigh; a surgical scar over the inner right thigh; and a three centimeter circular fragment entry scar over the medial left thigh with left thigh damage. Impressions of right thigh shell fragment wound residuals with some muscle impairment affecting prolonged standing and walking and left thigh shell fragment wound residuals with minimal muscle damage were advanced. In May 1990, the RO recharacterized the veteran's right thigh shell wound residuals as right thigh shell wound residuals with Muscle Group XIV injury and post-operative femoral artery repair residuals evaluated as 30 percent disabling. In May 1991, the RO determined that the 30 percent evaluation of the veteran's right thigh shell fragment wound residuals encompassed both his post-operative right femoral artery injury and right knee impairment and denied separate evaluations for those disabilities. In January 2001, the RO granted a separate 10 percent evaluation for right thigh shell fragment wound neurological residuals under the provisions of 38 C.F.R. § 4.124a, Diagnostic Code 8526 (2000). II. Increased Evaluations Disability evaluations are determined by comparing the veteran's current symptomatology with the criteria set forth in the Schedule For Rating Disabilities. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (2000). A noncompensable disability evaluation is warranted for slight injury to Muscle Group XIV (the anterior thigh group: (1) sartorius; (2) rectus femoris; (3) vastus externus; (4) vastus intermedius; (5) vastus internus; and (6) tensor vaginae femoris). A 10 percent evaluation requires moderate injury. A 30 percent evaluation requires moderately severe injury. A 40 percent valuation requires severe injury. 38 C.F.R. § 4.71a, Diagnostic Code 5314 (2000). A 10 percent disability evaluation is warranted for mild incomplete paralysis of the anterior crural (femoral) nerve. A 20 percent disability evaluation requires moderate incomplete paralysis. A 30 percent evaluation requires severe incomplete paralysis. A 40 percent evaluation requires complete paralysis of the quadriceps extensor muscles. The term "incomplete paralysis" used in reference to evaluation of peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a, Diagnostic Code 8526 (2000). A 10 percent disability evaluation is warranted for superficial, poorly nourished scars with repeated ulcerations. 38 C.F.R. § 4.118, Diagnostic Code 7803 (2000). A 10 percent disability evaluation is warranted for superficial scars which are tender and painful on objective demonstration. 38 C.F.R. § 4.118, Diagnostic Code 7804 (2000). Scars may be evaluated on the basis of any associated limitation of function of the body part which they affect. 38 C.F.R. § 4.118, Diagnostic Code 7805 (2000). The provisions of 38 C.F.R. § 4.56(c), (d) (2000) offer guidance for evaluating muscle injuries caused by various missiles and other projectiles. The Board observes that that 38 C.F.R. § 4.56(d) (2000) recodified the provisions of 38 C.F.R. § 4.56(a)-(d) (1996) in effect prior to July 3, 1997 without substantive change. The regulation directs, in pertinent part, that: (c) For VA rating purposes, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue- pain, impairment of coordination and uncertainty of movement. (d) Under diagnostic codes 5301 through 5323, disabilities resulting from muscle injuries shall be classified as slight, moderate, moderately severe or severe as follows: (1) Slight disability of muscles-(i) Type of injury. Simple wound of muscle without debridement or infection. (ii) History and complaint. Service department record of superficial wound with brief treatment and return to duty. Healing with good functional results. No cardinal signs or symptoms of muscle disability as defined in paragraph (c) of this section. (iii) Objective findings. Minimal scar. No evidence of fascial defect, atrophy, or impaired tonus. No impairment of function or metallic fragments retained in muscle tissue. (2) Moderate disability of muscles-(i) Type of injury. Through and through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. (ii) History and complaint. Service department record or other evidence of in-service treatment for the wound. Record of consistent complaint of one or more of the cardinal signs and symptoms of muscle disability as defined in paragraph (c) of this section, particularly lowered threshold of fatigue after average use, affecting the particular functions controlled by the injured muscles. (iii) Objective findings. Entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue. Some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side. (3) Moderately severe disability of muscles-(i) Type of injury. Through and through or deep penetrating wound by small high velocity missile or large low velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. (ii) History and complaint. Service department record or other evidence showing hospitalization for