BVA9500415 
DOCKET NO.  93-07 221     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Pittsburgh,
Pennsylvania

THE ISSUES

1.  Entitlement to service connection for later loss of teeth,
secondary to fractures of the mandible, maxilla, and teeth in
service.  .

2.  Entitlement to a compensable evaluation for residuals of
fractures of the mandible and maxilla.

REPRESENTATION

Appellant represented by: The American Legion

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

Brynn K. Bloomgren, Associate Counsel
The veteran had active duty from August 1967 to May 1969.

This matter came before the Board of Veterans' Appeals
(hereinafter the Board) on appeal from a March 1992 rating
decision of the Pittsburgh, Pennsylvania, Regional Office
(hereinafter RO) of the Department of Veterans Affairs
(hereinafter VA), which confirmed a noncompensable evaluation for
residuals of the mandible.

By his substantive appeal and his personal hearing, the veteran
raised the issues of entitlement to service connection for
additional loss of teeth, secondary to residuals of fractures of
the mandible, maxilla, and teeth in service.  The VA must
consider all issues raised from a liberal reading of all
documents and testimony in the claims file.  EF v. Derwinski, 1
Vet.App. 324, 326 (1991). We find that resolution of this issue
turns on the same set of facts as the issue of entitlement to a
compensable evaluation for residuals of mandible and maxilla.
Harris v. Derwinski, 1 Vet.App. 180, 183 (1991).  These issues
must be addressed together.

We observe that, by a rating action dated in February 1993, the
RO granted entitlement to service connection for facial scar,
headaches, and a fracture of the maxilla, secondary to his
service injuries, a combined rating of 30 percent.  The fracture
of the maxilla was included with the service-connected mandibular
fracture, and the noncompensable rating was continued for these
residuals.

REMAND

Service records reflect that, in September 1968, the veteran
sustained multiple injuries as a result of a Jeep accident.  He
was hospitalized until January 1969.  The final diagnoses of the
facial injuries were (1) compound fracture of the mandible, left
body between teeth numbers 19 and 20, inferior alveolar
anesthesias. (Treated, delayed union) and compound fracture of
the mandible, right body between teeth numbers 26 and 28,
inferior alveolar nerve anesthesias. (Treated, healing) with
compound fracture of the maxilla, alveolus, with teeth numbers 9,
10, 11, in block, with severe labial displacement.  V2 dental
branches severed.  (Treated improved);  (2) Fracture of teeth
numbers 8, 12, 13, 14, 15, v2, dental branches 8 and 12, severed.
(Treated, improved); and (3) partial avulsion of tooth number 27,
inferior alveolar nerve to 27, severed with facial lacerations,
through and through of the left face, left upper lip, and midline
lip.

A dental rating sheet dated in September 1969 shows that the
veteran was granted service connection for teeth numbers 8, 9,
10, 11, 12, 13, 14, 15 due to trauma.  The veteran submitted
private dental treatment reports dated in 1969, 1977, 1984-1986,
1988, 1989, and October and November 1991.  He also requested
that the RO obtain treatment reports from the VA medical centers
on Highland and University Drives in Pittsburgh, Pennsylvania,
with reference to a claim for an increase of the residuals of his
injuries.  The RO has not obtained these reports.  The VA has a
duty to obtain all relevant private and government medical
records under 38 U.S.C.A. § 5107 (West 1991);  Murphy v.
Derwinski, 1 Vet.App. 78, 82 (1990);  See also Littke v.
Derwinski, 1 Vet.App. 90 (1991).

The veteran was recently afforded a VA neurologic examination in
March 1992.  At that time, the veteran failed to cooperate so
that a complete study was not obtained.  The radiologist
recommended that in order to obtain a satisfactory examination, a
computerized tomography (CT) scan with bone algorithms should be
obtained with attention to the mastoid and temporal bones.
Because most of the dentition was absent in the upper and lower
mandible, the radiologist suggested that other methods of
examination may be necessary, depending on the veteran's
symptoms.  The VA has a duty to provide the veteran with a
thorough and contemporaneous examination of the claimed
disability so that an evaluation will be a fully informed one.
Green v. Derwinski, 1 Vet.App. 121, 124 (1991).

Based on the foregoing, the case is REMANDED to the RO for the
following development:

1.  The RO should obtain and associate with
the claims file treatment reports from the
VA medical centers on Highland and
University Drives in Pittsburgh,
Pennsylvania, referred to in the claims
file.

2.  The veteran should be afforded VA
examination of his jaw and teeth by an oral
surgeon, neurologist, and orthopaedist.
All indicated tests should be performed,
including a CT scan with bone algorithm
with attention to the mastoid and temporal
bones.

The examiners should express an opinion as
to whether the veteran's later dental
problems and loss of teeth is attributable
to the fracture of the mandible, maxilla,
and/or teeth in service.

With regard to the maxilla and mandible,
the examiners should state whether there is
any loss of substance of body or loss of
continuity.  They should ascertain whether
there is any loss of masticatory surface,
and, if so, whether it can be restored by
suitable prosthesis.  Supporting clinical
findings should be included in the final
examination report.

The claims folder should be made available
to the examiner for review before the
examination.

After the requested development has been completed to the extent
possible, the RO should again review the record.  If the benefits
sought on appeal are not granted, the RO should furnish the
veteran and his representative a supplemental statement of the
case, including a summary of the relevant evidence, citation to
the applicable diagnostic codes, and reasons and bases for the
decision, and be afforded the opportunity to respond before the
record is returned to the Board for further appellate review.

Inasmuch as the issue of entitlement to service connection for
loss of teeth, secondary to fractures of the mandible, maxilla or
teeth in service is deemed to be "inextricably intertwined" with
the issue of entitlement to a compensable evaluation for
residuals of the mandible and maxilla, the RO should take
appropriate adjudicative action, and provide the appellant and
representative, if any, notice of the determination and the right
to appeal.  The RO should consider the potential applicability of
38 C.F.R. Part 4, § 4.150, Diagnostic Codes 9904, 9913, and 9916
(1993) in rating the service-connected disabilities.  If a timely
notice of disagreement is filed, the appellant and
representative, if any, should be furnished with a statement of
the case and given time to respond thereto.

The purpose of this remand is to obtain additional development
and the Board does not intimate any opinion as to the merits of
the case.  No further action is required of the veteran until he
is notified.

          JACK W. BLASINGAME
          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) (1993).