BVA9502806 DOCKET NO. 92-04 044 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUES 1. Whether a July 1981 rating action denying service connection for schizophrenia involved clear and unmistakable error. 2. Whether new and material evidence has been submitted to reopen a claim for entitlement to service connection for schizophrenia. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD Michael P. Vander Meer, Associate Counsel INTRODUCTION The veteran served on active duty from May 1979 to January 1980. In July 1981, the Department of Veterans Affairs (VA) Regional Office in Chicago, Illinois, denied the veteran's claim of entitlement to service connection for schizophrenia. The veteran did not file a notice of disagreement within one year of notice of that decision. This appeal arises from a February 1992 rating decision of the VA Regional Office (RO) in Detroit, Michigan. This case was last before the Board of Veterans' Appeals (Board) in March 1993, at which time it was remanded for further development. Following completion of the requested development, a rating decision entered in March 1994 continued to deny each benefit sought on appeal, and a Supplemental Statement of the Case was issued the same month. A hearing was held at the RO in May 1994, and the hearing officer's decision was entered the following month. A Supplemental Statement of the Case was issued in August 1994. The appeal was returned to and redocketed at the Board in December 1994. REMAND With respect to the issue of whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for schizophrenia, it is noted that when the veteran was examined for Medical Board purposes in November 1979, he indicated having been seen by a psychiatrist on seven or eight occasions prior to service due to a 'nervous breakdown.' He indicated that such nervous breakdown, which he felt was the same condition with which he was then experiencing in service, was accompanied by voices "coming to him" which made him nervous. He also noted that he had become particularly afraid of being changed into a cat. When examined for Medical Board purposes in November 1979, the veteran related that he was afraid of being killed or changed into a bat or iguana. Findings on mental status examination included auditory and visual hallucinations as well as persecutory delusions accompanied by anxiety. The examiner noted that the veteran had been admitted to the psychiatric ward of a service hospital in a state of panic, frightened that various individuals wanted to change him into a girl, bat or cat, though his persecutory delusions receded gradually in the course of treatment which included supportive psychotherapy. After a period of sufficient treatment and observation, a conference of staff psychiatrists found that the veteran had "been suffering from a chronic psychotic process which became exacerbated and aggravated by the service." The diagnosis was schizophrenia, paranoid type, severe, chronic, exacerbated, existing prior to service. Most recently, the veteran underwent VA psychiatric examination in November 1993, the report of which includes the examiner's opinion in response to an inquiry whether the psychosis with which the veteran was diagnosed in service underwent pathological advancement during service beyond that consistent with the natural progress of the condition. However, after reviewing the report of the November 1993 examination, the Board is of the opinion that another VA examination, as specified in greater detail below and to be performed by an examiner who has not previously examined the veteran, would be helpful before an appellate determination is made. It is also noted, on review of the file, that an April 1984 entry in clinical reports pertaining to therapy rendered the veteran by the City of Chicago Department of Health reflects that the veteran had been recently discharged following a one-month period of hospitalization at the VA West Side Medical Center in Chicago, Illinois. In response to a March 1993 request from the RO for records pertaining to treatment rendered the veteran at that facility since 1981, such facility indicated that the veteran's records could be obtained from the VA Medical Center in Battle Creek, Michigan. However, an apparent attempt by the RO in May 1993 to obtain the foregoing records from the Battle Creek facility is shown to have been unavailing. In addition, at his May 1994 hearing, the veteran testified that he has received treatment for psychiatric problems from 1987 to the present at the VA Outpatient Clinic in Grand Rapids, Michigan. However, an apparent attempt by the RO in March 1993 to obtain records reflecting treatment rendered the veteran at that facility since 1986 is shown to have been unsuccessful. Further development pertaining to the foregoing matters is specified below. The veteran also indicated at his hearing that he began to receive psychiatric treatment in 1987 from Frank W. King, D.O. In response to the RO's previous request for records in March 1993, Dr. King indicated that the veteran had last been treated under the auspices of his office in October 1990. However, Dr. King did not provide copies of any clinical records that may have been prepared in conjunction with treatment rendered the veteran at any time. Further development in this regard is specified below. Accordingly, the case is REMANDED for the following: 1. The RO should contact the veteran and request him to identify the names, addresses, and approximate dates of treatment for any health care provider(s), other than the VA Medical Center and Outpatient Clinic in Battle Creek and Grand Rapids, Michigan, respectively, or any therapist associated with Frank W. King, D.O., who may possess additional records pertinent to his claim for service connection for schizophrenia. Thereafter, in light of the response received and after obtaining any necessary authorization, the RO should take appropriate action to obtain copies of any clinical records indicated. In any event, the RO should obtain copies of all clinical records pertaining to the veteran in the custody of the VA Medical Center in Battle Creek, Michigan, to specifically include all reports pertaining to the veteran's VA hospitalization in 1984; copies of all clinical records reflecting treatment rendered the veteran from 1986 to the present at the VA Outpatient Clinic in Grand Rapids, Michigan; and copies of any clinical reports that may have been prepared in conjunction with therapy rendered the veteran from 1986 to the present under the auspices of Frank W. King, D.O., 19048 Obert Drive, Big Rapids, Michigan 49307. 2. Thereafter, the RO should arrange for the veteran to undergo an examination by a board certified psychiatrist, who has not previously examined the veteran, to determine the nature and extent of any current acquired psychiatric disability. In addition, after reviewing the record, to specifically include the report contained in service medical records pertaining to the veteran's November 1979 Medical Board examination, as well as the report of the veteran's examination by VA in November 1993, to offer an opinion whether it is at least as likely as not that the psychosis diagnosed during service underwent pathological advancement during service beyond the natural progress normally expected by reason of the inherent character of the condition. It is imperative that the claims folder and a copy of this REMAND be provided to the examiner for review prior to the examination. The rationale for all opinions expressed should be fully explained. 3. Then, after undertaking any development deemed necessary in addition to that specified above, the RO should readjudicate the issues on appeal. 4. If the foregoing benefit on appeal is not granted to the veteran's satisfaction, the veteran and his representative should be provided a Supplemental Statement of the Case on all issues in appellate status. The veteran should be provided appropriate notice of the requirements to perfect an appeal with respect to any issue addressed therein which does not appear on the title page of this decision. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. In taking this action, the Board implies no conclusions, either legal or factual, as to any ultimate outcome warranted. No action is required of the veteran until he is notified. ROBERT E. SULLIVAN 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).