a prolonged period for treatment of wound. Record of consistent complaint of cardinal signs and symptoms of muscle disability as defined in paragraph (c) of this section and, if present, evidence of inability to keep up with work requirements. (iii) Objective findings. Entrance and (if present) exit scars indicating track of missile through one or more muscle groups. Indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. Tests of strength and endurance compared with sound side demonstrate positive evidence of impairment. (4) Severe disability of muscles-(i) Type of injury. Through and through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. (ii) History and complaint. Service department record or other evidence showing hospitalization for a prolonged period for treatment of wound. Record of consistent complaint of cardinal signs and symptoms of muscle disability as defined in paragraph (c) of this section, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. (iii) Objective findings. Ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track. Palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area. Muscles swell and harden abnormally in contraction. Tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. If present, the following are also signs of severe muscle disability: (A) X-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile. (B) Adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle. (C) Diminished muscle excitability to pulsed electrical current in electrodiagnostic tests. (D) Visible or measurable atrophy. (E) Adaptive contraction of an opposing group of muscles. (F) Atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle. (G) Induration or atrophy of an entire muscle following simple piercing by a projectile. The provisions of 38 C.F.R. § 4.55(a) (2000) address the combination of an evaluation for a muscle injury with other evaluations. The Board notes that 38 C.F.R. § 4.55(a) (2000) recodified the provisions of 38 C.F.R. § 4.55(g) (1996) in effect prior to July 3, 1997 without substantive change. The regulation directs, that: (a) A muscle injury rating will not be combined with a peripheral nerve paralysis rating of the same body part, unless the injuries affect entirely different functions. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45 (2000). The Court has held that the RO must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40 (2000), which requires the VA to regard as "seriously disabled" any part of the musculoskeletal system that becomes painful on use. DeLuca v. Brown, 8 Vet. App. 202 (1995). The Schedule For Rating Disabilities does not specifically address femoral artery laceration residuals. In such situations, it is permissible to evaluate the veteran's service-connected disorder under provisions of the rating schedule which pertain to a closely-related disease or injury which is analogous in terms of the function affected, anatomical localization and symptomatology. 38 C.F.R. § 4.20 (2000). The Board finds that the veteran's service- connected post-operative right femoral artery laceration repair residuals are most closely analogous to post-operative arterial aneurysm residuals as both disorders encompass essentially the same arterial repairs. Prior to January 12, 1998, post-operative aneurysm residuals of any large lower extremity artery with graft insertion was evaluated by analogy to the most appropriate disorder. A minimum 20 percent evaluation was to be assigned for such post-operative residuals. 38 C.F.R. § 4.104, Diagnostic Code 7111 (1997). On January 12, 1998, the Secretary of the VA amended the portions of the Schedule For Rating Disabilities applicable to vascular disabilities including post-operative aneurysm residuals. Under the amended rating schedule, post-operative aneurysm residuals of any large artery with claudication on walking more than 100 yards and diminished peripheral pulses or ankle/brachial index of 0.9 or less warrants a 20 percent evaluation. A 40 percent evaluation requires claudication on walking between 25 and 100 yards on a level grade at two miles per hour and trophic changes (thin skin, absence of hair, or dystrophic nails) or ankle/brachial index of 0.7 or less. 38 C.F.R. § 4.104, Diagnostic Code 7111 (2000) The Court had clarified that "where the law or regulation changes after a claim has been filed or reopened but before the administrative or judicial appeal process has been concluded, the version most favorable to appellant should ... apply unless Congress provided otherwise or permitted the Secretary ... to do otherwise and the Secretary did so." Cohen v. Brown, 10 Vet. App. 128, 139 (1997) citing Fugere v. Derwinski, 1 Vet. App. 103, 109 (1990). In a precedent opinion dated April 10, 2000, the General Counsel of the VA concluded that when a provision of the rating schedule is amended while a claim for an increased evaluation under that provision is pending, the Board should