BVA9508219 DOCKET NO. 93-10 453 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to service connection for post-traumatic stress disorder. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD N. W. Fabian, Associate Counsel REMAND The veteran had active duty from June 1965 to June 1967. The veteran contends that he has post-traumatic stress disorder (PTSD) as the result of his service in Viet Nam. The report of a VA psychiatric examination conducted in October 1990 shows that the veteran did not endorse re-experiencing, avoidance, or arousal phenomena with sufficient persistence, intensity, or change from pre-trauma pattern or from dysthymia to qualify as clinically significant for PTSD. That report provides a diagnosis of major depression, recurrent. The report of a May 1992 VA psychiatric examination shows that the veteran did not describe an emotional bent to his service in Viet Nam that would lead to later post-traumatic stress symptoms. His problems with recurrent flashbacks and dreams about Viet Nam and concern about tunes from the Viet Nam era that make him think about Viet Nam were not considered of sufficient severity to be disabling. He described little avoidant behavior and did not give a significant history of a heightened degree of arousal to support a diagnosis of PTSD. The report of the May 1992 VA examination provides a diagnosis of dysthymia with a history of passive aggressive traits. The veteran submitted medical reports from Wautauga Mental Health Services, Inc., dated in August 1991, October 1992, and December 1992 that provide a diagnosis of major depression, recurrent, with PTSD. The reports from Wautauga, however, do not relate the diagnosis to specific stressors. Because the most recent reports from Wautauga are more recent than the most current VA examination, the reports raise a question of whether a diagnosis of PTSD is appropriate. The veteran's representative has requested that the case be remanded to reconcile the diagnoses. To ensure that the VA has met its duty to assist the claimant in developing the facts pertinent to the claim and to ensure full compliance with due process requirements, the case is REMANDED to the regional office (RO) for the following development: 1. The RO should obtain the names and addresses of all medical care providers, both VA and private, inpatient and outpatient, who treated the veteran for a psychiatric disorder since October 1990. After securing the necessary release, the RO should obtain these records. The records need not be obtained if copies of the records are already in file. Specifically, the RO should obtain copies of all treatment records from Peter G. Frizzel, M.D., and the Wautauga Area Mental Health Center. The physician and the mental health center should be asked to provide copies of the actual clinical records, not narrative descriptions of treatment. 2. The veteran should be afforded a VA psychiatric examination to determine the nature and extent of any psychiatric disorder that he has. The claims folder must be made available to the examiner for review before the examination. The diagnosis should be provided in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM- III), American Psychiatric Association. If the examination results in a diagnosis of PTSD, the examiner should be asked to specify the stressor(s) upon which the diagnosis is based. 3. If the above-referenced development results in a diagnosis of PTSD, the RO should determine if the veteran was in combat with the enemy while serving in Viet Nam. Specifically, the veteran's discharge certificate indicates that he was awarded the Air Medal with clusters. A determination should be made as to whether this medal constitutes a "combat citation" within the meaning of 38 C.F.R. § 3.304(f), in regard to conclusive evidence of a claimed stressor. The RO should, if necessary, verify through proper channels the basis for the veteran's receipt of the Air Medal. 4. If the RO is unable to verify that the veteran served in combat while in Viet Nam or the Air Medal is found not to constitute a "combat citation" under 38 C.F.R. § 3.304(f), the RO should contact the veteran and ask him to identify all stressors that he incurred while in active service. He should be asked to specify the events, dates, names of the individuals involved, and location of all claimed stressors. The RO should also obtain a copy of the veteran's service personnel file and forward a copy of the file, along with the veteran's description of the claimed stressors, to the Environmental Support Group for verification of the claimed stressors. 5. After the development requested above has been completed to the extent possible, the RO should again review the record. If any benefit sought on appeal, for which a notice of disagreement has been filed, remains denied, the appellant and representative should be furnished a supplemental statement of the case and given the opportunity to respond. Thereafter, the case should be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The appellant need take no further action until notified. WILLIAM J. REDDY 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).