Citation Nr: 0006121 Decision Date: 03/07/00 Archive Date: 03/14/00 DOCKET NO. 97-26 975 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to an increased rating for post-traumatic stress disorder (PTSD), currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Richard A. Cohn, Associate Counsel INTRODUCTION The veteran served on active duty from July 1969 to January 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 1996 rating decision of the Department of Veterans Affairs (VA) Regional Office in Cleveland, Ohio (RO) which continued the 10 percent evaluation assigned for PTSD. The veteran appealed the decision to the Board which remanded the case to the RO in March 1999 for further development. After completion of the requested development to the extent possible, including clarification of the identity of the veteran's representative and continued denial of the veteran's claim, the RO returned the case to the Board for further appellate review. To allay concerns expressed in a February 2000 Written Brief Presentation, the Board assures the veteran's representative that the veteran's signed April 1999 representative appointment form is valid and acceptable. The Board invites the representative's attention to the claim for VA benefits, Notice of Disagreement and substantive appeal, all of which have been signed only by the veteran and all of which the Board has considered valid and acceptable, notwithstanding a currently effective April 1991 RO decision finding the veteran incompetent to handle his own financial affairs. REMAND While the Board appreciates the efforts of the VA physician who conducted the veteran's May 1999 psychiatric examination and the RO's attempt to clarify the physician's initial examination report, neither the initial report nor the addendum constitute an adequate response to the March 1999 REMAND. Specifically, neither report identifies and differentiates the symptomatology or impairment attributable to the veteran's service-connected PTSD from that of another nonservice-connected entity or explains why differentiation is not possible. VA evaluates a service-connected disability by comparing a veteran's actual symptoms to rating standards articulated by an applicable diagnostic code provision in VA regulations. 38 U.S.C.A. §§ 1155, 7104(a), (c), (d)(1); 38 C.F.R. § Part 4 (1999); Schafrath v. Derwinski, 1 Vet. App. 589, 592-93 (1991). For example, VA rates the severity of PTSD under diagnostic code 9411 describing various levels of occupational and social impairment. 38 C.F.R. § 4.130. VA compares a veteran's particular PTSD symptomatology and impairment with the most closely matching diagnostic code criteria, then assigns the corresponding disability rating. If a veteran with PTSD also has another mental disorder manifested by similar symptoms and impairment, VA necessarily must attempt to differentiate them so as to consider only the manifestations resulting from the service-connected disorder. That is not possible here given the current state of the record. In this case, the physician's assessment that the veteran's PTSD and schizophrenia together render him unable "to function in any working situation" and that "10% of this disability is due to the [service-connected] PTSD and the rest of [sic] the [nonservice-connected] schizophrenia" clearly is not useful for rating purposes. It fails to describe manifestations attributable only to PTSD sufficient to permit VA to match these objective medical findings to the diagnostic code rating standards. Therefore, the Board is constrained to REMAND this case again for fuller development. See Stegall v. West, 11 Vet. App. 268, 270-71 (1998). In consideration of the foregoing, the Board has determined that further development of the case is necessary to provide the veteran due process of law and full consideration of this appeal. Accordingly, this case is REMANDED for the following action: The veteran is to be afforded a VA psychiatric examination by a physician other than the one who performed the May 1999 examination. The purpose of the examination is to determine the nature and severity of the veteran's service- connected PTSD. The evaluation must include a comprehensive mental status evaluation and all appropriate testing following the examiner's detailed review of the veteran's claims folder. Upon completion of the examination, the psychiatrist must specify all current psychiatric diagnoses and, to the extent possible, differentiate the symptomatology attributable to the service-connected PTSD from that of any other nonservice-connected psychiatric entity. In the event differentiation is not possible the examiner must so state and explain why. In addition, the examiner should provide an assessment of the degree of the veteran's social and industrial impairment due solely to the service-connected PTSD and explain the basis for this opinion. The examiner must also consider the severity of the PTSD, and only the PTSD, in terms of the Global Assessment of Functioning Scale including designation of a numerical score and a full discussion of the significance of the score assigned. Thereafter, the RO should readjudicate the veteran's claim for PTSD. If the RO denies the benefit sought on appeal, it should issue a supplemental statement of the case and provide the veteran with a reasonable time within which to respond. The RO then should return the case to the Board for final appellate consideration. The purpose of this REMAND is to obtain additional development, and the Board does not now intimate an opinion, either favorable or unfavorable, as to the merits of the case. Although the veteran need not take further action until so notified by the RO, the veteran may submit to the RO additional evidence and argument pertaining to this remand. Kutscherousky v. West, 12 Vet. App. 369 (1999). WARREN W. RICE, JR. Member, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 1991 & Supp. 1999), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. 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) (1999).