BVA9508441 DOCKET NO. 93-12 639 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUES 1. Entitlement to service connection for a low back disorder. 2. Entitlement to service connection for a genitourinary disorder, variously diagnosed as chronic cystitis, prostatic urethritis, and neurogenic bladder disease. 3. Entitlement to restoration of service connection for a psychiatric disorder, variously diagnosed. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. D. Hayden, Counsel INTRODUCTION The veteran performed active duty from May 1985 to February 1987. Pursuant to a claim for compensation benefits submitted in November 1987, the Department of Veterans Affairs (VA) Regional Office in Phoenix, Arizona (RO) granted service connection for adjustment disorder to enuresis with anxiety which was evaluated as 10 percent disabling. Following a July 1990 VA examination, the RO in a July 1990 rating decision proposed to reduce the 10 percent evaluation for adjustment disorder to enuresis with anxiety to no percent. In an October 1990 rating decision, following a review of a statement submitted by the veteran, the RO characterized the veteran's psychiatric disorder as depressive disorder and determined that it was not disabling to a compensable degree. This matter has come before the Board of Veterans' Appeals (Board) on appeal from that decision. In June 1991, the RO granted service connection for enuresis which was evaluated as 10 percent disabling. The zero percent evaluation for depressive disorder was continued. In a companion decision, the RO proposed to sever service connection for depressive disorder. After review of additional evidence, including the veteran's testimony at an RO hearing, the RO severed service connection for depressive or dysthymic disorder and denied service connection for a low back disorder, prostatic urethritis and chronic cystitis and neurogenic bladder. The veteran has also appealed that decision. REMAND Service connection will be severed only where evidence establishes that the grant of service connection was clearly and unmistakably erroneous with the burden of proof being on the Government. 38 C.F.R. § 3.105(d) (1994). During service the veteran was evaluated for periods of enuresis. A VA examination performed in February 1988 found an adjustment disorder due to enuresis manifested by anxiety, sadness and frustration. The veteran was service-connected for an adjustment disorder due to enuresis with anxiety. In January 1992, the Social Security Administration found the veteran to be qualified for disability benefits, based primarily on VA records. Dysthymic disorder was diagnosed following an August 1992 VA examination. In connection with that examination, the examiner reported that it would be helpful to obtain formal psychological testing. In addition to restoration of service connection for a psychiatric disorder, the veteran seeks service connection for a number of physical disorders. It appears that he is relating his bladder infections to a neurogenic bladder resulting from a spinal cord injury. In this regard, the Board observes that a March 1988 VA neurological examination found the left lower extremity to be slightly weaker than the right. The examiner felt that it was not abnormal at the time. However, subsequent examinations have shown definite neurologic dysfunction. Because of the episodes of enuresis during service, the findings on the 1988 VA examination and the current findings, the veteran's claim is well grounded. The VA has the duty to assist the veteran in developing all facts pertinent to a well-grounded claim. 38 U.S.C.A. § 5107(a) (West 1991). Because the severance of service connection is initiated by the VA, the plausibility of the veteran's claim is not an issue with regard to that matter. The case is REMANDED for the following additional development: 1. The veteran should be requested to furnish a comprehensive list of all examinations and treatment before and subsequent to service. This list should include the name and address of the treating or examining physician(s), including pediatricians or facility (ies) and the approximate dates of examination or treatment. The veteran should be requested to authorize the release of all identified examination or treatment records and furnished the necessary forms to do so. Thereafter, the RO is to contact the named individuals and facilities and obtain copies of the pertinent records and associate with them with the claims file. 2. The RO is to contact the Social Security Administration and obtain from them copies of the records, including medical reports used in their January 1992 disability determination. These records are to be associated with the claims folder. 3. When the foregoing development has been completed, the veteran should be scheduled for a period of observation and examination at a VA medical center. While confined, he is to be examined by Boards of VA specialists in urology, neurology and psychiatry, for a total of not less than two physicians in each speciality, and a total of six physicians in all. Such examinations should be conducted in accordance with the Physician's Guide for Disability Evaluation Examinations (Physician's Guide) and should include all indicated tests and studies, including psychological testing. The claims file must be made available and reviewed by each examiner prior to the examinations. Thereafter, the examiners should be requested to coordinate their findings to discuss the following questions: (a) Whether it is more or less or equally probable that the enuresis in service was the manifestation of a psychiatric disorder, an organic disease or isolated episodes of no clinical significance. (b) If the enuresis was due to a psychiatric disorder, what is the most probable diagnosis and the probable date of inception. (c) If the veteran has a neurological disorder, including a discogenic problem, as a cause for his bladder dysfunction, it should be reported whether it is more, less or equally probable that the findings on the March 1988 VA neurological examination represented the first manifestation of the neurologic abnormality. (d) The physicians should be requested to discuss their conclusions in some detail pointing out the reasons for their conclusions and the specific findings upon which such conclusions were based. Following completion of the foregoing, the RO must review the claims folder and ensure that the foregoing development has been completed to the extent possible. If any development is incomplete or if the medical opinions are not adequately supported, appropriate corrective action is to be implemented. When the foregoing development is completed, all of the evidence should be reviewed and the case should be readjudicated by the RO. If the benefits sought on appeal are not granted to the veteran's satisfaction, he and his representative should be furnished a supplemental statement of the case and afforded a suitable opportunity to respond. If the matter is not resolved to the veteran's satisfaction, the case should be returned to the Board, if in order, in accordance with the provisions of the laws and regulations regarding the processing of appeals. No further action is required of the veteran until he receives further notice. By this REMAND, the Board intimates no opinion, regarding the decision warranted, either factual or legal. RENÉE M. PELLETIER 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).