Citation Nr: 1323226 Decision Date: 07/19/13 Archive Date: 07/24/13 DOCKET NO. 08-13 143 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for spinal meningitis. 2. Entitlement to service connection for hypertension, to include as secondary to spinal meningitis. 3. Entitlement to service connection for arthritis currently diagnosed as gout, to include as secondary to spinal meningitis. 4. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to spinal meningitis. 5. Entitlement to service connection for a neck disability, to include as secondary to spinal meningitis. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD C. D. Simpson INTRODUCTION The Veteran served on active duty from July 1955 to May 1957. This matter comes to the Board of Veterans' Appeals (Board) from August 2006 and February 2008 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas and Cleveland, Ohio, respectively. The Veteran testified at a Board hearing in March 2012; the transcript is of record. In June 2012, the Board remanded the appeal for additional development. In February 2013, the Board granted the petition to reopen a service connection claim for spinal meningitis. It remanded the underlying service connection claim for spinal meningitis along with the other issues on appeal for additional development. A review of the Virtual VA paperless claims processing system includes ongoing treatment records. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). 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 In February 2013, the Board determined that another medical opinion was necessary to adjudicate the appeal. Specifically, the examiner was asked to identify all chronic residuals of spinal meningitis and provide an opinion as to whether any of the additionally claimed disabilities were aggravated by any spinal meningitis residuals. The RO/AMC obtained a May 2013 addendum medical opinion based upon review of the claims folder from the examiner conducting the April 2011 VA neurology examination. She opined that the subsequent development of joint pain is not related to the in-service meningitis episode due to its onset approximately 20 years after the episode of meningitis in service. Although she concluded that the Veteran did not have meningitis residuals, she stated that his recent memory difficulties were contributed to by his prior episodes of meningitis. On an April 2011 VA psychiatric examination, the examiner did not identify even mild memory loss. Further clarification is needed. First, the VA examiner's statements are ambiguous as to whether the Veteran's current memory problems are considered a residual of the in-service meningitis episode. Second, if any residuals are identified, the examiner must comment on whether they caused or aggravated gout, hypertension, neck disability, and/or psychiatric disability to comply with the instructions from the February 2013 remand. Stegall v. West, 11 Vet. App. 268 (1998). Another medical is necessary as detailed below. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. Contact the May 2013 VA examiner for an opinion. If she is unavailable, contact an appropriate healthcare provider. The claims folder and any pertinent documents in the Virtual VA or VBMS efolders must be available and the examiner should indicate receipt and review of these documents. If the examiner believes it is necessary, a physical examination and all necessary testing should be included. The examiner is asked to opine on whether it is as likely as not (50 percent probability or greater) that the Veteran has memory problems that are a residual of the in-service meningitis episode (note the April 2011 VA psychiatric examination reflecting no mild memory loss). If so, comment on whether it is at least as likely as not (50 percent probability or more) that the memory impairment residual caused or aggravated (in whole or in part) the additionally claimed gout, hypertension, neck disability, and/or psychiatric disabilities. If aggravated, specify the baseline of disability prior to aggravation, and the permanent, measurable increase in disability resulting from the aggravation. A rationale for all medical opinions must be stated. The examiner is advised that the Veteran is competent to reports his medical history and readily observable symptoms. His reports must be considered and cannot be rejected solely on a basis of an absence of contemporaneous medical treatment. 2. Thereafter, readjudicate the Veteran's claims on appeal. If the full benefit sought on appeal is not granted, provide the Veteran and his representative with a supplemental statement of the case, and after they have had an adequate opportunity to respond, return his appeal to the Board for further appellate review. 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). _________________________________________________ THOMAS J. DANNAHER 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).