Citation Nr: 0002825 Decision Date: 02/04/00 Archive Date: 02/10/00 DOCKET NO. 96-16 897 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim for entitlement to service connection for a neck disorder and, if so, whether all the evidence both old and new warrants the grant of service connection. 2. Whether new and material evidence has been submitted to reopen a claim for entitlement to service connection for a left eye disorder and, if so, whether all the evidence both old and new warrants the grant of service connection. 3. Entitlement to a compensable evaluation for service- \connected disabilities under the provisions of 38 C.F.R. § 3.324 (1999). REPRESENTATION Appellant represented by: Georgia Department of Veterans Service WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. Eckart, Associate Counsel INTRODUCTION The veteran served on active duty from September 1966 to October 1968. The veteran's original claims seeking entitlement to service connection for a neck disorder and a left eye disorder were denied by the Atlanta, Georgia Regional Office (RO) of the Department of Veterans Affairs (VA), in a July 1979 rating decision, and service connection for a left eye disorder was denied again in an October 1979 rating decision. The veteran filed a notice of disagreement, but did not timely perfect an appeal of these denials. This matter now comes before the Board on appeal from an April 1994 decision of the RO, which, in part, found that new and material evidence had not been presented to reopen the veteran's claims for service connection for a neck disorder and a left eye disorder. This matter also comes before the Board on appeal from a March 1996 hearing officer's determination which denied entitlement to a compensable evaluation for service-connected disabilities under the provisions of 38 C.F.R. § 3.324 (1999). It is noted that the appellant appeared at a hearing before the undersigned Member of the Board on September 13, 1999, at which time he testified with respect to the claims now at issue before the Board. A transcript of that hearing has been associated with the record on appeal. The issue concerning entitlement to a compensable evaluation based on service connected disabilities under 38 C.F.R. § 3.324 (1999) will be addressed in the remand portion of this decision. FINDINGS OF FACT 1. The most recent final decision, denying service connection for a neck disorder was in July 1979. Although the veteran filed a notice of disagreement, he did not perfect his appeal of this decision. 2. Evidence associated with the record since the July 1979 decision shows that the veteran has a cervical spine disorder that was possibly incurred from a combat injury, wherein his head was struck by an enemy projectile during a river patrol. 3. The claims file contains evidence that establishes a plausible nexus for a cervical spine disorder based on injuries received under the hardships and conditions of combat, but the RO has not obtained sufficient evidence for correct disposition of the claim. 4. The most recent final decision, denying service connection for a left eye disorder was in October 1979. Although the veteran filed a notice of disagreement, he did not perfect his appeal of this decision. 5. Evidence associated with the record since the October 1979 decision shows that the veteran was diagnosed in March 1996 with the same left eye disorder that was diagnosed in a July 1968 service medical record. 6. The claims file contains evidence of a current diagnosis of a left eye disorder which may plausibly be a manifestation of a chronic eye disease first shown inservice, but the RO has not obtained sufficient evidence for correct disposition of the claim. CONCLUSIONS OF LAW 1. Evidence received subsequent to the most recent unappealed decision of July 1979, which denied entitlement to service connection for a cervical spine disorder is new and material; thus the claim is reopened and must be considered on the basis of all the evidence of record, both new and old. 38 U.S.C.A. §§ 5108, 7105 (West 1991); 38 C.F.R. §§ 3.104, 3.156(a), (1999). 2. The claim of entitlement to service connection for a cervical spine disorder is well grounded. 38 U.S.C.A. § 5107(a) (West 1991); Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table). 3. Evidence received subsequent to the most recent unappealed decision of October 1979, which denied entitlement to service connection for a left eye disorder is new and material; thus the claim is reopened and must be considered on the basis of all the evidence of record, both new and old. 38 U.S.C.A. §§ 5108, 7105 (West 1991); 38 C.F.R. §§ 3.104, 3.156(a), (1999). 4. The claim of entitlement to service connection for a left eye disorder is well grounded. 