BVA9506296 DOCKET NO. 91-51 182 ) DATE ) ) On appeal from rating decisions of the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to service connection for a headache disorder. 2. Entitlement to service connection for a seizure disorder. 3. Entitlement to service connection for hypertension. 4. Entitlement to a total disability rating based on unemployability due to service-connected disabilities. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Frank L. Christian, Counsel INTRODUCTION The veteran served on active duty from August 1969 to October 1970, including a tour of duty in the Republic of Vietnam. This case is before the Board of Veterans' Appeals (Board) on appeal from rating decisions of April 1990, November 1990, and March 1991 from the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. In a December 1993 letter to his Congressman, the veteran stated that the Army had not acknowledged his "head surgery or some of my other wounds like my groin area." The Board interprets that language as reasonably revealing that the veteran is seeking a particular benefit, i.e., service connection for residuals of a groin injury. That issue is referred to the RO for appropriate development and adjudication. REMAND In several communications addressed to the RO, the veteran has raised the issue of entitlement to service connection for residuals of a shell fragment wound of the head. Appropriate action by the the RO is required. Further, the veteran has alleged that his headaches and/or seizure disorder are due to a shrapnel wound of the head. The Board finds that these issues are inextricably entertwined with the certified issue of entitlement to service connection for a seizure disorder. The United States Court of Veterans' Appeals (Court) has held that to prevent piecemeal litigation the Board must simultaneously adjudicate an issue not developed for appellate consideration which is inextricably intertwined with an issue that is developed if the undeveloped issue could have a "significant impact" upon the other claim. Harris v.Derwinski, 1 Vet.App. 180,183 (1991). This case initially came before the Board in August 1992, and was remanded to the RO for additional development of the medical evidence of record, to include special VA surgical, orthopedic, neurological, and cardiovascular examinations, and for an opinion as to any relationship which might exist between any cardiovascular disease found and a service-connected disease or injury. Following that additional development, the RO was to readjudicate the issues of entitlement to service connection for headaches and for hypertension, and to consider the issue of entitlement to service connection for a seizure disorder which had recently been raised by the veteran. Thereafter, the RO was to readjudicate the issue of entitlement to a total disability rating based on unemployability due to service-connected disabilities in light of those determinations. Following completion of the requested development, a rating decision of November 1993 confirmed and continued the denial of service connection for a headache disorder and for hypertension, as well as the denial of a total disability rating based on unemployability due to service-connected disabilities. In addition, that decision denied service connection for a seizure disorder and denied increased ratings for the veteran's service- connected left below-knee amputation and for residuals of a shell fragment wound of the left thigh with fracture of the subtrochanter. In his substantive appeal, submitted in December 1993, the veteran asserted, inter alia, that his service-connected left below-knee amputation and residuals of a shell fragment wound to the left thigh should each be assigned a higher disability evaluation. The Board construes this language to constitute a notice of disagreement with the denial of increased ratings for the veteran's service-connected left below-knee amputation and his residuals of a shell fragment wound to the left thigh. A rating decision of May 1994 denied entitlement to service connection for disability due to exposure to Agent Orange or other defoliants. The veteran was notified of these determinations by letter of May 18, 1994. However, a statement of the case concerning this issue containing adequate notice to the veteran was not issued. Review of the record shows that in a Statement in Support of Claim, submitted in June 1993, the veteran stated that on May 22, 1993, he was hospitalized at the Palo Verdi Hospital in Blythe, California, with complaints of chest pain, and was subsequently transferred to the John F. Kennedy Hospital in Indio, California. He further stated that on May 26, 1993, he was seen at the VA Medical Center, Loma Linda, California, and that his physician was Dr. Sudha Pai. The Court has held that the duty to assist the veteran in obtaining and developing available facts and evidence to support his claims includes obtaining all medical records to which the veteran has referred. Littke v. Derwinski, 1 Vet.App. 90 (1990). The failure of the RO to obtain and review records of the treatment cited by the veteran constitutes a failure to assist the veteran in obtaining and developing available facts and evidence to support his claims. 