Citation Nr: 0006015 Decision Date: 03/07/00 Archive Date: 03/14/00 DOCKET NO. 94-40 256 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston- Salem, North Carolina THE ISSUES 1. Entitlement to an increased evaluation for urinary tract infections, currently evaluated as 40 percent disabling. 2. Entitlement to an increased evaluation for a keloidal scar on the left side of the face, currently evaluated as 10 percent disabling. 3. Entitlement to an increased evaluation for Frey's syndrome (fifth cranial nerve disorder), currently evaluated as 10 percent disabling. 4. The propriety of the initial evaluation of the veteran's service-connected residuals of a left parotid gland excision (seventh cranial nerve disorder), currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD M. L. Wright, Counsel INTRODUCTION The veteran had active service from December 1958 to March 1962. This appeal arises from a May 1992 rating decision of the Winston-Salem, North Carolina, Regional Office (RO). In this decision, the RO denied increased evaluations for the veteran's urinary tract infection (UTI) and the residuals of her parotid gland excision to include a keloidal scar of the left face and Frey's syndrome. The former disability was evaluated as 20 percent disabling and the latter disabilities were each evaluated as 10 percent disabling. the rating decision also assigned a separate 10 percent rating for residuals of left parotid gland surgery, with left facial weakness and diminished sensation. Those determinations were appealed by the veteran. A hearing was held before the Board of Veterans' Appeals (Board) in July 1997 sitting at the RO. This hearing was conducted by W. R. Harryman, an acting member of the Board, who was designated by the Chairman of the Board to preside at this hearing pursuant to 38 U.S.C.A. § 7102(a) (West Supp. 1999). Mr. Harryman will make the final determination in this appeal. The Board remanded this case in December 1997 for development of the medical evidence. By rating decision of March 1999, the RO granted an increased evaluation to 40 percent disabling for the veteran's UTI. She continued her appeal. The case has now returned for further appellate consideration. The issue of an increased evaluation for the veteran's Frey's syndrome and facial scar are discussed in the remand section of this decision. FINDINGS OF FACT 1. All evidence required for equitable decisions on the issues of increased evaluations for UTI and residuals of a left parotid gland excision (seventh cranial nerve disorder) have been obtained. 2. During the period from December 26, 1991, to November 19, 1996, the veteran's residuals of a left parotid gland excision (seventh cranial nerve disorder) were manifested by mild to moderate symptoms of left facial weakness and intermittent pain. 3. From November 20, 1996, to the present time, the veteran's residuals of a left parotid gland excision (seventh cranial nerve disorder) were manifested by symptoms of extreme blepharospasm, severe left facial weakness, and constant pain that is somewhat alleviated by over-the-counter medication and compresses. 4. The veteran's UTI has been manifested in recent years by symptoms of urinary frequency, intermittent incontinence that requires changing of absorbent material less than four times a day, and some abdominal discomfort. CONCLUSIONS OF LAW 1. As the assignment of an initial 10 percent evaluation for the veteran's service-connected residuals of a left parotid gland excision (seventh cranial nerve disorder) is proper for the period from December 26, 1991, to November 19, 1996, a higher evaluation is not warranted for this period. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.14, 4.20, Diagnostic Code 5325, 8207 (1999). 2. An increased evaluation to 20 percent disabling, but not more, is warranted for the residuals of a left parotid gland excision (seventh cranial nerve disorder) from November 20, 1996 to the present time. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.14, 4.20, Diagnostic Code 5325, 8207 (1999). 3. An increased evaluation in excess of 40 percent disabling is not warranted for the veteran's urinary tract infections. 38 U.S.C.A. § 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.14, 4.20, Diagnostic Code 7512 (Effective prior to and on September 8, 1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background In a rating decision in March 1964, the RO granted service connection for the veteran's chronic UTI. This disability was evaluated as 10 percent disabling under the U. S. Department of Veterans Affairs (VA) Schedule for Rating Disabilities, 38 C.F.R. Part 4, Diagnostic Code (Code) 7512. A 10 percent rating for a residual facial scar from a left superficial parotidectomy was also assigned. These awards were made effective from April 1963. The evaluations were confirmed and continued in rating decisions of May 1965, May 1969, and September 1972. By rating decision of December 1973, the RO granted an increased evaluation for the veteran's UTI to 20 percent disabling effective from March 1973. These evaluations were confirmed and continued in rating