BVA9503483 DOCKET NO. 93-10 359 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in San Francisco, California THE ISSUES 1. Entitlement to an increased evaluation for depression with hypochondriasis, currently evaluated as 50 percent disabling. 2. Entitlement to a total rating for compensation purposes based on individual unemployability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J. Horrigan, Counsel REMAND The veteran served on active duty from October 1965 to October 1968. This matter came before the Board of Veterans' Appeals (Board) from an August 1990 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Francisco, California. The veteran last received a VA psychiatric examination in July 1991 and last received a VA examination of any of his other service-connected disabilities in February 1984. In addition, the record indicates that considerable relevant medical evidence may be available which is not in the claims folder. Significantly, the record reflects the presence of a personality disorder which, according to a December 1992 statement from J. P. Howard, Ph.D., clinical psychologist, increases the intensity and disabling effects of the acquired psychiatric disorders. Dr. Howard stated that the veteran suffers from depression, anxiety, phobias, and an obsessive compulsive disorder in addition to a paranoid personality disorder. Where, as here, the record reflect that the appellant suffers from multiple Axis I diagnoses as well as an Axis II diagnosis, the Board must be able to point to clinical data reflecting the degree of impairment caused by the service-connected disorder, as opposed to the impairment caused by other Axis I disorders and the personality disorder. In a recent decision, Massey v. Brown, No. 93-135 (U.S. Vet.App. Dec. 6, 1994), the United States Court of Veterans Appeals (Court) held that the record must contain data that correlates to the schedular criteria set forth in the VA Schedule for Rating Disabilities, 38 C.F.R. Part 4 (1994). A comprehensive contemporaneous psychiatric examination is needed to obtain such data. In view of the foregoing and given the duty to assist the veteran in the development of his claim under the provisions of 38 U.S.C.A. 5107(a) (West 1991), this case is remanded to the RO for the following development: 1. The RO should request the veteran to provide the names and addresses of all health care providers who have treated him for any of his service-connected disabilities from 1989 to the present. The RO should attempt to obtain copies of all indicated records which are not currently in the claims folder. The RO should obtain up-to-date records from the VA Medical Center in San Francisco and the VA Outpatient Clinic in Oakland, as well as the medical facility at Fort Miley. All records obtained should be associated with the claims folder. 2. The appellant should then be afforded a VA psychiatric examination to determine the nature and severity of all psychiatric disorders which are present. The claims folder must be made available to the examiner for review in conjunction with the examination. The examination report should include a detailed account of all pathology found to be present. Primary personality disorders should be fully described and classified. The relationship, if any, between the appellant's service connected psychiatric disorder and any other condition identified, to include any personality disorder, should be discussed. The examiner should reconcile the diagnoses and specify which symptoms are associated with each of the disorders. If certain symptomatology cannot be dissociated from one disorder or another, the examiner should so specify. Any psychological testing deemed necessary to make a complete diagnostic evaluation and to differentiate symptoms attributable to the service-connected psychiatric disorder from those due to other conditions should be accomplished. Likewise, the examiner should utilize Social Work Service to obtain any additional data which may be needed to assist in evaluating the degree of social, psychological, and industrial impairment due to the service-connected psychiatric disorder. The examiner should describe how the symptoms of the service- connected psychiatric disorder affect the appellant's social and industrial capacity, and specifically comment on the degree to which the service-connected psychiatric disorder affects the appellant's initiative, flexibility, efficiency and reliability levels. The examiner should assign a numerical code under the GAF scale provided in the Diagnostic and Statistical Manual for Mental Disorders and specify which descriptive phrase(s) most appropriately reflect the veteran's level of functioning. 3. The veteran should also be afforded VA examinations by appropriate specialists of all his other service connected disabilities. All appropriate special studies should be performed and all pertinent clinical findings reported in detail. The claims folder must be made available to the examining physicians prior to their evaluations so that they may study the pertinent clinical records prior to their evaluations. 4. Following completion of the foregoing, the RO must review the case to ensure that the development has been completed in full and that the report of the psychiatric examination contains data reflecting the degree of reduction in initiative, flexibility, efficiency and reliability levels attributable to service-connected psychiatric disorder. When the requested development is fully completed, the RO should review the appellant's claims, including the claim that his service- connected disabilities precludes employment. The rating decision should reflect consideration of all potentially applicable criteria, to include consideration of the applicability of 38 C.F.R. § 3.321(b)(1). If the decision remains adverse to the appellant in any way, he and his representative should be furnished with a supplemental statement of the case which summarizes the pertinent evidence and reflects detailed reasons and bases for the decision. They should then be afforded the applicable time period to respond. The case should then be returned to the Board for further appellate consideration. No action is required of the appellant until he is so notified. The purpose of this REMAND is to obtain additional clarifying medical data and to ensure due process of law. No inference should be drawn regarding the final disposition of the claim as a result of this action. GARY L. GICK 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 action has been taken in accordance with the Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 303, 108 Stat. 4645, ___ (1994), and 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).