38 U.S.C.A. § 5107(a) (West 1991); Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Factual Background Service medical records previously before the RO, reveal that in July 1967, the veteran was hanging heavy objects over his head and felt sharp pain over his left scapula, radiating towards his neck, with the left side of neck and left trapezius were sore. Service medical records further reveal that the veteran was wounded by enemy recoilless rifle fire, in June 1968, while his river assault boat was on combat patrol. He was diagnosed with multiple fragment wounds of the face, left shoulder and both arms. He also complained of decreased visual acuity of the left eye. The wounds were cleansed, with major amounts of fragments removed, and he was placed on light duty. In July 1968, the veteran was again wounded by enemy fire while his river assault craft was suppressing enemy fire. The diagnosis was multiple fragment wounds of the left arm and face. Superficial treatment included one fragment in the face removed, and wound debrided, and all other wounds were cleansed. He was placed on 1 day's light duty. This treatment note also documented a complaint of a black spot of the left eye, when looking at near (objects). This was not visible with opthamologist and was most likely a floater, with a visual acuity of 20/20, distant to near, noted. The report from his October 1968 separation examination noted no significant musculoskeletal findings, and no findings of eye abnormalities, with a reading of 20/20 uncorrected noted. The report from a May 1969 VA examination previously before the RO gave a history of the veteran having been struck by an exploding artillery shell, and suffering a mild concussion and multiple shell fragment wounds to the face, left shoulder and arms. Examination of the musculoskeletal system and eyes was normal. Also previously before the RO is a report from an Agent Orange examination performed in July 1979, which noted that the head and neck showed no evidence of inflammatory disease and no evidence of cervical nodes or bruits. This report did diagnose arthritis of the spine. This report also indicated that he was referred to neuro-surgery clinic for C-spine radiculitis and to an opthamologist for evaluation of the left eye. Evidence received after the prior final decisions of July 1979 and October 1979, includes photocopied letters from June and July 1969, which appear to be from Emory University Department of Neurosurgery to another physician, regarding the veteran's headaches, to include neck complaints. The June 1969 letter describes a history of complaints on the left side of the head and neck dating back to an injury in Vietnam, that occurred on the right side of his helmet. This letter noted that there was some extension of the discomfort retro-aurally and into the neck on the left side, but there were no other complaints referable to the neck. The July 1969 letter noted that X-rays revealed evidence of retained shrapnel in the angle of the jaw on the left, while cervical X-rays were within normal limits. The July 1969 letter suggested that the retained shrapnel may be of some significance with regard to pain the veteran was having in the temporal region as well as on the left side of the neck. Additional evidence includes the report from a VA examination from March 1981, which gives a history of a rocket having hit the veteran's helmet, with shrapnel having hit the face, forearms and both legs. There were no findings from this examination regarding either the neck or left eye. Private treatment records from June 1981 included complaints of pain in his neck, with findings of early osteoarthritis. The report from an August 1993 VA examination indicates that this examination was conducted without a review of the claims file. Complaints that included pain in the veteran's neck were reported. A history was elicited from the veteran that "a rocket creased my helmet" while in Vietnam. Examination of the eyes revealed that the sclerae of the eyes were not icteric and conjunctivae were not pale. Normal extraocular movements were present and visual fields were not pale. Left eye vision was 20/30 with glasses. Examination of the cervical spine revealed 55 degrees forward bending; 15 degrees backward extension; 25 degrees left rotation; 20 degrees right rotation; 15 degrees left flexion and 10 degrees right flexion. The pertinent diagnoses were chronic neck pain syndrome, history of, with degenerative disc disease and degenerative joint disease. X-rays of the cervical spine from August 1993 revealed straightening of the normal cervical lordosis; hypertrophic degenerative changes and disc space narrowing at C5-C6 and C6-C7. Posterior osteophytes are encroaching upon both the right and left neural foramina at these levels. The veteran testified at a hearing before a hearing officer at the RO in July 1995. He testified that he during combat a rocket "creased" his helmet. He testified that the rocket knocked his head to one side, wherein he struck the left side of his face against the gunmount, then the rocket exited the gun mount, through three pieces of 1/4 inch steel and 9 inches of bulletproof vest. He testified that he was knocked out temporarily. He indicated that he received treatment for his neck at the same time he received treatment for his head, and that he was told he would always have problems with his neck. He testified that after his discharge from active duty, he first received treatment for his neck in 1969. Regarding his left eye, he testified that he believed it was from shrapnel. He testified that the eye only bothers him while reading. Also at the hearing, the veteran presented photographs that included depictions of a helmet with the cover torn partially off, and a photograph of a man, standing in front of a combat boat, presumed to be the veteran, with bandages around his chest, left shoulder and right forearm and holding the torn helmet. In January 1995, the veteran presented at a private neurological surgeon for evaluation for complaints of cervical stenosis and radicular pain. A history of stiffness of his neck and neck pain over the years was given. Computerized