BVA9502879 DOCKET NO. 93-05 850 ) 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 atypical anxiety disorder with a history of psychophysiological gastrointestinal reaction with reflux esophagitis, currently evaluated as 50 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD Robert E. O'Brien, Counsel INTRODUCTION The veteran had active service from April 1956 to March 1959. This case is on appeal from an August 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, which confirmed a 50 percent disability rating for the veteran's atypical anxiety disorder with history of psychophysiological gastrointestinal reaction with reflux esophagitis. By rating decision dated in October 1992, service connection was denied for flat feet, diverticulitis, and an ear disability and hearing loss based on new and material evidence. A communication from the veteran or his representative expressing disagreement with this determination was not submitted. In the October 1992 rating action, entitlement to service connection for an eye disorder and for a prostate disorder under the provisions of 38 U.S.C.A. § 1151 (West 1991) was deferred pending further instructions. The Board refers this back to the RO for such as deemed appropriate in light of recent instructions from the Veterans Benefits Administration. In a letter dated in December 1994, the veteran claimed entitlement to service connection for a left foot disorder. This matter is also referred back to the RO for further action. REMAND Under the provisions of 38 U.S.C.A. § 5107 (West 1991), a person who submits a claim to VA has a burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well-grounded. If the person meets this burden, VA is obligated to assist in developing the facts pertinent to the claim. A well-grounded claim is one that is plausible; that is, meritorious on its own or capable of substantiation. King v. Brown, 5 Vet.App. 19 (1993). In this case, the veteran has complained that the symptoms of his psychophysiologic disorder that are within the competence of a lay party to report have worsened in severity. Accordingly, under the case law from the United States Court of Veterans Appeals (Court), the Board finds that the claim is plausible and, therefore, well-grounded. Proscelle v. Derwinski, 2 Vet.App. 629 (1992). Accordingly, VA is obligated to assist in the development of the claim. A review of the evidence of record discloses that the veteran's service-connected disability has both organic and psychiatric aspects. When the case was before the Board in July 1987, it was determined that the percentage evaluation for the veteran's disability would be assigned under the diagnostic code for a psychiatric disability, because it appeared that the veteran's psychiatric symptomatology predominated his disability picture. Reference was made to 38 C.F.R. § 4.132 (Note 4) (1993) indicating that when two diagnoses, one organic and the other psychophysiologic or psychoneurotic, are present 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. At that time, the Board made a finding that the service connected disorder produced severe industrial impairment. Subsequently, the veteran was accorded examinations by VA in June 1991. On psychiatric examination, the diagnosis was generalized anxiety disorder manifested by numerous somatic complaints and preoccupation. Also diagnosed was psychological factors affecting physical condition. Notation was made that there were a number of physical disorders, including hiatal hernia, reflux esophagitis, peptic ulcer disease, diverticulitis, hemorrhoids, ear problems "etc." The veteran was also accorded a gastrointestinal examination by VA in June 1991 and the diagnoses were: Gastroesophageal reflux disease, not relieved with high dose Tagamet and regular antireflux measures; and dysphagia, with notation that an upper gastrointestinal series was negative for stricture. By rating decision dated in August 1991, it was indicated the psychiatric disability remained the predominant condition versus the veteran's gastrointestinal symptomatology. Thereafter, the veteran and his wife gave testimony at a personal hearing held at the RO in March 1992. The veteran stated he was going to see a psychiatrist the following week. The report of that visit is not of record. He also stated that he was receiving ongoing care at the VA Medical Center in Tampa, Florida. However, the most recent records from that facility are dated back in March 1992. The outpatient records covering treatment and evaluation of the veteran in the early 1990's refer primarily to gastrointestinal complaints. Received in July 1992 was a lengthy communication from the veteran in which, among other things, he stated that in the last nine years he had been told by "five doctors and at least 200-300 trainees, that if I lift anything heavy I could die." There are no statements to this effect from any medical providers in the claims folder. More recently, the veteran has submitted additional medical evidence, however, this evidence concerns mainly disorders for which service connection is not currently in effect, including foot and cardiovascular pathology. In view of the foregoing, the Board believes that additional VA examinations should be performed, especially since the veteran has not undergone VA psychiatric or gastrointestinal examinations for rating purposes since 1991. The Court has held that the duty to assist a veteran in obtaining and developing available facts and evidence to support a claim includes obtaining an adequate and contemporaneous VA examination. Littke v. Derwinski, 1 Vet.App. 90 (1990). Accordingly, the case is REMANDED to the RO for the following actions: 1. The RO should contact the appellant and request that he provide the names and addresses of any health care providers, other than VA, who have treated him for his service-connected psychiatric disability since March 1990, and specify the approximate dates of treatment, if possible. Then, after any necessary authorization is obtained from him, the RO should obtain copies of all treatment records from the health care providers identified. Also, the VA Medical Center in Tampa, Florida, should be contacted and asked to provide the complete clinical records regarding any treatment furnished the veteran at that facility since March 1992. 2. The RO should arrange for a social and industrial survey of the veteran to determine his actual level of daily functioning. 3. Following the above, the RO should arrange for VA psychiatric and gastrointestinal examinations of the veteran to determine the current nature and extent of impairment attributable to the service-connected anxiety disorder with history of psychophysiological gastrointestinal reaction. The psychiatric examiner should provide a Global Assessment of Functioning Scale (GAF) score concerning the service connected psychiatric pathology in accordance with the American Psychiatric Association, Diagnostic and Statistical Manual for Mental Disorders (Third Edition Revised 1987). The examiner is respectfully requested to include in the report a definition of what the GAF score means to assist the RO and the Board to comply with Thurber v. Brown, 5 Vet.App. 119 (1993). The claims folder should be made available to each examiner in conjunction with the examination. 4. Thereafter, the RO should re adjudicate the claim for an increased rating for the veteran's psychophysiologic disorder. In this regard, the RO should specifically address the appellant's contention, in effect, that separate ratings are now appropriate for the organic and functional portions of his service connected disorder. Further, the RO should address the impact, if any, of the finding by the Board in 1987 that the appellant then had severe industrial impairment in light of the subsequent change of the rating criteria. Thereafter, if the benefits sought on appeal are not granted to the veteran's satisfaction, he and his representative should be provided a supplemental statement of the case and be afforded an opportunity for response. Then, the case should be returned to the Board for further consideration, if otherwise in order. By this REMAND, the Board intimates no opinion as to any final outcome warranted. No action is required of the veteran until he is contacted by the RO. RICHARD B. FRANK 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).