Citation Nr: 18143521 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 15-18 765A DATE: October 19, 2018 REMANDED Entitlement to service connection for a neurological disorder of the left side of the face and left shoulder, to include Bell’s palsy, to include as secondary to left chin facial scars, and left chin scar neuralgia is remanded. Entitlement to service connection for a right buttock scar is remanded. Entitlement to service connection for keratosis of the lower abdomen is remanded. Entitlement to service connection for cluster headaches is remanded. The issue regarding what initial rating is warranted for major depression with generalized anxiety disorder is remanded. Entitlement to an effective date prior to February 16, 2016 for the grant of service connection for major depression with generalized anxiety disorder is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities is remanded. Entitlement to recognition of E.B. as a helpless child based on permanent incapacity for self-support prior to attaining 18 years of age is remanded.   REASONS FOR REMAND The Veteran served on active duty from October 1951 to February 1954. Neurological disorder The record contains conflicting medical evidence regarding the nature and etiology of the claimed neurological disorder. A March 2012 VA examiner diagnosed the Veteran with Bell’s palsy, and opined that this disorder was less likely than not related to his service-connected facial cysts. A November 2015 VA examiner opined that the Veteran had Bell’s palsy in August 2011, but that it had resolved completely, and had “nothing to do with his scar neuralgia.” A November 2016 VA examiner declined to diagnose any cranial nerve condition. By contrast, in an August 2018 opinion, Dr. R.P., a board-certified orthopedist, diagnosed a “neuralgia of the inferior mental (sic) branch of the facial (7th cranial) nerve, causing pain and partial loss of sensation at the anterolateral aspect of the mandible (lower jaw).” In response to the question whether the Veteran’s “Bell’s palsy” was “service related in any way” Dr. R.P. replied in the affirmative, and opined that the disorder was related to in service surgery for a facial lesion based on “review of the records,” but provided no further rationale for that opinion. Given the conflicting evidence of record, the Board finds that remand is necessary to obtain a new medical opinion. Right buttock scar, keratosis of the lower abdomen, and cluster headaches; initial rating for major depression with generalized anxiety disorder; effective date for major depression with generalized anxiety disorder; and recognition of E.B. as a helpless child Regarding these claims, the Veteran has submitted timely notices of disagreement with October 2017, January 2018 and May 2018 rating decisions, but statements of the case have not yet been issued. A remand is required for the AOJ to issue a statement of the case addressing these issues. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). Individual unemployability The issue of entitlement to a total disability evaluation based on individual unemployability must be deferred pending the development requested herein. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on an appellant’s claim for the second issue). Finally, the Board notes that a January 2018 rating decision references a December 18, 2017 VA psychiatric examination, but the report of that examination is not associated with the record. On remand the report of the December 2017 VA examination must be obtained and associated with the electronic file. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period since September 2017. 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. Obtain the December 18, 2017 VA psychiatric examination report and associate it with the electronic record. If the RO cannot locate such record, it must specifically document the attempts that were made to locate it, 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. 3. Thereafter, provide the Veteran’s VBMS and Virtual VA/Legacy files to a neurologist for review. Following that review the neurologist is to identify each and every neurological disorder pertaining to the left side of the face and left shoulder, other than the previously service-connected left chin scar neuralgia, which has been diagnosed at any time since October 28, 2011. For each such diagnosed neurological disorder, the neurologist must opine whether it is at least as likely as not related to a March 1952 excision and drainage of an abscess of the head and neck. If not, the neurologist must address whether any such diagnosed neurological disorder is proximately due to the appellant’s service-connected left chin facial scars, and left chin scar neuralgia. If not, the neurologist r must address whether any such diagnosed neurological disorder is aggravated beyond its natural progression by service-connected left chin facial scars, and left chin scar neuralgia. The neurologist must specifically discuss and address the August 23, 2018 opinion offered by R.N. Phelps Jr., M.D. A complete, well-reasoned rationale must be provided for any opinion offered. If the requested opinion cannot be rendered without resorting to speculation, the neurologist must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the neurologist, i.e., additional facts are required, or the neurologist does not have the needed knowledge or training. 4. Send the Veteran and his representative a statement of the case that addresses the issues of entitlement to service connection for a right buttock scar, keratosis of the lower abdomen, and cluster headaches; what initial rating is warranted for major depression with generalized anxiety disorder; entitlement to an effective date prior to February 16, 2016 for the grant of service connection for major depression with generalized anxiety disorder; and entitlement to recognition of E.B. as a helpless child based on permanent incapacity for self-support prior to attaining 18 years of age. If, and only if, the Veteran perfects an appeal by submitting a timely VA Form 9, the issues should be returned to the Board for further appellate consideration. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Paul J. Bametzreider, Associate Counsel