BVA9503887 DOCKET NO. 93-13 080 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for headaches and a sinus disability. 2. Entitlement to an increased rating for residuals of a nasal fracture, currently rated 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Mark J. Swiatek, Counsel REMAND The veteran had active duty from October 1958 to September 1961. November 14, 1988. This matter comes before the Board of Veterans' Appeals (Board) from a June 1991 decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The Board observes that the veteran's claim for service connection of headaches and a sinus disability has been adjudicated without benefit of a medical opinion regarding the etiology of either disorder. In fact, on a May 1991 examination, a VA physician recommended that the veteran receive examinations from an ear, nose and throat specialist and an allergist. Neither examination was obtained. The Board notes that in an August 1992 rating decision on appeal, the RO determined that the veteran's sinus and headache disorders were related to facial injuries sustained in a November 1988 motor vehicle accident. This appears to be based on a medical history reported in the summary of the veteran's February 1992 VA hospital admission for submucous resection. Though requested, contemporaneous medical treatment have not been located. The record, however, shows that the veteran's headache and sinus complaints were recorded on a June 1983 VA examination, though no diagnosis of a chronic disorder was made at the time. At the hearing, the veteran testified regarding the extent of the nasal fracture residuals and a history of headache and sinus complaints. The testimony and medical records subsequent to the 1988 accident on file are inconsistent with a medical history of nasal injury and breathing difficulty reported in February 1992. In view of the foregoing, and to ensure that the VA has met its duty to assist the claimant in developing the facts pertinent to the claim and to ensure full compliance with due process requirements, it is the opinion of the Board that additional development, as set forth below, is desirable. Accordingly, the case is REMANDED to the RO for the following development 1. The veteran should be requested to identify all sources of recent treatment for his service-connected nasal fracture residuals. At the same time, he should be asked to provide information regarding medical treatment that he has received for headaches and a sinus disorder at any time. With any necessary authorization from the veteran, the RO should attempt to obtain legible copies of all indicated records which have not been previously secured. This should include any records from the veteran's admission to Massachusetts General Hospital in 1986, the complete record of a VA hospital admission in February 1992, and any record of treatment following the November 1988 motor vehicle accident. 2. The RO should make another attempt to obtain medical records for the veteran's admission or observation at St. Joseph Hospital, 172 Kinsley Street, Nashua, NH 03061, reported to have occurred in November 1988. 3. Thereafter, the veteran should be afforded a VA neurology and ear, nose and throat examinations to determine the current extent of the residuals of the nasal fracture and any headaches and sinus disorder found. The claims folder must be made available to the examiner(s) in connection with the examination. With regard to the above, all pertinent complaints should be recorded and evaluated. All indicated studies should be performed. The ear, nose and throat examiner should also render an opinion as to the effect, if any, that residuals of the nasal fracture have on the veteran's ability to work. 4. Regarding headaches the neurologic examiner, after review of the claims folder, is requested to provide an opinion regarding the etiology therefor and the degree of probability, if any, that a headache disorder found is causally related to the service-connected nasal fracture residuals. The ear, nose and throat examiner should also provide an opinion regarding the etiologic significance of nasal complaints reported by the veteran during service and the degree of probability, if any, that any sinus disorder or headaches found are etiologically related to the service- connected nasal fracture residuals. The rationale for all conclusions and opinions should be provided. Any other special examination, such as an allergy examination, deemed necessary by the examiner should be conducted. 5. Then, in light of the evidence obtained pursuant to the requested development, the RO should readjudicate the claim for an increased rating for nasal fracture residuals and the claims for service connection for headaches and a sinus disorder If in order, the RO should render an administrative decision regarding whether the injuries the veteran sustained in a November 14, 1988, motor vehicle accident were the result of his willful misconduct. The rating for the nasal fracture residuals should reflect consideration of the provisions of 38 C.F.R. § 3.321(b)(1). A supplemental statement of the case should then be prepared and furnished to the veteran and his representative. They should be provided the applicable period in which to respond. Thereafter, in accordance with the proper appellate procedures, the case should be returned to the Board for further appellate review, if otherwise in order. In taking this action, the Board implies no conclusion, either legal or factual, as to any final outcome warranted. No action is required of the veteran until he is otherwise notified by the RO. CHARLES E. HOGEBOOM 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 deter- mination. 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 action has been taken in accordance with the Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 303, 108 Stat. 4645, (1994) and is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1993).