Veterans Medical Advisor

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                         Case from Bureau of Veterans Appeals

Dr. Bash is a veteran of


Citation Nr: 9932465

Decision Date: 11/17/99 | Archive Date: 11/29/99

DOCKET NO. 96-15 438

On appeal from the Department of Veterans Affairs (VA) Regional Office in Sioux Falls, South Dakota

THE ISSUE

Entitlement to compensation pursuant to 38 U.S.C.A.§ 1151 (West 1991 & Supp. 1997) for additional disability resultant from VA hospitalization and treatment.

REPRESENTATION

Appellant represented by: Paralyzed Veterans of America, Inc.

ATTORNEY FOR THE BOARD

R. A. Caffery, Counsel

INTRODUCTION

The veteran had active service from January 1951 to July 1953. This is an appeal from an August 1995 rating action by the VA Regional Office, Sioux Falls, South Dakota, which denied entitlement to compensation under 38 U.S.C.A. § 1151 for anterior spinal artery stenosis. The case was initially before the Board of Veterans' Appeals (Board) in September 1998 when it was remanded to obtain all volumes of the veteran's VA medical records. The records were obtained and have been associated with the claims file. In June 1999 the Board obtained an opinion from a VA medical expert. Later in June 1999 the Board referred the opinion to the veteran's representative for review and comment. The veteran's representative responded in September 1999. The case is again before the Board for further appellate consideration.

REMAND

The record indicates that the veteran incurred acute transverse myelitis at C6 - C7 of the cervical spine cord from a vascular insult following a viral syndrome or autoimmune phenomenon, while hospitalized by the VA from August 27 to September 20, 1991. This caused incomplete quadriplegia with loss of bowel and bladder function.

A June 1997 opinion of a VA physician was obtained by the regional office. The physician indicated that signs of paresis had been present as early as September 17, 1991, and there was a failure to make the diagnosis until September 20, 1991. It was stated that there was a failure to examine the veteran on September 19, 1991 and that there was no documentation that nurses or aids notified a physician or anyone else of neurologic deterioration. It was indicated that early treatment with steroids and possibly Cytoxan could in some patients result in reversal of paresis and/or paralysis according to current medical literature.

Following issuance of a May 1998 supplemental statement of the case and after the veteran's records were transferred to the Board during that month, the veteran's representative submitted a June 1998 medical opinion by Craig N. Bash, M.D., who reviewed the claims file and the June 1997 VA physician's opinion. Dr. Bash concluded that the veteran did suffer additional disability as a result of treatment at the VA medical center: Anterior spinal artery stenosis with loss of anal and bladder sphincter control.

In his June 1999 opinion, the VA medical expert indicated that he did not agree with Dr. Bash that the anterior spinal artery stenosis resulted from the August 27 to September 20, 1991, VA hospitalization. He indicated that the correct statement was that the anterior spinal artery stenosis occurred during that period of hospitalization. He further indicated that he disagreed with the VA physician and Dr. Bash that the use of steroids and possibly Cytoxan could have had a beneficial effect. He stated that those treatment modalities were helpful in transverse myelitis but not anterior spinal artery syndrome as the veteran had.

In his September 1999 response, the veteran's accredited representative indicated that the veteran had not waived initial regional office consideration of the June 1998 statement by Dr. Bash under the provisions of 38 C.F.R. § 20.1304(c). The representative further requested that the veteran be afforded an opportunity to have a hearing in connection with his appeal. There was also submitted a July 1999 statement by Dr. Bash in which he indicated his opinion was the same as his previous opinion in June 1998. He also indicated that it was likely that the veteran received suboptimal care at the VA medical center which delayed an accurate diagnostic evaluation treatment being promptly made. He stated that that would definitely increase the risk that any underlying neurological or vascular problems would progress to a more severe state.

In view of the foregoing, the case is REMANDED to the regional office for the following action:

1. The veteran should be contacted and asked to advise whether he wishes a hearing in connection with his appeal. If so, one should be scheduled for him.

2. The veteran's claim should then be reviewed by the regional office. In particular, consideration should be afforded the June 1998 opinion by Dr. Bash, the June 1999 opinion by the VA medical expert, and the July 1999 statement by Dr. Bash. If the determination remains adverse to the veteran, he and his representative should be sent a supplemental statement of the case and be afforded the appropriate time in which to respond.

When the above action has been completed the case should be returned to the Board for further appellate consideration, if otherwise in order. No action is required of the veteran until he receives further notice.

The purpose of this REMAND is to ensure that the requirements of due process of law are satisfied. The Board intimates no opinion as to the disposition warranted in this case pending completion of the requested action.




ROBERT D. PHILIPP

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) (1999).



Department of Veterans Affairs

drbash@doctor.com

______________________

Craig N. Bash M.D., M.B.A.

Neuro-Radiologist and Associate Professor

Uniformed Services School of Medicine

NPI/UPIN-1225123318

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Bethesda, Md 20814

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