BVA9505788 DOCKET NO. 91-43 144 ) DATE ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to an increased rating for posttraumatic stress disorder (PTSD), currently evaluated as 30 percent disabling. 2. Entitlement to an effective date earlier than September 11, 1989, for an award of service connection and a compensable rating for PTSD. 3. Entitlement to a total schedular rating for PTSD under the provisions of 38 C.F.R. 4.16 (c) (1993). REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARING ON APPEAL The veteran and J. Grand ATTORNEY FOR THE BOARD R. L. Shaw, Counsel INTRODUCTION The veteran had active military service from June 1968 to May 1970. This matter is again before the Board of Veterans' Appeals (the Board) on appeal from an April 1990, rating decision by the Newark, New Jersey, Regional Office of the Department of Veterans Affairs (VA). (In August 1990 the veteran moved to the Atlanta, Georgia, area; all adjudication since then has been by the Atlanta Regional Office (hereinafter RO.)) The appeal was remanded by the board on July 27, 1992, for additional evidentiary development. REMAND The development requested included the procurement of records from various facilities where the veteran had received treatment for PTSD, including VA hospitals in Boston, Massachusetts, and Sioux Falls, South Dakota. Additional clinical records were received, and it appears that the material available from those facilities is complete to the extent available. A request to the St. Joseph's Marion Mental Health Hospital in Sioux City, Iowa, for records dated since 1984 elicited a reply that the veteran had last been seen there in September 1983. The need for a followup was noted by the RO in May 1994, but it appears that no further request was actually sent. The requested development was also directed toward obtaining clinical studies to clarify the veteran's current condition, including psychiatric testing, a social and industrial survey, and a special psychiatric examination. The studies are necessary not only to determine the extent of current psychiatric impairment but to differentiate social and industrial inadaptibility caused by PTSD from that caused by nonservice- connected disorders, including an underlying personality disorder and alcohol and drug abuse. VA examinations performed in July and September 1993 showed a diagnosis of PTSD but did not contain answers to questions posed in the remand. Psychological testing performed in October 1993 resulted in findings which were deemed unreliable or distorted. Further testing was recommended but was not performed. Rulings by the United States Court of Veterans Appeal (the Court) require that the Board justify its conclusions by articulating adequate reasons and bases for its decisions. See Gilbert v. Derwinski, 1 Vet.App 49 (1990). Since the Board may consider only independent medical evidence in the record, see Colvin v. Derwinski, 1 Vet.App 171 (1991), there remains a need for medical information originating outside of the adjudication process. Where the record on appeal is inadequate, a remand is required. Green v. Derwinski, 1 Vet.App 121 (1991). Where a medical opinion requested by the Board has not been rendered, the claim must be remanded. Smith v. Brown, 5 Vet.App 335 (1993). In view of the foregoing, the case is therefore remanded to the RO for the following additional actions: 1. The RO should send a followup to the St. Joseph's Marion Mental Health Hospital in Sioux City, Iowa, to obtain copies of all medical records pertaining to examination or treatment of the veteran at that facility at any time. 2. The veteran should be scheduled for further comprehensive psychological testing in accordance with he VA Physician's Guide for Disability Evaluation Examinations (IB- 11-56, March 1, 1985) (Physician's Guide), including the preparation of a complete personality profile. 3. After completion of the foregoing, and only then, the veteran should undergo a special examination by a panel of two psychiatrists who have not previously examined him. The examination is for the purpose of ascertaining the current severity of the service-connected PTSD. The study should be conducted in a accordance with the requirements of the VA Physician's Guide, and all findings should be reported in detail. The examiner should specifically itemize all of the symptoms which support a diagnosis of PTSD, if found. The examination report should address each of the following in detail: (1) If PTSD is found, coexisting psychopathology such as a personality disorder or substance abuse disorder should also be identified and described; (2) the overall degree of psychiatric impairment resulting from PTSD alone, without regard to any coexisting personality disorder or substance abuse, should be characterized; (3) A determination should be made as to whether substance abuse is caused by or the proximate result of PTSD, if found, and the basis for such conclusion sould be expressly stated. (4) The diagnosis on Axis V should include a GAF score (Cf. Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.) (DSM III-R) of the American Psychiatric Association); (5) A conclusion should be expressed regarding the extent to which PTSD, considered independently of any coexisting personality disorder or substance abuse, constitutes an impediment to securing or maintaining substantially gainful employment. It is imperative that the claims folder be reviewed carefully in advance by each examiner. The conclusions stated by the examiners should reflect consideration of current findings and information reported in the file, in addition to current examination findings. 4. Upon receipt of the material obtained pursuant to this remand, the RO should make a determination as to whether the specifications stated herein have been satisfied; if necessary, all followup actions required to obtain the requested information should be performed. Thereafter, the claim should be reviewed by the RO. If the decision remains adverse to the veteran, in whole or in part, a supplemental statement of the case should be prepared and the veteran and his representative should be given a reasonable period of time for reply. The claim should then be returned to the Board for further review, if in order. No action is required of the veteran until he receives further notice. The purpose of this REMAND is to obtain additional information. The Board does not intimate any factual or legal conclusions as to the outcome ultimately warranted in this appeal. 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).