first determine whether the amended regulation is more favorable to the veteran. If so, the retroactive application of the amended regulation is governed by 38 U.S.C.A. § 5110(g) (West 1991 & Supp. 2000) which provides that the VA may award an increased evaluation based on a change in the regulation retroactive to, but no earlier than, the effective date of the amended regulation. In such situations, the Board should apply the prior version of the regulation for the period prior to the amendment and utilize the amended regulation for the period on and after the effective date. VAOPGPREC 3-2000 (Apr. 10, 2000). In Esteban v. Brown, 6 Vet. App. 259, 262 (1994), the Court held that evaluations for distinct disabilities resulting from the same injury could be combined so long as the symptomatology for one condition was not "duplicative of or overlapping with the symptomatology" of the other condition. The evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. 38 C.F.R.§ 4.14 (2000). A. Right Thigh An April 1989 written statement from Don W. Bailey, M.D., conveys that the veteran's right thigh shell fragment wound residuals necessitated that he restrict his physical activities. The veteran's shell fragment wound residuals prevented him from standing, walking, or climbing for prolonged periods of time. At the May 1989 VA examination for compensation purposes, the veteran complained of right leg pain, numbness, and giving way. He reported that his right lower extremity symptomatology prevented him from walking for distances in excess of one-quarter mile or standing for prolonged periods of time without resting and impaired his ability to work on his feet. On examination of the right thigh, the veteran exhibited a well-healed, non-tender, and "relatively movable" scar on the lateral right thigh; a scar on the inner aspect of the right thigh; right lower extremity ranges of motion within normal limits; a slight loss of sensation on the bottom of the right forefoot; and no right thigh atrophy. A July 21, 1989 written statement from Dr. Bailey relates that the veteran experienced leg pain and dysfunction secondary to his "war nerve injury." The doctor directed that the veteran needed to stay off of his feet. A July 31, 1989 written statement from Dr. Bailey reports that the veteran exhibited right leg pain; right knee instability with associated sudden falls; right lower extremity paresthesia with weakness and giving way; right femoral and saphenous nerve damage; and an impaired ability to use the right lower extremity for work and play. An August 1989 VA treatment record states that the veteran complained of right thigh muscle cramping and right knee instability with associated falls. He reported that his right lower extremity had given way recently and caused him to fall. The treating VA physician observed that the veteran exhibited a full range of motion of the right knee with pain on extension and crepitation; an inability to heel and toe walk; and reduced right foot vibratory sensation. An impression of right knee instability was advanced. A September 1989 VA treatment record notes that the veteran complained of right knee pain and giving way. Impressions of right quadriceps muscle weakness and probable right femoral nerve disruption secondary to the veteran's right thigh shell fragment wound residuals and instability related to the right quadriceps muscle weakness and probable right femoral nerve disruption were advanced. An October 1989 VA treatment record indicates that the veteran complained of increased right lower extremity symptoms following an April 1989 incident in which his right knee gave way. On physical evaluation, the veteran exhibited slightly reduced sensation to light touch and spotty pinprick over the right lower extremity and 4/5 right lower extremity muscle strength. Contemporaneous electromyographic and nerve conduction velocity studies revealed no electrodiagnostic evidence of right femoral neuropathy. In a January 1990 written statement, the veteran stated that his right thigh shell fragment wound residuals were manifested by right lower extremity weakness, fatigue, and cramping; right foot numbness and tingling; and significant right knee instability. He clarified that his right thigh shell fragment wound residuals severely impaired his ability both to sit, to stand, to walk, and to drive a car for prolonged periods and to carry moderately heavy items. In his June 1990 substantive appeal, the veteran advanced that his lower extremity shell fragment wound residuals prevented him from obtaining suitable employment. At the November 1990 hearing on appeal, the veteran testified that he experienced right lower extremity pain, cramping, and numbness and right knee instability. He clarified that he had difficulty standing for prolonged periods of time; walking across rough terrain; and climbing stairs, ladders, and the like. His right foot was "permanently