BVA9504726 DOCKET NO. 93-14 760 ) 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 residuals of a brain concussion and temporomandibular joint dysfunction. 2. Entitlement to an increased (compensable) rating for residuals, fracture of the left mandible. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Mark J. Swiatek, Counsel REMAND The veteran had active duty from March 1958 to December 1967. This matter comes before the Board of Veterans' Appeals (Board) from a November 1992 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 temporomandibular joint dysfunction has been adjudicated without benefit of a medical opinion regarding the etiology of the disorder. In fact, on a September 1992 VA examination of the ear, nose and throat, the examiner did not report any diagnosis for the findings referable to the temporomandibular joints. In addition, the veteran has clearly raised a claim of service connection for tinnitus as a head injury residual, to which the RO has not, as yet, responded. The Board notes that in a November 1992 rating decision on appeal, the RO granted service connection for the veteran's headaches but determined that the disorder was not related to a head injury sustained in a service accident. This does not appear to have been based on an independent medical opinion. On a September 1992 VA examination, the general medical examiner's diagnoses included residuals of concussion with recurrent headaches. The representative has requested that the veteran be afforded an additional examination to ascertain the extent of the head injury residuals. The significance of the characterization of headaches or other claimed head injury residuals for future rating determinations cannot be overlooked. 38 C.F.R. § 4.124(a), Diagnostic Code 8045 (1994). 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 headaches, service-connected mandible fracture residuals and tinnitus. 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. 2. Thereafter, the veteran should be afforded VA neurology, audiology, ear, nose and throat and dental examinations to determine the current extent of the residuals of the head injury. The claims folder must be made available to the examiners in connection with each examination. With regard to the above, all pertinent complaints should be recorded and evaluated. All indicated studies should be performed. The dental and ear nose and throat examiners should identify the etiology for any temporomandibular joint dysfunction found, to include an opinion regarding the degree of probability of an etiologic relationship to the head injury during service. With regard to the left mandible fracture, the examiners should identify those findings considered for higher ratings provided under 38 C.F.R. § 4.150 (1994), in particular the specific range of motion of the temporomandibular articulation. 3. Regarding headaches and tinnitus, 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 or tinnitus found is causally related to the head injury in service. The audiology examiner should also provide an opinion regarding the etiologic significance of the head injury during service and the degree of probability, if any, that any tinnitus found is etiologically related to the inservice head injury. The rationale for all conclusions and opinions should be provided. 4. Then, in light of the evidence obtained pursuant to the requested development, the RO should readjudicate the claim for an increased rating for a left mandible fracture and the claims for service connection for head injury residuals and temporomandibular joint dysfunction. The RO should also adjudicate the claim of service connection for tinnitus. The rating for the mandibular 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 for all issues in appellate status. 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) (1994). - 2 -