decisions of May and June 1975. By a rating decision in November 1975, the RO assigned a separate 10 percent rating for auriculo-temporal (Frey's) syndrome secondary to the veteran's parotidectomy. This disability was evaluated by analogy under Code 8205 and the rating was made effective from February 1975. In a rating decision in February 1976, the above evaluations were confirmed and continued. In December 1991, the veteran filed a claim for increased evaluations of her service-connected disabilities. She was afforded a VA compensation examination in March 1992. She complained of left face and ear pain, sweating on the left side of her face when eating, loss of hearing, loss of sensation on the left side of the face, dry mouth, and left eyelid weakness. The examiner found that the veteran had mild left facial weakness and sensory decrease to the left face, forehead, cheek, and mandible. The diagnoses were Frey's syndrome secondary to resected tumor and status post- left parotid surgery with mild residuals of left facial weakness and diminished sensation. In a rating decision in May 1992, the evaluations for the veteran's UTI, left face scar, and Frey's syndrome were confirmed and continued. However, the RO assigned a separate 10 percent rating for "status post left parotid surgery with left facial weakness and diminished sensation-mild" under the provisions of Code 8207, effective from December 1991. The veteran appealed that determination. A statement of the case (SOC) was issued to the veteran in April 1993 that discussed the rating criteria for Codes 7800, 8205, and 8207. It was determined that the evidence of record did not warrant increased evaluations for a disfiguring facial scar, Frey's syndrome, or left facial weakness. However, the issue on the title page of the SOC was listed as "Increased evaluation for residuals of parotid gland excision." In her subsequently received substantive appeal (VA Form 9) of May 1993, the veteran specifically discussed the evaluations of her left facial scar, Frey's syndrome, and left facial weakness. She claimed that her service-connected disabilities entitled her to a 100 percent schedular evaluation. The veteran alleged that she was incontinent because of her recurrent UTI. She asserted that she had to restrict her eating because of the embarrassment caused by her face sweating during such activity. The veteran also claimed that her Frey's syndrome had caused dry mouth and loss of taste. She alleged that her latest VA examination was only perfunctory and did not adequately evaluate her condition. Private treatment records dated in February 1993 were received which noted the veteran's hospitalization for genitourinary surgery. A cystourethrogram found a normal appearing bladder, but the urethra could not be visualized. The post-operative diagnosis was multiple ureteral diverticula. A letter from her private physician was received in July 1993. It was noted that examination had revealed a tender urethra with a cystic area on the left side. This was determined to be the result of urethral diverticula. Surgery was performed that removed those diverticula and the veteran's urethra was reconstructed. It was noted that since this surgery the veteran had markedly improved and the source of her urinary infection and pain had been eliminated. The physician opined that the veteran was expected to have excellent long term results. Additional letters were received from her private physician in December 1993, March 1994, and June 1995. It was noted that the veteran continued to experience residual urinary urgency, incontinence, and incomplete emptying of her bladder documented at between 120 and 300 cc. In a written statement received in January 1994, the veteran claimed that she was unable to obtain even a part-time job because of her lack of bladder control. She maintained that her UTI disability should be evaluated as 60 percent disabling. VA medical records dated in the early and mid-1990's were associated with the claims file in August 1995. An outpatient record in August 1994 found left temporal and facial weakness. The impression was partial left fifth and seventh nerve damage with residual pain. In November 1994, the veteran was noted to have facial neuralgia. An outpatient record in March 1995 reported left lower facial weakness and noted an impression of fifth and seventh nerve injury. In May 1995, the veteran complained of urinary frequency with some dysuria. At her Board hearing in July 1997, the veteran testified to symptoms she had previously reported in her written statements and on examination. She claimed that she took over-the-counter medication and used compresses to relieve her facial and ear pain. The veteran alleged that this pain was throbbing in nature and could happen at any time. She asserted that she would experience facial pain at least 20 days out of a month. The veteran maintained that because of her incontinence problems she was forced to wear adult diapers. She asserted that these diapers had to be changed three to four times a day and that she had to urinate five to six times a night. The veteran acknowledged that she had some control over her bladder, but it was not consistent. The veteran was afforded a series of VA examinations in November 1996. On a genitourinary examination, the veteran complained of urinary frequency, but no notable discomfort on urination. She denied any blood, pus, or other abnormality associated with her urine. The veteran complained of some incontinence to include stress incontinence when she sneezed or coughed. On examination, there was minimal soreness around the bladder area. The diagnoses were chronic cystitis with incontinence and status post-surgery for cystic dilatation of the urethra. A gynecological examiner reported that the veteran's ureteral meatus appeared normal. The diagnoses included a history of chronic cystitis that was apparently secondary to undiagnosed urethral diverticula. A neurological examination on November 20, 1996, noted the veteran's complaints of inability to taste, a drooping left eyelid, and daily throbbing headaches. On examination, there was decreased response to light touch over the entire face. Vibration sense was decreased over the entire left side and the veteran's responses were slow. The examiner noted that it was extremely difficult to evaluate the strength of the veteran's facial muscles, but estimated that her left eyebrow and buccinator muscle were 20 to 40 percent weaker than normal. The diagnoses included left facial weakness as a residual of parotid surgery and left hemihypesthesia of unknown cause. Another series of VA examinations was conducted in March 1998. A genitourinary examiner reported the veteran's complaints of urinary incontinence. It was noted that the examination was within normal limits. The examiner noted the veteran's assertion that her symptoms had not improved. On examination, the left orbital muscles in the left eyebrow were weak. The examiner summarized that the veteran had left facial weakness that was probably a residual of surgery. A gynecology examination in May 1998 reported that the veteran's urethral meatus appeared normal. The diagnoses again included a history of chronic cystitis that was apparently secondary to undiagnosed ureteral diverticula. An addendum to the VA genitourinary examination was prepared in May 1998. It was reported that the veteran had intermittent lower abdominal and bladder pain that she had treated with over-the-counter medication. She had urinary frequency during the daytime every hour and approximately five times a night. The veteran experienced urinary incontinence one to two times a day. It was reported that she controlled her incontinence with the use of adult diapers which she had to change one to two times a day. The veteran experienced urinary tract infections every two to three months which were treated with antibiotics. Another VA neurological examination was afforded the veteran in July 1999. She claimed that her neurological disorder had gotten worse. The veteran alleged that she a constant, throbbing pain in her ear and left face. She asserted that he left eyelid was uncontrollable. On examination, the veteran could not identify objects out of her left eye and there was extreme blepharospasm. Her left nasal labial fold was smooth at rest, but she was able to have a symmetrical smile. The veteran could raise her left eye brow intermittently. Superficial sensation was absent on her left side. The diagnoses included constant left hemicranial pain with persistent variable control of her left face characterized by blepharospasm and protestations of blindness, and left hemidysesthesias with some psychogenic features. II. Applicable Criteria Initially, the Board finds that the veteran's claims for higher evaluations for residuals of a left parotid gland excision (seventh cranial nerve disorder) and UTI are well grounded, pursuant to 38 U.S.C.A. § 5107(a) (West 1991). See Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). Further, the Board finds that, as the record contains sufficient evidence to evaluate each of the disabilities under consideration, the duty to assist the veteran in developing the facts pertinent to the claim have been met. Under the applicable criteria, disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1999). Separate diagnostic codes identify the various disabilities. The VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). These regulations include, but are not limited to, 38 C.F.R. §§ 4.1 and 4.2 (1999). Also, 38 C.F.R. § 4.10 (1999) provides that, in cases of functional impairment, evaluations must be based upon lack of usefulness of the affected part or systems, and medical examiners must furnish, in addition to the etiological, anatomical, pathological, laboratory and prognostic data required for ordinary medical classification, full description of the effects of the disability upon the person's ordinary activity. These requirements for evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decisions based upon a single, incomplete, or inaccurate report, and to enable the VA to make a more precise evaluation of the level of the disability and of any changes in the condition. Schafrath, 1 Vet. App. at 594. The evaluation of the same disability or manifestations under different diagnoses is to be avoided. 38 C.F.R. § 4.14 (1999). Rather, the veteran's disability will be rated under the diagnostic code which allows the highest possible evaluation for the clinical findings shown on objective examination. When an unlisted condition is encountered it will be permissible to rate it under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20 (1999). Applicable rating criteria are noted below: Code 5325. Muscle injury, facial muscles. >Evaluate functional impairment as seventh (facial) cranial nerve neuropathy (diagnostic code 8207), disfiguring scar (diagnostic code 7800), etc. >Minimum, if interfering to any extent with mastication; rate as 10 percent disabling. Seventh (Facial) Cranial Nerve: Paralysis (Code 8207), Neuritis (Code 8307), or Neuralgia (Code 8407). >Complete; rate as 30 percent disabling. >Incomplete, severe; rate as 20 percent disabling. >Incomplete, moderate; rate as 10 percent disabling. * Note: Dependent upon relative loss of innervation of facial muscles. Code 7512. (Effective from September 8, 1994) Cystitis, chronic, includes interstitial and all etiologies, infectious and non-infectious: >Rate as voiding dysfunction. Voiding dysfunction: Continual Urine Leakage, Post Surgical Urinary Diversion, Urinary Incontinence, or Stress Incontinence: >Requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day; rate as 60 percent disabling. >Requiring the wearing of absorbent materials which must be changed 2 to 4 times per day; rate as 40 percent disabling. Urinary frequency: >Daytime voiding interval less than one hour, or; awakening to void five or more times per night; rate as 40 percent disabling. Urinary tract infection: >Recurrent symptomatic infection requiring drainage/frequent hospitalization (greater than two times/year), and/or requiring continuous intensive management; rate as 30 percent disabling. Code 7512. Cystitis, chronic (Effective prior to September 8, 1994): >Where incontinence exists, requiring constant wearing of an appliance; rate as 60 percent disabling. >Severe; urination at internals of one hour or less; contracted bladder; rate as 40 percent disabling. III. Analysis a. Residuals of Left Parotid Gland Excision (Seventh Cranial Nerve Disorder) Before proceeding with its analysis of the veteran's claim, the Board believes that some discussion of the holding of the United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (Court) in Fenderson v. West, 12 Vet. App. 119 (1999), is warranted. In that case, the Court distinguished between a veteran's dissatisfaction with an initial rating assigned following a grant of service connection, as in this case, and a claim for an increased rating of an already service- connected condition. Fenderson, at 126. The Court held that the significance of this distinction is that, at the time of an initial rating, separate ratings may be assigned for separate periods of time based on the severity of the disability; this is a practice known as "staged ratings." Id. Since the veteran's notice of disagreement expressed dissatisfaction with the initial rating assigned for the residuals of her left parotid gland excision evaluated under Code 8207, her claim must be considered in light of the Court's holding in Fenderson. Consequently, the issue on appeal has been recharacterized accordingly. From a review of the record, including the SOC and various SSOC's, it is apparent that the RO considered evidence submitted in connection with the veteran's claim at various times during the course of her appeal, in light of the governing legal authority. Therefore, the RO, in effect, considered whether "staged ratings" were warranted. Consequently, it is not necessary to remand this case to the RO for further consideration of the possibility of receiving staged ratings because this would not result in a different analysis by the RO or new arguments by the veteran. That being the case, she will not be prejudiced by the Board's proceeding to adjudicate her claim. See Bernard v. Brown, 4 Vet. App. 384 (1993); see also Robinette v. Brown, 8 Vet. App. 69 (1995). It is noted that the disabilities associated with the excision of the veteran's left parotid gland include a separate evaluation of her Frey's syndrome, that is, a fifth cranial nerve disorder. The claimed symptoms of that disorder include sweating on the left side of the face during eating, dry mouth, and loss of taste. As that disorder is discussed in the remand section of this decision, those symptoms will not be discussed in the evaluation of the disability associated with her seventh cranial nerve. See 38 C.F.R. § 4.14 (1999). The veteran has presented lay evidence that the symptoms associated with her seventh cranial nerve as a result of her parotid gland excision are of a severe nature. She claims that these symptoms include facial weakness, inability to control her left eyelid, and constant pain. The veteran has contended that these symptoms warrant an evaluation of 60 percent disabling. A review of the objective medical evidence indicates