Citation Nr: 1318205 Decision Date: 06/05/13 Archive Date: 06/11/13 DOCKET NO. 09-21 281 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUE Entitlement to service connection for trigeminal neuralgia, to include as secondary to service-connected disability. REPRESENTATION Appellant represented by: California Department of Veterans Affairs ATTORNEY FOR THE BOARD Siobhan Brogdon, Counsel INTRODUCTION The Veteran served on active duty from September 1968 to August 1972. This appeal comes before the Department of Veterans Affairs (VA) Board of Veterans Appeals (Board) from an April 2008 rating decision of the VA Regional Office in San Diego, California that denied entitlement to service connection for psychiatric disability and trigeminal neuralgia. The case was certified to the Board by the Los Angeles, California RO. During the pendency of the appeal, by rating decisions in June 2011 and August 2012, service connection was granted for residuals of a traumatic head injury, and for a schizoaffective disorder with anxiety neurosis, respectively. These represent a grant of the full benefit sought on appeal as to these matters and they are no longer for appellate consideration. Following review of the record, the appeal is REMANDED to the RO via the Appeals Management Center (AMC) in Washington, DC. VA will notify the appellant if further action is required. REMAND Review of the record discloses that the Veteran was involved in an automobile accident in June 1971 while in service and sustained injuries that included a compound comminuted nasal fracture, facial and scalp lacerations, and a concussion. VA outpatient records dated in March 2007 reflect that the appellant sought treatment for facial pain of unclear etiology. He related that facial pain began in the military. Following a physical examination it was felt that he likely had trigeminal neuralgia. It was recommended that the Veteran consult with the neurology department who could better assist him but the appellant declined, relating that the neurology department did not want to treat him and that he did not want to be seen by them. The Veteran was afforded a VA compensation examination in May 2011 whereupon the examiner stated that trigeminal neuralgia could not be diagnosed at that time, and that it had been, it was less likely than not secondary to nasal fracture sustained in service. The examiner noted that "The exiting three branches of the trigeminal nerve leave the skull in three distinct anatomical locations which do not approximate the nasal bone." It was added that "It is also very unlikely that a nasal bone fracture could somehow migrate within the skull and affect the main trigeminal nerve before it branches." Thus, a conflict exists between the Veteran's treating physician and the VA compensation examiner as to whether the appellant has trigeminal neuralgia. Additionally, subsequent to the May 2011 VA examination was conducted, service connection was established for traumatic brain injury residuals. The VA examiner did not address whether head injury in service might be implicated in the Veteran's current symptomatology. As such, although the May 2011 examination report was comprehensive with a thorough review and analysis of the evidence, it was incomplete in that it did not consider head injury in service relative to the Veteran's current symptoms. As well, the fact that the appellant's treating physician has a differing assessment and recommends securing a neurologist's opinion in addressing his symptomatology warrants further development. In this respect, the Board notes that the May 2011 examiner was a specialist in physical and rehabilitative medicine, and not a neurologist. The Veteran should thus be afforded a VA examination by a neurologist. The fulfillment of the VA's statutory duty to assist the appellant includes requesting a contemporaneous and thorough VA medical examination by a specialist when indicated, and providing a medical opinion that takes into account the records of prior medical treatment so that the disability evaluation will be a fully informed one. See Hyder v. Derwinski, 1 Vet.App. 221 (1991); Green v. Derwinski, 1 Vet.App. 121, 124 (1991). The Board also observes that the Veteran appears to receive ongoing VA outpatient treatment. However, the most recent records of record date only through April 2011. As there is potential notice of the existence of additional VA clinical data, they must be retrieved and associated with the other evidence on file. See Bell v. Derwinski, 2 Vet.App. 611 (1992). Therefore, VA clinical records dating from April 2011 to the present should be requested and associated with the claims folder. Accordingly, the case is REMANDED for the following actions: 1. Request all pertinent VA outpatient records dating from April 2011 to the present and associate them with the claims folder. If the RO cannot locate such records, it must specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. The RO must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claims. The claimant must then be given an opportunity to respond. 2. Thereafter, schedule the Veteran for a VA examination by a VA neurologist (preferably one who has not previously seen the appellant) to determine whether he has trigeminal neuralgia, and if so, whether it is at least as likely as not that the disorder is related to service or is secondary to a service-connected disability. The examining neurologist must be provided access to the Veteran's claims folder, his Virtual VA eFile, and a copy of this remand. All indicated tests and studies should be performed and clinical findings must be reported in detail. If trigeminal neuralgia is found but is not found to be related to service, the examining neurologist must specifically address whether it is at least as likely as not that the disorder is secondary to a service-connected disability, including residuals of a compound comminuted nasal fracture and/or traumatic brain injury, or whether it has been made permanently worse by a service-connected disorder, including residuals of a compound comminuted nasal fracture and/or traumatic brain injury. If aggravation is found, the examiner must address the extent of the aggravation and provide a baseline prior to the aggravation. 3. The Veteran is to be notified that it is his responsibility to report for all examinations ordered and to cooperate in the development of his claim. The consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655 (2012). In the event that the Veteran does not report for an ordered examination, documentation should be obtained which shows that notice scheduling the examination was sent to the last known address. It should also be indicated whether any notice that was sent was returned as undeliverable. 4. After taking any further development deemed appropriate, re-adjudicate the issue on appeal. If the benefit is not granted, provide the appellant and representative a supplemental statement of the case and afford an opportunity to respond before the case is returned to the Board. 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. 2012). _________________________________________________ DEREK R. BROWN Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), 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) (2012).