BVA9506281 DOCKET NO. 93-15 730 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to an increased rating for post-traumatic stress disorder (PTSD), currently rated as 30 percent disabling. REPRESENTATION Appellant represented by: AMVETS ATTORNEY FOR THE BOARD Richard E. Coppola, Associate Counsel INTRODUCTION The veteran served on active duty from September 1963 to September 1966. This matter came before the Board of Veterans' Appeals (Board) on appeal from a rating decision of March 1993 from the Waco, Texas, Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for PTSD and awarded a 30 percent disability rating, effective from August 24, 1992. The veteran has raised a claim for a total rating for compensation purposes due to individual unemployability by reason of service-connected disability. This issue is referred to the RO for further action. REMAND The veteran was hospitalized in April 1992 with admission diagnoses of ethanol dependence, major depressive episode and personality disorder. The report states that the veteran has a history of alcohol dependence, and that two weeks prior to admission his alcohol consumption increased to one-half gallon of vodka per day. The veteran underwent a VA psychiatric examination in connection with his claim for benefits. This report also includes a prior history of alcohol abuse and the physician reported that this had impaired the veteran's judgment. Based on the examination and evaluation, the examiner stated that the veteran's occupational and social functioning were mild to moderately impaired at that time. The examiner opined that it was not clear how much of the veteran's functional impairment was due to his alcohol problem, his recent divorce, or his PTSD symptoms. The diagnoses were alcohol dependence, in partial remission, mild PTSD, and narcissistic traits. Although the examiner separates these diagnoses, she does not specifically relate the veteran's alcohol use to PTSD or rule out any such relationship. The veteran and his representative argue that the veteran's alcoholism is either a symptom of the PTSD or is a chronic disability which has been incurred secondary to the PTSD. This issue is inextricably intertwined with the issue of the proper rating for the veteran's PTSD. The Board finds that additional medical development is necessary to reconcile the current medical findings prior to assignment of a rating for PTSD. Accordingly, the claim is REMANDED for the following action: 1. The veteran should state where he has received inpatient and/or outpatient treatment for PTSD and/or alcoholism since December 1992. After obtaining any needed authorization from the veteran, the RO should obtain copies of all these records. 2. The veteran should then be afforded a psychiatric examination in order to determine the severity and manifestations of his service-connected PTSD. 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 PTSD 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 PTSD. 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 PTSD. 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 PTSD. 3. 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). 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. WARREN W. RICE, JR. 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).