BVA9507380 DOCKET NO. 93-13 564 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to an increased disability rating for a service- connected psychiatric disorder, currently rated as 30 percent disabling. 2. Whether new and material evidence has been submitted to reopen a claim for service connection for a hiatal hernia. 3. Whether new and material evidence has been submitted to reopen a claim for service connection for a skin disorder. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD K. Keyes, Associate Counsel INTRODUCTION The veteran served on active duty from January 1943 to December 1945. The veteran was a prisoner of war in Germany from January 1945 to April 1945. In September 1983, the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri, denied the veteran's claim for service connection for a skin disorder. The veteran filed a notice of disagreement but did not perfect his appeal by filing a substantive appeal with the September 1983 rating decision, and the decision became final. In August 1990, the RO denied the veteran's claim for service connection for a hiatal hernia and notified the veteran of its decision that same month. The veteran did not appeal this decision. This appeal arises from December 1992 and December 1993 rating decisions of the RO which denied the veteran's petition to reopen his claims for service connection for a hiatal hernia and a skin disorder, respectively. The December 1992 rating decision also denied the veteran's claim for an increased disability rating for a service-connected psychiatric disorder, currently rated as 30 percent disabling. REMAND In a May 1993 statement of the veteran's representative, it is noted with regard to the veteran's May 1992 claim for an increased rating for his service-connected psychiatric disorder that the veteran has not been afforded a VA examination for compensation purposes since July 1990. In this regard, the Board notes that the few VA outpatient records which the RO obtained subsequent to receiving the veteran's claim which were relevant to his psychiatric disorder were not adequate reports for rating purposes. The Board notes that in a May 1993 statement of the veteran's representative it is contended that the RO also erred in its December 1992 decision by denying service connection for an ulcer. The essence of his argument is that the pathology suggestive of hiatal hernia is also a manifestation of peptic ulcer disease. Furthermore, the Board notes that the veteran has presented a well grounded claim for an increased disability evaluation for his service-connected disorders within the meaning of 38 U.S.C.A. § 5107(a) (West 1991); see Proscelle v. Derwinski, 2 Vet.App. 629, 632 (1992) (where veteran asserted that his condition had worsened since the last time his claim for an increased disability evaluation for a service-connected disorder had been considered by VA, he established a well grounded claim for an increased rating). Therefore, VA is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a) by affording the veteran an examination. Accordingly, the Board concludes that further assistance to the veteran is required, and the case is REMANDED to the RO for the following: 1. The veteran should be asked to provide a list of treatment for his psychiatric disorder since 1992. The RO should obtain all records of any treatment reported by the veteran, and these records should be associated with the claims file. 2. Subsequently, the RO should schedule the veteran for a comprehensive VA psychiatric examination. The study is to be conducted in accordance with the VA Physician's Guide for Disability Evaluation Examinations. All indicated tests, including appropriate psychological studies with applicable subscales, are to be conducted. The claims file must be made available to and reviewed by the examiner prior to the requested study. The examiner should review the pertinent history of the veteran's service-connected psychiatric disorder, including the veteran's history of having been a prisoner of war and prior diagnoses of major depression and post-traumatic stress disorder. The examiner should render a current diagnosis of any psychiatric disorders found. If there are different psychiatric disorders, the examiners should reconcile the diagnoses and should specify which symptoms are a part of which disorder. If certain symptomatology cannot be disassociated from one disorder or another, it should be specified. A complete rationale should be provided for all conclusions. The examiner should describe how the symptoms of the veteran's service connected psychiatric disorder affect the veteran's social and industrial capacity. In this respect the examiner should review the records relating to the medication prescribed for the veteran and discuss their role in affecting the level of severity of the condition. The examiner must assign a Global Assessment of Functioning Score consistent with the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (3d ed. rev., 1987), and explain what the assigned score represents. A detailed discussion of the extent to which the service-connected psychiatric disorder interferes with the veteran's ability to work or to function with regard to the activities of daily living and the extent to which it interferes in his relationships with others must be provided. 3. The RO should also schedule the veteran for a comprehensive VA gastrointestinal examination. The study is to be conducted in accordance with the VA Physician's Guide for Disability Evaluation Examinations. All indicated tests are to be conducted and the examiner should review the results of the tests prior to completion of the report. The claims file must be made available to and reviewed by the examiner prior to the requested study. The report of examination should contain a detailed account of all manifestations of gastrointestinal pathology found to be present. The examiner must review and discuss the medical reports concerning the presence of a hiatal hernia and express an opinion as to whether any of the findings are also manifestations of a peptic ulcer or whether a hiatal hernia is, itself, a peptic ulcer. The report of examination should include complete rationale for all conclusions reached. 4. Following completion of the foregoing, the RO must review the claims folder and ensure that all of the foregoing development actions have been conducted and completed in full. If any development is incomplete, including if the requested examination does not include all test reports, special studies or adequate responses to the specific opinions requested, appropriate corrective action is to be implemented. If the decision remains unfavorable following completion of these actions, the veteran and his representative should be provided with a supplemental statement of the case and afforded a reasonable period of time in which to respond. Thereafter, in accordance with the current appellate procedures, the case should be returned to the Board for completion of appellate review. No action is required of the veteran until further notice is issued. ______________________________ JAN DONSBACH 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).