BVA9507488 DOCKET NO. 93-14 875 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in No. Little Rock, Arkansas THE ISSUE Entitlement to an increased rating for service-connected schizophrenia, currently rated as 30 percent disabling. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD Richard E. Coppola, Associate Counsel INTRODUCTION The veteran served on active duty from April 1969 to March 1971. This matter came before the Board of Veterans' Appeals (Board) on appeal from a rating decision of October 1991 from the North Little Rock, Arkansas, Department of Veterans Affairs (VA) Regional Office (RO), which denied a rating in excess of 30 percent for service-connected schizophrenia. In April 1992 and March 1993, the RO awarded the veteran temporary total disability evaluations for hospitalizations under 38 C.F.R. § 4.29 (1994). The veteran did not appeal these determinations. The veteran has raised a claim for a total rating for compensation purposes due to individual unemployability by reason of service-connected disability. This issue is referred to the RO for further action. REMAND The veteran was hospitalized from November 1992 to February 1993 with primary diagnoses of undifferentiated schizophrenia, manic disorder, and cocaine dependence. The report indicates that the veteran had had up to 40 prior hospital admissions for schizophrenia and/or substance abuse. It also indicates a past history of alcohol abuse, but the veteran reported no alcohol use since 1990. The veteran underwent detoxification and was then transferred to the Schizophrenic Chemical Abuse Treatment Program. The veteran's problems were identified as: emotional dysfunction manifested by drug and ethanol abuse and audiovisual hallucinations; diagnosis of schizophrenia and post-traumatic stress disorder; and deficient functional role skills and diversional activities manifested by poor leisure skills and stress management. The claims folder discloses numerous reports of hospitalization and examinations with diagnoses of alcohol and substance abuse. In August 1983, the diagnoses were anti-social personality disorder, amphetamine and cocaine abuse, amphetamine dependence, Valium abuse and dependence, alcohol abuse and dependence, cannabis abuse, multiple amphetamine delusional disorder, hallucinogen abuse and hallucinogen hallucinosis and schizophrenic disorder in full remission. The physician stated that the veteran had no signs, symptoms of schizophrenia, or any significant social or industrial impairment whatsoever as a direct consequence of any type of schizophrenic disorder. Subsequent hospitalization and examination reports dated through 1988 include continued diagnoses of alcohol abuse, mixed substance abuse and anti-social personality disorder. On VA examination in April 1989, the physician diagnosed undifferentiated schizophrenia and a history of drug abuse and opined that the veteran was severely impaired as a result of the schizophrenia and was not competent at that time. That same physician indicated similar diagnoses and opinions on VA examination in September 1989. Report of VA hospitalization in September 1991 indicated a diagnosis of chronic paranoid schizophrenia; however, the primary diagnosis during VA hospitalization from October to November 1991 indicated a diagnosis of bipolar disorder and only a history of schizophrenia. On VA examination in December 1991, the physician indicated a diagnosis of chronic paranoid schizophrenic disorder fairly well-controlled by medication, and opined that the veteran was competent at that time. Finally, on VA examination in June 1992 the reported diagnosis was undifferentiated schizophrenia in remission by medication. The veteran's representative argues that the veteran's substance abuse is either a symptom of the schizophrenia or is a chronic disability which has been incurred secondary to the schizophrenia. This issue is inextricably intertwined with the issue of the proper rating for the veteran's schizophrenia. The Board finds that additional medical development is necessary to reconcile the current medical findings prior to assignment of a rating for schizophrenia. Accordingly, the claim is REMANDED for the following action: 1. The veteran should state where he has received inpatient and/or outpatient treatment for schizophrenia and/or substance use since February 1993. After obtaining any needed authorization from the veteran, the RO should obtain copies of all these records. 2. The veteran should then be afforded a psychiatric examination in order to determine the severity and manifestations of his service-connected schizophrenia. The claims folder must be made available to the examiner prior to the examination. The examination should be conducted in accordance with VA's Physician's Guide for Disability Evaluation Examinations. Any psychological testing deemed necessary to make a complete diagnostic evaluation and to differentiate symptoms attributable to schizophrenia from those due to other conditions should be accomplished. The examiner should also, if needed, utilize Social Work Service to obtain data to clarify the nature and sequence of events which may have affected the veteran's life and to assist the examiner in evaluating the degree of social, psychological, and industrial impairment due to the schizophrenia. The examiner should provide a numerical GAF score, along with the associated descriptive phrase, which most appropriately reflects the veteran's level of functioning. The examiner should also specifically discuss the reduction, if any, in initiative, efficiency and reliability levels which is due to schizophrenia. Finally, the examiner should express an opinion regarding the etiology of substance abuse and/or alcoholism and the degree of probability that these are symptoms of or secondary to schizophrenia. 3. Following completion of this development, the RO should review the veteran's claims, including the claim that substance abuse is a symptom of schizophrenia or secondary to schizophrenia. 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 veteran 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. Thereafter, the case should be returned to the Board for further appellate consideration. No action by the veteran is required until he is contacted by the RO. 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. EUGENE A. O'NEILL 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 deter- mination. 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).