BVA9502552 DOCKET NO. 91-39 407 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to an increased rating for post-traumatic stress disorder, currently rated 30 percent disabling. REPRESENTATION Appellant represented by: Military Order of the Purple Heart WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD D.P. Dean, Counsel INTRODUCTION The appellant is a veteran of active military service from March 1966 to April 1971. This matter came before the Board of Veterans' Appeals (Board) on appeal from rating determinations by the Nashville, Tennessee, Regional Office (RO) of the Department of Veterans Affairs (VA). In an appellate decision dated in March 1993, the Board denied the appeal on three issues, including entitlement to an increased rating for post-traumatic stress disorder (PTSD), currently rated 30 percent disabling. Subsequently, the issue of an increased rating for PTSD was appealed to the United States Court of Veterans Appeals (Court). In a decision dated in September 1994, the Court vacated that portion of the Board's March 1993 decision dealing with an increased rating for PTSD and remanded the issue to the Board. The Court did not retain jurisdiction over the matter. REMAND The latest VA psychiatric examination of the appellant occurred in March 1992. There is considerable doubt that this examination is current enough to fulfill VA's obligation to accord the appellant a "contemporaneous" examination. Caffrey v. Brown, 6 Vet.App. 377 (1994). In addition, the Court directed the Board to "address the issue of whether the appellant is entitled to a total disability rating based upon individual unemployability for either compensation or pension purposes." Accordingly, this appeal is hereby remanded to the RO for the following further actions: 1. The RO should ask the appellant to provide the names, addresses, and approximate dates of treatment for all health care providers who may have treated or evaluated him for any disability since at least 1989. After obtaining any necessary releases from the appellant, the RO should attempt to obtain copies of any relevant medical records not already contained within the claims file. 2. After all such medical records have been incorporated into the claims file, the RO should next schedule the appellant for a comprehensive general medical examination in order to determine the exact nature and severity of all current medical disabilities. This examination must be conducted in accordance with the VA Physician's Guide for Disability Evaluation Examinations. All indicated tests, including appropriate X-ray films and laboratory studies, must be conducted. The claims file must be made available to and reviewed by the examiner prior to the requested examination. The medical examiner should also be requested to express an opinion as to the effect each and every currently demonstrated medical disability has on the appellant's ability to obtain and retain substantially gainful employment. 3. At the same time, the RO should also schedule the appellant for a comprehensive VA psychiatric examination. This examination must be conducted in accordance with the VA Physician's Guide for Disability Evaluation Examinations. All indicated tests, including appropriate psychological studies with applicable subscales, must be conducted. The claims file must be made available to and reviewed by the examiner prior to the requested examination. The examiner must assign a Global Assessment of Functioning Score consistent with the American Psychiatric Association's DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS (3d ed. rev., 1987) and explain what the assigned score represents. In addition, the examiner must offer an opinion as to whether or not the finding (as interpreted by the Court) offered by the examiner on the earlier March 1992 psychiatric examination of the appellant, to the effect that there is a relationship between the appellant's PTSD and his inability to be employed on a full- time basis, would be an opinion generally shared in the psychiatric community. A complete rationale for any opinion expressed must be provided. The examiner should also be requested to assign a Global Assessment of Functioning Score based upon the symptoms reported on the earlier VA examination of the appellant in March 1992 and in any relevant outpatient medical records contained within the claims file, if this is possible; and to express an opinion on the question of whether the appellant's current psychiatric status has worsened, improved, or remained the same since that earlier examination. 4. Following completion of the foregoing, the RO must review the claims file and ensure that all of the requested development actions have been conducted and completed in full. If any development is incomplete, including the absence of any requested test reports, special studies, or medical opinions, appropriate corrective action is to be implemented. 5. The RO should next review all the relevant evidence and readjudicate the claim seeking a disability rating in excess of 30 percent for PTSD. At the same time, the RO should also "address the issue of whether the appellant is entitled to a total disability rating based upon individual unemployability for either compensation or pension purposes" as directed by the Court in its September 1994 decision. If any of these determinations are unfavorable to the appellant, he should be informed in writing of the reasons and bases for the RO's unfavorable determination, and he should be informed of his appellate rights with respect to the new issues. If the benefits sought on appeal are not granted to the appellant's satisfaction, or if a timely Notice of Disagreement is received with respect to any other matter, including any additional issues raised by the appellant or the Court, a Supplemental Statement of the Case addressing all issues in appellate status should be prepared and furnished to the appellant and his representative. They should be provided an opportunity in which to respond. Thereafter, in accordance with proper appellate procedures, the case should be returned to the Board for further appellate review, if otherwise in order. All issues properly in appellate status should be returned to the Board at the same time. In taking this action, the Board implies no conclusion, either legal or factual, as to any final outcome warranted. No action is required of the appellant until he is otherwise notified by the RO. SAMUEL W. WARNER Member, Board of Veterans' Appeals (CONTINUED ON NEXT PAGE) The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. 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) (1993).