BVA9501298 DOCKET NO. 93- 06 897 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in San Francisco, California THE ISSUES 1. Entitlement to an increased evaluation for post traumatic stress disorder (PTSD), currently evaluated as 30 percent disabling. 2. Entitlement to an earlier effective date for the assignment of service connection for PTSD (prior to February 10, 1988). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD L. M. Barnard, Counsel INTRODUCTION The veteran served on active duty from January 1967 to July 1969. This appeal arises from an August 1988 rating decision of the San Francisco, California, Department of Veterans Affairs (VA), Regional Office (RO), which granted service connection for PTSD and which assigned a 10 percent disability evaluation. This evaluation was confirmed and continued by a rating action issued in December 1989. In March 1990, a rating action was issued that increased his disability evaluation to 30 percent. This evaluation was confirmed and continued by rating actions issued in April 1990, February 1991, and by rating actions issued by the Phoenix, Arizona RO in February, May and August 1992. The veteran has raised the issue of entitlement to an earlier effective date for the grant of service connection for PTSD. However, a final determination concerning this issue will be deferred pending the outcome of this appeal. REMAND The veteran contends, in essence, that he should be granted an increased evaluation for his PTSD. He asserts that he suffers from panic attacks, nightmares, alcoholism, drug addiction, anxiety attacks, severe depression, and persistent thoughts of suicide. He recounts experiencing recurrent thoughts about killing and mutilation. He also states that he has lost job after job because of his PTSD symptoms. Finally, he says that he has lost his family and friends because of this disorder. Therefore, he asserts that a greater degree of disability evaluation is in order. VA has a duty to assist the veteran in the development of all facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1993). This includes the duty to obtain VA examinations which are an adequate upon which to determine entitlement to the benefits sought. Littke v. Derwinski, 1 Vet.App. 90 (1991). In those case which present a complicated disability picture, examinations by specialists are recommended. Hyder v. Derwinski, 1 Vet.App. 221 (1991). In determining the disability evaluation, the VA has a duty to acknowledge and consider all regulations which are potentially applicable based upon the assertions and issues raised in the record and to explain the reasons used to support the conclusion. Schafrath v. Derwinski, 1 Vet.App. 589 (1991). These regulations include, but are not limited to, 38 C.F.R. § 4.1, that requires that each disability be viewed in relation to its history and that there be an emphasis placed upon the limitation of activity imposed by the disabling condition, and 38 C.F.R. § 4.2 which requires that medical reports be interpreted in light of the whole recorded history, and that each disability must be considered from the point of view of the veteran working or seeking work. These requirements for the evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decision based upon a single, incomplete or inaccurate report and to enable VA to make a more precise evaluation of the disability level and any changes in the condition. In psychiatric cases, social integration is one of the best evidences of mental health. However, in evaluating impairment resulting from the ratable psychiatric disorders, social inadaptability is to be evaluated only as it affects industrial adaptability. This contemplates the effect that the abnormalities have upon the veteran's earning capacity. 38 C.F.R. § 4.129 (1993). Two of the most important determinants of disability are time lost from gainful work and decrease in work efficiency. Emphasis is to be placed upon the examiner's description of actual symptomatology. Ratings are to be assigned which represent the impairment of social and industrial adaptability based on all the evidence of record. 38 C.F.R. § 4.130 (1993). In the instant case, the last VA examination was conducted in April 1992. Following this examination, the veteran was hospitalized on two separate occasions. His condition following these hospitalizations was never determined through an additional examination. Moreover, the examination in question referred to factors completely outside the rating criteria provided by the regulations. There is no discussion of the extent to which his ability to establish and maintain relationships is impaired by his PTSD. There was also no discussion of the reduction or absence of initiative, efficiency or reliability levels as to demonstrate considerable industrial impairment. Massey v. Brown, U.S. Vet.App. No. 93-135 (December 6, 1994). Therefore, the examination under consideration does not provide an adequate basis upon which to evaluate his claim. Given that this case is to be remanded, and because the last outpatient treatment records date from 1982, it is the finding of the undersigned that it must be ascertained whether additional outpatient treatment records are extant. Littke, supra. Furthermore, the veteran has claimed that his alcoholism is caused by his service-connected PTSD. This claim appears to be inextricably intertwined with his claim for an increased evaluation for PTSD. According to Harris v. Derwinski, 1 Vet.App. 180 (1991), all issues which are inextricably intertwined with an issue on appeal must be determined before the issue on appeal can be decided. Under the circumstances of this case, the undersigned has concluded that further assistance is necessary and this case is REMANDED to the RO for the following: 1. The RO should contact the Prescott, Arizona, VA Medical Center's Mental Health Clinic and request that they provide copies of all outpatient treatment records pertaining to the veteran developed between January 1992 and the present. 2. Once the above-requested records have been obtained and associated with the claims folder, the RO should afford the appellant a VA psychiatric examination in order to fully evaluate the degree of severity of his service-connected PTSD. The examiner should discuss the degree of impairment in the appellant's ability to establish and maintain relationships, as well as the reduction or absence of initiative, efficiency or reliability levels as they affect industrial impairment. The examiner should also render an opinion as to whether the veteran's alcohol abuse exists as a primary condition or if it is etiologically related to his service-connected PTSD. All indicated special studies should be accomplished. The claims folder must be made available to the examiner prior to the examination so that the veteran's entire history can be taken into consideration. 3. The RO should review the evidence of record and determine whether the veteran's alcohol abuse can be service connected as secondary to his service-connected PTSD. In the event that the veteran's claim remains denied, in whole or in part, he and his representative should be provided with an appropriate supplemental statement of the case and an opportunity to respond, and the case should be returned to the Board for further appellate consideration if otherwise in order. C. P. RUSSELL 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).