Citation Nr: 0810082 Decision Date: 03/27/08 Archive Date: 04/09/08 DOCKET NO. 03-34 948A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Hartford, Connecticut THE ISSUES 1. Entitlement to service connection for a heart condition. 2. Entitlement to specially adapted housing or a special home adaptation grant. 3. Entitlement to assistance in the purchase of an automobile or other conveyance and adaptive equipment. 4. Entitlement to an initial evaluation in excess of 10 percent for service-connected neurological disorder, residuals of solvent exposure, and arachnoid cyst. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant, appellant's spouse ATTORNEY FOR THE BOARD T. Stephen Eckerman, Counsel INTRODUCTION The veteran served on active duty from April 1981 to April 2001. 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 Hartford, Connecticut. In August 2003, the RO denied a claim of entitlement to service connection for a heart condition. In September 2004, the RO granted service connection for a neurological disorder as a residual of solvent exposure, and arachnoid cyst, evaluated as 10 percent disabling, and denied claims for assistance in the purchase of an automobile or other conveyance and adaptive equipment, and for specially adapted housing or a special home adaptation grant. In January 2008, the veteran was afforded a hearing at the Central Office before Stephen F. Sylvester, who is the Acting Veterans Law Judge rendering the determination in this claim. REMAND The veteran has submitted a May 2006 notice from the Social Security Administration (SSA) which shows that he is receiving disability benefits. The SSA's records are not currently associated with the claims file. The administrative decision by SSA, along with the medical evidence relied upon, must be obtained and associated with the claims folder. Murinscak v. Derwinski, 2 Vet. App. 363, 370-72 (1992). With regard to the claim for an initial evaluation in excess of 10 percent for service-connected neurological disorder, residuals of solvent exposure, and arachnoid cyst, the veteran asserts that an increased initial evaluation is warranted primarily due to difficulty in concentration, memory impairment, and loss of balance. See Transcript of veteran's hearing, held in January 2008; veteran's arguments, received in January 2008. In its September 2004 rating decision, the RO granted service connection for a "neurological condition diagnosed as encephalopathy due to solvent exposure and arachnoid cyst claimed as dizziness, memory loss, and loss of balance and concentration." In that decision, the RO rated the veteran's encephalopathy as 10 percent disabling under 38 C.F.R. § 4.124a, diagnostic codes (DC's) 8003-8000. See 38 C.F.R. § 4.27 (2007) (hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen; unlisted disabilities requiring rating by analogy will be coded utilizing the numbers of the most closely related body part and "99"). This hyphenated diagnostic code may be read to indicate that "Benign, minimum" (DC 8003) is the service-connected disorder, and it is rated as if the residual condition is chronic epidemic encephalitis under DC 8000. However, in a June 2006 rating decision, the RO characterized this disability as "neurological condition formerly diagnosed as encephalopathy due to solvent exposure and arachnoid cyst claimed as dizziness, memory loss, and loss of balance and concentration" (emphasis added). The RO maintained the 10 percent evaluation under 38 C.F.R. §§ 4.124a, 4.130, DC's 9304-8045. This hyphenated diagnostic code may be read to indicate that dementia due to brain trauma (DC 9304) is the service-connected disorder, and it is rated as if the residual condition is a traumatic brain injury under DC 8045. The RO apparently utilized these diagnostic codes based on a November 2006 letter from a VA physician, which stated, in part, that, "This is not a physical trauma brain injury but the manifestations would be similar." The medical evidence shows that the veteran has a complex medical history, to include sleep apnea, and hypertension. In addition, service connection is currently in effect for a number of disabilities that include multiple joint disorders, as well as asthma, tinnitus, and status post cervical spine fusion. The medical evidence further shows that the veteran is using a wide variety of medications. The claims files do not include a competent medical opinion as to whether the veteran's claimed symptoms of difficulty in concentration, memory impairment, and/or loss of balance are associated with his service-connected disability. In summary, the RO has indicated that the diagnosis for the veteran's service-connected disability may have changed, and it has evaluated the disability under a number of diagnostic codes. The medical evidence indicates that the veteran has a complex medical history, and this evidence is currently inadequate to determine the scope of his symptomatology, to include whether the veteran's claimed symptoms of difficulty in concentration, memory impairment, and loss of balance are associated with his service-connected disability. Therefore, on remand, the veteran should be afforded a VA neuropsychiatric examination to determine the correct diagnosis related to his residuals of solvent exposure, and arachnoid cyst, and to assess the current extent of the residuals thereof. Accordingly, the case is REMANDED for the following action: 1. The RO should contact the Social Security Administration (SSA) and attempt to obtain that agency's decision awarding benefits to the veteran, as well as all supporting medical documentation that was utilized in rendering the SSA's decision. 2. Thereafter, afford the veteran a comprehensive VA neuropsychiatric examination. The claims folder is to be made available to the examiner prior to the examination, and the examiner is asked to review the claims folder. The examiner should be advised that VA has granted service-connection for a neurological condition as a residual of solvent exposure, and an arachnoid cyst. The examiner should be requested to provide a current diagnosis. The examiner should also be requested to discuss all symptoms and manifestations of the diagnosed disability, to include a statement as to whether it is at least as likely as not (i.e., whether there is a 50 percent or greater likelihood) that any current a) difficulty in concentration, b) memory impairment, and, c) loss of balance are related to his service-connected disability. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached. 3. Finally, readjudicate the veteran's claims, with application of all appropriate laws, regulations, and case law, and consideration of any additional information obtained as a result of this remand. If any of the decisions remain adverse to the veteran, he and his representative should be furnished a supplemental statement of the case and afforded an appropriate period of time within which to respond. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. 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 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). ______________________________________________ S. F. SYLVESTER Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs