BVA9503607 DOCKET NO. 93-04 167 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in New York, New York THE ISSUE Entitlement to an increased evaluation for schizophrenic reaction, currently rated at 10 percent. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Nancy R. Kegerreis, Associate Counsel INTRODUCTION The veteran served on active duty from July 1942 to January 1946. This matter comes before the Board of Veterans' Appeals (Board) from an October 1991 rating decision by the Department of Veterans' Affairs (VA) Regional Office (RO) in New York, New York, which denied an increased evaluation for an acquired psychiatric disorder. REMAND The veteran has repeatedly contended that while he was in the service during World War II he became ill with pains in the right side of his face. He alleges that after separation from service, this illness became worse, with unbearable pains in his brain and in the back of his head, followed by paralysis. He reports being sent to Kings Park State Hospital, but being discharged later at his own request. He states that he then sought care from the VA, but all they did was send him to see a psychiatrist. This decision, he believes, labeled him a mental case and prevented him from receiving the proper and necessary care for his various physical ailments. Having reviewed the record, the Board notes that the veteran has had a long-standing psychiatric disorder, essentially dating from 1946, although he was noted to have been "nervous" while he was in the Army during World War II. In September 1946, shortly after separation from the service, he was admitted to Bellevue Hospital in New York City, and was later discharged to Kings Park State Hospital. The diagnosis at that time was dementia praecox, simple type, and the veteran was service connected for the disability. A VA diagnosis in October 1950 was schizophrenic reaction. A 10 percent rating has been in effect since 1953. In August 1990, the veteran was afforded a VA psychiatric examination. Reported medical history revealed that during service he had been stationed in a number of areas, where he worked as a baker in field hospitals. The veteran stated that toward the end of his tour, he started to have severe pains in the right side of the face and head and that he was never properly treated for this. He stated that his head pain had continued for years, but had diminished over the past year, although he was very non-specific in his description of his pain. He had been married for 42 years and had two grown children. In 1947 he had been hospitalized for a period of three months at Kings Park State Hospital due to depression and a pain in the back of his head. After a stay of three months, he was discharged and had not sought further psychiatric treatment. He was noted to have worked sporadically from 1946 to 1984 as a baker and cake decorator at various bakeries in the New York metropolitan area. The mental status examination showed the veteran to be poorly related, withdrawn, and neurotic. As he began to describe his head pain, he began to cry in the office, and it was some time before he could contain himself. He complained about the attitude he had faced in previous years with the VA Hospital when he came out of the service. He felt that he was made fun of and that his head pain was not taken seriously. His thought process was generally concrete, and he was alert and oriented, although he made very poor eye contact. He denied any auditory or visual hallucinations at present or ever in the past, denied suicidal or homicidal ideation, and denied any paranoid ideation. His short- term and long-term memory were vague, however, and he could not really recall the nature of his hospitalization at Kings Park. The relevant Axis I diagnosis was chronic schizophrenia, undifferentiated, residual. The Axis V Global Assessment of Functioning was 65. A June 1992 VA psychiatric examination noted a similar medical history, but added that the veteran enjoyed oil painting and belonged to the Flushing Art League. He also enjoyed working in his garden and spending time with friends. A mental status examination revealed that he was moderately anxious and looked depressed. He was usually on the edge of tears and did cry briefly once or twice. His speech was very circumstantial and at times almost tangential. He admitted that he had felt nervous for years. He stated that he frequently became depressed, but did not believe this to be unusual, as he thought that everyone got depressed. He stated that he had crying spells when talking about his military service, but denied fears or that people were talking behind his back. He denied visions or voices. He was unable to give any cause for a recent depression and said he always got depressed when he thought of the past and how when he was sick, no one would help. Diagnostic tests did not suggest organicity, psychosis, or post-traumatic stress disorder. The diagnoses were dysthymia and major depression in remission. The examiner's overall impression was that the veteran had been chronically depressed for many years and may well have had a major depression while in the service and after separation from service. However, he was unable to confirm a diagnosis of schizophrenia. It seemed doubtful that the veteran had residual schizophrenia. He stated additionally: "The absence of the C- file and service records and Kings Park State Hospital Records make assessment more difficult." He considered the veteran's psychiatric incapacity to be moderate. In reviewing the evidence, the veteran's current psychiatric disability picture is somewhat unclear, particularly with respect to his service-connected disability. Also, the examiner in 1992 did not provide an Axis V, Global Assessment of Functioning, which would be helpful in determining the veteran's degree of impairment at the present time. The Board recognizes that the examiner was under a disadvantage in not having the claims for review. Under the circumstances, further development would be helpful before a final decision is reached. Accordingly, this case is REMANDED for the following action: The veteran should be afforded a VA psychiatric examination by a physician who has not previously examined him to determine the nature and severity of the veteran's psychiatric disorder, and to provide a multiaxial evaluation, to include Axis V, Global Assessment of Functioning. The veteran's claims file must be made available to the examiner for review in connection with the evaluation. If the veteran's symptoms no longer support a diagnosis of schizophrenia, the examiner should render an opinion with respect to whether this represents merely a progression of the earlier diagnosis, an error in the prior diagnosis of a psychosis, or possibly a disease entity independent of the service-connected disability. When the requested development has been completed, the case should again be reviewed by the RO. Unless the veteran is satisfied with any favorable outcome and withdraws his appeal, the case then should be returned to the Board after compliance with the provisions for processing appeals, including the issuance of a supplemental statement of the case and provision of the applicable time period for response thereto. By its REMAND, the Board intimates no opinion, either legal or factual, as to any ultimate determination warranted. CHARLES E. HOGEBOOM 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 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).