BVA9505660 DOCKET NO. 92-05 613 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to an increased evaluation for generalized anxiety disorder, currently assigned a 30 percent evaluation. 2. Entitlement to a total rating based on individual unemployability due to service-connected disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD K. Hudson, Associate Counsel REMAND The veteran had active service from September 1943 to February 1945. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a regional office (RO) rating decision of June 1991 which denied the veteran's claim for an increased evaluation for anxiety reaction. The case was previously remanded in May 1993 for an examination; however, a review of this examination report, in connection with the other evidence of record, and in light of Massey v. Brown, No. 93-135 (U.S. Vet. App. Dec. 6, 1994), discloses the necessity for additional development. Specifically, an outpatient treatment note dated in May 1991 indicates the veteran was hospitalized while being evaluated for complaints including memory loss. The report of this hospitalization is not of record. Nevertheless, the outpatient record which refers to the examination and hospitalization reveals that multiple small ischemic lesions were found on magnetic resonance imaging (MRI), and that the veteran experienced a transient ischemic attack while being given an electroencephalogram (EEG). The clinical impression contains the following: "C/W [decreased] Memory; Insomnia; [secondary] to [the ischemic lesions], i.e., Early Multi-Infarct Dementia vs. Depression." Although a note in June 1991 indicated that the physician's final impression had been multiple small ischemic strokes resulting in early multi-infarct dementia, the source of this "final impression" was not noted, and we do not believe that it can be gleaned from the somewhat elliptical clinical impression quoted above. The VA examination report of June 1993 did not contain any mention of this question of organicity, and in fact noted no gross sign of organic brain damage. Memory was not discussed. Particularly since the veteran contends that memory loss is one of his primary symptoms, the etiology of any mental impairment must be determined. Consequently, the records of the VA hospitalization referred to in the May 1991 outpatient note must be obtained, and the veteran must be afforded an examination to ascertain the symptomatology due to his service-connected anxiety disorder. See Littke v. Derwinski, 1 Vet.App. 90 (1990). Moreover, in Massey, the United States Court of Veterans Appeals (Court) emphasized that the rating criteria set forth in 38 C.F.R. § 4.132 (1994) must be adhered to in evaluating increased ratings for psychiatric disorders, and that consideration of factors outside the rating criteria, such as memory, mood, or affect, was "error as a matter of law." Slip op. at 7. Consequently, such factors must be discussed only insofar as they affect his social and industrial adaptability generally, or the specific factors listed in the rating schedule. Because of this, it is our opinion that an examination should include a discussion of the manifestations in light of resulting social and industrial impairment, as well as an evaluation of the veteran's global assessment of functioning (GAF), Axis V on the multiaxial diagnoses set forth in DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS, 12 (3d ed. rev., 1987) (DSM-III-R). Accordingly, this case is REMANDED for the following: 1. Records of the veteran's hospitalization in the Bay Pines VA medical center for neurological work-up in about April or May, 1991, should be obtained. In addition, the veteran's outpatient neurology and/or mental health clinic records, including periodic case summaries, from June 1991 to the present should be obtained from the Fort Myers outpatient facility, and associated with the claims folder. 2. Thereafter, the veteran should be afforded a special VA psychiatric examination to determine the manifestations and severity of his service-connected anxiety disorder. Any psychological and/or neurological testing necessary to differentiate symptomatology due to psychiatric causes from that of organic etiology should be conducted. In addition, the claims folder must be available for review prior to the examination. The examiner should be requested to delineate the symptomatology due to the service- connected anxiety disorder, and discuss the impact on the veteran's social and industrial adaptability. Factors identified in the rating code, such as isolation in the community, totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality, disturbed thought or behavioral processes, such as fantasy, confusion, panic and explosions of aggressive energy resulting in profound retreat from mature behavior, and the effect of the symptoms on the ability to obtain or retain employment, should be discussed to the extent they apply to the veteran's service-connected anxiety disorder. Particular emphasis should be placed on the impact of the service connected disorder on the veteran's employability. The global assessment of functioning (GAF) defined in DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS (3d ed. rev., 1987) (DSM-III-R) should be estimated as well, and the extent to which his service-connected anxiety disorder affects the GAF should be identified. After completion of the requested development, the case should be reviewed by the originating agency. If the decision remains adverse to the veteran, he and his representative should be furnished a supplemental statement of the case and afforded an opportunity to respond. Thereafter, the case should be returned to the Board for appellate consideration, if otherwise in order. JACK W. BLASINGAME 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).