BVA9508392 DOCKET NO. 91-39 549 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUES 1. Entitlement to an increased rating for an anxiety disorder, formerly paranoid schizophrenia, currently rated as 30 percent disabling. 2. Entitlement to a total rating for compensation purposes based on individual unemployability. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD R. D. Turano, Counsel INTRODUCTION The veteran served on active duty from January 1968 to February 1970. This matter came before the Board of Veterans Appeals (Board) from a March 1986 decision by the Regional Office (RO) which denied the veteran's claim for a compensable rating for his psychiatric disability then classified as paranoid schizophrenia. A notice of disagreement was received in April 1986. The statement of the case was issued in May 1986. A substantive appeal was received in August 1986. In August 1987, the RO again reclassified the service connected disability to anxiety disorder with a history of atypical psychosis and assigned a 30 percent evaluation. In a decision dated in July 1989, entitlement to a total rating for compensation purposes based on individual unemployability was denied. The RO confirmed and continued the 30 percent evaluation for an anxiety disorder. The case was remanded by the Board in February 1992 which at this time construed the issues to be entitlement to an increased evaluation for service connected anxiety disorder prior to and following the Schedule for Rating Disabilities changes effective February 3, 1988; entitlement to service connection for schizophrenia and entitlement to a total rating for compensation purposes based on individual unemployability. In action by the RO dated in July 1993 it was proposed that the veteran be rated incompetent for Department of Veterans Affairs (VA) purposes. In a rating decision dated on February 16, 1994, this proposal was implemented effective on that date. In a decision dated in May 1994, the RO incorporated schizophrenia into the current service connected disability therein rendering the issue of entitlement to service connection for schizophrenia moot. In a decision dated in January 1995, the RO determined that the veteran was competent for VA purposes and confirmed the 30 percent evaluation for anxiety disorder. In light of the foregoing, the Board will undertake to review those issues listed on the first page of this decision with consideration given to all applicable laws, regulations and schedular criteria. REMAND A review of the history of the adjudicative action and the veteran's psychiatric disorder indicates significant fluctuations in the evaluations assigned and the classification of his psychiatric disorder. Currently, the veteran is evaluated for anxiety disorder which, according to the May 1994 decision by the RO, incorporates all impairment associated with schizophrenia. The veteran was last examined by the VA in June 1993 at which time it was noted that the veteran had poly-substance abuse. The diagnoses included acute confusional state and history of polysubstance abuse. He was found, at this time to be incompetent to manage his financial affairs. The record indicates that the veteran failed to report for a scheduled VA examination in January 1994. However, further records indicate that the veteran was hospitalized at the VA Medical Center, Battle Creek, Michigan from October 16, 1993, to January 13, 1994. Upon discharge, the diagnoses included schizophrenia, alcohol dependence and post-traumatic stress disorder. On the rating decision dated in May 1994, it was indicated that the veteran failed to report for the VA examination and that in the absence of a request by the veteran to re-schedule this examination, or an indication the veteran was willing to report for an examination, the claim would be reviewed based on the evidence of record. The veteran was subsequently found to be competent for VA purposes in January 1995. The Board finds that in light of the circumstances relating to the veteran's failure to report for this scheduled examination, and the apparent changes in his condition as to his competency, he should be provided another opportunity for examination. As well, any current inpatient or outpatient treatment records should be secured. Moreover, under the circumstances, the Board finds that a social and industrial survey would assist in the proper adjudication of these matters on appeal. Additionally, the Board construes the findings on the June 1993 VA examination as well as other related evidence, to necessitate review of the issue of entitlement to service connection for poly substance abuse, including alcohol, as secondary to his long- standing psychiatric impairment. The United States Court of Veterans Appeals has stated that issues which are inextricably intertwined must be resolved together, because the Court will not review Board decisions in a piecemeal fashion. Harris v. Derwinski, 1 Vet. App. 180 (1991). As such, the Board finds that resolution of this issue by the RO should be accomplished to the extent possible, prior to appellate review. Following this action the RO should review those issues currently in appellate status with consideration given to all evidence and applicable laws and regulations including 38 C.F.R.§§ 3.321, 4.16(b) (1994), if appropriate. In light of the foregoing, it is the decision of the Board that further development of this claim is in order. Accordingly, this case is hereby remanded for the following actions: 1. The RO should secure copies of all VA inpatient and outpatient treatment of the veteran which are relative to this claim, and have not previously been secured. 2. The RO should schedule the veteran for a VA social and industrial examination to determine the effect the veteran's service connected disabilities may have on his ability to obtain or maintain substantially gainful employment. 3. The RO should schedule the veteran for a VA psychiatric examination in order to determine the degree of impairment associated with the service connected psychiatric disorder and any associated industrial impairment. The examiner should state whether any alcohol or poly-substance abuse is demonstrated and any etiology thereof. Detailed findings should be set forth as well as a statement in support of any conclusions reached. All necessary studies should be accomplished and the claims folder should be made available to the examiner prior to the examination. 4. The RO should then adjudicate the issue of entitlement to service connection for poly- substance abuse, including alcohol as secondary to the veteran's service connected psychiatric disorder. The veteran should be notified of this decision, and if adverse, should be informed of his procedural and appellate rights. 5. Thereafter, the RO should review all issues in appellate status with consideration given to any additional evidence obtained. With regard to the issue of entitlement to an increased rating for an anxiety disorder, the RO should consider any impairment related to a possible psychosis as well as that resulting from a psychoneurosis. Further, consideration should be given to the provisions of 38 C.F.R.§ 3.321 (1994), if in order. In adjudicating the issue of entitlement to a total rating for compensation purposes based on individual unemployability, consideration should be given to impairment associated with all service connected disorders as well as 38 C.F.R.§ 4.16(b) (1994), if appropriate. 6. In the event findings remain adverse to the veteran with respect to any issue in appellate status, the veteran and his representative should be furnished a supplemental statement of the case and be afforded the opportunity to respond. Thereafter, the case should be returned to the Board after compliance with all appropriate appellate procedure. No action is required of the veteran until he is further notified. In reaching these conclusions the Board intimates no opinion, either legal or factual, as to the ultimate outcome of this case pending completion of the requested development. G.H. SHUFELT 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) (1994).