Citation Nr: 0002427 Decision Date: 01/31/00 Archive Date: 02/02/00 DOCKET NO. 98-05 130A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Whether new and material evidence has been submitted, which is sufficient to reopen a claim of entitlement to service connection for a headache disorder. 2. Entitlement to an evaluation in excess of 10 percent for service-connected fractured left zygoma. 3. Entitlement to service connection for residuals of dental trauma. 4. Entitlement to an initial compensable evaluation for service-connected deviated nasal septum. REPRESENTATION Appellant represented by: Military Order of the Purple Heart WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD P. A. Kultgen, Associate Counsel INTRODUCTION The veteran had active service from May 1981 to May 1984. This matter is before the Board of Veterans' Appeals (Board) on appeal of a July 1997 rating decision from the Los Angeles, California, Department of Veterans Affairs (VA) Regional Office (RO), which continued a noncompensable evaluation for service-connected status post-operative facial fracture of the left zygomatic. The RO further found that no new and material evidence, adequate to reopen the claim for service connection for migraine headaches, had been submitted. By rating decision in October 1998, the RO granted an increased evaluation of 10 percent for service-connected fractured zygoma, effective from January 6, 1997. In a VA Form 9, received in November 1998, the veteran stated that he had an eye/vision disability due to his service- connected left zygoma fracture. This issue is referred to the RO for further adjudication and development as necessary. Further, the veteran has alleged that his dental condition is due, at least in part, to surgery conducted at a VA facility for correction of his nasal septal deviation. The issue of direct service connection for a dental disorder is decided herein, but, the issue of entitlement to compensation for a dental disorder under 38 U.S.C.A. § 1151 is referred to the RO for further adjudication and development as necessary. The issue of entitlement to an initial compensable evaluation for service-connected deviated nasal septum is discussed in the remand portion of this decision. FINDINGS OF FACT 1. By rating decision dated in December 1993, the RO denied service connection for headaches. The veteran was properly notified of that decision, and did not perfect a timely appeal. 2. The evidence received subsequent to the December 1993 RO decision is not cumulative or redundant, bears directly and substantially upon the specific matter under consideration, and must be considered to fairly decide the merits of the claim. 3. The veteran's current chronic headaches are due to in- service facial trauma. 4. The veteran's fractured left zygoma is manifested by mild ptosis and mild left-sided paresis of the face. 5. The record contains no competent medical evidence of a nexus between the veteran's current dental conditions and any incident of his military service, including the left zygomatic fracture. CONCLUSIONS OF LAW 1. New and material evidence having been presented, the claim of entitlement to service connection for headaches is reopened. 38 U.S.C.A. § 5108 (West 1991), 38 C.F.R. § 3.156(a) (1999). 2. The veteran's chronic headaches were incurred in his active military service. 38 U.S.C.A. §§ 1131, 5107(b) (West 1991); 38 C.F.R. § 3.303 (1999). 3. The criteria for an evaluation in excess of 10 percent for service-connected left zygoma fracture have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.31, 4.84a, 4.118, 4.124a, Diagnostic Codes 6019, 7800, 8205 (1999). 4. The claim of entitlement to service connection for residuals of dental trauma is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background The veteran's service medical records reported trauma to the left side of the face in August 1981 resulting in a left zygomatic fracture. In September 1981, the veteran complained of headaches in the frontal region. Dental treatment in September 1981 noted that following the veteran's left zygomatic fracture, the veteran's occlusion was grossly within normal limits. Complaints of a headache in connection with assessment of upper respiratory infection were noted in October 1981. In February 1982 the veteran suffered a trauma to the frontal area of the cranium, in an auto accident. In March 1982 the veteran complained of intermittent headaches. The veteran complained of headaches along with other symptoms in February 1983, with an assessment of upper respiratory infection. A dental treatment record noted that teeth 1, 16, 17, and 32 were extracted in June 1983. The veteran's discharge physical examination in April 1984 noted left facial asymmetry with mild depression of the left zygomatic arch and lateral left eyebrow. Dental examination showed teeth 1, 16, 17, and 32 to be missing. In a report of medical history, completed at the same time, the veteran denied a history of frequent or severe headaches. The examiner noted a history of left zygoma fracture without difficulty with vision/hearing or frequent headaches. In December 1988 the veteran filed an initial claim for VA benefits for service connection for residuals of a blow to the temple incurred in 1981. In a report of accidental injury, received in January 1989, the veteran stated that his head was injured in approximately June 1981 during an attempted mugging. The veteran stated that he was admitted into intensive care following this incident and stainless steel stitches were