BVA9502406 DOCKET NO. 92-22 607 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUE Entitlement to service connection for a chronic acquired psychiatric disorder. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD James A. Frost, Associate Counsel REMAND The veteran served on active duty from August 1946 to August 1947. This appeal arises from a rating decision in June 1991 by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. In a decision of August 1994, the Board of Veterans' Appeals (the Board) remanded this case to the RO so that the veteran could be apprised of the provisions of 38 C.F.R. § 3.303(b) and have an opportunity to present additional evidence and argument in support of his appeal. The case was returned to the Board in October 1994. The veteran's service medical records disclose that at an examination for enlistment in August 1946 no psychiatric disorder was noted. During service the veteran developed hive-like lesions on his body; at a dermatological examination in March 1947 the impression was psychogenic nocturnal urticaria. During hospitalization in March 1947, the veteran underwent a neuropsychiatric examination. He reported that he was jumpy and didn't sleep well. Despite having received medical clearances, he didn't want to leave the hospital. The diagnosis was emotional instability reaction, chronic, moderate, manifested by transient psychogenic urticaria, shallow sleep, tremulousness and hyperhidrosis, which existed prior to entry into service. At an examination for service separation in July 1947, the psychiatric diagnosis was "inaptness." In November 1960 the veteran was admitted to a VA medical center for treatment of a duodenal ulcer. The hospital summary indicated that the veteran "admitted to being very emotional and to being a worrying type." In July 1990 F. J. Walnista, M.D., a private physician, reported that the veteran had marked ulcer pains, hiatal hernia pains and insomnia, "all due to a marked stress situation at his work." He had marked anxiety and periods of marked depression. Dr. Walnista was of the opinion that the veteran was unable to keep working. He stated, "I have known Frank for many years and I can not believe in this short time all this happened." In May 1991 Dr. Walnista reported that the veteran had marked anxiety and depression and frequent attacks of angina pectoris. In June 1991 Dr. Walnista stated that the veteran had suffered from "a severe stress syndrome" since he became disabled on August 2, 1990. He was taking Xanax. In a letter to the RO, received in May 1992, the veteran stated that he was healthy when he joined the Army in 1946 and had a "nervous breakdown" in service. In his substantive appeal, received in August 1992, he stated that he was emotionally stable at entrance into service. In June 1992, an administrative law judge of the Social Security Administration found that the veteran had been disabled since August 1990 by reason of severe anxiety and depressive disorders. Service connection may be granted for disability resulting from injury or disease incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131. Service connection connotes many factors but basically it means that facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with military service or, if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303(a). Service connection may be also be granted for an acquired psychiatric disorder when psychosis is compensably disabling within one year of the veteran's separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. A personality disorder, as distinguished from an acquired psychiatric disorder, is not a disease or injury within the meaning of applicable legislation providing disability compensation to veterans. 38 C.F.R. § 3.303 (c). In the veteran's case, the Board finds that there is an unresolved medical question as to whether the diagnosis of "emotional instability reaction" rendered in 1947 by the service department psychiatrist constituted a finding or diagnosis of a personality disorder or of an acquired psychiatric disorder. The Board takes notice of the fact that the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders was not published until 1952. This case is REMANDED to the RO for the following: 1. The RO should obtain the records which were used by the Social Security Administration in the June 1992 decision. 2. After receipt of the above records, the RO should schedule the veteran for a psychiatric examination, to be conducted by a physician who is a specialist in psychiatry. It is imperative that the examiner review the veteran's medical records in his claims folder, especially the report of the neuropsychiatric examination in March 1947 which resulted in a diagnosis of "emotional instability reaction". The examiner is to review the symptomatology noted in service, and thereafter, and make a diagnosis(es) of the psychiatric condition presented by the veteran during service, using the multiaxial system. of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition (1994). The examiner also should render all appropriate psychiatric diagnoses, including any acquired disorders and any personality disorders found on current examination. The examiner should also offer an opinion on the question of whether the March 1947 diagnosis of "emotional instability reaction" referred to an acquired psychiatric disorder or to a personality disorder. Following completion of these actions, the RO should review the evidence and determine whether the veteran's claim may now be granted. If the decision remains adverse to the veteran, he and his representative should be provided with an appropriate Supplemental Statement of the Case and an opportunity to respond thereto. The case should then be returned to the Board for further appellate consideration. The purpose of this REMAND is to obtain clarifying medical information. No action is required of the veteran until he receives further notice. 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).