BVA9507911 DOCKET NO. 93-16 165 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Hartford, Connecticut THE ISSUE 1. Entitlement to service connection for alcohol and drug abuse secondary to the service-connected post-traumatic stress disorder. 2. Entitlement to a temporary total disability rating based on a period of hospitalization from January 22 through July 22, 1991, under the provisions of 38 C.F.R. § 4.29 (1994). REPRESENTATION Appellant represented by: AMVETS WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD P. M. Lynch, Associate Counsel INTRODUCTION The veteran's active military service extended from August 1967 to September 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 1993 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Hartford, Connecticut which denied entitlement to a temporary total disability rating based on hospitalization from January 22 through July 22, 1991 under the provisions of 38 C.F.R. § 4.29 (1994). The Board notes that the RO denied the veteran's claim of entitlement to service connection for polysubstance abuse in June 1993. In view of the contentions and arguments raised in the informal hearing presentation dated in August 1993, it is accepted as the veteran's notice of disagreement with respect to this adverse determination. Although the veteran has not formally submitted an appeal with respect to this claim, the Board assumes jurisdiction over this matter as the appeal on the issue of entitlement to a temporary total disability rating based on hospitalization from January 22 through July 22, 1991 is "inextricably intertwined" to the issue of secondary service connection for the veteran's alcohol and drug abuse disorder. See Harris v. Derwinski, 1 Vet.App. 180 (1991). REMAND The veteran's claims are "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, he has presented claims which are plausible. However, for the reasons that follow, it appears that the statutory duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a) has not yet been fully met. In his notice of disagreement dated in February 1993, the veteran contended that his previously diagnosed substance abuse disorder was related to his service connected post traumatic stress syndrome (PTSD) and was a form of self-medication. Therefore, he maintains that he is entitled to a temporary total disability rating for his period of hospitalization for his substance abuse disorder from January 22 through July 22, 1991. This contention is construed as a claim for entitlement to service connection for substance abuse secondary to service-connected PTSD. In a recent decision, the United States Court of Veterans Appeals held that a veteran is entitled to service connection for an increment in severity of a nonservice-connected disability that is attributable to a service-connected disability. Allen v. Brown, No. 93-245 (U.S. Vet.App. Mar 17, 1995), slip op. at 16. The RO must review the veteran's claim in light of this decision. Accordingly, a medical opinion would be helpful in determining if the veteran's substance abuse is etiologically related to his PTSD or otherwise made worse by his PTSD. Therefore, the RO should have the veteran examined and his file reviewed by a VA psychiatrist who should express the required opinions. In addition, it appears that the veteran's complete medical records are not currently associated with the claims folder. A review of the record reveals that he was hospitalized at the Park City Hospital in approximately 1979; at the VA Medical Center in West Haven, Connecticut at various times from 1984 to the present; and at a facility in Puerto Rico in approximately 1989. It is also possible that he received treatment at a halfway house following his January 22 through July 22, 1991 VA hospitalization. Therefore, the RO should make arrangements to obtain the veteran's complete medical records from these facilities. See Littke v. Derwinski, 1 Vet.App. 90 (1990); Hyder v. Derwinski, 1 Vet.App. 221 (1991). To ensure that 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 RO for the following development: 1. The RO should contact the veteran and request that he provide the names and addresses of all health care providers which have treated him for any psychiatric disorder or substance abuse disorder since his discharge from service. The Board is particularly interested in any treatment received at the Park City Hospital in approximately 1979; at the VA Medical Center in West Haven, Connecticut at various times from 1984 to the present; at a facility in Puerto Rico in approximately 1989; and at a halfway house after his January through July 1991 VA hospitalization. 2. After securing the necessary releases, the RO should obtain all treatment reports and hospital treatment folders from all private health care providers listed by the veteran that are not already on file. The veteran's complete VA medical records, including discharge summaries and treatment notes, should also be obtained. If any records are not available, that fact and the reason(s) should be annotated in the claims folder. 3. Following the above, the veteran should be examined by a VA psychiatrist who has not previously examined him in order to determine if there is any relationship between his service connected PTSD and any drug and alcohol abuse disorder. The entire claims folder and a copy of this REMAND must be made available to and reviewed by the examiner prior to the examination. All necessary special studies or tests including psychological testing are to be accomplished. The results of the testing should be reviewed by the psychiatrist prior to completion of the report. The report of examination should include a detailed account of all manifestations of psychiatric pathology found to be present. The examiner should describe the relationship between the service connected PTSD and any alcohol or drug abuse disorder the veteran may have. The psychiatrist should provide complete rationale for all conclusions reached. In particular, the examiner should furnish opinions with respect to the following: a. Whether the veteran's alcohol or drug abuse disorder is active or in remission. b. An opinion as to whether there is a probability that the veteran's PTSD caused his alcohol or drug abuse disorder. In rendering this opinion, the examiner should discuss any substance abuse prior to and during the veteran's active service. c. If the PTSD did not cause a substance abuse disorder, did it aggravate a substance abuse disorder. In particular, did the PTSD cause increased impairment with respect to an alcohol or drug abuse disorder. 4. The RO should 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, appropriate corrective action is to be implemented. Specific attention is directed to the examination reports. If any requested examination does not include fully detailed descriptions of pathology and all test reports, special studies or adequate responses to the specific opinions requested, the report must be returned to the examiner for corrective action. 5. The RO should adjudicate the claim for secondary service connection for alcohol and drug abuse. In resolving this matter, the RO should give full consideration to the following decision: Allen v. Brown, No. 93- 245 (U.S. Vet.App. March 17, 1995). Once the foregoing has been accomplished, and if the benefits are not granted to the satisfaction of the veteran, both the veteran and his representative should be furnished a supplemental statement of the case covering all the pertinent evidence, law and regulatory criteria. They should be afforded a reasonable period of time in which to respond. Thereafter, the case should be returned to the Board for further appellate consideration. The veteran needs to take no action until so informed. The purpose of this REMAND is assist the veteran and to obtain clarifying information. JOAQUIN AGUAYO-PERELES Member, Board of Veterans' Appeals (CONTINUED ON NEXT PAGE) 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).