BVA9506115 DOCKET NO. 91-43 811 ) 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 rating for generalized anxiety disorder, currently evaluated as 50 percent disabling. 2. Entitlement to an increased rating for lumbosacral strain, currently evaluated as 20 percent disabling. 3. Entitlement to a total rating based on individual unemployability due to service-connected disabilities. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL The veteran ATTORNEY FOR THE BOARD R. L. Shaw, Counsel REMAND The veteran had active military service from July 1971 to November 1972. This matter is again before the Board of Veterans' Appeals (the Board) on appeal from a September 1989, rating decision by the St. Petersburg, Florida, Regional Office (RO) of the Department of Veterans Affairs (VA). The appeal was remanded by the Board on May 6, 1992, for additional evidentiary development and adjudication. At the time of the remand, the Board took jurisdiction of the additional issues of entitlement to service connection for organic brain syndrome and temporal lobe epilepsy due to trauma in service and for alcohol and multiple drug abuse secondary to service-connected disability. The issue of entitlement to a total rating based on individual unemployability was also addressed. After completion of certain actions requested by the Board, the veteran requested a second hearing on appeal, which was held at the RO on July 14, 1994. Before presenting testimony he withdrew the appeals involving the three additional service connection issues. The development requested with respect to the psychiatric disability was directed toward establishing whether the veteran's social and industrial adaptability was affected by an organic personality disorder and seizure disorder due to head trauma and by drug or alcohol abuse and, if so, whether there was a basis for the granting of service connection for such pathology. Psychiatric and neurological examinations performed following the remand led to medical findings that the veteran's personality disorder was functional rather than organic, that there was no organic neurological disease, and that the veteran was presently incapable of employment. However, the examinations reports do not adequately describe the extent to which social and industrial impairment results from PTSD alone. Withdrawal of the appeal for service connection for these disorders does not solve the problem since adjudication of the appeal for an increased rating for generalized anxiety disorder requires that the evidence be adequate to permit the symptoms of the service- connected and nonservice-connected disorders to be separated. In addition, the record contains no overall characterization of the degree of disability, such as a Global Assessment of Function (GAF) score on Axis V of the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.) (DSM III-R) of the American Psychiatric Association) (DSM-III-R) diagnosis classifications. A medical determination regarding these matters is required inasmuch as the Board is not free to exercise its own independent judgment on medical issues. Colvin v. Derwinski, 1 Vet.App. 171 (1991). See also Massey v. Brown, No. 93-135, U.S. Vet.App. (December 6, 1994). While the appeal was pending at the RO, a rating board increased the evaluation for lumbosacral strain from 10 percent to 20 percent from January 14, 1993. Since the medical evidence also shows degenerative disease of the lumbar spine, including herniated nucleus pulposus of L2-L3 and L3-L4, a determination must be made as to whether this pathology is to be included within the existing service connection grant. It appears that impairment resulting from degenerative disease may have been included in the award of a 20 percent rating, but the rating decision did not so state; clarification is therefore necessary. If service connection for degenerative disease has not in fact been granted, then this issue must be addressed on appeal following completion of additional evidentiary development; an orthopedic examination to determine whether degenerative disease due to or the proximate result of the service-connected lumbosacral strain will be required. 38 C.F.R. 3.310 (a) (1993). In view of the foregoing, the case is remanded to the RO for the following evidentiary development and adjudication: 1. The RO should review the rating determination of January 19, 1994, and clarify whether that decision resulted in an award of service connection of degenerative disk disease of the lumbar spine. If it is found that service connection was not granted, the issue of entitlement to service connection for this disability must de developed and certified for appeal. The development must necessarily include, as part of the orthopedic examination requested herein, a written medical opinion as to whether lumbosacral strain proximately caused the degenerative disk disease within the meaning of 38 C.F.R. 3.310 (a) (1993). 2. The veteran should undergo comprehensive psychological testing in accordance with the VA Physician's Guide for Disability Evaluation Examinations, including preparation of a complete personality profile. 3. Upon completion of the foregoing, the veteran should undergo a complete examination by a psychiatrist to ascertain the current status of the veteran's PTSD. The examination should conform to the requirements of the VA Physician's Guide for Disability Evaluation Examinations (IB-11- 56, March 1, 1985) (Physician's Guide) and the report should be detailed. The examiner should itemize in detail all of the manifestations of PTSD. The degree of impairment due to PTSD should be characterized and a Global Assessment of Functioning (GAF) score should be assigned. The basis for the determinations should be stated in full. The examiner should base her or his conclusions on current findings, history reported by the veteran and information documented in the complete claims file, which should be carefully reviewed. 4. The veteran should undergo a special examination by an orthopedist to ascertain the current status of the veteran's service- connected low back disability. The examination should conform to the requirements of the VA Physician's Guide and all findings should be reported in detail. All necessary special studies should be performed. The extent to which pain contributes to functional impairment should be specifically described. The examiner should base his or her determinations on current findings, history reported by the veteran and information documented in the complete claims file, which should be carefully reviewed. 5. When the foregoing development has been completed, the RO should review the reports for compliance with the instructions stated herein and take all necessary followup actions. The issues on appeal should then be reviewed by the RO. All medical determinations should be based on medical evidence in the written record, which should be expressly cited. If the decision remains adverse to the veteran, in whole or in part, a supplemental statement of the case should be prepared and the veteran and his representative should be given a reasonable period of time for reply. Thereafter, the claim should be returned to the Board for further review, if in order. No action is required of the veteran until he receives further notice. The purpose of this REMAND is to obtain additional information. The Board does not intimate any factual or legal conclusions as to the outcome ultimately warranted in this appeal. __________________________________ STEPHEN L. WILKINS 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).