Citation Nr: 0007549 Decision Date: 03/21/00 Archive Date: 03/28/00 DOCKET NO. 98-00 769 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to increased disability evaluation for post- traumatic stress disorder (PTSD), currently evaluated as 30 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD B. N. Booher, Associate Counsel INTRODUCTION The veteran had active service from October 1968 through August 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 1997 rating decision of the Department of Veterans Affairs (VA) Regional Office in Cleveland, Ohio (RO), which denied the benefit sought on appeal. REMAND The veteran claims that he is entitled to a disability evaluation in excess of 30 percent for PTSD to more accurately reflect the severity of his symptomatology. Historically, by rating decision dated May 1995, the RO granted the veteran service connection and a 10 percent evaluation for PTSD. By rating decision dated June 1996, the RO continued the veteran's 10 percent evaluation. In a September 1997 rating decision, the RO granted the veteran a temporary total evaluation for hospitalization from August to September 1997. By rating decision dated October 1997, the RO increased the veteran's disability evaluation to 30 percent. Thereafter, the veteran was granted temporary total disability evaluations for two separate periods of hospitalization occurring in November 1998-January 1999 and March 1999-May 1999. An allegation that a service-connected disability has become more severe is sufficient to establish a well-grounded claim for an increased evaluation. Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); Proscelle v. Derwinski, 2 Vet. App. 629, 631-32 (1992). Based on the veteran's contention, the Board finds that the claim is well grounded within the meaning of 38 U.S.C.A. § 5107 (West 1991). However, a review of the evidence of record reveals that additional development is required prior to further appellate review. The evidence of record shows that the veteran was first diagnosed with PTSD in February 1995. As previously indicated, the veteran's disability evaluation for PTSD was increased to 30 percent effective September 1997, by rating decision dated in October 1997. Thereafter, in a notice of disagreement (NOD) submitted in November 1997 the veteran requested an increased evaluation. The veteran alleges that his PTSD is currently manifested by nightmares, flashbacks and social withdrawal, which all render him unemployable. He also indicates that he is unable to get along with coworkers and function in the workplace due to his paranoia. Additionally, he contends that his anxiety and depression have increased and that he has no social life, as he does not like to be around people. During a personal hearing held before the RO in April 1998, the veteran testified that his PTSD symptoms included sleep disturbance, flashbacks, nightmares, isolation, increased startle response, difficulty sustaining relationships due to a negative attitude, hypervigilence, and depression. The veteran also testified that he had started to abuse drugs again and that he had sought treatment for the same. Finally, the veteran testified that he was attempting to return to school and obtain employment through a VA Rehabilitation Program. During a February 2000 video conference hearing conducted by the undersigned, the veteran testified that he continues to seek ongoing treatment for PTSD and that his PTSD is currently manifested by isolation, difficulty sleeping, depression, irritability, auditory hallucinations, suicidal ideation, an inability to get along with other people, increased startle response to loud noise and certain scents that remind him of Vietnam and an inability to work. The veteran testified that he is currently not abusing drugs. Since September 1997, the veteran has been hospitalized on four occasions (December 1997-January 1998, November 1998- December 1998, April 1999, May 1999), and he has been afforded two VA examinations, with one being in September 1997 and the second being in April 1998. While the veteran's last VA examination in April 1998 was comprehensive, the examiner diagnosed the veteran with PTSD, major depressive disorder and cocaine and cannabis dependence in remission. Additionally, the record on appeal contains other treatment records which diagnose PTSD in addition to other nonservice- connected disorders affecting mental status. However, none of the clinical evidence of record relevant to this appeal differentiate the veteran's symptoms and impairment attributable to PTSD from the symptoms and impairment attributed to other nonservice-connected disorders. In this regard, the Board notes that from September 1997 through November 1999, the veteran was diagnosed with chronic PTSD and marijuana abuse (September 1997); PTSD and substance abuse (December 1997-January 1998); PTSD and major depression (April 1998), PTSD and polysubstance abuse (November-December 1998) and cocaine, cannabis, and nicotine dependence and a history of PTSD (May 1999). Further, the veteran was assigned various Global Assessment of Functioning (GAF) scores by VA physicians, examiners and social workers ranging from 35 to 70. The scores are 65 (September 1997), 50 (December 1997-January 1998), 55 (December 1997), 70 (April 1998), an admission score of 35 (November 1998), an admission score of 50 (April 1999), and an admission score of 50 (May 1999). A statement from [redacted], CCDC III, submitted in November 1999 shows that he had the opportunity to work with the veteran in an alcoholism treatment facility from April to May 1999. Mr. [redacted] noted that the veteran had a GAF score of 40/50 and that the veteran was active in seeking follow-up treatment upon conclusion of the inpatient alcoholism program. Additionally, in terms of the veteran's ability to obtain and maintain employment, a review of the claims file shows that after his release from service, the veteran was employed by a hospital in the maintenance division. Thereafter, the veteran had his own painting business for a period of time and then worked in the laundry division at a hotel. Hospitalization records dated December 1997-January 1998 and November-December 1998 reflect that VA physicians believed that the veteran was not gainfully employable. However, in January 1998 it was indicated that this opinion was subject to reassessment. The opinions regarding the veteran's ability to maintain gainful employment were rendered in connection with dual diagnoses of PTSD and substance abuse (December 1997-January 1998) and PTSD and polysubstance abuse (November-December 1998). There is no discussion of record regarding the extent to which the veteran's PTSD prevents him from maintaining gainful employment versus the extent to which his substance abuse contributes to his unemployability. Under the circumstances of this case, the Board finds that additional development of the record consistent with VA's duty to assist the veteran in development of the facts pertinent to his claim, is required. Accordingly, the case is REMANDED to the RO for the following action: 1. The veteran should be requested to identify all sources of recent treatment received for his service-connected PTSD since September 1997. All treatment records not already associated with the claims file should be obtained. 2. The RO should arrange for the veteran to be scheduled for a VA psychiatric examination to ascertain the current severity of his PTSD. The examiner should review all pertinent records in the veteran's claims file and a copy of this REMAND. All indicated studies, to include psychological testing, if deemed appropriate by the examiner, should be performed. The examiner should offer an opinion regarding the degree of functional impairment, if any, caused by PTSD, as opposed to any other psychiatric disorders found. If there are psychiatric disorders other than PTSD, the examiner should reconcile the diagnoses and should specify which symptoms are associated with each of the disorder(s). If certain symptomatology cannot be dissociated from one disorder or another, the examiner should so specify. The examiner should attempt to quantify the degree of impairment in terms of the nomenclature set forth in the rating criteria (38 C.F.R. § 4.130, Diagnostic Code 9411). The examiner should include in the diagnostic formulation an Axis V diagnosis (Global Assessment of Functioning score), and an explanation of what the assigned GAF score represents. The examiner should also comment on the impact that the veteran's PTSD has on his ordinary activity and his ability to obtain and maintain gainful employment. The examiner should provide a detailed rationale for all opinions expressed. 3. Following completion of the foregoing, the RO should review the claims folder and ensure that all the aforementioned development action has been conducted and completed in full. If any development is incomplete, including if all requested medical records have not been obtained, or the requested examination does not include all special studies or comments requested, appropriate corrective action is to be implemented. 4. Thereafter, the RO should readjudicate the veteran's claim on the basis of all of the evidence of record. If the benefit sought is not granted, the veteran and his representative should be provided a Supplemental Statement of the Case and an opportunity to respond thereto before the record is returned to the Board for further appellate review. The purpose of this REMAND is to further develop the veteran's claim and to obtain clarifying medical information. By this REMAND, the Board intimates no opinion as to the ultimate disposition of the appeal. The veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). However, no action is required of the veteran until he is further notified. WARREN W. RICE, JR. Member, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 1991 & Supp. 1999), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. 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) (1999).