BVA9504608 DOCKET NO. 93-10 116 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to an increased evaluation for a psychophysiological gastrointestinal disorder, currently rated as 30 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD John D. Nachmann, Associate Counsel INTRODUCTION The veteran had active military service from November 1943 to December 1944. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of October 1992 by the Department of Veterans Affairs (VA) St. Petersburg, Florida, Regional Office (RO). REMAND The veteran has submitted a well-grounded claim within the meaning of 38 U.S.C.A. § 5107(a). See Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990); Gilbert v. Derwinski, 1 Vet.App. 49, 55 (1990). That is, the Board finds that he has submitted a claim which is plausible. The VA therefore has a duty to assist the veteran in developing facts pertinent to his claim. See Littke v. Derwinski, 1 Vet.App. 90, 91-92 (1990). The report of an August 1992 VA gastrointestinal examination reveals that the veteran's abdomen was flat and that no free fluid, palpable organomegaly, or tenderness to palpation was found. In addition, the veteran's bowel sounds were normal. An impression of myxoneurosis intestinalis was recorded. The report of an August 1992 VA psychiatric examination indicates that the veteran was alert and his speech was to the point. In addition, the veteran appeared troubled and was definitely somatically involved. There were no signs of psychotic phenomena, his memory and orientation were intact, and his insight as well as his judgment were fair. A diagnosis of moderately severe generalized anxiety state with somatic inclusions was recorded. By rating decision in October 1992, the RO confirmed the 30 percent evaluation that had been assigned to the veteran's psychophysiological gastrointestinal disorder in November 1975. The RO determined that the report of the August 1992 VA gastrointestinal examination did not show that the veteran had malnutrition, excessive weight loss, or poor health due to his nervous stomach and that he was therefore not entitled to the next higher evaluation of 60 percent. In the February 1993 statement of the case, however, the RO indicated that the veteran was not entitled to the next higher evaluation of 50 percent because the report of the August 1992 VA psychiatric examination did not show that the veteran's psychophysiological gastrointestinal disorder resulted in considerable impairment in the ability to establish or maintain effective or favorable relationships with people. The RO has rated the veteran's psychophysiological gastrointestinal disorder pursuant to the provisions of 38 C.F.R. § 4.132, Diagnostic Code 9502 (1994). Under this diagnostic code, when two diagnoses, one organic and the other psychological or psychoneurotic, are presented covering the organic and psychiatric aspects of a single disability entity, only one percentage evaluation will be assigned under the appropriate diagnostic code determined by the rating board to represent the major degree of disability. When the diagnosis of the same basic disability is changed from an organic one to one in the psychological or psychoneurotic categories, the condition will be rated under the new diagnosis. As is evident from the above discussion regarding the October 1992 rating decision and the February 1993 statement of the case, a clear determination as to the appropriate diagnostic code under which to rate the veteran's psychophysiological gastrointestinal disorder has not been established. In addition, the Board notes that the report of the August 1992 VA psychiatric examination does not objectively relate the pertinent symptoms of the veteran's disorder to the relevant rating criteria to ascertain his social and industrial adaptability. See Massey v. Brown, No. 93-135 (U.S. Vet. App. Dec. 6, 1994). Lastly, the Board notes that in a July 1992 statement, the veteran indicated that he had been receiving treatment, apparently for his psychophysiological gastrointestinal disorder, at the Oakland Park, Florida, VA Outpatient Clinic since 1981. All of the records pertaining to this treatment have not been associated with the veteran's claims file. Therefore, in order to give the veteran every consideration with respect to the present appeal, it is the Board's opinion that further development of the case is warranted. Accordingly, this case is REMANDED for the following actions: 1. The RO should contact the VA Outpatient Clinic in Oakland Park, Florida, in order to obtain copies of all medical records pertaining to the veteran. All records obtained should be associated with the veteran's claims file. 2. After the above development has been completed, the veteran should be afforded special gastrointestinal and psychiatric examinations in order to ascertain the nature and severity of his stomach disorder. All indicated tests, including appropriate psychological studies with applicable subscales, must be conducted. In addition, a Global Assessment of Functioning Score consistent with the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (3d ed. revised, 1987) must be assigned along with an explanation as to what the assigned score represents. The claims file must be made available to and reviewed by the examiner prior to the examinations. 3. After the development in the above paragraphs has been completed, the RO should determine whether the veteran's organic or psychological disorder represents the major degree of disability and, by applying the medical evidence to the appropriate rating criteria, assign a percentage evaluation under the appropriate diagnostic code. 4. If any determination made is unfavorable to the veteran, a supplemental statement of the case, which sets forth the evidence of record as well as the laws and regulations on the issue of entitlement to an increased evaluation for a psychophysiological gastrointestinal disorder, including the diagnostic code under which the disorder was evaluated and the specific rating criteria considered, should be furnished to the veteran and his representative. After affording the veteran and his representative the appropriate period of time in which to respond to the supplemental statement of the case, the veteran's claim should be returned for the further appellate consideration, if otherwise in order. The purpose of this REMAND is to obtain additional development, and the Board does not intimate any opinion as to the merits of the case, either favorable or unfavorable, at this time. No action is required of the veteran until he is notified. JACQUELINE E. MONROE 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) (1994).