tomography (CT) findings from January 1995 reportedly included degenerative disc changes and spondylosis, with mild degrees of spinal canal stenosis and moderate to marked foraminal stenosis at C5-6 and C6-7, with probably significant impingement on the right C6 nerve root. In February 1995, the veteran was hospitalized for continued cervical spine problems, that included severe degenerative disc disease at C5-6 and C6-7 and lesser morphologic evidence of degeneration at C4-5. A CT scan showed central disk herniation. The veteran underwent discography, which revealed evidence of central disk herniation. The veteran also underwent anterior C4-5; C5-6 and C6-7 diskectomies with anterior interbody arthrodesis fusions. The final diagnoses included cervical radiculopathy, cervical myelopathy, herniated C4-5 cervical disc; C5-6 bilateral neural foraminal stenosis with herniated degenerative cervical disc; bilateral C6-7 neural foraminal stenosis with herniated degenerated C6- 7 cervical disc and cervical spondylosis. Treatment records from March 1996 include treatment for his eyes, with a diagnosis of floater, left eye rendered. Also of record, is an informative pamphlet about "floaters" which indicates that floaters can be part of the aging process or that certain eye diseases or injuries can cause floaters. The veteran testified before the undersigned Member of the Board in September 1999. On that occasion, the veteran testified that while on a river operation in Vietnam, a B 40 rocket came over his left shoulder, hit his gun mount, exploded, creased his helmet, and went out through the other side of the gun mount. He testified that he was knocked out briefly for about a minute. He testified that his head was knocked against the inside of the gun mount. He testified that he's had trouble with his neck ever since this episode. His representative asserted that a photograph presented at this hearing shows damage from the rocket, including the camouflage from the helmet being ripped off, and extensive wrapping and bandaging to the veteran around his upper torso. The representative asserted that the veteran was injured by a rocket, not by recoilless rifle fire in June 1968, as recorded in the June 1968 service medical record. Regarding his left eye, the veteran testified that the last time his eye was checked, he was diagnosed with a floater, which is the same as he was diagnosed with inservice. Additional evidence includes a private orthopedic examination report in October 1999, which gave a history of the veteran having been struck in the right side of his helmet while on a patrol boat, followed by difficulty with his neck since that incident. Current complaints included discomfort in the back of the neck, with pain radiating down to the right and left shoulders, but more so on the right, and with occasional catching and popping in the neck. There was no history of recent trauma. A history of cervical spine surgery, with fusion of three discs and plate insertion four years prior was given. Physical examination revealed healed surgical incision, lateral aspect of the right side of the neck. The examiner noted limitation of flexion/extension of the cervical spine, as well as lateral rotation left and right. Neurological examination was intact. X-rays showed a metal plate with screws and fusions of C4-5; C5-6 and C6-7. The impression was post-cervical fusion for degenerative disc disease. A follow up letter by this same physician in October 1999 provided the following opinion regarding the history of cervical fusion four years prior and the history described by the veteran of injury to his head and neck while in the military, wherein a rocket apparently struck him on the right side of the head, with history of the veteran being seen for multiple injuries including his neck pain. The veteran denied previous difficulty with his neck and the difficulty that he was now experiencing appeared to be related to the injury he described as occurring in 1968 in Vietnam. Analysis As noted above, the most recent prior final denial of a neck disorder is the RO's July 1979 decision, which denied entitlement to service connection for both a neck disorder and a left eye disorder. The most recent prior final denial of the left eye disorder is the October 1979 decision. The veteran filed a notice of disagreement with these decisions, but did not perfect his appeal by filing a substantive appeal. These decisions are therefore final and may not be reopened, in the absence of new and material evidence. 38 U.S.C.A. §§ 5108, 7105; 38 C.F.R. §§ 3.104(a), 3.156(a), 20.302(a) (1998); Manio v. Derwinski, 1 Vet. App. 140 (1991). The question now presented is whether new and material evidence has been submitted, since the most recent prior adverse decision, to permit reopening of the claim. New and material evidence means evidence not previously submitted to agency decisionmakers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156 (1999). It is significant, for the outcome portion of this case, that the presumption of credibility attaches to evidence submitted for purposes of reopening a claim. Justus v. Principi, 3 Vet. App. 510 (1992). In determining which evidence is to be considered as newly presented for purposes of deciding whether to reopen a claim, in Evans v. Brown, 9 Vet. App. 273 (1996), the United States Court of Appeals for Veterans Claims (formerly the United States Court of Veterans Appeals) explained that to reopen