BVA9506504 DOCKET NO. 93-11 223 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to an increased evaluation for post-traumatic stress disorder (PTSD) currently evaluated at 50 percent. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Raymond F. Ferner, Counsel INTRODUCTION This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a February 1992 rating decision of the Department of Veterans Affairs (VA) Regional Office in St. Petersburg, Florida (RO) which denied the benefit sought on appeal. The veteran, who had active service from February 1971 to December 1972, appealed that decision to the BVA, and the case was received at the Board in May 1993. REMAND A preliminary review of the record discloses several areas which would benefit from some additional development. The veteran's representative has suggested that the veteran's polysubstance abuse disorder is a manifestation or a secondary complication of his PTSD. While rating decisions refer to this disorder as being due to the veteran's own willful misconduct, the RO has not formally addressed this matter in this regard. The veteran also has reported that he is in receipt of Social Security disability benefits which were awarded by a Federal judge in 1986 due to his PTSD. A copy of that decision, as well as any medical evidence considered in reaching the decision, are relevant evidence and should be obtained and associated with the claims file. In addition to PTSD, the record reflects several psychiatric diagnoses including depression and adjustment reaction, and an antisocial personality disorder. It is not clear what relationship these various disorders may have, if any, to the veteran's service-connected PTSD and what psychiatric symptomatology may be attributable to each disorder. As such, a further examination of the veteran and a review of pertinent medical records would be helpful. Also, an opinion is necessary concerning any possible etiological relationship of the veteran's polysubstance abuse disorder to his PTSD. Lastly, the record reflects that the veteran receives treatment for psychiatric symptomatology at the VA Medical Center in Gainesville, Florida. While the RO obtained records of the veteran's treatment at that facility in September 1992, given the passage of time, there are no doubt more recently dated records which should be obtained. Therefore, in order to give the veteran every consideration with respect to the present appeal, the Board determines that further development of the case is necessary. Accordingly, this case is REMANDED for the following actions: 1. Pursuant to 38 U.S.C.A. § 5106 (West 1991), the RO should obtain and associate with the claims file a copy of the decision concerning the veteran's claim for Social Security disability benefits, as well as copies of all medical records considered in connection with that claim. 2. The RO should obtain and associate with the claims file any hospital and outpatient treatment records dated subsequent to April 1992 from the VA Medical Center in Gainesville, Florida. 3. The veteran should be afforded a psychiatric examination by a board of two psychiatrists in order to assess the severity and manifestations of the veteran's PTSD, and to determine the etiology of the diagnosed substance abuse disorder. Each psychiatrist should actually examine the veteran. Any and all indicated evaluations, studies, and tests deemed necessary by the examiners should be accomplished, but should include appropriate psychological studies. The examiners are requested to review all pertinent records in the veteran's claims file and offer an opinion, if possible, as to whether the veteran's substance abuse disorder is a manifestation or a secondary complication of the veteran's PTSD, and whether such disorder is active or in remission. The examiners also are requested to attempt to reconcile the various psychiatric diagnoses of record and offer opinions and comments concerning the degree of functional impairment each diagnosed psychiatric disorder causes and the veteran's capacity for performing substantially gainful employment. The examiners are further requested to attempt to quantify the degree of social and industrial impairment due to the veteran's service-connected PTSD in terms of the nomenclature in 38 C.F.R. § 4.132, Diagnostic Code 9411 (1994). The examiners specifically are requested to include in the diagnostic formulation an Axis V diagnosis (Global Assessment of Functioning Scale) consistent with the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (3rd. ed. revised 1987) and an explanation of what the assigned score represents. The complete rationale for any opinion expressed should be provided. Since it is important "that each disability be viewed in relation to its history[,]" 38 C.F.R. § 4.1 (1994), copies of all pertinent medical records in the veteran's claims file or, in the alternative, the claims file, must be made available to the examiners for review prior to, and during, the examinations. 4. In adjudicating the issue on appeal on the basis of all relevant evidence of record, including that developed on remand, the RO should determine whether any active substance abuse disorder is a manifestation of, or a disorder secondary to, the veteran's service-connected PTSD. See Ohland v. Derwinski, 1 Vet.App. 147, 150 (1991) When the development requested has been completed, the case should again be reviewed by the RO on the basis of the additional evidence. If the benefit sought is not granted, the veteran and his representative should be furnished a supplemental statement of the case, and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. The purpose of this REMAND is to obtain additional development, and the Board does not intimate any opinion as to the merits of the case, either favorable or unfavorable, at this time. The veteran is free to submit any additional evidence he desires to have considered in connection with his current appeal. No action is required of the veteran until he is notified. JACQUELINE E. MONROE 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).