Citation Nr: 0003518 Decision Date: 02/10/00 Archive Date: 02/15/00 DOCKET NO. 98-20 245 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUES 1. Entitlement to a rating in excess of 30 percent for headaches, status post posterior fossa decompression surgery for Chiari malformation, with dizziness. 2. Entitlement to a compensable rating for chronic sinusitis, status post rhinoplasty and septoplasty. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Michael A. Holincheck, Associate Counsel INTRODUCTION The veteran has unverified active duty from March 1984 to April 1988, June 1988 to December 1994, and from April 1996 to June 1998. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Newark, New Jersey. The Board notes that the veteran relocated during the course of his appeal and his claims file was transferred to the Indianapolis RO. The Board notes that in addition to the disabilities at issue in this appeal, the veteran has been granted service connection and a 30 percent rating for a skull defect. Although a tender scar was found on a February 1998 VA examination of the veteran's head and neck, the RO has not addressed whether service connection is warranted for this tender scar. Therefore, this matter is referred to the RO for appropriate action. REMAND The record reflects that the veteran's most recent VA examination for the purpose of evaluating his service- connected nasal and sinus disability was performed in March 1998, before his discharge from service. At that time, no evidence of active disease was found. According to reports of contact with the veteran in February and March 1999, he was unable to appear for a scheduled VA ENT examination in early February 1999 because of a school conflict. He requested that the examination be rescheduled for a particular period in March 1999. The claims folder does not contain any official notice that the veteran failed to report for an ENT examination in February 1999 or that he has even been scheduled for such an examination since March 1998. The Board further notes that the RO has rated the service- connected headaches, status post posterior fossa decompression surgery for Chiari malformation, with dizziness, as 30 percent disabling under Diagnostic Code 8100. Diagnostic Code 8100 provides a 30 percent rating for migraine headaches with characteristic prostrating attacks occurring on an average of once a month over the last several months. A 50 percent rating is warranted for very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability. The veteran's initial VA neurological examination pertaining to this disability was performed in February 1998. The veteran related his history of development of symptoms in 1997 and his subsequent surgery for his Arnold-Chiari malformation. He said that he still had headaches about three times a day that were partially relieved by Ibuprofen. The headaches consisted of severe throbbing and were bitemporal and bioccipital with nausea, vomiting and blurred vision. He also complained of dizziness off and on secondary to quick change of posture. He would get light-headed but would not fall or suffer a loss of balance at such times. He complained separately of an occasional loss of balance and problem with gait at times. Following examination, the diagnoses were migraine headaches and postural dizziness. The examiner added that the veteran was not employable at the time of the examination. However, he could be employable in other areas as determined by a job counselor. The record reflects that the veteran was granted entitlement to VA vocational rehabilitation benefits by rating decision of May 1998. However, his VA vocational rehabilitation folder has not been associated with the claims folder. In addition, in the Board's opinion the VA examination reports of record do not provide an adequate description of the veteran's headaches with dizziness and their impact on the veteran's ability to work. In light of these circumstances, the case is REMANDED to the RO for the following development: 1. The RO should request the veteran to identify specific names, addresses, and approximate dates of treatment for all health care providers, private and VA, who may possess additional records pertinent to his claims. When the requested information and any necessary authorization have been received, the RO should attempt to obtain copies of all pertinent records which have not already been obtained. 2. The veteran's VA vocational rehabilitation folder or a copy of the records therein should be associated with the claims folder. 3. Then, the RO should arrange for a VA examination of the veteran by a physician with appropriate expertise to determine the current degree of severity of the veteran's chronic sinusitis, status post rhinoplasty and septoplasty. Any indicated studies should be performed. All current manifestations of the disability should be identified. In addition, the examiner should elicit history from the veteran concerning the frequency and severity of any episodes of active sinusitis, to include information concerning any treatment received for active sinusitis. The examiner should also provide an opinion concerning the impact of the service-connected disability on the veteran's ability to work. The rationale for all opinions expressed should also be provided. The claims folder must be made available to and reviewed by the examining physician. 4. The veteran should also be provided a VA examination by a neurologist to determine the current degree of severity of the service- connected headaches, status post posterior fossa decompression surgery for Chiari malformation, with dizziness. All current manifestations of the disability should be identified. In addition, the examiner should elicit history from the veteran concerning the frequency and severity of his episodes of headaches and dizziness. In particular, the examiner should determine whether the veteran has completely prostrating headaches and if so, the length and frequency of such episodes. The examiner should provide an opinion concerning the etiology of the veteran's dizziness. The examiner should also provide an opinion concerning the impact of the service-connected disability on the veteran's ability to work. The rationale for all opinions expressed should also be provided. The claims folder must be made available to and reviewed by the examining physician. 5. Thereafter, the RO should review the claims folder and ensure that all development actions, including the medical examinations and requested opinions, have been conducted and completed in full. Then, the RO should undertake any other indicated development and readjudicate the issues on appeal. The RO should also consider whether the case should be forwarded to the Director of the VA Compensation and Pension Service for extra-schedular consideration. 6. If the benefits sought on appeal are not granted to the veteran's satisfaction, the RO should issue a Supplemental Statement of the Case and afford the veteran and his representative an appropriate opportunity to respond. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. By this REMAND, the Board intimates no opinion as to any final outcome warranted. No action is required of the veteran until he is otherwise notified by the RO. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded to the RO. Kutscherousky v. West, 12 Vet. App. 369 (1999). This case 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 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. SHANE A. DURKIN Member, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 1991 & Supp. 1999), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. 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) (1999).