asleep." The veteran's accredited representative asserted that: the veteran's right thigh muscle injury warranted assignment of a 40 percent evaluation; the veteran sustained a severe right femoral artery laceration requiring anastomosis; such an injury merited assignment of a minimal 20 percent evaluation under the provisions of 38 C.F.R. § 4.104, Diagnostic Code 7111 (1990); and the assignment of a separate evaluation under Diagnostic Code 7111 would not violate the provisions of 38 C.F.R. § 4.14. Electromyographic studies from James M. Thompson, M.D., dated in July and August 1991 note that the veteran exhibited nerve conduction velocity findings consistent with generalized bilateral peripheral neuropathy and normal electromyographic lower extremity findings encompassing the muscles innervated by the femoral nerve. An October 1991 VA orthopedic treatment record states that an impression of chronic right lower extremity muscle pain and spasm was advanced. An April 1992 written statement from [redacted] conveys that he was a naval hospital corpsman aboard the U.S.S. Valley Forge. He was on the emergency surgical and evacuation team which treated the veteran's shell fragment wounds in February 1966. Mr. [redacted] recalled that the veteran had sustained a severed right femoral artery and subsequently underwent arterial surgical repair which included placement of a femoral arterial graft. At the June 1993 hearing before a Member of the Board, the veteran stated that his right thigh shell fragment wound "frayed" a right leg nerve and severed his right femoral artery. He subsequently underwent a "Moore-Army" graft to repair his severed right femoral artery after being evacuated to the U.S.S. Valley Forge. The veteran reiterated that he experienced chronic right lower extremity instability and generalized numbness. He was unable to run or to kneel. The veteran reported that strenuous activity significantly increased his right lower extremity complaints. At a November 1994 VA examination for compensation purposes, the veteran complained of severe right lower extremity pain, numbness, and muscle spasms. He was observed to walk with a halting gait favoring the right leg and to be unable to heel and toe walk. On examination of the right thigh, the veteran exhibited well-healed scars; moderately atrophic quadriceps muscles; 4+/5 quadriceps function; and subjectively decreased sensation at the anterior aspect of the right leg and the dorsum of the right foot. The VA examiner commented that the veteran's quadriceps muscle weakness could be secondary to either femoral nerve involvement, loss of soft tissue, or disuse. At the February 1996 hearing before the undersigned Member of the Board, the veteran testified that he experienced right lower extremity pain, weakness, cramping, and swelling. He stated that his right thigh scars were tender and subject to episodic ulceration. He could walk for distances up to one-quarter of a mile without stopping due to right lower extremity pain and numbness. In a February 1996 written statement, the veteran reiterated that he underwent a right femoral arterial graft in February 1966. Many of his service medical records had been lost while he was still on active duty. The veteran stated that he experienced chronic right lower extremity weakness and right knee instability. At a January 1997 VA examination for compensation purposes, the veteran complained of right lower extremity pain, muscle spasms, numbness, tingling, weakness, and instability. He reported that his right thigh shell fragment wound residuals impaired his ability to sit, to stand, or to drive a car for prolonged periods of time. On orthopedic examination of the right lower extremity, the veteran exhibited non-tender and non-sensitive right thigh scars; findings consistent with penetration of the vastus lateralis and the quadriceps mechanism; 4/5 muscle strength; good right lower extremity pulses; and no nerve or joint damage, clinical indication of arterial lesions, or evidence of pain. On neurological evaluation, the veteran was noted to limp on the right side while walking. The veteran was diagnosed with "mostly subtle" multiple peripheral nerve injuries. VA electromyographic and nerve conduction velocity studies conducted in July 1997 revealed findings consistent with bilateral lower extremity peripheral neuropathy. In a May 1998 written statement, the veteran advanced that a 40 percent evaluation was warranted for his right thigh shell fragment wound residuals. At a September 1998 VA examination for compensation purposes, the veteran complained of difficulty walking downhill and right knee buckling with subsequent falls. On examination, he exhibited depressed and adherent right thigh scars; "clear and significant" right thigh atrophy; and 4/5 thigh muscle strength. An impression of right thigh shell fragment wound residuals including musculature and femoral nerve involvement; "significant