used to hold the bones together. A VA examination was conducted in February 1989. No complaints of headaches were reported. By rating decision in March 1989, the RO granted service connection for status post-operative facial fracture of the left zygoma with a noncompensable evaluation, effective from December 30, 1988. By rating decision in November 1989, the RO denied service connection for dental trauma. The record contains no evidence that the veteran was properly notified of this decision. By rating decision in December 1993 the RO denied service connection for headaches, including as secondary to the veteran's service-connected facial fracture. The veteran was notified of this decision under cover letter dated in January 1994. The veteran filed a timely notice of disagreement with this decision in January 1994 and a statement of the case was issued in August 1994. An appeal consists of a timely filed notice of disagreement in writing and, after a statement of the case has been furnished, a timely filed substantive appeal. 38 C.F.R. § 20.200 (1999). A substantive appeal must either indicate that the appeal is being perfected as to all issues addressed in the statement of the case, or must specifically identify the issues appealed. 38 C.F.R. § 20.202 (1999). A substantive appeal must be filed within 60 days from the date that the agency of original jurisdiction mailed the statement of the case to the appellant, or within the remainder of the 1-year period from the date of mailing of the notification of the determination being appealed, whichever period ends later. 38 C.F.R. § 20.302(b) (1999). Therefore, to timely perfect his appeal, the veteran needed to submit a substantive appeal prior to January 1995. The veteran's VA Form 9, substantive appeal, was received on February 16, 1995. By letter in March 1995, the RO informed the veteran that his substantive appeal was not timely filed. The letter informed the veteran that he had the right to appeal that decision. No notice of disagreement to this decision on the timeliness of the veteran's substantive appeal was received. Therefore, the RO decision is final as to evidence of record at the time. 38 U.S.C. § 4005(c) (1988) (1988) (38 U.S.C.A. § 7105(c) (West 1991 & Supp. 1999)); 38 C.F.R. § 20.1103 (1999). The veteran filed a request to reopen his claim for service connection for headaches in January 1997. The evidence, submitted since the final RO decision in December 1993, includes VA treatment records, statements of the veteran and testimony at a hearing before an RO hearing officer. VA outpatient treatment records in July 1994 noted complaints of severe headaches with a history of head trauma during service. The veteran stated that he began having headaches two-to-three years previous and the headaches were increasing in duration. An impression of recurrent headaches secondary to left orbital surgery was provided. In August 1994, the veteran reported that the headaches began in 1986 and occurred approximately once per week. The examiner noted that the veteran had atypical left-sided headaches that were unlikely to be related to facial trauma. In April 1995, chronic headache syndrome secondary to old trauma was noted. In November 1995, assessments of post-traumatic left facial pain and headaches secondary to the 1981 mugging were provided. VA X-ray examination in October 1994 noted old trauma to the lateral wall of the right orbit as well as the right medullary sinus and possible fracture of the floor of the left orbit. VA outpatient treatment records in April 1996 noted follow-up for headaches, status post facial trauma in 1981. The examiner noted that the veteran was status post traumatic fracture in 1981, but indicated that medical records were not available. The examiner noted that the veteran had a full orthopedic, neurological, and ENT work-up for his complaints of headaches, but all examinations were negative. In May 1996, the veteran reported complaints of headache pain with a history of facial trauma in 1981. The examiner provided an assessment of history of post-traumatic facial and orbital pain with headache. VA records contain continued treatment for chronic headaches through January 1999. A VA fee basis general medical examination was conducted in August 1998, and the examiner noted review of the "submitted medical records." The veteran reported that he suffered a blow to his left face during an attempted mugging in 1981. His chief complaints were migraine headaches and poor concentration. He reported that the headaches occurred three-to-four times per week over the left eye with no associated blurred vision. The veteran stated that he had been taking over-the-counter medication for his headaches since 1985. The physician noted that the veteran was able to chew, swallow, and move his tongue adequately. A VA fee basis dental examination was conducted in August 1998, and the physician noted review of the medical record. The veteran reported that during the surgical procedure to repair the deviated nasal septum, an instrument slipped and hit his teeth (#6 and 8), causing a crack on those two teeth. The veteran reported numbness on teeth #11, 12, and 13. The examiner noted pain on palpitation and when biting on the left at teeth #11, 12, and 13. The examiner noted no missing teeth except wisdom teeth removed in April 1981. No limitation of inter-incisal range or lateral excursion range of motion and no bone loss of mandible, maxilla or hard palate were reported. X-ray showed no abnormality except surgical