BVA9502531 DOCKET NO. 93-09 667 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim for entitlement to service connection for post- traumatic stress disorder. 2. Entitlement to a permanent and total disability rating for pension purposes. REPRESENTATION Appellant represented by: AMVETS ATTORNEY FOR THE BOARD Ronald R. Bosch, Counsel INTRODUCTION The veteran served on active duty from October 1970 to June 1972. The claims file contains a report of a June 1986 rating decision denying entitlement to service connection for post-traumatic stress disorder on the basis that it was not shown by the evidence of record. This appeal arose from a May 1990 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The RO denied entitlement to a permanent and total disability rating for pension purposes. The RO affirmed the above determination in January 1991. The RO determined that new and material evidence had not been submitted to reopen a previously denied claim of entitlement to service connection for post-traumatic stress disorder when it issued a rating decision in June 1991. The RO affirmed the denial of entitlement to a permanent and total disability rating for pension purposes and the determination that new and material evidence had not been submitted to reopen a claim of entitlement to service connection for post-traumatic stress disorder in later dated rating decisions issued in 1991 and 1992. The case has been forwarded to the Board of Veterans' Appeals (Board) for appellate review. REMAND The veteran served on active duty with the United States Army as an operation room specialist and medical corpsman. His decorations include a Vietnam Service Medal and a Vietnam Campaign Medal with 60 device. In a March 1990 statement on file the veteran has reported receiving treatment for psychiatric symptomatology at VA Medical Centers in Bay Pines, Florida; St. Louis, Missouri; Marion, Illinois; and Houston, Texas. Prior to submission of the above statement, the claims file already had a hospital discharge summary pertaining to inpatient care during November and December, 1979, at the VA Medical Center in St. Louis, Missouri, and other hospital records from Bay Pines, Florida. Additional records pertaining to his treatment have been secured from the VA Medical Center in Bay Pines, Florida; however, possible additional records of treatment at the VA Medical Center in St. Louis, Missouri, and records from the other medical facilities noted above have not been requested. Moreover, the veteran states that he has been receiving treatment in the Post-traumatic Stress Disorder Program at the VA Medical Center in Bay Pines, Florida. These records have not been obtained. The veteran has received extensive treatment for paranoid schizophrenia from VA and non-VA health care professionals. Such treatment has included inpatient care. Although paranoid schizophrenia was reported to be in remission when he was examined by VA in May 1991, he was subsequently hospitalized on several occasions for treatment of psychiatric symptomatology. The appellant has been diagnosed with post-traumatic stress disorder by a non-VA health care professional, and records pertaining to his treatment for this disorder in addition to treatment for paranoid schizophrenia are on file. The veteran is receiving disability benefits from the Social Security Administration. The records utilized in determining his eligibility for such benefits are not on file. While the veteran has been psychiatrically examined, he has not been afforded the benefit of a general medical examination of medical body systems for pension purposes. As the Board noted earlier, the veteran served as a medical corpsman in Vietnam. He has described the death of a noncommissioned officer and being subjected to enemy attacks. As such, more specific detail as to the nature of his alleged exposure to personal life threatening stressors with action by the RO to obtain verification of such exposure is desirable. The Board is of the opinion that association with the appellate record of the above discussed missing VA records of treatment and Social Security Disability records, a more comprehensive and detailed stressor statement from the veteran, as well as contemporaneous comprehensive psychiatric testing by VA would materially assist in the adjudication of the claimant's appeal. Under 38 C.F.R. § 3.304(f) (1994), service connection for post- traumatic stress disorder requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed inservice stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed inservice stressor(s). If the claimed stressor(s) is(are) related to combat, service department evidence that the veteran engaged in combat or that the veteran was awarded the Purple Heart, Combat Infantryman Badge, or similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor(s). In addition, VA's Manual M21-1 contains specific procedures for VA to follow in evaluating claims for service connection for post-traumatic stress disorder. Manual M21-1, Part VI, Para 7.46(e), (f) (Dec. 21, 1992). Pursuant to VA's duty to assist the veteran in the development of facts pertinent to his claim under 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1994), the Board is deferring a final decision pending a REMAND of the case to the RO for further development as follows: 1. The RO should request and associate with the claims file photocopies of the complete records pertaining to the veteran's treatment at the VA Medical Centers in Houston, Texas; Marion, Illinois; St. Louis, Missouri; and Bay Pines, Florida, including records pertaining to his treatment in the Post- traumatic Stress Disorder Program, which have not previously been secured. 2. The RO should obtain from the Social Security Administration the records pertinent to the appellant's claim for Social Security Disability Benefits as well as the records relied upon concerning that claim. If records pertaining to such claim and medical evidence utilized in processing such claim are not available, that fact should be entered in the claims file. 3. The veteran should be asked to provide more specific facts, if available, about the stressful events he claims to have experienced in service. He should be asked to provide dates and places, as well as his unit assignment at the time of each claimed stressor. The appellant should provide the names of service comrades killed or wounded in action, and the approximate date of death or injury for each such person. 4. The information provided by the claimant concerning the specific circumstances of the claimed stressors and a copy of his service records should be sent to the United States Army and Joint Services Environmental Support Group (ESG), 7798 Cissna Road, Springfield, Virginia 22150, for verification of the claimed stressors. 5. The RO should arrange for the veteran to be seen by a psychologist who should conduct appropriate diagnostic studies, including the Minnesota Multiphasic Personality Inventory evaluation with post- traumatic stress disorder sub scale testing, to determine the nature and extent of any psychiatric disability which may be present. The veteran should be scheduled for any further indicated psychological testing. 6. After, and only after, all of the foregoing development has been completed, the RO should schedule the veteran for an examination by a board of 2 VA psychiatrists. It is imperative that each examiner actually review the appellant's entire claims file, prior to conducting their examinations. It is requested that a diagnosis of post-traumatic stress disorder be confirmed or ruled out. If it is concluded that a diagnosis of post- traumatic stress disorder is warranted, the examiners should specify the stressor(s) believed to have brought on the disorder and it should be specified what evidence was relied upon to determine that the veteran was exposed to such stressor(s). Any opinions expressed must be accompanied by a detailed rationale. Again, the claims file must be made available to and reviewed by the examiners for a comprehensive study as specified above prior to the examinations. Any examination which does not fulfill all of these requirements must be returned to the examiners as being inadequate. In particular, any examination report which relies on a questionable history must be returned as inadequate. 7. After undertaking any development deemed appropriate in addition to that specified above, the RO should readjudicate the issue of whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for post-traumatic stress disorder. If the benefits requested on appeal are not granted to the veteran's satisfaction, the RO should issue a supplemental statement of the case. The supplemental statement of the case should include the provisions of the appropriate diagnostic codes under which the RO has rated each of the appellant's disabilities, as well as a discussion of the average person standard and unemployability standard by which a permanent and total disability rating for pension purposes may be assigned. The veteran and his representative should be provided a reasonable opportunity to respond. Thereafter, the case should be returned to the Board for further appellate review, if otherwise in order. By this REMAND, the Board intimates no opinion as to any final outcome warranted. No action is required of the veteran until he is notified by the RO. BRUCE KANNEE 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).