and demonstrable" quadriceps muscle atrophy; hamstring muscle weakness; and depressed and adherent scars was advanced. At an August 2000 VA examination for compensation purposes, the veteran exhibited an abnormal gait: "clear and significant" right thigh atrophy; diminished right thigh muscle strength of 4/5; and decreased right lower extremity sensation below the knee in a distribution consistent with right femoral nerve damage. The Board has reviewed the probative evidence of record including the veteran's testimony and statements on appeal. The veteran sustained a through and through right thigh shell fragment wound with significant Muscle Group XIV injury, a femoral artery laceration, and femoral nerve involvement. He subsequently underwent surgical repair of the femoral artery. The veteran's service medical records do not appear to be complete. The veteran stated on appeal that a portion of the documentation was lost during his period of active service. The existing service medical records reflect that the veteran underwent primary anastomosis of the right femoral artery. The April 1992 written statement from Mr. [redacted] clarifies that the veteran's right femoral artery was repaired by insertion of a graft. Given the apparent loss of some of the veteran's service medical records and the clarity of Mr. [redacted] recollection, the Board accepts that the veteran underwent a surgical repair of the right femoral artery which included placement of a graft. It is now necessary to apply the applicable diagnostic criteria to the voluminous clinical and examination findings of record. In turning first to the veteran's Muscle Group XIV injury, the veteran has presented complaints of chronic right lower extremity pain, muscle spasms, cramping, and instability and an inability to sit, to stand, to walk, to run, and to carry moderately heavy weights due to his right thigh shell fragment wound residuals. Treating and examining VA and private physicians have repeatedly found the veteran's right thigh through and through shell fragment wound to encompass two well-healed surgical scars; essentially full ranges of motion of the right lower extremity; moderate right quadriceps muscle atrophy; 4/5 right lower extremity muscle strength; and right lower extremity instability with associated sudden falls. Such findings reflect not more than moderately severe Muscle Group XIV injury. The objective evidence of record does not establish wide damage to Muscle Group XIV; loss of deep fascia or muscle substance; soft flabby muscles in wound area; abnormal muscle swelling and hardening in contractions; severe functional impairment on strength, endurance, and coordinated movement testing; adhesion of the veteran's scars to the femur with epithelial sealing over the bone in an area where bone is normally protected by muscle; diminished muscle excitability to pulsed electrical current in electrodiagnostic tests; adaptive contraction of an opposing group of muscles; atrophy of muscle groups not in the track of the missile; induration or atrophy of an entire muscle following simple piercing by a projectile; or other clinical findings indicative of severe Muscle Group XIV injury. In the absence of such findings, the Board concludes that the current 30 percent evaluation adequately reflects the veteran right thigh muscle injury disability picture. 38 C.F.R. §§ 4.10, 4.40, 4.56, 4.71a, Diagnostic Code 5314 (2000). In turning next to the veteran's post-operative right femoral artery laceration residuals, the Board initially observes that the pre-January 12, 1998 version of 38 C.F.R. § 4.104, Diagnostic Code 7111 is more favorable to the veteran's claim than the amended regulation given that it provides a minimum evaluation for post-operative residuals with graft insertion. The veteran has been repeatedly found to exhibit good lower extremity circulation and pulses. There is no current evidence of claudication or other significant impairment associated with his post-operative right femoral artery disability. Therefore, the Board finds that a separate 20 percent evaluation is now warranted for the veteran's post-operative right femoral artery laceration residuals under the provisions of 38 C.F.R. § 4.104, Diagnostic Code 7111 (1997). The veteran has testified on appeal that his right thigh scars are chronically tender and subject to episodic ulceration. The Board observes that the veteran's testimony is belied by the objective evidence of record. The multiple physical evaluations of record have consistent reported that the veteran's scars were well-healed, non-tender, and essentially asymptomatic. No physician has reported that the veteran's scars were poorly nourished, subject to frequent ulceration, chronically tender, or limited right lower extremity function. Given these findings, a separate compensable evaluation is not warranted for the veteran's right thigh scars. B. Left Thigh At the May 1989 