BVA9504387 
DOCKET NO.  90-53 066     )       DATE
          )
          )

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

THE ISSUE

Entitlement to service connection for temporomandibular joint
derangement on the right side.

REPRESENTATION

Appellant represented by: The American Legion

INTRODUCTION

The veteran had active service from March 1950 to October 1951.

This matter comes before the Board of Veterans Appeals (Board) on
appeal from rating determinations by the St. Petersburg, Florida
Regional Office (RO) and the Boston, Massachusetts RO of the
Department of Veterans Affairs.

REMAND

This case has been the subject of three previous remand orders to
the St. Petersburg, Florida RO.  After the third remand the
veteran moved to the state of Massachusetts, and, the most recent
development was undertaken by the Boston, Massachusetts RO.

In May 1989 the RO denied secondary service connection for a
disorder classified as temporomandibular joint pain on the basis
that it was not in itself a disability and on the basis that it
was not caused by the veterans service-connected otitis media
with labyrinthitis and postoperative mastoiditis.  The rating
action was not the subject of a timely notice of disagreement.
When an appeal of a subsequent rating action first came before
the Board in April 1991, the Board noted that the veteran was
seeking service connection for a disorder manifested by
temporomandibular joint pain on the basis that the disorder
originated in service and, alternatively, on the basis that it
resulted from the veteran's service-connected otitis media with
labyrinthitis and postoperative mastoiditis.

The failure of the Board to characterize the secondary service
connection aspect of the issue as having been raised on the basis
of the submission of new and material evidence in April 1991, was
apparently based on the fact that the service connection issue
had also been raised on a primary basis.  In any event, at the
current time we have a VA diagnosis of temporomandibular joint
derangement on the right side, as distinguished from just
temporomandibular joint pain.  This constitutes new and material
evidence on the secondary service connection question.  As such,
primary and secondary service connection questions will
ultimately be reviewed by the Board on a de novo basis.

The second remand order was in March 1992 and the most recent
remand order was in June 1993.  In June 1993, we requested that
the veteran be examined by an otolaryngologist and an oral
surgeon to determine if he had a disability entity manifested by
temporomandibular joint pain and, if so, the nature and etiology
of such disability.  The requested examinations were conducted in
October 1993.  On the ear examination we had a diagnosis of right
radical mastoid cavity, right temporomandibular joint syndrome,
positional vertigo and cervical arthritis and dysequilibrium.  On
the dental examination temporomandibular joint derangement on the
right side was found.  There was no expression of opinion by
either examiner as to etiology.

We would further note for the guidance of the RO, in view of
matters addressed in the September 1994 supplemental statement of
the case, that the issue of entitlement to an increased rating
for otitis media with labyrinthitis and postoperative mastoiditis
was dropped as an issue on appeal prior to the June 1993 remand
order.  The issue of entitlement to a total rating for
compensation purposes based on unemployability has not been the
subject of a notice of disagreement.

In January 1995 the representative took exception to the lack of
complete medical development, as detailed above by the Board.

The case is remanded for the following action:

1.  All three volumes of the claims folder
should be returned to the physician and
dentist who conducted the October 1993 VA
examinations for further review and an
expression of opinion as to whether
derangement of the right temporomandibular
joint was caused by the veteran's service-
connected otitis media with labyrinthitis
and postoperative mastoiditis.  If the same
physician and dentist are no longer
available, the opinion may be offered by
other appropriate specialists.  If further
examination is deemed necessary to resolve
the question posed, such examination should
be conducted.

2.  When the above development has been
completed the rating board should review
the case to ensure that the medical
question posed has been answered.
Thereafter the issue of service connection
for temporomandibular joint derangement on
the right side should be considered on a de
novo basis as to both primary and secondary
service connection.

If the benefit sought on appeal is not granted a supplemental
statement of the case should be issued which cites and explains
the provisions of 38 U.S.C.A. § 1110 (West 1991) and 38 C.F.R.
§ 3.310(a) (1994).  The veteran and his representative should
thereafter be afforded a reasonable time to reply thereto.
Thereafter, the case should be return to the Board for further
consideration, if in order.  No action is required of the veteran
unless notified.  The purpose of this remand is to procure
clarifying data.

          BRUCE E. HYMAN
          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).