BVA9505256 DOCKET NO. 89-08 629 ) DATE ) RECONSIDERATION ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUES 1. Entitlement to service connection for cerebral artery disease. 2. Entitlement to service connection for residuals of a craniotomy. 3. Entitlement to service connection for a seizure disorder. 4. Entitlement to service connection for residuals of a myocardial infarction. 5. Entitlement to service connection for residuals of strokes. 6. Entitlement to service connection for hearing loss. 7. Entitlement to service connection for tinnitus. 8. Entitlement to an increased disability rating for seventh cranial nerve paralysis, with right and left side facial tic, currently rated as 10 percent disabling. 9. Entitlement to a total disability rating, for compensation purposes, based on individual unemployability due to service- connected disabilities. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD C. R. Olson, Counsel INTRODUCTION The veteran's active military service extended from June 1955 to December 1958. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Lincoln, Nebraska. An April 1988 rating decision continued a 10 percent rating for seventh cranial nerve paralysis which had been in effect since July 1970. That decision also denied service connection for light headedness, slurred speech, blurred vision and numbness of the upper and lower extremities. The notice of disagreement was received in April 1988. A March 1989 rating decision denied service connection for a urinary tract infection under the provisions of what is now 38 U.S.C.A. § 1151 (West 1991) and also denied a total disability rating, for compensation purposes, based on individual unemployability due to service-connected disabilities. In December 1989, the Board considered the issues of entitlement to service connection for lightheadedness, slurred speech, blurred vision, and numbness of the arms and legs, and an increased rating for partial paralysis of the seventh cranial nerve. The matter was remanded for neurologic examination and to clarify the issues. The requested development was completed. A May 1990 rating decision continued the previous denials and also denied service connection for a cerebral artery disorder, residuals of a craniectomy, and a seizure disorder. In March 1991, the Board denied service connection for disabilities manifested by lightheadedness, slurred speech, blurred vision, and numbness of the arms and legs, as well as an increased rating for partial paralysis of the seventh cranial nerve. In a separate March 1991 decision, the Board remanded the issues of entitlement to compensation benefits under 38 U.S.C. § 1151 (previously § 351) for a urinary tract infection and service connection for residuals of a craniotomy, a cerebral artery disorder, and a seizure disorder. The RO was instructed to obtain VA medical records and adjudicate the issues. In an October 1991 rating decision, the RO denied service connection for a hearing loss, tinnitus, and numbness of the legs. In December 1991, the RO denied a total disability rating, for compensation purposes, based on individual unemployability due to service-connected disabilities. A January 1992 rating decision denied service connection for a myocardial infarction and strokes. In September 1993, the Board remanded the case to the RO for consideration of the additional issues which had been raised by the veteran. The RO developed these additional issues for appellate consideration. In May 1994, the Board issued a decision denying service connection for cerebral artery disease, residuals of a craniotomy, a seizure disorder, residuals of a myocardial infarction, residuals of strokes, hearing loss and tinnitus, an increased disability rating for seventh cranial nerve paralysis, with right and left side facial tic, and a total disability rating, for compensation purposes, based on individual unemployability due to service-connected disabilities. In November 1994, the Board granted the veteran's motion for reconsideration. This has the effect of vacating the Board's May 1994 decision. The veteran's appeal will now be decided, based on all evidence of record, by an expanded section of the Board. REMAND In December 1991, the veteran requested copies of 1952 letters or examination reports of Dr. Henry Woltman and Dr. Joe Rushton. The RO responded that they were not available in the VA record. A search of the claims folder by the Board reveals two copies of a July 1952 letter from Henry W. Woltman, M.D. The letter refers to the opinion of Dr. Joe Rushton. A separate letter from Dr. Rushton was not found. Dr. Woltman's letter has been clearly marked and the RO should send a copy to the veteran. The veteran has submitted recent letters from Stephen A. Samuelson, M.D., and Jeffrey C. Brittan, M.D., in support of his claims. Review of the file discloses that some of the doctors' notes are of record. A complete picture is desirable and complete copies of the doctors' records should be obtained. The recently submitted letters indicate that additional examination and testing of the veteran may provide a basis for relevant medical opinion on his claims. The veteran has repeatedly asserted that he has an eye disorder as a result of his service-connected seventh cranial nerve disorder. This matter has not been developed for appellate consideration. The veteran should be informed of the law requiring the submission of evidence of a well grounded claim. 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, the case is REMANDED to the regional office RO for the following development: 1. The RO should send the veteran a copy of the July 1952 letter from Henry W. Woltman, M.D. 2. The RO should make an additional search for a separate letter from Dr. Joe Rushton, and if found, send a copy to the veteran. 