BVA9502787 
DOCKET NO.  93-08 541     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Boston,
Massachusetts

THE ISSUE

Entitlement to a permanent and total disability rating for
pension purposes.

REPRESENTATION

Appellant represented by: Veterans of Foreign Wars of the
United States

ATTORNEY FOR THE BOARD

Raymond F. Ferner, Counsel

INTRODUCTION

This matter comes before the Board of Veterans' Appeals (BVA or
Board) on appeal from a November 1991 rating decision of the
Department of Veterans Affairs (VA) Regional Office (RO) in
Boston, Massachusetts, which denied the benefits sought on
appeal.  The veteran, who had active service from December 1971
to August 1972, appealed that decision to the BVA and the case
was received at the Board in April 1993.

REMAND

A preliminary review of the record discloses that the series of
VA examinations performed in July 1992 did not include pulmonary
function testing or a chest X-ray.  Also, the VA examination for
"non-tuberculosis diseases and injuries" did not conclude with an
assessment, impression or diagnosis.  In view of the diagnoses of
chronic obstructive pulmonary disease and asthma which are of
record, and the fact that during an April 1992 outpatient
psychiatric evaluation the veteran was described as "gasping for
breath" and talkative but affected by shortness of breath, the
Board is of the opinion that a complete and comprehensive
examination of the veteran's pulmonary status would be useful in
evaluating the veteran's capacity for performing substantially
gainful employment.

Also, the veteran submitted a statement from a VA physician which
was apparently obtained for submission to the Massachusetts
Department of Public Welfare, which indicates, essentially, that
the veteran is totally disabled and that he has an "inability to
function in almost all areas."  None of the VA examinations
express a medical opinion concerning the veteran's degree of
disablement or his capacity for performing substantially gainful
employment, and in particular, the VA psychiatric examination
does not contain an Axis V diagnosis (Global Assessment of
Functioning) as referred to in the American Psychiatric
Association Diagnostic and Statistical Manual of Mental Disorders
(3rd ed. rev. (1987) which has been adopted into the VA's
Schedule for Rating Disabilities by 38 C.F.R. §§ 4.125, 4.126
(1994).  Consequently, an additional psychiatric evaluation of
the veteran would also be useful.

Therefore, in order to give the veteran every consideration with
respect to the present appeal, it is the Board's opinion that
further development of the case is desirable.  Accordingly, this
case is REMANDED for the following actions:

1.  The veteran should be afforded a
pulmonary examination to ascertain the
nature, severity and manifestations of the
veteran's respiratory disorders.  Any and
all indicated evaluations, studies, and
tests deemed necessary by the examiner
should be accomplished, but should include
pulmonary function tests.  The examiner is
specifically requested to offer an
interpretation of the findings of the
pulmonary function testing.  The primary
purpose of the examination is to assess the
severity of the veteran's respiratory
impairment and to quantify the degree of
social and industrial impairment caused by
the veteran's respiratory disorders.  The
examiner is specifically requested to
comment and offer an opinion as to the
degree of impairment in the veteran's
capacity for performing substantially
gainful employment which is produced by the
veteran's respiratory disorders.  Since it
is important "that each disability be
viewed in relation to its history[,]"
38 C.F.R. § 4.1 (1994), copies of all
pertinent medical records in the veteran's
claims file or, in the alternative, the
claims file, must be made available to the
examiner for review prior to, and during,
the examination.

2.  The veteran should be afforded a
psychiatric examination by an examiner who
has not previously examined or treated the
veteran to ascertain the nature, severity
and manifestations of all psychiatric
disorders which may be present.  Any and
all indicated evaluations, studies, and
tests deemed necessary by the examiner
should be accomplished, but should include
psychological testing.  The primary purpose
of this examination is to assess the
severity of the veteran's psychiatric
disorders and the degree of impairment
those disorders produce in connection with
the veteran's capacity for performing
substantially gainful employment.  The
examiner is specifically requested to
comment and offer an opinion concerning the
degree of impairment to the veteran's
capacity for performing substantially
gainful employment which is caused by the
psychiatric disorders which may be present.
The examiner must assign an Axis V
diagnosis (Global Assessment of Functioning
Scale), consistent with the American
Psychiatric Association's Diagnostic and
Statistical Manual for Mental Disorders
(3rd. ed. rev. 1987), and explain what the
assigned score represents.  A complete
rationale for any opinion expressed would
be helpful.  The examiner is also requested
to attempt to quantify the degree of social
and industrial impairment which may be
present in terms of the nomenclature in
38 C.F.R. § 4.132 (1994).  Since it is
important "that each disability be viewed
in relationship to its history[,]"
38 C.F.R. § 4.1 (1994), copies of all
pertinent medical records in the veteran's
claims file or in the alternative, the
claims file, must be made available to the
examiner for review prior to, and during,
the examination.

When the development requested has been completed, the case
should again be reviewed by the RO on the basis of the additional
evidence.  If the benefit sought is not granted, the veteran and
his representative should be furnished a supplemental statement
of the case, and be afforded a reasonable opportunity to respond
before the record is returned to the Board for further review.

The purpose of this REMAND is to obtain additional development,
and the Board does not intimate any opinion as to the merits of
the case, either favorable or unfavorable, at this time.  The
veteran is free, of course, to submit any additional evidence he
desires to have considered in connection with his current appeal.
No action is required of the veteran until he is notified.

          WARREN W. RICE, JR.
          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).