BVA9506450 
DOCKET NO.  93-12 968     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Cleveland, Ohio

THE ISSUE

Entitlement to a 100 percent rating for chronic undifferentiated
schizophrenia, currently evaluated as 70 percent disabling.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

Richard E. Coppola, Associate Counsel

INTRODUCTION

The veteran served on active duty from April 1968 to June 1971.

This matter came before the Board of Veterans' Appeals (Board) on
appeal from a rating decision of January 1993 from the Cleveland,
Ohio, Department of Veterans Affairs (VA) Regional Office (RO),
which denied entitlement to a 100 percent rating for chronic
undifferentiated schizophrenia.

REMAND

The claims folder contains numerous reports of VA examination and
hospitalization dated as early as June 1982.  These reports
include treatment and diagnoses of alcohol dependence.  Several
of these reports also contain diagnoses of antisocial personality
disorder.  On VA examination in January 1990, the diagnoses were
alcohol abuse and rule out paranoid schizophrenia.  The physician
stated that the extent of the veteran's alcohol abuse could not
be determined at that time because the veteran was unable to
provide clear details regarding his illness.  The claims folder
also contains a March 1992 report of psychiatric examination for
VA purposes.  During that examination, the veteran reported
continued use of alcohol, but reported that he had reduced
considerably his consumption.  The reported diagnoses were
paranoid schizophrenia and alcohol abuse by history.  These
physicians do not specifically relate the veteran's alcohol use
to his service-connected psychiatric disability or rule out any
such relationship.

In support of his claim is a June 1993 statement of Robert A.
Williams, M.D., indicating a diagnosis of paranoid schizophrenia
and an opinion that the veteran's prognosis is poor.  He reported
that the veteran has been "alcohol free for quite sometime," and
opined that the veteran has been unemployed since 1978 due to his
service-connected psychiatric disorder.

The RO denied that veteran's claim for a total rating because it
determined that the veteran's chronic alcoholism was a
significant additional cause of interference with employability.
The RO concluded that the veteran was not unemployable solely by
reason of his service-connected symptoms.  A liberal reading of
the evidence in the claims folder raises the issue whether the
veteran's alcohol dependence is either a symptom of the service-
connected psychiatric disorder or is a chronic disability which
has been incurred secondary to the service-connected psychiatric
disorder.  This issue is inextricably intertwined with the issue
of the proper rating for the veteran's chronic undifferentiated
schizophrenia.  The Board finds that additional medical
development is necessary to reconcile the current medical
findings prior to assignment of a rating.

The evidence includes February 1988 Social Security
Administration (SSA) decision awarding disability benefits,
effective June 1983.  It is not clear whether all the evidence
used in that determination has been obtained for use in the
current appeal.  In September 1994 and January 1995 additional
records were added to the records assembled for appellate review.
This new evidence consists of additional medical statements from
Dr. Williams and VA outpatient records showing treatment and
evaluation of the veteran's service-connected psychiatric
disorder.

Under the present circumstances, the Board finds that additional
development of the evidence is necessary.  Accordingly, the case
is REMANDED for the following actions:

1.  The veteran should state where he has
received inpatient and/or outpatient
treatment for schizophrenia and/or alcohol
use since March 1992.  After obtaining any
needed authorization from the veteran, the
RO should obtain copies of all these
records.

2.  The RO should obtain copies of any
medical records used in connection with the
February 1988 SSA determination awarding
disability benefits from that agency, which
are not already part of the claims folder.

3.  The veteran should then be afforded a
psychiatric examination in order to
determine the severity and manifestations
of his service-connected schizophrenia.
The claims folder must be made available to
the examiner prior to the examination.  The
examination should be conducted in
accordance with VA's Physician's Guide for
Disability Evaluation Examinations.  Any
psychological testing deemed necessary to
make a complete diagnostic evaluation and
to differentiate symptoms attributable to
the service-connected psychiatric disorder
from those due to other conditions should
be accomplished.  The examiner should also,
if needed, utilize Social Work Service to
obtain data to clarify the nature and
sequence of events which may have affected
the veteran's life and to assist the
examiner in evaluating the degree of
social, psychological, and industrial
impairment due to the psychiatric disorder.
The examiner should provide a numerical GAF
score, along with the associated
descriptive phrase, which most
appropriately reflects the veteran's level
of functioning.  The examiner should also
specifically discuss the reduction, if any,
in initiative, efficiency and reliability
levels which is due to the psychiatric
disorder.  Finally, the examiner should
express an opinion regarding the etiology
of alcoholism and the degree of probability
that alcoholism is a symptom of or
secondary to the service-connected
psychiatric disorder.

4.  Following completion of this
development, the RO should review the
veteran's claims, including the claim that
alcoholism is a symptom of PTSD or
secondary to PTSD.  The rating decision
should reflect consideration of all
potentially applicable criteria, to include
consideration of the applicability of 38
C.F.R. §§ 3.321(b)(1) and 4.16(c).  If the
decision remains adverse to the veteran in
any way, he and his representative should
be furnished with a supplemental statement
of the case which summarizes the pertinent
evidence and reflects detailed reasons and
bases for the decision.  They should then
be afforded the applicable time period to
respond.

Thereafter, the case should be returned to the Board for
further appellate consideration.  No action by the veteran is
required until he is contacted by the RO.  The purpose of
this REMAND is to obtain additional clarifying medical data
and to ensure due process of law.  No inference should be
drawn regarding the final disposition of the claim as a
result of this action.

          EUGENE A. O'NEILL
          Member, Board of Veterans' Appeals

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 deter-
mination.  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 action has been taken in
accordance with the Veterans' Benefits Improvements Act of 1994,
Pub. L. No. 103-446, § 303, 108 Stat. 4645, ___ (1994), and 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).