a previously and finally disallowed claim (whether decided by the Board or an RO), there must be new and material evidence presented or secured since the time that the claim was finally disallowed on any basis, not only since the time that the claim was last disallowed on the merits. The United States Court of Appeals for the Federal Circuit (Federal) Circuit has also recently set forth new guidance regarding the adjudication of claims for service connection based on the submission of "new and material evidence." In the case of Hodge v. West, 155 F.3rd 1356 (1998), the Federal Circuit held that in Colvin v. Derwinski, 1 Vet. App. 171, 174 (1991), the Court impermissibly ignored the definition of "material evidence" adopted by VA under 38 C.F.R. § 3.156(a) as a reasonable interpretation of an otherwise ambiguous statutory term (found under 38 U.S.C. § 5108) and, without sufficient justification or explanation, rewrote the statute to incorporate the definition of materiality from an altogether different government benefits scheme. Pursuant to the holding in Hodge, the legal hurdle adopted in Colvin that required reopening of claim on the basis of "a reasonable possibility that the new evidence, when viewed in the context of all the evidence, both new and old, would change the outcome" of the case was declared invalid. Thus, the legal standard that remains valid, 38 C.F.R. § 3.156(a), requires that in order for new evidence to be material, it must be "so significant that it must be considered in order to fairly decide the merits of the claim." Precedent decisions of the Court must be given full force and effect immediately, even if VA appeals the decision. See Tobler v. Derwinski, 2 Vet. App. 8 (1991); see also Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). It therefore follows that a precedent decision of the Federal Circuit, a court of superior jurisdiction, must be given immediate force and effect as well. The Court has recently stated that a review of the claim under the more flexible Hodge standard accords the appellant a less stringent "new and material" evidence threshold to overcome. See Fossie v. West, 12 Vet. App. 1 (1998). More recently, the Court has articulated a new test for adjudicating claims based on new and material evidence. In Elkins v. West, 12 Vet. App. 209 (1999) (en banc), the Court held that the two-step process set out in Manio v. Derwinski, 1 Vet. App. 140, 145 (1991), for reopening claims became a three-step process under the Federal Circuit's holding in Hodge, supra: VA must first determine whether new and material evidence has been presented under 38 C.F.R. § 3.156(a); second, if new and material evidence has been presented, immediately upon reopening VA must determine whether, based upon all the evidence and presuming its credibility, the claim as reopened is well grounded pursuant to 38 U.S.C. § 5107(a); and third, if the claim is well grounded, VA may evaluate the merits after ensuring the duty to assist under 38 U.S.C. § 5107(b) has been fulfilled. See also Winters v. West, 12 Vet. App. 203 (1999) (en banc). Although prior to Hodge a conclusion that new and material evidence had been presented necessarily meant that the reopened claim was well grounded, the Court stated in Elkins that the Federal Circuit in Hodge effectively "decoupled" the relationship between determinations of well-groundedness and of new and material evidence by overruling the reasonable-possibility-of-a-change-in-outcome prong of Colvin, supra. There is no duty to assist in the absence of a well-grounded claim. Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997) cert. denied, sub nom. Epps v. West, 118 S.Ct. 2348 (1998). Neck Disorder Upon review of the evidence, the Board finds that new and material evidence has been submitted to reopen a claim for service connection for a cervical spine disorder. Specifically, the evidence submitted after the July 1979 decision includes treatment records which were not previously before the RO, including records from June 1969 and July 1969 regarding neck complaints as they related to retained shrapnel in the jaw, treatment records documenting cervical spine surgery for cervical spine problems, including degenerative disc disease and the medical opinion forwarded by a private physician in October 1999 regarding the etiology of cervical spine complaints, all of which suggest that the combat injury to the head also is related to his current cervical spine complaints. This new evidence is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled, is so significant, that it must be considered in order to fairly decide the merits of the claim. In view of the foregoing, the evidence cited above permits the claim to be reopened. The Board must now determine whether the claim is well-grounded, in accordance with the requirements of Elkins, Winters, supra. In order for a claim to be well grounded, there must first be competent medical evidence of a current disability; second, there must be an incurrence or aggravation of a disease or injury in service shown in either competent lay or medical evidence; third, there must be competent medical evidence showing a nexus between the current disability and the in- service incurrence or aggravation of a disease or injury. Caluza v. Brown 7 Vet. App. 498 (1995). Evidentiary assertions by the appellant must be accepted as true for the purposes of determining whether a claim is well grounded, except where the evidentiary assertion is inherently incredible or is beyond the competence of the person making the assertion. See King v. Brown, 5 Vet. App. 19 (1993). For service connection to be granted, it is required that the facts, as shown by the evidence, establish that a particular injury or disease resulting in chronic disability was incurred in service, or, if pre-existing service, was aggravated therein. 