that her loss of sensation and muscle weakness in the left face were mild to moderate in degree in March 1992. At that time, she asserted that her facial and ear pain was intermittent in nature. Based on her complaints on VA examination in November 1996 and the hearing testimony in July 1997, it appears that her left facial pain, while perhaps increasing in frequency, was still intermittent. In November 1996, the examiner estimated that her left facial weakness was as high as 40 percent less than normal. By examination in July 1999, the veteran's left facial and ear pain were found to be constant and there was an "extreme" blepharospasm of the left eye. The objective evidence reveals increasing symptomatology over the entire appeal period. Applying the "benefit of the doubt rule" under the provisions of 38 U.S.C.A. § 5107(b), the undersigned finds that her seventh cranial nerve disorder was at a severe level under Code 8207 on objective examination in November 1996, commensurate with a 20 percent rating. Prior to that date, the objective evidence only indicated a mild to moderate disability, and warranted not more than a 10 percent evaluation under Code 8207. However, a 30 percent evaluation is not warranted under Code 8207. There is no evidence that the veteran's seventh cranial nerve disorder has resulted in complete paralysis. Nor does the noted symptomatology indicate extreme problems with neuritis or neuralgia type symptoms. While her left facial pain has become constant, she has acknowledged that it can be alleviated to some degree with over-the-counter medication and compresses. She is also able to have a symmetrical smile and some use of her left eyebrow. In addition, the examiner of July 1999 attributed part of the veteran's neurological symptoms to psychogenic features and not as a residual of her parotid gland excision. Therefore, the seventh cranial nerve symptomatology has not reached a level in recent years that would warrant a 30 percent evaluation under Code 8207. Finally, to the extent that Code 5325 provides for a minimum 10 percent rating, the Board notes that the disability has been rated at 10 percent during the entire appeal period. Based on the above analysis, the undersigned finds that the veteran's residuals of a left parotid gland excision (seventh cranial nerve disorder) were manifested, prior to November 19, 1996, by mild to moderate symptoms of left facial weakness and intermittent pain. From November 20, 1996, (the date of the VA examination), to the present, this disorder has caused symptoms of extreme blepharospasm, severe left facial weakness, and constant pain that is somewhat alleviated by over-the-counter medication and compresses. Thus, the preponderance of the evidence indicates that the veteran's seventh cranial nerve disorder warrants a 10 percent evaluation from December 26, 1991, to November 19, 1996, and a 20 percent evaluation from November 20, 1996 to the present time under Code 8207. b. Urinary Tract Infections. The veteran has claimed that her service-connected genitourinary disability has resulted in urinary frequency, some incontinence requiring the use of an adult diaper, and objective evidence of soreness in her lower abdomen. However, genitourinary examinations of recent years have been reported to be within normal limits. Her incontinence also appears to have improved somewhat in recent years. At her hearing in July 1997, she claimed that she was required to change her absorbent material three to four times a day. However, the May 1998 examination addendum noted that the veteran changed these materials one to two times a day. It appears that the veteran is not required to constantly wear an adult diaper. She has acknowledged that she has some control over her bladder movement and does not wear an absorbent material at night when she is near a bathroom. As the veteran's genitourinary disability is currently evaluated as 40 percent disabling under current Code 7512, analysis under the criteria for urinary frequency and urinary tract infection are not warranted. Turning to the criteria under Code 7512 effective prior to September 1994, the evidence does not indicate that the veteran is forced to constantly use an appliance (as opposed to absorbent material) due to her incontinence. Thus, a 60 percent evaluation is not warranted on that basis. Under the criteria of Code 7512 effective since September 1994, the evidence of record indicates that in recent years her genitourinary disorder has not required the changing of absorbent material four or more times a day. Therefore, a 60 percent evaluation is not warranted under the new criteria. Based on the above analysis, the Board finds that the veteran's genitourinary disability is characterized by urinary frequency, intermittent incontinence that requires changing of an absorbent material less than four times a day, and some abdominal discomfort. The preponderance of the evidence does not warrant an evaluation of this disorder in excess of 40 percent disabling. ORDER A rating greater than 10 percent disabling for residuals of a left parotid gland excision (seventh