BVA9503229 
DOCKET NO.  93-10 979     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Sioux Falls,
South Dakota

THE ISSUE

Entitlement to an increased disability evaluation for Post-
Traumatic Stress Disorder (PTSD), currently rated as 10 percent
disabling.

REPRESENTATION

Appellant represented by: Veterans of Foreign Wars of the
United States

ATTORNEY FOR THE BOARD

Sandra L. Smith, Associate Counsel

INTRODUCTION

The veteran had active service from October 1966 to October 1968
and from November 1968 to November 1971.  This appeal is before
the Board of Veterans' Appeals (the Board) from a December 1992
rating decision of the Regional Office (RO) which granted service
connection for PTSD, and assigned a 10 percent rating to the
disability.  The case is now ready for appellate review.

REMAND

The veteran and his representative are contending that the
veteran's PTSD symptoms are of such severity to warrant a higher
disability evaluation than the 10 percent currently assigned.  In
a written statement, received in June 1993, the veteran asserted
that his current doctor had prescribed different medication which
kept him "in a daze."  He was having difficulty functioning and
was trying to "hang in there" while on a waiting list for a
treatment program.

The Board notes that the veteran's representative, in the
Informal Hearing Presentation, initially stated that "we waive
local office jurisdiction" as to the letter received by the Board
in June 1993.  However, in the conclusion of the Presentation,
the representative requests that the case be remanded in order
for the RO to review this letter.

In addition, the veteran's representative has alleged that the VA
psychiatric examination conducted in September 1992 is inadequate
in that the examiner failed to indicate the severity of the
veteran's PTSD and agoraphobia in the examination report.  Thus,
it is argued that the veteran should be afforded another VA
psychiatric examination.

The Board has reviewed the September 1992 examination report and
notes that the examiner did fail to indicate the severity of the
veteran's psychiatric disorder.  While the words "mild to
moderate" appear on AXIS IV of the diagnosis, this is supposed to
be an indication of the severity of stressors - not the severity
of symptoms.  Furthermore, although the examiner gave the veteran
a score of 65 on the Global Assessment of Functioning scale, the
examiner did not provide any explanation for this finding.  Thus,
the examination report fails to objectively relate the veteran's
symptoms to his social and industrial adaptability (or lack
thereof).

The VA has a duty to assist the veteran in developing pertinent
information relating to his claim pursuant to 38 U.S.C.A.
§ 5107(a) (West 1991).  The Court of Veterans Appeals (the Court)
has held that the duty to assist also includes providing a
thorough and contemporaneous medical examination, which takes
into account prior medical evaluations and treatment.  Green v.
Derwinski, 1 Vet.App. 121 (1991).
The Court has also held that when the Board concludes the medical
evidence of record is insufficient it may supplement the record
by ordering a medical examination.  Colvin v. Derwinski, 1
Vet.App. 171 (1991).

Finally, in the case of Hood v. Brown, 4 Vet.App. 301 (1993), the
Court stated that the term "definite" in 38 C.F.R. § 4.132 (1993)
was "qualitative" in character, whereas, the other terms were
"quantitative" in character, and invited the Board to "construe"
the term "definite" in a manner that would quantify the degree of
impairment for purposes of meeting the statutory requirement that
the Board articulate "reasons and bases" for its decision.  38
U.S.C.A. § 7104(d)(1) (West 1991).

In a precedent opinion, dated November 9, 1993, the General
Counsel of the VA concluded that "definite" is to be construed as
"distinct, unambiguous, and moderately large in degree."  It
represents a degree of social and industrial inadaptability that
is "more than moderate but less than rather large."  O.G.C. Prec.
9-93, 59 Fed. Reg. 4753 (1994).  The VA, including the Board, is
bound by this interpretation of the term "definite."  38 U.S.C.A.
§ 7104(c) (West 1991).  As the case is otherwise in need of
additional development, the RO will have a chance to readjudicate
the evaluation of the psychiatric disorder mindful of this
interpretation.

In light of the above facts and law, the Board has determined
that the case should be REMANDED to the RO for the following
actions:

1.  The RO should obtain and associate with
the claims folder all current private and
VA medical records pertaining to treatment
of the veteran's acquired psychiatric
disorder since September 1992.

2.  The RO should schedule the veteran for
a comprehensive VA psychiatric examination
to determine the nature and severity of the
service-connected PTSD.  This study must be
conducted in accordance with the VA
Physician's Guide for Disability Evaluation
Examinations.  If there are different
psychiatric disorders, the examiner is to
associate, insofar as possible, the
specific symptoms with each disorder.  All
indicated tests, including appropriate
psychological studies with applicable
subscales, must be conducted.  The claims
file must be made available to and reviewed
by the examiner prior to the requested
study.  The examiner must assign a Global
Assessment of Functioning Score consistent
with the American Psychiatric Association's
DIAGNOSTIC AND STATISTICAL MANUAL FOR
MENTAL DISORDERS (3d ed. rev., 1987), and
explain what the assigned score represents.
The examiner should also express an opinion
as to the extent the veteran suffers from
social and industrial impairment which is
due solely to the PTSD.  A complete
rationale for any opinion expressed must be
provided.

3.  Following completion of the foregoing,
the RO must review the claims folder and
ensure that all of the foregoing
development actions have been conducted and
completed in full.  If any development is
incomplete, including if the requested
examination does not include all test
reports, special studies or opinions
requested, appropriate corrective action is
to be implemented.

4.  When the aforementioned developments
have been accomplished, the issue should be
readjudicated by the RO.  The review of the
evaluation for the psychiatric disorder
should encompass consideration of the
interpretation of the term "definite" as
set out in the G.C. Precedent Opinion 9-93.

When the aforementioned development has been accomplished, if the
benefits sought are not granted, the veteran and his
representative should be provided with a supplemental statement
of the case and afforded a reasonable opportunity to respond
thereto.  This document should include a discussion of the
General Counsel's Opinion and its application to the facts of
this case.  Thereafter, the case should be returned to the Board
for further appellate review, as appropriate.  No action is
required of the veteran until he is notified.

          MICHAEL D. LYON
          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).