Citation Nr: 0004636 Decision Date: 02/23/00 Archive Date: 02/28/00 DOCKET NO. 96-08 678 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Boise, Idaho THE ISSUE Entitlement to an increased evaluation for post traumatic stress disorder (PTSD), currently evaluated as 50 percent disabling. REPRESENTATION Appellant represented by: Keith D. Snyder, Attorney-at- Law WITNESSES AT HEARING ON APPEAL Appellant and S.T. ATTORNEY FOR THE BOARD K.L. Salas, Associate Counsel INTRODUCTION The veteran had active military service from October 1940 to April 1946. This appeal arose from a September 1995 rating decision by the Department of Veterans Affairs (VA) Boise, Idaho Regional Office (RO). The RO denied the claim of entitlement to increased evaluations for PTSD, lumbar spine traumatic arthritis, dorsal spine traumatic arthritis, and right hip traumatic arthritis. In February 1997 an increased evaluation of 30 percent was assigned for PTSD. Lumbar spine traumatic arthritis was rated as 20 percent disabling. Dorsal spine traumatic arthritis was assigned a separate 10 percent evaluation. A 10 percent evaluation was continued for right hip traumatic arthritis. In August 1997 the Board of Veterans' Appeals (Board) remanded the case to the RO for further development and application of new regulations. In July 1998 the Board granted an increased evaluation of 50 percent for PTSD, an increased evaluation of 40 percent for lumbar spine traumatic arthritis, denied an increased evaluation for dorsal spine traumatic arthritis, and granted an increased evaluation of 20 percent for right hip traumatic arthritis. The veteran filed an appeal to the United States Court of Appeals for Veterans Claims (Court) with respect to that portion of the July 1998 decision wherein the Board granted an increased evaluation of 50 percent for PTSD. In May 1999 the Court vacated the Board's decision only with respect to the denial of an evaluation in excess of 50 percent for PTSD, and remanded the case for further action consistent with the matters raised in its order. The Court found that the Board did not ensure compliance with its own remand directives as required pursuant to Stegall v. West, 11 Vet. App. 268 (1998). Specifically it was found that on VA examination in March 1998 there was no opinion as to the impact of PTSD on the veteran's ability to obtain and retain substantially gainful employment. The Court found that the Board did not ensure that this requested opinion was provided. REMAND This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board or by the Court for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44-8.45 and 38.02-38.03. As noted before the purpose of this remand is to ensure compliance with the prior Board remand. Specifically, a VA psychiatric examiner must offer an opinion as to whether by reason of PTSD the veteran is capable of substantially gainful employment. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the RO. Kutscherousky v. West, 12 Vet. App. 369 (1999). Pursuant to VA's duty to assist the appellant in the development of facts pertinent to his claim under 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1999), the Board is deferring adjudication of the issue of entitlement to an increased evaluation for PTSD pending a remand to the RO for further development as follows: 1. The RO should request the veteran to identify the names, addresses, and approximate dates of treatment for all health care providers, VA or non-VA, inpatient or outpatient, who may possess additional records pertinent to his claim. 2. After obtaining any necessary authorization, the RO should request and associate with the claims file legible copies of the veteran's complete treatment reports from all sources identified whose records have not previously been secured. Regardless of the veteran's response, the RO should secure all outstanding VA treatment reports. 3. The RO should arrange for a VA examination of the veteran by a psychiatrist in order to determine the nature and extent of severity of PTSD, completing any indicated special studies. The claims file, and a separate copy of this remand must be made available to and reviewed by the examiner prior and pursuant to conduction and completion of the examination and the examiner must annotate the examination report in this regard. The examiner must specifically address whether the veteran by reason of PTSD has occupational and social impairment with deficiencies in most areas, such as school, work, family relations, judgment, thinking or mood due to symptoms such as suicidal ideation, obsessional rituals that interfere with routine activities, intermittently illogical, obscure or irrelevant speech, near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, impaired impulse control (such as unprovoked irritability with periods of violence), spatial disorientation, neglect of personal appearance or hygiene, difficulty adapting to stressful circumstances (including work or a work-like setting) or inability to establish and maintain effective relationships. The examiner should also address whether by reason of PTSD the veteran's ability to establish and maintain effective or favorable relationships with people is severely impaired, and whether the psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain and retain employment. A global assessment of functioning (GAF) score should be assigned. The examiner must explain in detail the purpose and meaning of the score as well as any limitations on the use of a GAF score in assessing disability from one cause. The GAF assigned must be explained with reference to criteria contained in the DSM-IV. With regard to the veteran's symptoms, the examiner should explain in detail whether any of the veteran's symptoms are not attributable to PTSD and can be clearly disassociated from disability due to PTSD. In this regard, the examiner should discuss the symptoms of PTSD, the psychiatric symptoms not fitting within the DSM criteria for PTSD and any diagnoses of other psychiatric disorders that are of record. The examiner must express an opinion as to the impact of PTSD on the veteran's ability to work. Any opinions expressed must be accompanied by a complete rationale. 4. Thereafter, the RO should review the claims file to ensure that all of the foregoing requested development has been completed. In particular, the RO should review the requested examination report and required opinions to ensure that they are responsive to and in complete compliance with the directives of this remand and if they are not, the RO should implement corrective procedures. Stegall v. West, 11 Vet. App. 268 (1998). 5. After undertaking any development deemed essential in addition to that specified above, the RO should readjudicate the issue of entitlement to an increased evaluation for PTSD with consideration of all applicable laws and regulations. If the benefit requested on appeal is not granted to the veteran's satisfaction, the RO should issue a Supplemental Statement of the Case. A reasonable period of time for a response should be afforded. Thereafter, the case should be returned to the Board for appellate review, if otherwise in order. By this remand, the Board intimates no opinion as to any final outcome warranted. No action is required of the veteran until he is notified by the RO. RONALD R. BOSCH Member, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 1991 & Supp. 1999), only a decision of the Board is appealable to the Court. 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) (1999).