38 U.S.C.A. § 5107(a) (West 1991). Based upon the foregoing, the case is REMANDED to the RO for the following actions: 1. With any necessary authorization from the veteran, the RO should obtain all clinical evidence pertaining to treatment of the veteran at the Palo Verdi Hospital in Blythe, California, and at John F. Kennedy Hospital in Indio, California, on May 22-23, 1993, and subsequently. All such evidence should be reviewed and associated with the claims file. 2. The RO should obtain all clinical evidence pertaining to treatment of the veteran at the VA Medical Center, Loma Linda, California, subsequent to June 1990. All such evidence should be reviewed and associated with the claims file. 3. The RO should contact the veteran and request that he identify by specific names, addresses, and approximate dates of treatment, of all health care providers from whom he has received treatment since August 1992 for any service-connected disability or for headaches, seizure disorder and/or hypertension since service. With any necessary authorization from the veteran, the RO should attempt to obtain the treatment records identified by the veteran that have not been previously secured. All such evidence should be reviewed and associated with the claims file. 4. The RO should schedule a VA neurological evaluation of the veteran by a board certified specialist, if available, to determine the current nature, extent, and etiology of any neurological disorder found to be present. All necessary and appropriate diagnostic tests and procedures should be conducted and the findings reported in accordance with the applicable provisions of the Physician's Guide for Disability Evaluation Examinations. The examining neurologist should be asked to render an opinion, with complete rationale, whether it is at least as likely as not that any headache or seizure disorder can be etiologically associated with post- traumatic stress disorder. The examining neurologist should be provided with the claims file for review prior to the requested examination. 5. The RO should schedule a VA orthopedic examination of the veteran by a board certified specialist, if available, to determine the current degree of disability stemming from his service-connected left below-knee amputation and his residuals of a shell fragment wound of the left thigh with fracture of the subtrochanter. All necessary and appropriate diagnostic tests and procedures should be conducted and the findings reported in accordance with the applicable provisions of the Physician's Guide for Disability Evaluation Examinations. The examining orthopedist should be provided with the claims file for review prior to the requested examination. 6. The RO should schedule a VA psychiatric evaluation of the veteran by a board certified specialist, if available, to determine the current nature and extent of the veteran's service-connected post- traumatic stress disorder and to determine the impact of such disorder on his ability to secure and maintain substantially gainful employment. The examiner must assign a Global Assessment of Functioning score consistent with the American Psychiatric Association's DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS (3rd. ed. rev., 1987), and explain what the assigned score represents. A complete rationale for any opinion expressed must be provided. 7. The RO should schedule a VA examination of the veteran by a board certified specialist in cardiology, if available, to determine whether essential hypertension is clinically manifest and, if so, to state whether, in his medical judgment, it is at least as likely as not that hypertension is attributable to the veteran's service- connected post-traumatic stress disorder. 8. Thereafter, in light of the evidence obtained pursuant to the requested development, the RO should adjudicate the veteran's claim of entitlement to service connection for residuals of a shell fragment wound of the head and residuals of a groin injury and readjudicate his claims of entitlement to service connection for a headache and/or seizure disorder, hypertension, as well as an increased evaluation for his service-connected left below-knee amputation, for residuals of a shell fragment wound of the left thigh with fracture of the subtrochanter, and for a total disability rating based on unemployability due to service-connected disabilities. If the benefits sought on appeal are not granted to the veteran's satisfaction or if a timely notice of disagreement is received with respect to any other matter, the RO should issue a supplemental statement of the case on all issues in appellate status, and the veteran and his representative should be provided an opportunity to respond. The veteran should be advised of the requirements to perfect an appeal on any issue addressed in the supplemental statement of the case which does not appear on the title page of this Remand order. The case should then be returned to the Board for further appellate consideration, if otherwise in order. ROBERT E. SULLIVAN 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).