BVA9500940 DOCKET NO. 93-03 942 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUES 1. Entitlement to an increased evaluation for prostatitis with bilateral vasectomy, currently evaluated at 20 percent. . 2. Entitlement to an increased (compensable) evaluation for residuals of a fracture of the left ankle. 3. Entitlement to an increased (compensable) evaluation for residuals of a fracture of the nose. 4. Entitlement to an increased (compensable) evaluation for a hearing loss of the left ear. 5. Entitlement to an increased (compensable) evaluation for postoperative status, right carpal tunnel release. 6. Entitlement to an increased evaluation for post-traumatic stress disorder (PTSD), currently evaluated at 10 percent. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Nancy R. Kegerreis, Associate Counsel INTRODUCTION The veteran served on active duty from April 1961 to April 1964, from March 1965 to March 1969, and from September 1969 to September 1982. This matter comes before the Board of Veterans' Appeals (Board) from rating decisions by the Department of Veterans' Affairs (VA) Regional Office (RO) in Lincoln, Nebraska, which denied increased or compensable evaluations for the veteran's service-connected disabilities. In June 1992, the veteran amended his original application for compensation to include claims for service connection for a back injury and for arthritis in his feet. The RO interpreted the back injury claim as arthritis of the thoracic, cervical, and lumbar spines, degenerative disc disease of the cervical spine, and in a decision dated in November 1992, denied service connection. Relative to the claim for arthritis of the feet, the RO also denied service connection, but, alternatively, granted service connection for bilateral metatarsalgia and hallux valgus deformity, bilaterally, at a 10 percent evaluation, effective from June 1992. These claims have not been appealed. REMAND The veteran contends, essentially, that his service-connected disabilities cause more serious impairment than has been recognized. He states that he has frequent urination at night and must take antibiotics for chronic prostate infection almost constantly. In terms of his left ankle, he alleges that he must wear high-top, laced boots in order to stabilize it and to prevent it from swelling. In addition, he maintains that doctors have recommended surgery on his nose, as one nostril is completely blocked. He is concerned about his left ear hearing loss. He also complains of numbness of the middle two fingers of his right hand, weakness of grip, loss of dexterity, and pain in his right wrist in cold weather. Relative to his PTSD, he believes that he is severely socially impaired. The veteran was last evaluated for genitourinary problems in March 1992. Reported history revealed a long history of multiple recurrent prostate infections with multiple long courses of antibiotics without resolution of the problem. Although x-rays showed that the previously noted stricture in the proximal penile urethra was no longer evident and that the kidneys and bladder appeared normal, a rectal examination revealed an enlarged, very tender, boggy prostate. The diagnosis was chronic prostatitis, status post multiple optical urethrotomies for recurrent urethral strictures. The Board believes that a special VA genitourinary examination should be conducted to determine the current degree of impairment. The Board notes also that the veteran has not had an audiological examination since January 1983. In order to assess the current state of his hearing acuity and to evaluate his claim relating to a deviated nasal septum requiring surgery, a special VA ear, nose, and throat examination should be performed. Additionally, although the veteran underwent orthopedic examinations of the spine and ankle in September 1992, no assessment of the residuals of right carpal tunnel release was done at that time. For this reason, and to update the findings relating to the veteran's medical status, a special VA orthopedic examination is also necessary. Relative to the issue of PTSD, the Board has found some limitations to the March 1992 psychiatric examination and at least one discrepancy between the evidence found on that examination and other evidence in the claims file. It is not known whether the examiner had the claims file for review. The evidence shows that the veteran had recently been prone to numerous panic attacks and was hospitalized from January 1992 to March 1992 for depression and alcohol abuse. The psychiatric examination did not specifically relate these disorders to his PTSD. In terms of the degree of the veteran's social impairment, the psychiatric examination revealed that the veteran avoided being around other people, spending all of his time at home, even refusing to eat with his family, because he became too nervous in their company, and that he reported markedly diminished interest in usual activities, not even attending any of his childrens' school activities. This evidence does not comport with a nearly- contemporaneous Recreation Therapy Assessment, dated in late January 1992, in which it was reported that the veteran enjoyed playing cards, playing bingo with his wife, and going to horse races in his leisure time and that he socialized with a group of friends at his local bar. A special VA psychiatric examination is thus required to assess the veteran's depression, panic attacks, and alcoholism in relation to his PTSD and to ascertain the degree to which he is impaired by PTSD. Accordingly, this case is REMANDED for the following actions: 1. The veteran should be afforded a special VA genitourinary examination to determine the nature and severity of his prostatitis. The examination should be conducted in accordance with the pertinent provisions of Chapter 8 of the VA Physician's Guide for Disability Examinations (1985). Any indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. All pertinent records in the veteran's claims file, or in the alternative, the claims file, must be made available to the examiner for a complete study of the case, prior to, and during, the examination. 2. The veteran should be afforded a special VA orthopedic examination to determine the nature and extent, as currently manifested, of all service- connected musculoskeletal disorders, to include postoperative residuals of right carpal tunnel release, and residuals of fracture of the left ankle. The examination should be conducted in accordance with the pertinent provisions of Chapter 2 of the VA Physician's Guide for Disability Evaluation Examinations (1985). Any indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. All pertinent records in the veteran's claims file, or in the alternative, the claims file, must be made available to the examiner for a complete study of the case prior to, and during, the evaluation. 3. The veteran should be afforded a VA special ear, nose, and throat (ENT) examination, to include an audiological examination, to ascertain the degree, if any, of obstruction of the nasal septa and to determine the extent of any current hearing loss. Any other indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The examination must be conducted in accordance with the pertinent provisions of Chapter 3 of the VA Physician's Guide for Disability Evaluation Examinations (1985). All pertinent records in the veteran's claims file, or in the alternative, the claims file, must be made available to the examiner for a complete study of the case prior to, and during, the evaluation. 4. The veteran should also be afforded a VA psychiatric examination by a psychiatrist who has not previously evaluated him. The purpose of the examination is to ascertain the nature and severity of the veteran's psychiatric disorders and to provide a multiaxial evaluation, to include Axis V, Global Assessment of Functioning Scale (GAF Scale), pursuant to the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (3rd ed. revised). Washington, DC, American Psychiatric Association, 1987. The examination must be conducted in conformity with Chapters 14 and 20 of the VA Physician's Guide for Disability Evaluation Examinations (1985). The examiner is requested to evaluate the veteran's alcoholism and substance abuse problem and to express an opinion as to whether it is a significant factor in his psychiatric disabilities and as to whether all of his current psychiatric symptomatology may be associated with PTSD. Copies of all pertinent records in the veteran's claims file, or in the alternative, the claims file, must be made available to the examiner for a complete study of the case prior to, and during, the evaluation. When the requested development has been completed, the case should again be reviewed by the RO. The case should be returned to the Board after compliance with the provisions for processing appeals, including the issuance of a supplemental statement of the case. By its REMAND, the Board intimates no opinion, either legal or factual, as to any ultimate determination warranted. 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 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) (1993).