BVA9504507 DOCKET NO. 93-11 108 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in New York, New York THE ISSUES 1. Entitlement to service connection for a psychiatric disorder, claimed as substance abuse including alcohol. 2. Entitlement to service connection for chronic disorders of the left shoulder and elbow. 3. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for asthma. 4. Entitlement to an increased evaluation for residual scars, post ganglionectomy, right foot, with history of mild atrophy of the peroneal muscles, currently evaluated as 10 percent disabling. 5. Entitlement to a permanent and total disability rating for pension purposes. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Ronald R. Bosch, Counsel INTRODUCTION The veteran served on active duty from November 1967 to June 1969. The claims file contains a report of a rating decision dated in October 1976 denying entitlement to service connection for bronchial asthma. The current appeal arose from an April 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in New York, New York. The RO denied entitlement to an increased evaluation for disability of the right lower extremity, affirmed the prior denial of entitlement to service connection for asthma, and denied entitlement to a permanent and total disability rating for pension purposes. In a rating decision issued in January 1992, the RO denied entitlement to service connection for a psychiatric disorder claimed as substance abuse including alcohol, determined that new and material evidence had not been submitted to reopen a prior denial of entitlement to service connection for asthma, and continued the denial of entitlement to an increased evaluation for disability of the right lower extremity. The RO affirmed the determinations previously entered and denied entitlement to service connection for chronic disorders of the left shoulder and elbow when it issued a rating decision in May 1992. The case has been forwarded to the Board of Veterans' Appeals (Board) for appellate review. REMAND The veteran is claiming permanent and total disability for pension benefits. The veteran last underwent a comprehensive general medical examination of all body systems when he was examined by VA in November 1970. Examinations on file since then have essentially been limited to assessing residual disability of the right foot. The April 1992 VA examination was neurological in nature. The veteran has claimed back, left shoulder and left elbow disorders, and a chronic asthmatic disorder. He has claimed psychiatric disability as reflected by abuse of drugs including alcohol. Appropriate examinations to determine his overall functional capacity for following substantially gainful employment have not been conducted.A VA Vocational Rehabilitation folder has been constructed for the veteran. Such folder has not been associated with the claims file. The appellant states that due to his service-connected right foot injury, he fell and sustained injuries of the left shoulder and elbow. In his statements on appeal the veteran has claimed initial treatment for injury of his right shoulder and elbow at Bellevue Hospital. He has also claimed treatment at VA Medical Centers in New York City and Brooklyn, New York. The records pertaining to treatment have not been associated with the claims file. The Board is of the opinion that association with the appellate record of the earlier discussed missing evidence and contemporaneous mediocal examinations would materially assist in the disposition of the claimant's appeal. Pursuant to VA's duty to assist the appellant 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 adjudication of all issues prepared and certified for appellate review pending a REMAND of the case to the RO for further development as follows: 1. The RO should contact the veteran and request that he submit a statement detailing the date, place, and circumstances of the injury to his left shoulder and elbow which he asserts was due to his service-connected right foot disability. 2. After obtaining any necessary authorization, the RO should request and associate with the claims file copies of the complete records pertaining to the veteran's treatment at Bellevue Hospital. 3. The RO should request and associate with the claims file copies of the complete records pertaining to the veteran's treatment at the VA Medical Centers in New York City and Brooklyn, New York, which have not previously been secured. 4. The appellant's VA Vocational and Rehabilitation folder should be obtained and associated with the claims file. 5. The RO should arrange for a comprehensive general medical examination to include a psychiatric evaluation. Inquiry should be made as to the veteran's complaints and he should be examined accordingly. This study is to determine the nature and severity of all of the veteran's disorders. Specifically, the examinations should evaluate the nature and extent of any disorders of the left shoulder and elbow which may be present, the nature and extent of asthma which may be present, and the the extent of severity of postoperative residuals of a ganglionectomy of the right foot which may be present. The veteram is to be given a psychiatric examination to determine the nature and extent of any psychiatric disorder(s) which may be present. These evaluations are to be conducted in accordance with the diagnostic procedures outlined in the VA Physician's Guide for Disability Evaluation Examinations. All indicated studies are to be conducted. The examiners conducting the evaluations are requested to provide an opinion as to the impact of the veteran's disabilities on his ability to secure or follow a substantially gainful occupation. All opinions expressed must be accompanied by a complete rationale. The psychiatric examiner must assign a Global Assessment of Functioning Score (GAF) consistent with the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (3rd. ed. rev., 1987), and explain what the assigned score represents. The claims file must be made available to and reviewed by the examiners prior to the examinations. 6. Thereafter, the RO should review the examination reports to ensure that they are in complete compliance with the instructions contained in this REMAND. If the examination reports, including the requested opinions, are not in complete compliance, the RO should take appropriate corrective action. 7. After undertaking any development deemed appropriate in addition to that specified above, the RO should readjudicate all pending issues including the issue of entitlement to a permanent and total disability for rating purposes consistent with the criteria under 38 U.S.C.A. §§ 1502(a)(1), 1521(a) (West 1991); 38 C.F.R. §§ 3.321(b)(2), 4.15, 4.16, 4.17, 4.25 (1994); as well as the provisions of Talley v. Derwinski, 2 Vet.App. 282 (1992); Brown v. Derwinski, 2 Vet.App. 444 (1992); and Roberts v. Derwinski, 2 Vet.App. 387, 390 (1992). 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 must include the criteria for all of the appropriate diagnostic codes under which the RO has rated each of the appellant's disabilities. The RO must include a discussion of the average person standard and unemployability standards by which a permanent and total disability rating for pension may be assigned. Brown. The veteran and his representative should then 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 claimant 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) (1994).