BVA9500700 DOCKET NO. 93-10 295 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to service connection for a psychiatric disorder including depression and post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD A. S. Nemeth, Associate Counsel INTRODUCTION The veteran's active service extended from January 1972 to May 1973. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 1992 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee, which denied, in part, service connection for PTSD. REMAND The veteran asserts that he has PTSD as a result of his being involved in a 300 car accident on the Autobahn while stationed in Germany. He has been diagnosed to have PTSD, major depression, and personality disorder by VA physicians. A diagnosis of PTSD was made in June 1992 by a VA physician. However, in a VA discharge summary also dated June 1992, physician failed to diagnose PTSD. Additionally, in a VA Discharge Summary dated October 1992, another VA physician diagnosed PTSD and noted that the veteran had auditory and visual hallucinations related to the accident on the Autobahn. Service connection for PTSD requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence of an inservice stressor, and a link established by medical evidence between the inservice stressor and the current PTSD. 38 C.F.R. § 3.304(f). The VA has a duty to assist the veteran in the development of his claim. 38 U.S.C.A. § 5107(a) (West 1991). This duty includes having the veteran examined. See Littke v. Derwinski, 1 Vet.App. 90 (1990). The veteran's claims file contains inconsistent diagnoses of PTSD. In light of these inconsistent diagnoses of PTSD, the RO should afford the veteran a VA psychiatric examination, in order to determine the extent, if any, of his PTSD and its relation to any inservice stressors. Other than the veteran's own statements, there is no evidence regarding the claimed inservice stressors in the claims file, nor is there any evidence that the RO attempted to verify the veteran's claimed stressors. The VA's duty to assist includes attempting to verify claimed inservice stressors. In light of the statutory duty to assist the veteran, the RO should attempt to verify his claimed inservice stressors. The Board also notes that in a Discharge Summary dated November 1992, it was reported that arrangements were made for the veteran's admission to the Dual Diagnosis Program at the Tuscaloosa, AL, VAMC, for follow-up and treatment of PTSD and major depression. The veteran's records from the Dual Diagnosis Program should be attached to the claims file. Accordingly, this case should be remanded to the RO for the following development: 1. The veteran should be contacted and requested to provide a detailed statement containing verifiable information regarding the events claimed as "stressors" during his military service. The veteran should be asked to provide specific details about the events such as dates, places and names of individuals involved in the events. The veteran should provide specific details about the alleged automobile accident. His response should include names of other fellow soldiers involved in the accident and information as to whether he sustained any injuries during the accident. He should be told that the information is necessary to obtain supportive evidence and that failure to cooperate could result in an adverse decision. 2. The RO should then make the necessary arrangements in order to obtain all the veteran's service personnel records, including all documents relating to any investigation and/or determination dealing with the alleged automobile accident reported by the veteran while he was in Germany. All information obtained should be associated with the claims folder. 3. Regardless of the veteran's response, the RO should review the file and prepare a summary of all of the claimed stressors already reported by the veteran in previous statements and to examining health care professionals. This summary and all associated documents, including his service personnel records should be sent to the United States Army and Joint Services Environmental Support Group (ESG), 7798 Cissna Road, Springfield, VA 22150. See DVB Circular 21-86-10, particularly, paragraph 4(d). They should be requested to provide any information available which might corroborate the veteran's alleged stressors. 4. The RO should obtain from the veteran a list of all doctors and hospitals that have treated him for his claimed psychiatric condition, including the dates and locations of the treatments since his separation from service. The RO should obtain all necessary signed releases and obtain all records that are not currently associated with the claims file. Specifically, the RO should obtain the records from the Dual Diagnosis Program at the Tuscaloosa, AL, VAMC. The RO should obtain any records of treatment from the prison authorities where the veteran is being detained. 5. Subsequently, the RO should make arrangements in order to have the veteran examined by a psychiatrist who has not previously examined him to determine the exact diagnosis, if any, of his current psychiatric disorder. The entire claims folder and a copy of this remand must be made available to and be reviewed by the examiner prior to the examination. The psychiatrist should conduct an examination with consideration of the criteria for PTSD. The examination report should include a detailed account of all pathology found to be present. If there are different psychiatric disorders 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 disassociated from one disorder or another, it should be specified. If a diagnosis of PTSD is appropriate, the examiner should specify the credible "stressors" that caused the disorder and the evidence relied upon to establish the existence of the stressor(s). The examiner should also describe which stressor(s) the veteran re-experiences and how he re-experiences them. The report of the examination should include a complete rationale for all opinions expressed. All necessary special studies or tests including psychological testing and evaluation such as the Minnesota Multiphasic Personality Inventory (MMPI) and the Mississippi Scale for Combat-Related Post-Traumatic Stress Disorder are to be accomplished if deemed necessary. The diagnosis should be in accordance with the current edition of the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorder. 5. The RO should review the aforementioned examination report and determine if it is adequate for rating purposes and in compliance with this Remand. If not, the report should be returned for corrective action. Following the completion of these actions, the RO should review the veteran's claim. If the decision remains unfavorable, the veteran and his representative should be provided with a supplemental statement of the case and be afforded a reasonable period of time in which to respond. Thereafter, the case, in accordance with the current appellate procedures, should be returned to the Board for completion of appellate review. No further action on the part of the veteran is required until further notice. JOAQUIN AGUAYO-PERELES 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).