BVA9505508 DOCKET NO. 93-15 393 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for residuals of a ruptured left medial collateral ligament. 2. Entitlement to an increased evaluation for post-traumatic stress disorder, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Robert E. O'Brien, Counsel REMAND The veteran had active service from May 1965 to January 1969. This case comes before the Board of Veterans' Appeals (Board) on appeal from an April 1992 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas, which, among other things, granted service connection for post- traumatic stress disorder and assigned a 10 percent rating, and denied service connection for residuals of a rupture of the left medial collateral ligament. The veteran has not been accorded the rating examination for his service-connected post-traumatic stress disorder by VA since 1991. The report of that examination does not reflect a Global Assessment of Functioning (GAF) score. Subsequently, the veteran was hospitalized at a VA medical center in July 1993 in the post- traumatic stress disorder unit brief treatment program. It was noted that he was currently visiting a Vet Center in San Antonio, Texas, on a regular basis. It was discovered the veteran had been consuming alcohol prior to hospitalization and, therefore, he was discharged on an irregular basis. Prior to discharge, he was referred to the alcohol rehabilitation unit for screening in the hope that he would be accepted the same day and possibly transferred there. However, this did not work out. After screening by the staff in the alcohol rehabilitation unit, he was accepted into the program and was informed his admission date would be August 18, 1993. He was told he could reapply to the post-traumatic stress disorder program, but would have to complete the alcohol rehabilitation program prior to admission into the post-traumatic stress disorder unit. Followup at the Vet Center in San Antonio was arranged and notation was made of an appointment on July 30, 1993. The final Axis I diagnoses were post-traumatic stress disorder and episodic alcohol abuse. The claims folder does not reflect whether the veteran was admitted on August 18, 1993. The Board notes the last communication from the Vet Center in San Antonio which is of record, is dated in August 1991. VA has a duty to assist the veteran in the development of facts pertinent to his claims under 38 C.F.R. § 3.103(a) (1994). The United States Court of Veterans Appeals has held that fulfillment of the VA's duty to assist a veteran includes providing him with a thorough and contemporaneous medical examination. Littke v. Derwinski, 1 Vet.App. 90, 92 (1990). With regard to the veteran's claim for a left knee disability, the service medical records which are available contain no reference whatsoever to a left knee disorder. In a July 1993 communication the veteran's representative reported that the veteran indicated he was sent sent from Vietnam to Okinawa and received treatment at a United States Air Force hospital at "NAHA" and later at a Marine Corps facility at Camp Hansen in Japan. Reportedly, this occurred in April 1966. Assistance was requested in locating this medical evidence. The Board notes the veteran has provided no indication of continuity of treatment of a left knee disorder in the years following service. However, since the case must be further developed with regard to post- traumatic stress disorder, the opportunity will also be used for further development with regard to the left knee disability. In view of the foregoing, the case is REMANDED to the RO for the following actions: 1. The RO should contact the veteran and request that he provide the names and addresses of all health care providers who have treated him for a psychiatric disability since 1993 and for a left knee disability since service discharge. Then, after any necessary authorization is obtained from the veteran, the RO should obtain copies of any treatment records identified by the veteran. Of particular interest are any records from the VA Medical Center in Waco, Texas, particularly regarding reported hospitalization of the veteran at that facility beginning August 18, 1993. Also of interest are the clinical records, or a detailed summary thereof, regarding any treatment of the veteran at the Vet Center, 231 West Cypress Avenue, San Antonio, Texas 78212, since August 1991. 2. The RO should schedule the veteran for a comprehensive VA psychiatric examination. This study must be conducted in accordance with the VA's Physician's Guide for Disability Evaluation Examinations. All indicated tests should be conducted. The claims file must be made available to and reviewed by the examiner. The examiner should be requested to assign a GAF score and explain what the assigned score represents. The examiner should also provide an opinion as to the extent to which the veteran's stress disorder interferes with his initiative, flexibility, efficiency and reliability levels. The rationale for the opinions expressed must be provided. 3. Based on a review of any information obtained pertaining to the veteran's left knee disability, a VA orthopedic examination should be authorized if warranted. In such case, the examiner should review the claims folder and express an opinion as to the etiology of any current left knee symptomatology. 4. The RO should then readjudicate the veteran's claims. The rating decision should reflect consideration of the applicability of the provisions of 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.129 and 4.130 (1994). Thereafter, unless the benefits sought are granted to the veteran's satisfaction, he and his representative should be provided with a supplemental statement of the case and be afforded the applicable time period in which to respond. The case should then be returned to the Board for further consideration, 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. CHARLES E. HOGEBOOM 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) (1994).