cranial nerve disorder) prior to November 20, 1996, is denied. An evaluation of 20 percent disabling, but not more, for residuals of a left parotid gland excision (seventh cranial nerve disorder) is granted from November 20, 1996, subject to the law and regulations governing the payment of monetary benefits An evaluation in excess of 40 percent disabling for urinary tract infections is denied. REMAND A review of the claims file indicates that the veteran has timely appealed the denial of an increased evaluation for her service-connected Frey's syndrome (fifth cranial nerve disorder) and residual scar of her left parotid gland excision. However, there has not been a review of the evidence of record in connection with these issues since the SOC in April 1993. Therefore, in accordance with the provisions of 38 C.F.R. § 19.31 (1999), these issues must be remanded to the RO for consideration of the recent evidence and the issuance of a SSOC. In addition, there does not appear to be a recent skin examination noting findings regarding the scar on the veteran's left face. It is also worrisome that the VA neurologist in May 1999 did not recognize the veteran's complaints of Frey's syndrome and stated that he could not find "Frye syndrome" in Dorland's Dictionary. A review of the veteran's medical records would have disclosed the diagnosis and findings that prior examiners had noted. Moreover, Frey's syndrome is clearly listed under "syndromes" on page 1630 of Dorland's Illustrated Medical Dictionary (28th ed. 1994). Because one of the reasons for the Board's December 1997 Remand was to obtain a detailed neurological examination of the veteran's disability, another examination must be scheduled. The Board would point out that the Court has held that "where remand orders of the Board or this Court are not complied with, the Board itself errs in failing to insure compliance." See Stegall v. West, 11 Vet. App. 268 (1998). Therefore, additional skin and neurological examinations should be conducted on Remand. See Gregory v. Brown, 8 Vet. App. 563 (1996) (When the available evidence is too old for an adequate evaluation of a current disability, VA's duty to assist requires a new examination). Under these circumstances, the undersigned finds that further development of the record is necessary, and the case is hereby REMANDED to the RO for the following action: 1. With any needed assistance from the veteran, including signed releases, the RO should request copies of up-to-date records of any examination or treatment, VA or non-VA, that the veteran has had for any of his service-connected disabilities. All records so obtained should be associated with the claims file. 2. The veteran should be scheduled for VA skin and neurological examinations. The purpose of these examinations is to determine the full nature and extent of the veteran's residual scar from a left parotid gland excision and her service- connected Frey's syndrome (fifth cranial nerve disorder). The claims folder must be made available to and be reviewed by the examiners in conjunction with their examinations. All necessary tests, studies, and consultations should be accomplished, and all clinical findings should be set forth in detail. The skin examiner should note in detail the dimensions of the scar and all defects associated with the scar, to include the degree of disfigurement, in a written report. The neurological examiner should provide a detailed description of the symptoms and clinical findings relative to the veteran's Frey's syndrome (fifth cranial nerve disorder). 3. Thereafter, the RO should review the claims file to ensure that the foregoing development actions have been conducted and completed in full. If any development is not undertaken, or is incomplete, appropriate corrective action should be implemented. 4. After completion of the foregoing requested development, and after completion of any other development deemed warranted by the record, the RO should again consider the claims for increased evaluations for a residual scar from a left parotid gland excision and the veteran's Frey's syndrome (fifth cranial nerve disorder). Such adjudication should be accomplished on the basis of all pertinent evidence of record, and all pertinent legal authority. 5. If any determination remains adverse to the veteran, she and her representative should be furnished with a SSOC and given a reasonable opportunity to respond. Thereafter, the case should be returned to the Board, if in order. The veteran need take no action until otherwise notified, but he may furnish additional evidence and argument while the case is in remand status. Kutscherousky v. West, 12 Vet. App. 369 (1999); Quarles v. Derwinski, 3 Vet. App. 129, 141 (1992); Booth v. Brown, 8 Vet. App. 109 (1995). By this REMAND, the Board intimates no opinion, either legal or factual, as to any final determination warranted in this case. The purpose of this REMAND is to obtain clarifying information and to provide the veteran with due process. This claim 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. W. R. Harryman Acting Member, Board of Veterans' Appeals