BVA9505148 DOCKET NO. 91-18 729 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for jungle rot. 2. Entitlement to service connection for bilateral defective hearing. 3. Entitlement to service connection for skin disability due to exposure to certain herbicide agents. 4. Entitlement to service connection for Post-Traumatic Stress Disorder (PTSD). 5. Whether new and material evidence has been received to reopen a claim for entitlement to service connection for an acquired psychiatric disability (other than PTSD) and, if so, whether all of the evidence, old and new, warrants a grant of that benefit. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Alan S. Peevy, Associate Counsel INTRODUCTION The veteran had active military service from September 1964 to November 1966. This case is before the Board of Veterans' Appeals (Board) on appeal from an April 1989 rating decision by the St. Petersburg, Florida, Regional Office (RO). A notice of disagreement was received in June 1989, and a statement of the case was issued in July 1989. In June 1990, the veteran was furnished a supplemental statement of the case and informed that he could perfect his appeal by filing a substantive appeal within 60 days. The veteran's substantive appeal was received in July 1990. The veteran appeared at a personal hearing at the RO in September 1990. This case was previously before the Board and was remanded by decisions dated in August 1991 and May 1994. The case is now again before the Board for appellate review. The veteran is represented by The American Legion. REMAND In the Board's remand decision of May 1994, it was noted that the veteran had also filed a claim for entitlement to service connection for tinnitus which had not yet been adjudicated by the RO. At that time, the Board viewed the tinnitus claim as intertwined with the issue of entitlement to service connection for bilateral hearing loss, and the case was remanded to the RO for adjudication of the tinnitus claim. Harris v. Derwinski, 1 Vet.App. 180 (1991). Despite the directions in the Board's remand, it does not appear that the RO has yet developed and adjudicated the tinnitus claim. Additionally, the record contains Department of Veterans Affairs (VA) outpatient reports which contain references to PTSD. However, there does not appear to be a clear diagnosis of PTSD. The Board notes that the veteran served aboard a ship off of Vietnam in 1965 and that he has submitted documentation showing that his ship was engaged in heavy shelling of the enemy. The Board also observes that certain psychiatric symptomatology appears to be related to what has been diagnosed as a personality disorder. Moreover, the veteran has also filed a claim for entitlement to service connection for what he described as a psychosis. It therefore appears that questions involving differential diagnosis are involved in the present case, and such questions requiring diagnostic skills must be resolved by medical experts. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Accordingly, additional development of the medical evidence pertinent to the psychiatric status of the veteran is necessary before the Board can proceed with its appellate review. The record further shows that by rating decision dated in October 1994, the RO continued its denial of entitlement to service connection for skin disease related to exposure to certain herbicide agents. By letter dated that same month, the veteran was advised of that determination and advised that he had the right to appeal that decision. However, the issue of entitlement to service connection for skin disease related to exposure to certain herbicide agents is already in appellate status and was, in fact, addressed in the original July 1989 statement of the case. This issue has been deferred since that time pending changes in pertinent regulations. Pertinent regulatory changes have now been published, and a supplemental statement of the case citing and discussing the pertinent facts regarding this claim in light of the amended regulations is therefore necessary. Finally, in view of the need for additional procedural action as outlined above, the Board believes it appropriate under the particular circumstances of this case to schedule the veteran for a VA medical examination in order to ascertain the nature and etiology of the claimed physical disabilities. For the reasons set forth above, the case is hereby REMANDED to the RO for the following actions: 1. The veteran should be scheduled for a "core" psychological test battery, including an MMPI and a WAIS-R at a VA medical facility for the purpose of assisting in diagnosing his psychiatric symptomatology. All other indicated tests should be performed, and the examiner(s) should set forth a clear and detailed analysis of the test results. In conjunction with the psychological testing, the veteran should be scheduled for an extensive examination by a board of two VA psychiatrists. The psychological test results should be made available to the board of psychiatrists and the board, after reviewing the claims file, including evidence in the claims file of the veteran's service on a warship involved in shelling the enemy off the coast of Vietnam in 1965, and the psychological test results, should examine the veteran to determine the nature and severity of all psychiatric disorders found to be present. The board of psychiatrists should elicit a detailed history of all stressful events and a full description of past and present symptoms. The board should clearly set forth any diagnosis or diagnoses supported by their examination in light of their review of the claims file and the test results. The examiners should be requested to offer opinions as to the likely time of onset of any psychosis found to exist. If a diagnosis of PTSD is made, then the examiners should cite and discuss any stressors and offer opinions as to the etiology and relationship, if any, of PTSD to the veteran's service and/or any other psychiatric disability or disabilities found to exist. If PTSD is not found to exist, then that fact should be clearly set forth. Any personality disorders found to be present should be clearly identified. It is imperative that the claims file be made available to the psychological examiner(s) and to the board of psychiatrists for review prior to the tests/examination. 2. The veteran should also be scheduled for special VA dermatological and audiological examinations for the purpose of ascertaining the nature and etiology of any skin conditions and any loss of hearing and tinnitus found to be present. It is imperative that the claims file be made available to the examiners for review in conjunction with the examinations. All appropriate tests, including audiometric testing, should be accomplished. The examiners should be asked to state their opinions, pertinent to their respective examinations, as to the most probable cause and the most likely time of first onset of any skin disorders, hearing loss and tinnitus found to be present. 3. The RO should then adjudicate the issue of entitlement to service connection for tinnitus. The veteran and his representative should be advised of this determination and, if the claim is denied, furnished notice of appellate rights and procedures, including the necessity of filing a timely notice of disagreement if the veteran wishes to initiate an appeal on this new issue. 4. The RO should also review the expanded record and determine if the veteran's claims for entitlement to service connection for jungle rot, bilateral hearing loss, skin disease related to exposure to certain herbicides and PTSD can be granted. The RO should also determine whether new and material evidence has been received to reopen a claim for entitlement to service connection for an acquired psychiatric disability (other than PTSD) and, if so, whether all of the evidence, old and new, warrants a grant of that benefit. The veteran and his representative should be furnished a supplemental statement of the case addressing all issues which remain in denied status. The supplemental statement of the case should set forth a summary of the evidence, a citation to and discussion of applicable laws and regulations (including pertinent parts of 38 C.F.R. §§ 3.307, 3.309 (1994) related to exposure to certain herbicide agents), and a detailed analysis of the reasons for the RO's determinations. After affording the veteran and his representative a reasonable opportunity to respond, the case should be returned to the Board for further appellate review. The purpose of this decision is to ensure compliance with applicable laws and regulations, to comply with the jurisprudence of the Court, to assist the veteran with the development of the evidence, and to afford the veteran due process of law. The Board intimates no opinions as to the eventual determinations to be made in this case. EUGENE A. O'NEILL 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).