38 U.S.C.A. § 1110 (West 1991 & Supp 1999); 38 C.F.R. § 3.303 (1999). There are some disabilities, including disorders such as arthritis, where service connection may be presumed if the disorder is manifested to a degree of 10 percent within one year of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991 & Supp 1999); 38 C.F.R. §§ 3.307, 3.309 (1999). In addition, service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). Where a veteran was engaged in combat with the enemy during a period of war, the VA shall accept as sufficient proof of service-connection of any disease or injury alleged to have been incurred in or aggravated by said service such satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service, and, to that end, shall resolve every reasonable doubt in favor of the veteran. Service-connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary. 38 U.S.C.A. § 1154(b) (West 1991). A combat veteran is still required to submit competent evidence of a current disability, and of a nexus between that disability and an incident of service. See Caluza v. Brown, 7 Vet. App. 498, 507 (1995). However, the United States Court of Appeals for Veteran's Claims has clarified the meaning of 38 U.S.C.A. § 1154(b) as relaxing the evidentiary requirement for combat veterans regarding the second element of Caluza, that being the question of service incurrence, that is what happened during service, not the questions of either current disability or nexus to service. Thus, the combat veteran who has well grounded his claim does not necessarily prevail on the merits absent clear and convincing evidence to the contrary, but still requires a weighing of positive and negative medical evidence as to whether the current disability is related to service. See Kessel v. West 12 Vet App. 477 (1999), overruling Arms v. West, 12 Vet App 188 (1999). Upon review of the evidence, the Board finds that the evidence submitted to reopen this claim, plus the evidence previously before the RO, serves to well-ground this claim. Specifically, the Board notes that the veteran is a combat veteran, with an award of the Purple Heart medal, as noted on his DD-214, service personnel record. The service medical records also reveal treatment to the face and shoulder area for shrapnel wounds. The Board finds the veteran's testimony credible regarding the helmet creasing incident, wherein he lost consciousness and struck the left side of his head against the gun. Treatment records from June and July 1969 document complaints of neck pain on the left, within one year after he was discharged from active duty, suggesting that the veteran's neck problems are long standing, and became present a few months after service although there was no evidence of arthritis at that time. These records from 1969 also document the same history of the rocket striking his helmet to the right side, which is the same history given to the physician in 1999. Finally, the Board finds that the opinion from the private orthopedic surgeon in October 1999, that the veteran's present difficulty with his neck appears to be related to the injury that was described as occurring in Vietnam in 1968, provides a nexus between his inservice injury and current cervical spine pathology. This medical opinion, which is based on the consistent history of a combat injury of a blow against the head, which for the purposes of well-groundedness must be accepted as true. King v. Brown, 5 Vet. App. 19 (1993). Accordingly, the Board also concludes that the claim is well grounded under 38 U.S.C.A. § 5107(a) (West 1991), see Elkins, Winters, supra, which thus permits further development of the appellant's claim, as set forth below in the REMAND section of this decision. Left Eye Disorder Upon review of the evidence, the Board finds that new and material evidence has been submitted to reopen a claim for service connection for a left eye disorder. Specifically, the evidence submitted after the prior decision of October 1979 is a medical treatment record from March 1996, showing treatment for what was diagnosed as a "floater, left eye." Essentially this is showing treatment in 1996 for the same left eye problem, that was complained of inservice as a "black spot" left eye, and diagnosed as "most likely a floater." This raises the possibility of the left eye floater to be a chronic condition dating back to July 1968. This new evidence is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled, is so significant, that it must be considered in order to fairly decide the merits of the claim. In view of the foregoing, the evidence cited above permits the claim to be reopened. The Board must now determine whether this claim is well-grounded, in accordance with the requirements of Elkins, Winters, supra. As discussed above, in order for a claim to be well grounded, there must first be competent medical evidence of a current disability; second, there must be an incurrence or aggravation of a disease or injury in service shown in either competent lay or medical evidence; third, there must be competent