Citation Nr: 0000552 Decision Date: 01/07/00 Archive Date: 01/11/00 DOCKET NO. 98-14 008 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to an increased evaluation for the residuals of a concussion, to include dementia due to head trauma. 2. Entitlement to a total rating based on individual unemployability due to the veteran's service-connected disability. REPRESENTATION Appellant represented by: Richard A. LaPointe, Esquire ATTORNEY FOR THE BOARD Patrick J. Costello, Counsel INTRODUCTION The veteran had active military service from January 1977 to June 1978. This matter came before the Board of Veterans' Appeals (hereinafter the Board) on appeal from an April 1998 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), in Montgomery, Alabama. REMAND The veteran is service-connected for the residuals of concussions that has been rated pursuant to 38 C.F.R. Part 4, Diagnostic Code 9304 (1999). When the veteran was initially granted service connection for the residuals of a concussion, the RO concluded that the sole residual was headaches. Based on this, a 10 percent disability rating was assigned. VA Form 21-6796, Rating Decision, October 28, 1982. In 1995, the RO increased the veteran's disability rating from 10 to 30 percent. See VA Form 21-6796, Rating Decision, June 7, 1995. When the RO wrote up the justification for the rating, it noted the following: . . . he is alert and oriented to person, place, time, and purpose. . . He had difficulty with immediate, intermittent, and remote memory, unable to recall questions post 10 minutes before and unable to recall three items in a list post minute prior and unable to recall social security number or former address. . . On the examiners impression the most outstanding feature of the examination was the quality of flat effect characterizing the entire description of numerous medical problems and career setbacks. Given his long history of depression, his most outstanding features on history and examination appeared to be his blunted affect. This generates a differential impression and possible front injury given his reports of head trauma in the past. There is a metabolic basis for difficulties of concentration, memory, and affect which he reports. Following the veteran's 1997 request for an increased evaluation, he sat for two psychiatric evaluations. Mental Disorders Exam, November 28, 1997; Mental Disorders Exam, January 28, 1998. Following the first examination, he was labeled schizophrenic and some of the manifestations and symptoms that may have been previously attributed to his concussion residuals were grouped under schizophrenia. Two months later, another psychiatric examination classified the veteran as suffering from a delusional disorder (persecutory type), not schizophrenia. No mention of dementia was made in the evaluation. Instead, the examiner wrote that all of the psychological manifestations and symptoms from which the veteran complained thereof were not related to the veteran's service-connected dementia secondary to head trauma. After reviewing the veteran's claims folder, it is the opinion of the Board that a clear picture of the veteran's current disability does not exist. That is, the Board is unsure whether the veteran now suffers from dementia or whether this mental condition has been overlaid by another psychiatric condition. Because there is uncertainty, the Board cannot adequately judge the veteran's claim in light of all of the evidence. Hence, the Board believes that a remand is necessary so that a more definite diagnosis can be made as to the symptoms and manifestations he now suffers from as a result of the dementia due to the head trauma and any other mental illness he may also suffer therefrom. Accordingly, this case is REMANDED to the RO for the following actions: 1. The veteran should be examined by a Board of two neuropsychiatrists who have not previously examined him to determine the nature and severity of any neurological and psychological disorder. Each neuropsychiatrist should conduct a separate examination with consideration of the criteria for dementia, schizophrenia, and a delusional disorder. The examination should be conducted in accordance with the DSM-IV. If the examiners determine that the veteran has any psychiatric disorder in addition to dementia, the examiners should determine the relationship of any such disorders among themselves (including etiological origin and secondary causation). and specify which symptoms are associated with each disorder. If certain symptomatology cannot be disassociated from one disorder or the other, it should be so specified. The examiners should also specify which symptoms and manifestations that can be definitely attributed as a residual of the service- connected head trauma. The report of the examination should include a complete rationale for all opinions expressed. All necessary studies or tests are to be accomplished. The entire claims folder and a copy of this Remand must be made available to and reviewed by the examiners prior to the examination. 2. The RO should review all requested reports and determine if they are adequate for rating purposes and in compliance with this remand. If they are not, they should be returned to the originator for supplemental action. Following completion of the requested development, the veteran's claim should be readjudicated. The appellant and his representative are put on notice that they have the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). If the decision remains unfavorable, the veteran and his lawyer should be given a supplemental statement of the case and allowed sufficient time for a response. Thereafter, the claim should be returned to the Board for further consideration. No action is required of the veteran until he is contacted by the regional office. The purpose of this REMAND is to ensure due process and to obtain additional clarifying medical evidence. 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). 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. JACK W. BLASINGAME Member, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 1991 & Supp. 1999), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. 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).