BVA9507611 
DOCKET NO.  93-09 375     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in No. Little
Rock, Arkansas

THE ISSUES

1.  Entitlement to service connection for hypertension secondary
to post-traumatic stress disorder.

2.  Entitlement to service connection got migraine headaches
secondary to post-traumatic stress disorder.

REPRESENTATION

Appellant represented by: Veterans of Foreign Wars of the
United States

ATTORNEY FOR THE BOARD

G. Wm. Thompson, Counsel

INTRODUCTION

The veteran served on active duty from January 1951 to January
1954.

This appeal arises from an August 1991 Department of Veterans
Affairs (VA) No. Little Rock, Arkansas, Regional Office (RO)
rating action denying an increased rating for post-traumatic
stress disorder (PTSD) and service connection for migraine
headaches and hypertension secondary to PTSD.  By a January 1993
rating action a 100 percent rating was assigned for PTSD so the
issue of an increased ratting is no longer on appeal.

REMAND

There is conflicting evidence in this case as to whether the
veteran's hypertension and headaches were caused by or aggravated
by his service-connected PTSD.  In regard to aggravation of a
nonservice-connected disability by a service-connected
disability, the RO's attention is directed to a recent decision
of the United States Court of Veterans Appeals, Allen v. Brown,
No. 93-245 (U.S. Vet. App. Mar 17, 1995), a copy of which is
filed in the claims folder.

The Board also notes that although the veteran seems to
experience two different kinds of headaches (referred to
generally as migraine and tension headaches), the issue of
service connection has been limited to migraine headaches.  While
it may be the veteran's intent to so limit the issue, this matter
should be clarified so that the Board's final decision will be
responsive to his claim.  In view of the foregoing, the case is
remanded for the following:

1.  The veteran should be asked whether it
is his intent to limit his claim for
service connection for headaches to
migraine headaches and he should be
permitted to submit any additional evidence
pertinent to the issues.  If he indicates
that he is seeking service connection for
headaches in addition to migraines and if
service connection for such headaches can
be granted on the record, the RO should
grant service connection.

2.  The veteran should be examined by a
board of board certified specialists (a
psychiatrist, a cardiologist and a
neurologist, each of whom has not
previously examined or treated him, if
possible) to determine whether his service
connected PTSD has caused or aggravated his
hypertension, his migraine headaches and,
if applicable, any tension or other type of
headaches.  Any indicated diagnostic
studies should be accomplished.  The
psychiatrist should express an opinion as
to all matters, but the other specialists
should limit their opinions to the area of
their expertise.  The rationale for any
opinion should be stated, to include an
explanation of the process by which PTSD
would cause or aggravate the other
disorders if the opinion supports the
veteran's claims.  In regard to
aggravation, a distinction should be drawn
between any temporary exacerbation of
symptoms as opposed to an increase in the
level of disability beyond natural
progress.  The examiners must be provided
with the claims folder and are asked to
read the various medical opinions on file
related to causation /aggravation.
Additionally, a separate copy of this
remand should be provided to each
physician.  If possible, any conflicting
opinions should be reconciled or at least
discussed.

3.  Upon completion of the development, the
RO should review the file and determine
whether the above instructions were
followed and the medical opinions are
complete.  If they are not, the RO Should
assure that any deficiencies are corrected.

Thereafter, the RO must determine whether any of the benefits
sought may be granted, particularly in light of Allen.  If any
benefit remains denied, the case should be returned to the Board
after issuance of a supplemental statement of the case, with
opportunity to respond.  The veteran need take no action until
notified.

          JANE E. SHARP
          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).