Citation NR: 9731311 Decision Date: 09/12/97 Archive Date: 09/17/97 DOCKET NO. 96-30 115 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Albuquerque, New Mexico THE ISSUES 1. Entitlement to service connection for asthma, claimed as due to chemical exposure, including Agent Orange. 2. Entitlement to an increased evaluation for headaches, currently rated 10 percent disabling. 3. Entitlement to an increased evaluation for contact dermatitis, currently rated 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD James L. Calis, Associate Counsel INTRODUCTION The veteran served on active duty from January 1968 to August 1969. This matter comes to the Board of Veterans’ Appeals (Board) from a January 1996 determination of the Department of Veterans Affairs (VA) Albuquerque Regional Office (RO) which granted a 10 percent evaluation for contact dermatitis, effective in March 1994, and a 10 percent evaluation for headaches, effective in November 1995. Service connection for asthma, claimed as due to chemical exposure, including Agent Orange, was denied by RO rating action in July 1996. REMAND The veteran contends that he has asthma, and that it was incurred in service. He also claims that his service- connected headaches and contact dermatitis warrant greater evaluations than currently assigned. The Board will defer review of the claims on appeal pending completion of the development requested below. Review of the claims folder reveals that VA outpatient records of treatment from September 1969 to August 1996 of disorders including those at issue in this appeal have not been reviewed by the RO in conjunction with the appeal. A waiver of initial review of evidence by the agency of original jurisdiction, submitted at the time of the veteran’s May 1997 Travel Board hearing, referred specifically to evidence received during the hearing, and did not encompass any previously submitted evidence. Thus, that evidence is referred to the RO for review and disposition, including issuance of a supplemental statement of the case reflecting review of the evidence. See 38 C.F.R. § 19.37. With respect to the claim of entitlement to an increased evaluation for contact dermatitis, the veteran argued in correspondence, and during his May 1997 personal hearing, that a greater evaluation is warranted for the service- connected disorder in light of exacerbations affecting the groin and buttocks. However, it is unclear, based on the evidence of record, as to whether the skin disorder currently affecting his groin and buttocks is contact dermatitis. Such a determination is critical as contact dermatitis is the only skin disorder that is service-connected. On VA dermatologic examination conducted in December 1969, a skin disorder affecting the left buttock and the pubic and genital areas was diagnosed as localized Neurodermatitis (Lichen Simplex Chronicus), and a skin disorder affecting the left wrist was diagnosed as contact dermatitis due to contact with metals. On VA dermatologic examination conducted in December 1974, a skin disorder affecting the penis, groin, and left buttock was diagnosed as nummular eczema, and a disorder affecting the wrist and neck was again diagnosed as contact dermatitis. On VA outpatient medical treatment in March 1994, a skin disorder affecting the penis was diagnosed as herpes simplex. During the most recent VA medical examination of the veteran’s dermatitis, conducted in December 1995, the veteran reported an inaccurate history of contact dermatitis in the groin area and the buttocks, which apparently the examiner did not verify, and chronic dermatitis, that was “presently non-acute” was diagnosed. It was also indicated that follow up dermatologic examination was necessary. The Board must consider independent medical evidence in supporting recorded findings, rather than providing its own medical judgment in the guise of a Board opinion. Where the Board determines that the evidence of record is insufficient for a fully informed evaluation, the Board is free to supplement to the record by seeking advisory opinion or ordering a medical examination. Colvin v. Derwinski, 1 Vet.App. 171 (1991). Based on the current evidence of record, the Board is unable to determine the nature of the skin disorder currently affecting the veteran’s groin area and buttocks, or if that disorder is service-connected. Thus, an additional VA medical examination is necessary for a fully informed evaluation of the claim on appeal. Caffrey v. Brown, 6 Vet.App. 377, 381 (1994); Green v. Derwinski, 1 Vet.App. 121, 124 (1991). With respect to the claim of entitlement to an increased evaluation for headaches, the medical evidence of record leaves unclear the severity of the veteran’s headaches, or the extent to which there were exacerbations of the headaches by nonservice-connected injury or disease. VA outpatient medical records of recent treatment essentially reflect complaints of daily headaches, with diagnoses including chronic headaches. On VA medical examination in December 1995, the examiner did not comment on the extent of exacerbation of the service-connected headaches by nonservice-connected events or disease, or on the frequency of completely prolonged and prostrating attacks produced by the service-connected headaches, necessary for an evaluation under the pertinent diagnostic criteria. See 38 C.F.R. § 4.124a, Diagnostic Code 8100. Thus an additional VA medical examination is necessary for a fully informed evaluation of the veteran’s service-connected headaches. Colvin, 1 Vet.App. at 175. In light of the foregoing, the case is REMANDED for the following actions: 1. The veteran should be afforded a VA dermatologic examination to assess the level of severity of his service- connected dermatitis and identify the nature of the skin disease affecting his groin and buttocks. The claims folder must be made available to the examiner for review in conjunction with the examination. All necessary testing should be conducted and the results reported in detail. If on medical evaluation another skin disease is found coexisting with the veteran’s service- connected contact dermatitis, the examiner should be requested to provide an opinion as to the etiology of such condition and determine whether it is related to his service-connected contact dermatitis. 2. The veteran should also be afforded a VA neurologic examination to determine the severity of his service-connected headaches. The claims folder must be made available to the examiner for review in conjunction with the examination. All necessary testing should be conducted and the results reported in detail. The examiner should be requested to clarify the severity of his service-connected headaches and the frequency of prolonged prostrating headache attacks, based on complaints reported by the veteran and medical findings. 3. Thereafter, the RO should again review the record, and specifically document consideration of 38 C.F.R. § 3.321(b)(1). See Floyd, 9 Vet.App. at 96 (the Board is precluded from assigning an extraschedular rating in the first instance). If any benefit sought on appeal remains denied, the veteran and representative should be furnished a supplemental statement of the case and given the opportunity to respond. The case should then be returned to the Board for further appellate consideration. J. F. GOUGH Member, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. 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) (1996). - 2 -