medical evidence showing a nexus between the current disability and the in-service incurrence or aggravation of a disease or injury. Caluza v. Brown 7 Vet. App. 498 (1995). Alternatively, the third Caluza element can be satisfied by evidence of continuity of symptomatology and medical or, in certain circumstances, lay evidence of a nexus between the present disability and the symptomatology. See Savage v. Gober, 10 Vet. App. 488, 495 (1997). Also, presumption period and (2) present disability from it. Savage, 10 Vet. App. at 495. With regard to a showing of a chronic disability in service, the United States Court of Appeals for Veterans Claims (known as the U. S. Court of Veterans Appeals prior to March 1, 1999) (hereinafter "the Court") concluded in Savage, supra, that chronicity could be shown by "either evidence contemporaneous with service or the presumption period or evidence that is post service or post presumption period." Id. In this instance, although the veteran has alleged that his left eye disorder is the result of combat injuries from shrapnel, there is no competent medical evidence of record to support this contention. Lay assertions of medical diagnosis or causation do not constitute competent evidence sufficient to render a claim well-grounded. Grottveit v. Brown, 5 Vet. App. 91, 93 (1992); Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). Therefore, his claim for a left eye disorder as due to combat injuries, under 38 U.S.C.A. § 1154(b), is not well grounded under that particular basis. As such, no combat presumptions apply in this particular claim. However, as discussed above, there is evidence of treatment inservice for a complaint of a "black spot" of the left eye in July 1968, which was diagnosed as "most likely a floater." There is evidence in March 1996 showing treatment for what was diagnosed as a floater of the left eye. This evidence suggests the left eye floater, diagnosed inservice may be a chronic condition dating back to service, and is a therefore a plausible claim, capable of substantiation. The Board therefore concludes that the claim is well grounded under 38 U.S.C.A. § 5107(a) (West 1991), see Elkins, Winters, supra, which thus permits further development of the appellant's claim, as set forth below in the REMAND section of this decision. ORDER New and material evidence having been submitted, the claim of entitlement to service connection for a neck disorder is reopened, and is well grounded; to this extent the appeal is granted. New and material evidence having been submitted, the claim of entitlement to service connection for a left eye disorder is reopened, and is well grounded; to this extent the appeal is granted. REMAND The Board finds that the veteran's claim for a compensable rating under 38 C.F.R. § 3.324 cannot be addressed until after the severity of each of his service-connected disorders has been evaluated. As this issue is inextricably intertwined with the other issues on appeal, it must therefore be addressed on remand following the development noted above. Harris v. Derwinski, 1. Vet. App. 180 (1991). Having reopened the claim for service connection for a left eye disorder, and a cervical spine disorder de novo review of all the evidence is indicated. In order so as to not prejudice the appellant's claim, initial review by the RO is also indicated. Bernard v. Brown, 4 Vet. App. 384 (1993). The Board has a duty to assist the veteran in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.159 (1999). This duty to assist involves obtaining relevant medical reports and examinations where indicated by the facts and circumstances of the individual case. See Abernathy v. Principi, 3 Vet. App. 461 (1992); Roberts v. Derwinski, 2 Vet. App. 387 (1992); Schafrath v. Derwinski, 1 Vet. App. 589 (1991); Littke v. Derwinski, 1 Vet. App. 90 (1990); Murphy v. Derwinski, 1 Vet. App. 78 (1990). In view of the foregoing, the Board finds that further development is warranted, in light of the continued questions that exist regarding the nature and severity of his cervical spine disorder and left eye disorder. Regarding the cervical spine, the Board observes that the record establishes that the veteran sustained a projectile blow to the head during combat conditions in Vietnam, and that he complained to physicians about neck pain in June and July 1969, within one year after discharge; although no evidence of arthritis was apparent on X-ray study of the cervical spine. Presently, the veteran is shown to have a diagnosis of severe degenerative joint disease, post-cervical fusion and a private physician has forwarded the opinion that the current cervical spine problems may be related to the injury in Vietnam. Regarding the claimed eye disorder, the Board observes that a possible "floater" of the left eye was diagnosed inservice. The private medical record from March 1993 diagnosed a "floater" in the same eye. A medical opinion is necessary to clarify whether the veteran's claimed left eye disability was caused or aggravated by service. The Court has held that such medical questions must be addressed by medical experts. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Accordingly, further appellate consideration will be deferred and the case is REMANDED to the RO for the following development: 1. The RO should contact the veteran to determine the names, addresses, and dates of treatments of any and all medical care providers who treated the veteran for the disabilities at issue, not already associated with the claims file. After securing the necessary release, the RO should obtain these records. All pieces of correspondence, as well as any medical or treatment records obtained, should be made a part of the claims folder. If private treatment is reported and those records are not obtained, the veteran and his representative should be provided with information concerning the negative results and afforded an opportunity to obtain the records. 38 C.F.R. § 3.159 (1999). 2. Thereafter, the veteran should be scheduled for a VA orthopedic examination, in order to ascertain the nature and etiology of any current cervical spine disability. All tests and studies deemed necessary by the examiner should be conducted. The examiner must review all the medical data on file and the combat history on file and should specifically address the following questions: (a) Does the veteran have any current disability of the cervical spine? (b) If so, is any current cervical spine disability the result of a disorder not classified as a congenital defect? (c) If any cervical spine disability, is not classified as a congenital defect, does the record reflect that any current cervical spine disability as likely as not became manifest as a result of the trauma encountered by the veteran while under the hardships of combat, while serving in Vietnam? (d) whether other factors, including the aging process after the veteran's military service may have played a role in the development of, or aggravation of, any cervical spine disorder found to be currently present. If the veteran is not currently suffering from any cervical spine pathology which could be regarded as having been incurred in or aggravated while the veteran was in service, the examiner must specifically indicate so. The examination report should set forth in a clear, comprehensive, and legible manner all pertinent findings and should include complete rationale for the opinions expressed. The veteran's entire claims folder and a copy of this remand must be made available to the examiner prior to the examination to facilitate a thorough, longitudinal review of the evidence, and the examiner should be requested to indicate in the examination report that he or she has reviewed the entire claims folder. 3. Thereafter, the veteran should be scheduled for a VA opthamology examination, in order to ascertain the nature and etiology of any current left eye disability. All tests and studies deemed necessary by the examiner should be conducted. The examiner must review all the medical data on file and should specifically address the following questions: (a) Does the veteran have any current disability of the left eye? (b) If so, is any current left eye disability the result of a disorder not classified as a congenital defect? (c) If any left eye disability, is not classified as a congenital defect, does the record reflect that any current left eye disorder as likely as not is the same disorder diagnosed in July 1968 or if not, whether it became manifest as a result of the trauma encountered by the veteran while under the hardships of combat, while serving in Vietnam? (d) whether other factors, including the aging process after the veteran's military service may have played a role in the development of, or aggravation of, any left eye disorder found to be currently present. If the veteran is not currently suffering from any left eye pathology which could be regarded as having been incurred in or aggravated while the veteran was in service, the examiner must specifically indicate so. The examination report should set forth in a clear, comprehensive, and legible manner all pertinent findings and should include complete rationale for the opinions expressed. The veteran's entire claims folder and a copy of this remand must be made available to the examiner prior to the examination to facilitate a thorough, longitudinal review of the evidence, and the examiner should be requested to indicate in the examination report that he or she has reviewed the entire claims folder. 4. Thereafter, the RO should review the claims folder and ensure that the examination report is complete and in full compliance with the above directives. If the report is deficient in any manner, it must be returned to the examining physician for correction. 38 C.F.R. § 4.2 (1999); See also Stegall v. West, 11 Vet. App. 268 (1998). 4. Following completion of the foregoing, the RO should again consider the veteran's claims in light of all the evidence of record, including that obtained pursuant to this remand. The RO should again consider whether the veteran warrants a compensable evaluation under 38 C.F.R. § 3.324 (1999). 5. If either determination remains adverse to the veteran, the RO should furnish the veteran and his representative a supplemental statement of the case in accordance with 38 U.S.C.A. § 7105 (West 1991), which summarizes all of the evidence, both new and old, and sets forth the applicable legal criteria pertinent to this appeal. Thereafter, the veteran and his representative should be afforded the opportunity to respond thereto. The case should then be returned to the Board for further appellate consideration, if otherwise in order. No action is required of the veteran until he receives further notice. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs 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. A. BRYANT Member, Board of Veterans' Appeals