VA examination for compensation purposes, the veteran complained of left leg pain, cramping, numbness, and tingling. He reported that his left lower extremity symptomatology prevented him from walking for distances in excess of one-quarter mile or standing for prolonged periods without resting and impaired his ability to work on his feet. He presented a history of sustaining a penetrating left thigh shell fragment wound in February 1966. The wound was subsequently debrided and treated. On examination of the left thigh, the veteran exhibited a three centimeter circular entry wound scar on the on the medial aspect; left lower extremity ranges of motion within normal limits; and slight loss of sensation in the anterior portion of the left upper tibial area. The veteran was diagnosed with left thigh shell fragment wound residuals including minimal muscle damage. In a January 1990 written statement, the veteran reiterated that a shell fragment traversed through his right thigh and penetrated his left thigh. He recalled that his left thigh wound appeared to be about the size of a fifty-cent piece and approximately two inches deep. He stated that he experienced left leg pain when he climbed stairs or extended his leg for more than brief periods of time; nocturnal left leg cramps; and an impaired ability to work. At the November 1990 hearing, the veteran again stated that a shell fragment had struck and passed completely through his right thigh and penetrated about half way through his left thigh. He testified that he experienced chronic left lower extremity pain. The veteran's accredited representative advanced that a compensable evaluation was warranted for the veteran's left thigh shell fragment wound residuals as he had sustained a penetrating left thigh shell fragment wound. A December 1990 VA hospital summary notes a well-healed surgical scar over the medial aspect of the veteran's left upper thigh. Electromyographic and nerve conduction velocity studies of the lower extremities from Dr. Thompson dated in July and August 1991 reveal findings consistent with bilateral generalized neuropathy. In an August 1991 written statement, the veteran advanced that his left thigh shell fragment wound measured three centimeters by two centimeters and resulted in more than minimal muscle damage. He stated that his left thigh shell fragment wound residuals were productive of left great toe numbness and tingling. At the June 1993 hearing before a Member of the Board, the veteran reported that he had sustained a "very large" penetrating left thigh shell fragment wound. He testified that he experienced left thigh pain and cramping and left big toe numbness. At the February 1996 hearing before the undersigned Member of the Board, the veteran testified that he received delayed closure of his shell fragment wounds. He experienced chronic left thigh pain. The veteran stated the left thigh scar became painful and sore during the winter months. In written statements dated in May 1998, the veteran advanced that he sustained a penetrating left thigh shell fragment wound which transversed through approximately three inches of his thigh. He clarified that the wound was productive of considerable muscle injury and significant functional impairment. At the September 1998 VA examination for compensation purposes, the VA examiner observed a circular scar over the medial left thigh with minor depression which measured approximately one inch in diameter and no "significant" muscle loss. At the August 2000 VA examination for compensation purposes, the veteran again exhibited a circular scar on the medial left thigh with minor depression which measured three inches in diameter. The record establishes that the veteran sustained a penetrating medial left thigh shell fragment wound involving Muscle Group XIV. The veteran has testified on appeal that the wound was deep and required both debridement and delayed primary closure. Multiple VA evaluations have described the veteran's left thigh wound as being manifested by a well-healed and depressed circular scar measuring one inch/three centimeters in diameter; minor/minimal muscle damage; and no neurological impairment. Giving the veteran the benefit of the doubt, such clinical findings are indicative of more than a superficial wound. Indeed, they are consistent with moderate Muscle Group XIV injury meriting a 10 percent evaluation under the provisions of Diagnostic Code 5314. In the absence of objective evidence of either a symptomatic scar or loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side, positive evidence of muscle impairment on strength and endurance testing, or other indicia of more than moderate muscle injury, the Board concludes that a 10 percent evaluation for the veteran's left thigh shell fragment wound residuals is now warranted. 