BVA9506323 DOCKET NO. 91-50 865 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to an increased evaluation for status post repair of facial and skull injuries with resulting scars, right medial canthus, currently evaluated as 30 percent disabling. 2. Entitlement to an increased evaluation for diplopia, currently evaluated as 30 percent disabling. 3. Entitlement to an increased evaluation for post-traumatic stress disorder, currently evaluated as 30 percent disabling. 4. Entitlement to an increased evaluation for status post fractures of the nasal bones, left maxilla and zygoma, currently evaluated as 10 percent disabling. 5. Entitlement to an increased evaluation for partial paralysis of the sixth cranial nerve with erythropia, currently evaluated as 10 percent disabling. 6. Entitlement to a compensable evaluation for status post fracture of left orbit with enophthalmos. 7. Entitlement to a compensable evaluation for left brachial plexopathy. 8. Entitlement to a compensable evaluation for donor site, right umbilicus REPRESENTATION Appellant represented by: Military Order of the Purple Heart ATTORNEY FOR THE BOARD Joseph Horrigan, Counsel INTRODUCTION The veteran served on active duty from November 1983 to December 1986. This matter came before the Board of Veterans' Appeals (Board) from a September 1990 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The case was remanded by the Board for further development in August 1992 and May 1994. On the former occasion, the RO was instructed to consider service connection for residuals of multiple lower extremity injuries as a result of an October 1989 motor vehicle accident. In a rating decision of February 1993, the RO denied the veteran's claim of service connection for these disabilities. The veteran was informed of this rating action but no timely Notice of Disagreement was filed from this decision. Subsequent to the Board's May 1994 remand, a rating action of August 1994 assigned 30 percent evaluations for the veteran's psychiatric and vision disabilities, both effective from August 30, 1990. Special monthly compensation on account of loss of use of one eye was also assigned from that date. The veteran's representative, in a statement dated in January 1995, appears to have again raised the issue of service connection for injuries sustained in a 1989 automobile accident. Since neither the veteran nor his representative submitted a timely Notice of Disagreement to the February 1993 rating action denying this claim, it is not before the Board for appellate consideration at this time. The RO should contact the veteran to ascertain his wishes in regard to this matter. Only those issues listed on the first page of this decision are before the Board for appellate consideration at this time. REMAND In the Board's remand of May 1994, the RO was to afford the veteran neurological and surgical examinations to evaluate the residuals of facial injuries and sixth cranial nerve dysfunction . All appropriate special studies were to be performed and all pertinent clinical findings, including the extent of facial scarring and disfigurement and the extent of sixth cranial nerve dysfunction, were to be reported in detail. The claims folder was to be made available to the examining physician for his review. The neurological examination was conducted in June 1994 but it does not appear that the examiner reviewed the claims folder at that time. Although the veteran complained of anosmia and tremors during the examination, no evaluation of these complaints was performed by the neurologist. While some dysfunction of left cranial nerve VI with limited abduction of the left eye and restriction of the eye lid was noted on psychiatric and ophthalmologic examinations, no detailed evaluation of left cranial nerve VI was reported by the neurologist. Headache complaints were reported on the neurological examination; however, no detailed history or description of this complaint was reported. The neurological examiner also indicated that the veteran was to have a MRI scan of the head, an electroencephalogram, and thyroid function studies, but no reports of these tests are in the claims folder. The Board also notes that recent photographs of the veteran's facial injuries are of record, but the surgical examination of the veteran's scars requested in the May 1994 remand has not been conducted. While reference was made to multiple scars on the face and lids on the June 1994 ophthalmologic examination, no detailed evaluation and description of the veteran's facial scarring was conducted. In view of the foregoing, and given the duty to assist the veteran in the development of his claim under 38 U.S.C.A. § 5107 (West 1991), this case is remanded to the RO for the following action: 1. The RO should obtain copies of all thyroid studies, electroencephalograms and MRI studies conducted in association with the neurological examination of June 16, 1994. All documentation obtained should be associated with the claims folder. 2. Then, the veteran should again be afforded a neurological examination to determine the current degree of severity of all neurological dysfunction due to the veteran's service connected facial and head injuries, especially in regard to the residuals the left cranial nerve VI injury, his claimed tremors, headaches, and anosmia. All necessary special studies should be obtained, to include an electroencephalogram, a MRI study of the head, and thyroid studies if the reports from the June 1994 examination are not available. All pertinent findings, including an exact description of the extent of dysfunction in the left cranial nerve VI, anosmia, any pathology causing tremors, and a complete description and history of the veteran's headaches, should be reported in detail. 3. The veteran should also be afforded a surgical examination to precisely determine the extent and severity of his facial and head scars, as well as the residuals of donor site, right umbilicus. Any necessary special studies should be conducted and all clinical findings, including an exact description of all head and facial scarring, reported in detail. The claims folder must be made available to the examining physician prior to the evaluation so that he may study the pertinent clinical records in detail. 4. Then, after any further development deemed appropriate, the RO should again adjudicate the veteran's claim for increased evaluations for facial injuries, left brachial palsy, and injury to the sixth cranial nerve. The rating decision should reflect consideration of all potentially applicable criteria, to include consideration of the applicability of 38 C.F.R. § 3.321(b)(1). If these benefits are not granted to the veteran's satisfaction, he and his representative should be provided a supplemental statement of the case and afforded a reasonable opportunity to respond. Thereafter, the case should be returned to the Board for further consideration, if appropriate. By this remand, the Board intimates no opinion as to the outcome warranted in this case. No action is required of the veteran until he is so informed by the RO. The issues of increased evaluations for the veteran's psychiatric disability and diplopia with left esotropia will be held in abeyance pending resolution of the above development. BARBARA B. COPELAND 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).