wires at the outer aspect of the left zygomatic region and evidence of decay at teeth # 6 and 8. The examiner noted that the pain in teeth #11, 12, and 13 could have resulted from nerve damage as a result of the fracture. The damage to teeth #6 and 8 could not be caused by the 1996 surgery or the jaw injury, as damage was due to decay. The physician reported no teeth loss due to substance of body or maxilla or mandible, no evidence of broken jaw, and no crack of teeth #6 and 8. At a hearing before an RO hearing officer in August 1998, the veteran testified that he had "sinkage" in his left eye. He stated that the area around the original area was completely numb. He reported that wire sutures were used to hold the zygoma and the upper maxilla together. Transcript, p. 2. The veteran testified that, during service, he had six migraine headaches that were so severe that he sought treatment for them. Transcript, pp. 7-8. He stated that he went to VA for treatment of headaches two days after discharge from service. Transcript, p. 8. He was later prescribed medication at VA for his headaches in approximately 1994. Transcript, p. 12. He reported that he was unable to perform his main occupation as a machinist due to the headaches, but was employed as a painter. Transcript, p. 9. The veteran testified that he had pain where his teeth were cracked. Transcript, pp. 1, 4. He reported that his teeth were cracked and became numb following surgery for his deviated nasal septum. Transcript, p. 16. He further stated that some of the teeth were cracked prior to the surgery. Transcript, p. 16. The veteran testified that he was not treated for cracked teeth during service, and that he first noticed the condition in approximately 1993. He stated that the steel wires in his jaw, as a result of a broken upper jaw, must be causing his problems with his teeth. Transcript, p. 17. In February 1999, the veteran submitted a letter, dated in January 1999, from a physician at the VA Medical Center (MC). The physician stated that a radiology report in October 1994 showed that the veteran had two metal sutures-one in the left maxilla and the other of the left orbit/zygoma. II. Analysis As an initial matter, the Board notes that the veteran has submitted additional evidence directly to the Board in February 1999. The veteran also directed that a VA facility forward treatment records directly to the Board in February 1999. An appellant has a 90 days period following the mailing of notice that an appeal has been certified to the Board or until the Board promulgates a decision, whichever comes first, during which additional evidence may be submitted. 38 C.F.R. § 20.1304(a) (1999). The notice of certification of appeal is dated November 19, 1998, and the evidence submitted in February 1999 was received within the 90-day period. Any evidence submitted must be referred to the agency of original jurisdiction for review, unless this right is waived by the appellant or unless the Board determines that the benefit may be allowed on appeal without such referral. 38 C.F.R. § 20.1304(c) (1999). In November 1998, the veteran, through his representative, stated that he wished to waive any further review by the RO. With the information submitted in February 1999, the veteran stated that he wished to waive review by the RO. The Board finds that the veteran has waived review of the records submitted directly to the Board, and the Board may proceed with a decision on the veteran's claim considering the evidence of record. The veteran, through his Congressman, also submitted records directly to the Board in May 1999. Such submission is not within the 90-day period for submission of additional evidence to the Board and it may not be considered unless the appellant demonstrates that there was good cause for the delay. 38 C.F.R. § 20.1304(b). The veteran has made no motion for consideration based on good cause. In any event, the Board notes that the evidence submitted by the veteran's Congressman are duplicates of medical records, which are already of evidence, and, as such, will be considered. New and Material Evidence for Migraine Headaches When a claim is denied by the RO and no timely appeal is filed, the claim, generally, may not thereafter be reopened and granted and a claim based upon the same factual basis may not be considered. 38 U.S.C.A. § 7105(c) (West 1991). However, if new and material evidence is presented or secured with respect to a claim which has been denied, the Secretary shall reopen the claim and review the former disposition of the claim. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a). When a veteran seeks to reopen a claim based on additional evidence, the Board must perform a three-step analysis. First, the Board must determine whether the evidence is "new and material." If the Board determines that the veteran has produced new and material evidence, the claim is reopened and the Board must then 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). Finally, if the claim is well grounded, the Board must evaluate the merits of the veteran's claim in light of all the evidence, after ensuring that the duty to assist has been fulfilled under 38 U.S.C. § 5107(b). Winters v. West, 12 Vet. App. 203 (1999) (en banc); Elkins v. West, 12 Vet. App. 209 (1999) (en banc). New and material evidence means evidence not previously submitted, which is neither cumulative nor redundant, and bears directly and substantially upon the specific matter under consideration, 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(a); see