Citation Nr: 0002838 Decision Date: 02/04/00 Archive Date: 02/10/00 DOCKET NO. 97-11 765 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Juan, Puerto Rico THE ISSUE Entitlement to an increased rating for conversion reaction, manifested by knee pains, currently evaluated as noncompensably disabling. REPRESENTATION Appellant represented by: Puerto Rico Public Advocate for Veterans Affairs WITNESS AT HEARING ON APPEAL Appellant's wife ATTORNEY FOR THE BOARD Panayotis Lambrakopoulos, Associate Counsel INTRODUCTION The veteran served on active duty from July 1953 to May 1955. This appeal arises from a June 1996 rating decision of the San Juan, Puerto Rico, Regional Office (RO) that denied the veteran's claim for an increased evaluation for conversion reaction manifested by knee pain, which is rated as noncompensably disabling. FINDINGS OF FACT 1. Service connection has been previously established for conversion reaction manifested by pain in the knees, which is evaluated as noncompensably disabling. 2. The veteran states that he is experiencing a greater amount of knee pain associated with his conversion reaction, that he now walks with a cane and a limp, and that he leans forward because of the pain. CONCLUSION OF LAW The claim for an increased evaluation for conversion reaction manifested by knee pain is well grounded. 38 U.S.C.A. § 5107(a) (West 1991); Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board must determine if the veteran's increased disability rating claim is well grounded. In Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997), cert. denied sub nom. Epps v. West, 118 S. Ct. 2348 (1998), the United States Court of Appeals for the Federal Circuit held that, under 38 U.S.C. § 5107(a) (West 1991), the Department of Veterans Affairs (VA) has a duty to assist only those claimants who have submitted well grounded (i.e., plausible) claims. More recently, the United States Court of Appeals for Veterans Claims held that VA cannot assist a claimant in developing a claim which is not well grounded. Morton v. West, 12 Vet. App. 477 (1999). The threshold question is whether a claimant has submitted evidence sufficient to justify a belief by a fair and impartial individual that the claim is well- grounded. If a claimant meets this threshold requirement, VA's duty to assist in developing the facts pertinent to the claim under 38 U.S.C.A. § 5107 is triggered. A well-grounded claim requires competent evidence to the effect that the claim is "plausible" or "possible." Epps, 126 F.3d at 1468. In determining whether a claim is well- grounded, the supporting evidence is presumed to be true. King v. Brown, 5 Vet.App. 19, 21 (1993). The veteran's increased rating claim is treated as a new claim and "is generally well grounded under 38 U.S.C.A. § 5107(a) when a claimant indicates that a service-connected disability has increased in severity." Colayong v. West, 12 Vet.App. 524, 532 (1999). The Board finds that the veteran's conversion reaction rating claim is well grounded on the basis of his wife's statements regarding his pain, his inability to kneel and to walk, and the testimony that he walks with a limp, a cane, and leans forward because of increased pain. Accordingly, VA's duty to assist the appellant in the development of these claims has been triggered. ORDER The claim for an increased evaluation for service-connected conversion reaction is well grounded. To this extent only, the appeal is granted. REMAND It is the opinion of the Board that additional development is required prior to a disposition of this appeal. Because the claim is well grounded, VA has a duty to assist the appellant in developing facts pertinent to the claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.159 (1999); Murphy v. Derwinski, 1 Vet. App. 78 (1990). In his September 1996 notice of disagreement, the veteran indicated that he was seeking service connection for psychosis as secondary to his service-connected conversion reaction. In May 1989, the veteran underwent a VA specialty examination to assess his condition. At that time, the examining physician diagnosed the veteran as having chronic paranoid schizophrenia. The physician also noted complaints of knee pain, and he stated: "Please note that the examiner is not sure about the diagnosis of conversion reaction back in the early 1950s. This may well have been the beginnings of the man's schizophrenia." Indeed, on a January 1989 VA discharge summary, a VA physician set forth a 30-year history of paranoid schizophrenia, "which appeared in the early 1950's," that is, near the time that the veteran served on active duty. Based on the observations of physicians in the record, it is the opinion of the Board that further clarification of the veteran's current disability (as well as its severity) is needed in order to render a fully informed and fair decision. In 1989, a VA physician indicated that his service-connected condition may have been the same as the veteran's current schizophrenia, for which there is a substantial amount of evidence suggesting some degree of disability. The Board is aware that in March 1978, the veteran was evaluated by a board of VA psychiatrists to determine the relationship between a current psychiatric condition and the service-connected conversion reaction. At that time, he was diagnosed with hysterical neurosis (conversion reaction) by history, an unrelated organic brain syndrome, chronic without psychosis, and residuals of a stroke with hemiplegia, right side. The Board notes that this examination did not address whether there was a relationship between chronic paranoid schizophrenia and conversion reaction. Therefore, further examination and resolution of diagnoses is still warranted. Incidentally, while service connection has been established for conversion reaction manifested by knee pain, the Board notes that there is also evidence suggesting that the knee pain may be attributable to prominent tibial tuberosities, according to a May 1977 VA consultation report. If necessary, on remand, the RO may address the issue of knee pain; however, the focus of the RO's readjudication on remand should remain on the psychiatric disability for which service connection is in place. Therefore, on remand, the RO should schedule the veteran for a complete and thorough VA neuropsychiatric examination, and any other required examinations or surveys, to assess the nature of any and all psychiatric diagnoses, to describe the impairment of functioning, if any, attributable to each disability, and most importantly, to discuss whether there is any relationship between the service-connected conversion reaction manifested by knee pain and subsequent diagnoses of chronic paranoid schizophrenia. Accordingly, to ensure that VA has met its duty to assist the veteran in developing the facts pertinent to his conversion reaction increased rating claim and to ensure full compliance with due process requirements, the case is REMANDED to the RO for the following: The RO must schedule the veteran for a complete and thorough VA neuropsychiatric examination in order to determine the precise nature of all of the veteran's current psychiatric conditions, to specifically discuss whether there is a relationship between the service-connected conversion reaction and any subsequently diagnosed psychiatric condition, including chronic paranoid schizophrenia, and to assess the limitation of function, if any, associated with each psychiatric disability. The examiner should be provided with the veteran's claims folder and should review the veteran's medical history prior to conducting the examination. All appropriate tests and studies should be accomplished at this time. The examination report should set forth all pertinent findings in a clear, comprehensive, and legible manner. The Board notes that a remand "confers on the veteran or other claimant, as a matter of law, the right to compliance with the remand orders." Stegall v. West, 11 Vet. App. 268, 271 (1998). Following completion of the above development, the RO should then review the entire evidentiary record in order to determine if an increased rating for the service-connected conversion reaction may be granted. If the decision remains adverse to the veteran, he and his representative should be furnished with a supplemental statement of the case. The case should thereafter be returned to the Board for further review, as appropriate. This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims 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). JEFF MARTIN Member, Board of Veterans' Appeals