3. The RO should ask the veteran to complete releases providing the names and addresses of all medical care providers who treated him for cerebral artery disease, strokes, transient ischemic attacks, a seizure disorder, a myocardial infarction, hearing loss, tinnitus, and seventh cranial nerve paralysis. The records of Stephen A. Samuelson, M.D. and Jeffrey C. Brittan, M.D., are particularly desirable. 4. After completion of the above, the RO should obtain these records. 5. A complete copy of the veteran's VA medical records should be associated with the claims folder. 6. A social and industrial survey should be conducted. It should be ascertained if the veteran is working. Family members, former coworkers, members of the community and the veteran should be interviewed. The purpose of this survey is to obtain information upon which to assess the impact of the service- connected disabilities on the veteran's ability to secure or follow a substantially gainful occupation. 7. Following the above, the veteran should be accorded an examination by a specialist in cardiovascular disease. The report of examination should include a detailed account of all cardiovascular manifestations of the service-connected seventh cranial nerve disorder found to be present. All necessary tests should be conducted and the examiner should review the results of any testing prior to completion of the report. A copy of this Remand and the claims folder must be made available to and be reviewed by the examiner prior to the examination. The specialist should respond to the following questions, providing a complete rationale for all conclusions reached. This case raises questions as to histories and diagnoses, so the physician's responses should be based on the records and test results. a. Did the service-connected seventh cranial nerve disorder require the 1983 craniotomy? b. During the 1983 craniotomy, the surgeon dealt with arteries near the seventh cranial nerve. Did the seventh cranial nerve disorder cause any abnormality of the cerebral arteries, if so what abnormalities were caused and how were they caused? If there was an abnormality of the cerebral arteries, was it first present before or during service? If a cerebral artery abnormality was present before service, did it increase in severity or remain stable during service? What evidence supports this conclusion? If a cerebral artery abnormality was present before service and increased in severity, was the increase beyond the expected course of the disorder? c. What, if any, cerebral artery disease does the veteran have? Does he have transient ischemic attacks? Has he had strokes? If he has any of these disorders, were they caused by the service-connected seventh cranial nerve disorder? If a cerebral artery disease began in service or prior to service but increased beyond its expected course during service, did it subsequently cause transient ischemic attacks, strokes, seizures, a myocardial infarction or any other residual disabilities? 8. Following the above, the veteran should be accorded an examination by a specialist in neurology. The report of examination should include a detailed account of all manifestations of the service-connected seventh cranial nerve disorder found to be present. All necessary tests should be conducted and the examiner should review the results of any testing prior to completion of the report. A copy of this Remand and the claims folder must be made available to and be reviewed by the examiner prior to the examination. The specialist should respond to the following questions, providing a complete rationale for all conclusions reached. Since this case raises questions as to histories and diagnoses, the physician's responses should be based on the records and test results. a. Did the service-connected seventh cranial nerve disorder require the 1983 craniotomy? b. Does the veteran have a seizure disorder and, if he does, did the service-connected seventh cranial nerve disorder cause the disorder? c. Does the veteran have cerebral artery disease or transient ischemic attacks? Has he actually had the alleged strokes and myocardial infarction? If the veteran has these disabilities, were any of them caused by the service-connected seventh cranial nerve disorder? d. Does the veteran have a hearing loss, and if so, was it caused by the service-connected seventh cranial nerve disorder? e. Does the veteran have tinnitus, and if he does, was it caused by the service-connected seventh cranial nerve disorder? f. How does the service-connected seventh cranial nerve disorder affect the veteran's ability to obtain and retain employment? 9. The RO should review the examination reports and determine if they are adequate for rating purposes and in compliance with this Remand. If not, any inadequate report should be returned for corrective action. Following completion of these actions the RO should review the veteran's claims. If the decision remains unfavorable, the veteran and representative should be provided with a supplemental statement of the case, including the law requiring the submission of evidence of a well grounded claims, and afforded a reasonable period of time in which to respond. Thereafter, in accordance with the current appellate procedures, the case should be returned to the Board for completion of appellate review. The Board intimates no opinion as to the ultimate outcome of this case. The appellant need take no action unless otherwise notified. JAN DONSBACH RENEE M. PELLETIER Member, Board of Veterans' Appeals Member, Board of Veterans' Appeals JOAQUIN AGUAYO-PERELES Member, Board of Veterans' Appeals JONATHAN E. DAY LEO W. TOBIN Member, Board of Veterans' Appeals Member, Board of Veterans' Appeals MICHAEL D. CHEEK Member, Board of Veterans' Appeals 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) (1993).