Hodge v. West, 155 F.3d 1336 (Fed. Cir. 1998). For the limited purpose of determining whether to reopen a claim, the credibility of the evidence is to be presumed. In addition for the purpose of determining whether a claim is well grounded, the credibility of the evidence is presumed. However, this presumption does not apply in the adjudication of a well-grounded claim. See Robinette v. Brown, 8 Vet. App. 69, 75 (1995); Justus v. Principi, 3 Vet. App. 510, 513 (1992). The veteran's claim for service connection for headaches was previously denied by the RO in December 1993. Since this denial, the veteran has submitted VA outpatient treatment records, statements, and testimony at a hearing before an RO hearing officer and a VA examination was conducted. VA outpatient treatment records in 1994 and 1995 noted diagnoses of chronic headaches secondary to in-service facial trauma. These records are both new, in that they were not previously considered by the RO, and material, in that they bear directly and substantially upon the specific matter under consideration. Therefore, the Board finds that the veteran has submitted new and material evidence sufficient to reopen his claim for service connection for headaches. The Board must now determine whether, based upon all the evidence and presuming its credibility, the appellant's claim as reopened is well grounded pursuant to 38 U.S.C. § 5107(a). "For a claim to be well grounded, there must be (1) a medical diagnosis of a current disability; (2) medical, or in certain circumstances, lay evidence of in[-]service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service [disease or injury] and the current disability." Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997) quoting Epps v. Brown, 9 Vet. App. 341, 343-344 (1996). Alternatively, the second an third elements may be satisfied under 38 C.F.R. § 3.303(b) (1999) by: a) Evidence that a condition was "noted" during service or during an applicable presumption period; b) Evidence showing post-service continuity of symptomatology; and c) Medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-497 (1997). The veteran has submitted evidence of a current disability. VA treatment records note continued treatment for chronic headaches. As required in the "alternative" method for submitting a well-grounded claim, the record shows that headaches were noted during service. The veteran's service medical records note complaints of headaches in September and October 1981 following the facial injury in August 1981. Headaches were again noted in March 1982 following an auto accident in February 1982. The veteran denied a history of headaches on a report of medical history at service separation and the examiner noted no headaches as a result of the left zygoma fracture at that time. The veteran has repeatedly stated that he has a continuity of symptomatology and testified at the August 1998 hearing that he had chronic headaches since the initial injury in 1981. VA treatment records beginning in July 1994, stated that the veteran's recurrent headaches were secondary to the 1981 injury. The Board notes that this conclusion was stated even in light of the noted history of headaches for only two-to- three years. Based on the service medical records, the veteran's statements, and the VA outpatient treatment records, the Board finds that the veteran's claim for service connection for headaches is well grounded. 38 U.S.C.A. §5107(a) (West 1991). The VA has a duty to assist the veteran in the development of all facts pertinent to his claim. 38 U.S.C.A. § 5107(a); 38 C.F.R. § 3.103(a) (1999). The claims folder contains all available service medical records and the RO has requested and received the available reports of VA medical examinations. The veteran has not identified any further treatment records, which are not already of record. It appears that all possible development has been completed, and the VA has satisfied its duty to assist the veteran under these circumstances. 38 U.S.C.A. § 5107(a). VA treatment records in July 1994, April 1995, November 1995, April 1996, and May 1996 indicated that the veteran's headaches were secondary to the 1981 in-service facial trauma. The initial finding in July 1994 was made based on the history of facial trauma during service, which is supported by the service medical records, and the veteran's report of headaches beginning in approximately 1991 or 1992. In the instant claim, as opposed to the claim for service connection for a nasal deformity, supra, the reported history, upon which the nexus opinions are based, is consistent with and supported by the service medical records. The VA examiner in August 1998 provided no opinion as to whether the veteran's headaches were secondary to the facial trauma in 1981. A single VA outpatient record in August 1994 noted that the veteran's headaches were unlikely to be related to the 1981 facial trauma. The Board finds no basis in the record for granting more weight to this negative opinion than to the repeated VA opinions providing that the veteran's current headaches are due to the 1981 facial trauma. As the evidence does not preponderate against the veteran's claim, entitlement to service connection for headaches is granted. Service Connection for Dental Trauma This issue has been certified to be in appellate status. It would appear that the notice of disagreement of August 11, 1997 included this issue on the theory that the failure to adjudicate the issue the preceding month was tantamount to a denial. The Form 9 of November 6, 1998, was within 60 days of the October 19, 1998, supplemental statement of the case. Service connection may be established where the evidence demonstrates that an injury or disease resulting in disability was contracted in the line of duty coincident with military service, or if pre-existing such service, was aggravated therein. