BVA9506363 DOCKET NO. 93-12 700 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to a compensable disability evaluation for cicatrices of the left temporal region. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Theresa M. Catino, Associate Counsel INTRODUCTION The veteran served on active military duty from January 1943 to October 1945. In a May 1993 statement, the veteran appeared to raise the issue of whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for a sinus condition. Furthermore, in the notice of disagreement, which was received at the RO in May 1992, and at the personal hearing which was held before a hearing officer at the RO in September 1992, the veteran appeared to raise the issue of clear and unmistakable error in the August 1950 rating decision. See hearing transcript at 5,6. These claims are not inextricably intertwined with the current appeal and are referred to the regional office (RO) for appropriate action. REMAND According to the veteran's testimony given at the September 1992 personal hearing, he sustained the cicatrices on his left temporal region during service when he was involved in a vehicle accident and suffered a severe concussion. Hearing transcript at 1. The veteran testified that, since sustaining this concussion, he has experienced pain in his head which radiates from under his skull on the left side of his forehead down through his nose to the left side of his upper lip. Id. at 2. In addition, the veteran testified that this pain has gotten worse in the five years prior to the hearing. Specifically, the veteran testified that these pains occur more frequently, approximately once a day, and are more severe. Id. at 3. A review of the claims folder reveals that in May 1950, on a claim for benefits, the veteran described pain behind his left ear which radiated to the top of his head. When he was examined by the VA in August 1950, he reported that he had occasional headaches but no other residuals of his head injury. The claim for service connection for sinusitis was denied by rating action of August 1950. It is unclear from a reading of the medical records included in the claims file whether the headaches that the veteran experiences are a result of his service-connected disability or are caused by his nonservice-connected sinusitis. The veteran testified at the personal hearing that he essentially takes no medication for the pain he experiences in his head which he attributes to his service-connected disability. He testified that the medication he does take includes mostly sinus tablets and Contact, and "once in a while," Tylenol. Hearing transcript at 3-4. Moreover, the veteran has also contended throughout the appeal that the VA examination he was given in February 1992 inadequately evaluated the service-connected cicatrices of his left temporal region. See hearing transcript at 3. He testified that X-rays of his head were not taken. Id. The veteran's representative specifically requested that the veteran be given another VA examination which would include X-rays of his head. Id. at 6. A review of the February 1992 examination report indicates that the veteran was only given a VA examination to evaluate the scar on his forehead. He was not given a neurology examination to determine whether he had any neurological deficit caused by the concussion he sustained during service. Consequently, the Board of Veterans' Appeals finds that the veteran should be given a VA neurology examination, to include X-rays if the examiner deems them to be necessary. The veteran testified at the personal hearing that, since his separation from service, he was received treatment for his head a few times at the VA hospital and also from local medical doctors. Hearing transcript at 2. Later at the personal hearing, he testified that he was unsure whether he had gotten treatment for this condition within the six months prior to the hearing. Id. at 4. It is noted that, towards the end of the hearing, the veteran testified that he was examined for the pain in his head in June 1992 at the VA Medical Center in Nashville, Tennessee. Id. at 4. Records of this treatment session are not included in the claims file. In addition, since the last supplemental statement of the case was furnished to the veteran in May 1993, the veteran submitted two records of private medical treatment. One document is a duplicative record of treatment the veteran received for his sinus condition. The other document notes treatment for a diagnosis of acute sinusitis. However, a handwritten notation on this record states "pain left temporal region." The United States Court of Veterans Appeals (Court) has held that there is a continuing obligation on the VA to assist the veteran in developing the facts of his claim throughout the entire administrative adjudication. This obligation includes the duty to obtain records regarding the veteran's medical history. Murincsak v. Derwinski, 2 Vet.App. 363, 373 (1992). The Board concludes that further assistance to the veteran is required. Accordingly, the case is REMANDED to the RO for the following: 1. The veteran should be contacted and requested to furnish a complete list of all medical personnel and facilities from which he has received treatment for his service-connected cicatrices of the left temporal region since 1992. The Board is particularly interested in records of any treatment that the veteran may have received from the VA Medical Center in Nashville, Tennessee and from any local private physicians. After obtaining the appropriate releases from the veteran where necessary, the health care providers should be contacted and requested to provide all treatment records in their possession pertaining to the veteran. If these records are unavailable, or are duplicates of those already on file, those facts should be annotated in the claims folder. Any available records should be associated with the claims folder. 2. Following the above, the veteran should be accorded an examination by a VA neurologist to determine the nature and extent of the cicatrices of his left temporal region. The report of examination should include a detailed account of all manifestations of the disorder found to be present. All necessary tests, including X-rays, should be conducted, and the examiner should review the results of any testing prior to completion of the report. The examination should be conducted in accordance with the diagnostic procedures outlined in the VA Physician's Guide for Disability Evaluation Examinations. The examiner is specifically requested to express an opinion as to whether any neurological deficits found on examination are related to the veteran's service-connected cicatrices of his left temporal region or have been caused by his nonservice-connected sinusitis. In expressing this opinion, the examiner should review the service medical records pertaining to treatment that the veteran received for his head injury in 1945. The claims folder and a copy of this remand must be made available to and reviewed by the examiner prior to the examination. The specialist should provide complete rationale for all conclusions reached. 3. The RO should review the examination report and determine if it is adequate for rating purposes and in compliance with this Remand. If not, it should be returned for corrective action. 4. Thereafter, the RO should formally adjudicate the issue of entitlement to a compensable disability rating for cicatrices of the left temporal region. Following completion of these actions, and, if the decision remains unfavorable, the veteran and his representative should be provided with a supplemental statement of the case and afforded a reasonable period of time in which to respond. The supplemental statement of the case should include a review and discussion of all of the evidence received by the VA since the last supplemental statement of the case was furnished to the veteran in May 1993. Thereafter, the case, in accordance with the current appellate procedures, should be returned to the Board for completion of appellate review. The purpose of this REMAND is to obtain clarifying evidence. No action is required of the veteran until further notice is issued. V. L. JORDAN 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).