38 C.F.R. §§ 4.10, 4.40, 4.56, 4.71a, Diagnostic Code 5314 (2000). ORDER An evaluation in excess of 30 percent for the veteran's right thigh shell fragment wound residuals under the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5314 is denied. A separate 20 percent evaluation for the veteran's post-operative right femoral artery laceration residuals under the provisions of 38 C.F.R. § 4.104, Diagnostic Code 7111 (1997) is granted. A 10 percent evaluation for the veteran's left thigh shell fragment wound residuals is granted. The preceding awards are made subject to the regulations governing the award of monetary benefits. REMAND At the August 2000 VA examination for compensation purposes, the VA examiner observed that the veteran exhibited left calf shell fragment wound residuals including decreased left foot strength with an associated gait impairment and diminished left foot sensation. The RO has assigned a separate compensable evaluation for left calf shell fragment wound neurological residuals under the provisions of 38 C.F.R. § 4.124a, Diagnostic Code 8525 (2000). However, as the examiner did not specifically discuss the presence, absence, or severity of a left calf muscle injury or identify the affected muscle or muscles, if any, the Board finds that additional evaluation would be helpful in addressing the issues raised by the instant appeal. The statutes governing the adjudication of claims for VA benefits have recently been amended. The amended statutes direct that, upon receipt of a complete or substantially complete application, the VA shall notify the veteran of any information and any medical or lay evidence not previously provided to the VA that is necessary to substantiate his claim. The VA shall make reasonable efforts to assist the veteran in obtaining evidence necessary to substantiate his claim. Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, §§ 3, 4, 114 Stat. 2096, 2096-2099 (2000) (to be codified as amended at 38 U.S.C. §§ 5103, 5103A, 5107). The veteran's claim for an increased evaluation has not been considered under the amended statutes. Therefore, the claim must be returned to the RO. Bernard v. Brown, 4 Vet. App. 384 (1993). Accordingly, this case is REMANDED for the following action: 1. The RO should schedule the veteran for a VA examination which is sufficiently broad to accurately determine the nature and severity of his left calf shell fragment wound residuals. All indicated tests and studies should be accomplished and the findings then reported in detail. The examiner should identify all muscle groups affected by the veteran's left calf shell fragment wound residuals; the limitation of activity imposed by his shell fragment wound residuals; and any associated pain with a full description of the effect of the disabilities upon his ordinary and vocational activities. Any muscle injury, no matter how slight, must be identified. The path of each wound must be described. The examiner should grade strength of the affected muscle groups. The claims file, including a copy of this REMAND, should be made available to the examiner. The examination report should reflect that such a review was conducted. 2. The RO must then review the claims file and ensure that all notification and development action required by the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, 114 Stat. 2096 (2000) is completed. In particular, the RO should ensure that the new notification requirements and development procedures contained in sections 3 and 4 of the Act (to be codified as amended at 38 U.S.C. §§ 5102, 5103, 5103A, 5107) are fully met. 3. The RO should then readjudicate the veteran's claim of entitlement to an increased evaluation for his left calf shell fragment wound residuals with express consideration of the applicability of 38 C.F.R. §§ 4.10, 4.40, 4.55, 4.56 (2000) and the Court's holdings in Ferraro v. Derwinski, 1 Vet. App. 326 (1991) and DeLuca v. Brown, 8 Vet. App. 202 (1995). If the claim is denied, the veteran should be provided with a supplemental statement of the case and be given the opportunity to respond. The veteran is free to submit additional evidence and argument while the case is in remand status. See Kutscherousky v. West, 12 Vet. App. 369 (1999). The veteran's claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board or the Court for additional development or other appropriate action must be handled in an expeditious manner. See the Veterans' Benefits Improvement Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994) and 38 U.S.C.A. § 5101 (West 1991 and Supp. 2000) (Historical and Statutory Notes). In addition, the Veterans Benefits Administration's ADJUDICATION PROCEDURE MANUAL, M21-1, Part IV, directs the RO is to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV. Paras. 8.44-8.45 and 38.02-38.03. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration if appropriate. The purpose of this REMAND is to allow for additional 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. C.W. Symanski Member, Board of Veterans' Appeals