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1999). When a disability is not initially manifested during service or within an applicable presumptive period, service connection may nevertheless be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in or aggravated by service. See 38 U.S.C.A. § 1113(b) (West 1991); 38 C.F.R. § 3.303(d). The threshold question to be answered in the veteran's appeal is whether he has presented evidence of a well-grounded claim. Under the law, a person who submits a claim for benefits shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107(a); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). A claim need not be conclusive but only possible to satisfy the initial burden of § 5107(a). Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). If a claim is not well grounded, the application for service connection must fail, and there is no further duty to assist the veteran in the development of his claim. 38 U.S.C.A. § 5107, Murphy, 1 Vet. App. 78 (1990). The United States Court of Appeals for the Federal Circuit held that, "For a claim to be well grounded, there must be (1) a medical diagnosis of a current disability; (2) medical, or in certain circumstances, lay evidence of in[-]service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service [disease or injury] and the current disability. Where the determinative issue involves medical causation, competent medical evidence to the effect that the claim is plausible is required." Epps, 126 F.3d at 1468; see 38 C.F.R. §§ 3.303, 3.307, 3.309; Caluza v. Brown, 7 Vet. App. 498, 506 (1995). For the purpose of determining whether a claim is well grounded, the credibility of the evidence is presumed. See Robinette v. Brown, 8 Vet. App. 69, 75 (1995). The record contains evidence of current dental disabilities. The VA fee basis examination in August 1998 noted decay of teeth #6 and 8 and pain in teeth #11, 12, and 13. The Board notes that pain, in itself, is not a disability. No limitation of range of motion or bone loss were noted and no X-ray abnormalities of teeth #11, 12, and 13 were shown. The veteran's service medical records note treatment for a fracture zygomatic arch and the veteran has been awarded service connection for residuals of this fracture to include a deviated nasal septum. The veteran's service medical records note extraction of 4 wisdom teeth in June 1983. The Board notes that the veteran's claim that his dental condition is secondary to VA surgery for his nasal septal deviation in May 1996 has been separately referred to the RO for further development and adjudication, under 38 U.S.C.A. § 1151. The record contains no competent medical evidence providing a nexus between the tooth decay in teeth #6 and 8 and any incident of service. The physician in August 1998 specifically stated that such damage could not be caused by the inservice jaw injury. Although the physician noted that the pain in teeth #11, 12, and 13 could be the result of nerve damage as a result of the facial fracture, such is not sufficient to establish a well-grounded claim. The degree of medical certainty that is necessary for a medical opinion, sufficient to establish a plausible medical nexus, has been repeatedly discussed by the Court, with no clear picture resulting. See Hicks v. West, 12 Vet. App. 86, 90-91 (1998) (discussing previous court findings regarding syntax necessary to establish medical nexus). The Court has recognized that the determination, of what is a speculative opinion, is fact specific. Bloom v. West, 12 Vet. App. 185, 187 (1999). However, in Bloom the Court recognized that an opinion, with no clinical data or other rationale to support it or other evidence of record to give it substance, was "purely speculative" and, therefore, an insufficient basis upon which to well ground a claim. Id. Without competent evidence providing a nexus between the veteran's current disability and any incident of service, including the facial fracture, the veteran's claim cannot be well grounded. The Board recognizes that there is no duty to assist in a claim's full development if a well-grounded claim has not been submitted. See Morton v. West, 12 Vet. App. 477, 480 (1999). However, the Court has held that there is some duty to inform the veteran of the evidence necessary for the completion of an application for benefits, under 38 U.S.C.A. § 5103 (West 1991), even where the claim appears to be not well grounded. Beausoleil v. Brown, 8 Vet. App. 459, 465 (1996); Robinette, 8 Vet. App. at 79-80. The appellant has not identified any medical evidence that has not been submitted or obtained, which would support a well-grounded claim. Thus, VA has satisfied its duty to inform the veteran under 38 U.S.C.A. § 5103(a). See Slater v. Brown, 9 Vet. App. 240, 244 (1996). Increased Evaluation for Fractured Zygoma In general, an allegation of increased disability is sufficient to establish a well-grounded claim seeking an increased rating. Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). When a veteran is awarded service connection for a disability and appeals the RO's rating determination, the claim continues to be well grounded as long as the claim remains open and the rating schedule provides for a higher rating. See Shipwash v. Brown, 8 Vet. App. 218, 224 (1995). In the instant case, there is no indication that there are additional records, which have not been obtained and which would be pertinent to the present claims. Thus, no further development is required in order to comply with VA's duty to assist mandated by 38 U.S.C.A. § 5107(a). Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Schedule), 38 C.F.R. Part 4 (1999). The percentage ratings contained in the Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (1999). In determining the disability evaluation, the VA has a duty to acknowledge and consider all regulations which are potentially applicable based upon the assertions and issues raised in the record and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). Governing regulations include 38 C.F.R. §§ 4.1, 4.2, which require the evaluation of the complete medical history of the veteran's condition. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the issue is the assignment of an initial rating for a disability, following an initial award of service connection for that disability, separate ratings can be assigned for separate periods of time based on facts found, and the Board must consider all evidence of record from the time of the veteran's application. Fenderson v. West, 12 Vet. App. 119 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7 (1999). All benefit of the doubt will be resolved in the veteran's favor. 38 C.F.R. § 4.3 (1999). The veteran's fractured left zygoma is currently evaluated under Diagnostic Code 7800, for disfiguring scars of the head, face, or neck. Under the Schedule, a 10 percent evaluation is warranted for moderate disfigurement. A 30 percent evaluation is warranted for severe disfigurement, especially if producing a marked and unsightly deformity of the eyelids, lips or auricles. A 50 percent evaluation is warranted for complete or exceptionally repugnant deformity of one side of the face or marked or repugnant bilateral disfigurement. 38 C.F.R. § 4.118, Diagnostic Code 7800. Paralysis of the fifth (trigeminal cranial nerve) warrants a 10 percent evaluation if moderate; 30 percent if severe; and 50 percent if complete. 38 C.F.R. § 4.124a, Diagnostic Code 8205. Unilateral or bilateral ptosis is rated as disfigurement if less than one-half of the pupil is obscured. 38 C.F.R. § 4.84a, Diagnostic Code 6019. In every instance where the Schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation will be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31 (1999). In the instant case, the VA examiner in August 1998 noted that the veteran had mild ptosis on the left, a somewhat puffy left upper eyelid and "drooping" left eye. These medical findings do not approximate a severe deformity of the face or marked and unsightly deformity of the eyelids. The examiner stated that the conditions noted were mild and only "somewhat" puffy. The veteran's symptomatology most closely approximates a moderate disfigurement, which warrants a 10 percent evaluation. Although the veteran argues that a higher evaluation is warranted for disfigurement, the evidence of record preponderates against an evaluation in excess of 10 percent under Diagnostic Code 7800 for the veteran's residuals of a left zygoma fracture. The VA records contain no mention of severe, unsightly, or marked disfigurement of the veteran's face. The veteran also noted numbness over the area of the original fracture. The examiner in August 1998 also noted mild left- side paresis of Cranial Nerve V. However, mild paresis of this nerve does not warrant a compensable evaluation under the Schedule. The remaining residuals alleged by the veteran as due to the in-service facial trauma have addressed separately by the Board and the RO. ORDER New and material evidence having been received, the claim for service connection for headaches is reopened, and that claim is well grounded. Entitlement to service connection for headaches is granted. Entitlement to an evaluation in excess of 10 percent for service-connected left zygoma fracture is denied. Entitlement to service connection for residuals of dental trauma is denied. REMAND In his VA Form 9, received in November 1998, the veteran indicated disagreement with the RO's noncompensable evaluation of his service-connected deviated nasal septum, by October 1998 rating decision. No statement of the case has been issued following this notice of disagreement. See 38 C.F.R. §§ 19.26, 19.29, 20.201 (1999). To ensure full compliance with due process requirements, the case is REMANDED to the RO for the following development: The RO should issue a statement of the case on the issue of entitlement to an initial compensable evaluation for service-connected deviated nasal septum, which summarizes the pertinent evidence, fully cites any applicable legal provisions, and reflects detailed reasons and bases for the determination. The veteran should then be afforded the applicable time period in which to respond. Thereafter, the case should be returned to the Board for appellate review, if otherwise in order. By this remand, the Board intimates no opinion as to any final outcome warranted. The veteran need take no action until he is notified. 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 (known as the United States Court of Veterans Appeals prior to March 1, 1999) 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. John E. Ormond, Jr. Member, Board of Veterans' Appeals