BVA9506145 DOCKET NO. 93-10 493 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUE Entitlement to service connection for residuals of a brain cyst. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Appellant and Albert F. Greiner ATTORNEY FOR THE BOARD Sandra L. Smith, Associate Counsel INTRODUCTION The veteran had active service from July 1973 to January 1986. This appeal is before the Board of Veterans' Appeals (the Board) from a September 1991 rating decision of the Regional Office (RO) which denied service connection for residuals of a brain cyst. The case is now ready for appellate review. The Board notes that the veteran has been determined to be incompetent for VA purposes. The veteran's stepfather, Albert F. Greiner has submitted a Power of Attorney and has been recognized by the VA. The Board further notes that the veteran, in testimony and written statements, has submitted evidence that he incurred a head injury in service and was unconscious for a period of time. He has also symptoms of mental impairment and headaches subsequent to that head injury. Thus, we infer from the record a claim for service connection for residuals of a head injury. EF v. Derwinski, 1 Vet.App. 324, 326 (1991). Pursuant to Harris v. Derwinski, 1 Vet.App. 180 (1991), we find this issue is not inextricably intertwined with the issue of entitlement to service connection for residuals of a brain cyst. As this additional issue has not been adjudicated and developed, it is referred to the RO for appropriate action. REMAND The veteran and his service representative contend that the brain cyst, first diagnosed in December 1990, was either caused or aggravated by the trauma of being struck by a motorcycle while in service. The veteran is also contending that he incurred a head injury as a result of the accident with the motorcycle. He has asserted that he was unconscious for a period of time. The Board has reviewed the claims folder and notes that the veteran's service medical records are not associated with the claims folder. It is difficult to ascertain whether they were reviewed by the RO prior to the September 1991 rating decision. The only service medical record mentioned is an excerpted x-ray report, dated in October 1984, which noted a questionable area of well defined radiolucency in the posterior parietal area of the brain. In reviewing the claims folder, the Board notes that the veteran's service medical records were apparently misplaced once before and subsequently recovered by the RO in 1987. Also noted is the lack of medical records from the veteran's treatment at the Butler VA Medical Center (VAMC) in 1987 and the reports of initial treatment for the brain cyst at the Oakland VAMC in 1990. These records should be obtained. The Board further notes that the veteran has not been afforded a VA neurological examination to determine the nature of his current disability and any etiological relationship there may be between the current disability and an alleged head injury incurred in service. The VA has a duty to assist the veteran in developing pertinent information relating to his claim pursuant to 38 U.S.C.A. § 5107(a) (West 1991). The Court of Veterans Appeals (the Court) has held that the duty to assist also includes providing a thorough and contemporaneous medical examination, which takes into account prior medical evaluations and treatment. Green v. Derwinski, 1 Vet.App. 121 (1991). The Court has also held that when the Board concludes the medical evidence of record is insufficient it may supplement the record by ordering a medical examination. Colvin v. Derwinski, 1 Vet.App. 171 (1991). In light of the above facts, the Board has determined that the case should be REMANDED for the following actions: 1. The RO should obtain and associate with the claims folder all of the veteran's service medical records, as well as any available inpatient medical records from the service hospital in which the veteran received treatment for his injuries after being struck by a motorcycle in 1986. 2. The RO should obtain and associate with the claims folder copies of treatment records pertaining to treatment of the veteran from the Butler VAMC in 1987 and from the Oakland VAMC in 1990-1991. 3. The veteran should be afforded a VA examination by a neurology specialist to determine the nature and severity of any brain pathology. Subjective complaints and objective findings should be legibly recorded in detail. All indicated tests and studies, including X-rays, should also be conducted. The claims folder must be made available for review by the medical examiner prior to the examination to facilitate study of this case. The examiner should also express an opinion as to whether the veteran's current brain disorder(s) is (are) related to any head injury received in service. The examiner should also express an opinion as to the etiology of the brain cyst found in 1990, including its relationship, if any, to head trauma in service and the probability that the inservice head trauma caused an increase in severity of the brain cyst if present at that time. The examiner should be requested to present all opinions and findings, and the reasons therefor, in a clear, comprehensive, and legible manner on the examination report. 4. Following completion of the foregoing, the RO must review the claims folder and ensure that all of the foregoing development actions have been conducted and completed in full. If any development is incomplete, including if the requested examination does not include all test reports, special studies or opinions requested, appropriate corrective action is to be implemented. If the claim remains denied, the veteran and his representative should be issued a supplemental statement of the case and they should be afforded the appropriate period of time within which to respond thereto. Then, if otherwise in order, the case should be returned to the Board for further appellate consideration. No action is required of the veteran until he is notified. The Board intimates no opinion, either legal or factual, as to the ultimate disposition warranted in this case, pending completion of the requested development. HOLLY E. MOEHLMANN 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).