93 Decision Citation: BVA 93-13788 Y93 BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 DOCKET NO. 92-24 241 ) DATE ) ) ) THE ISSUES 1. Entitlement to an increased evaluation for post-traumatic stress disorder, currently evaluated as 50 percent disabling. 2. Entitlement to a temporary total rating under the provisions of 38 C.F.R. § 4.29 for a period of VA hospitalization from October 20, 1991, to November 13, 1991. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Robert E. O'Brien, Counsel INTRODUCTION The veteran had active service from May 1967 to May 1971. This appeal came before the Board of Veterans' Appeals (Board) on appeal from a June 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Boston, Massachusetts, which confirmed a 50 percent rating for the veteran's post-traumatic stress disorder. The notice of disagreement with that determination was received in July 1991. The statement of the case was issued in August 1991. In a March 1992 rating decision, entitlement to a temporary total rating under the provisions of 38 C.F.R. § 4.29 (1992), for a period of hospitalization from October 20, 1991, to November 13, 1991, was denied. The substantive appeal regarding the increased rating was received in March 1992. A supplemental statement of the case with regard to both issues was issued in September 1992. The appeal was received and docketed at the Board in December 1992. The veteran has been represented throughout his appeal by the Disabled American Veterans. That organization submitted written argument on the veteran's behalf in November 1992 and again in April 1993. In a June 1991 personal history questionnaire, the veteran referred to exposure to Agent Orange. This matter has not been developed or adjudicated by the RO and is therefore referred to the RO for appropriate action. REMAND Initially, the Board notes that the veteran has had several mailing addresses in the recent past. In a September 1992 communication, he gave his address as 106 West River Drive, Apartment 17, Manchester, New Hampshire 03104. However, a March 1993 communication from the VA Medical Center, Northampton, Massachusetts, was sent to the veteran at 77 Market Street, Manchester, New Hampshire 03101. In that communication it was indicated the veteran was to be hospitalized at that facility from August 9 to August 11, 1993, for evaluation for the post-traumatic stress disorder program. In a January 1991 communication, John J. Goldsberry, Jr., M.D., stated that the veteran had extreme symptoms of post-traumatic stress disorder, which included exacerbation of his dermatitis involving the lower extremities, resulting in ulcerations and oozing and weeping of purulent material. In testimony at a personal hearing held at the RO in July 1990 and in other communications of record, the veteran has raised the issue of an increased evaluation for his service-connected dermatitis of the lower extremities. Also, the evidence of record, including the September 1992 communication from the veteran, indicates that he is claiming to be unemployable due to his post-traumatic stress disorder. These issues have not been developed or adjudicated by the RO. The United States Court of Veterans Appeals has held that the Board must address all issues that have been reasonably raised by the record. EF v. Derwinski, 1 Vet.App. 324 (1991). With regard to the veteran's employment status, he indicated in a June 1991 VA personal history questionnaire that he left the Cambridge, Massachusetts, Police Department in 1983 due to injuries. He stated that he had a suit pending against the department where he had been employed from November 1975 to January 1986 as a patrol officer. No information from the Cambridge Police Department is of record. A review of the entire evidence of record indicates that the veteran has a longstanding history of alcohol abuse. He attributes his alcoholism to self-medication in an attempt to reduce his psychiatric symptomatology. The principal reason for his hospitalization from October to November 1991 at the Northampton VA Medical Center was listed as detoxification due to alcohol abuse. It is our opinion that the veteran and his representative believe that his alcoholism is a manifestation of his service-connected post-traumatic stress disorder. A review of the record discloses no medical opinion as to whether the alcohol abuse may be considered as a manifestation of the post- traumatic stress disorder. We note that the veteran has not been accorded a psychiatric examination for rating purposes by VA since April 1990. His representative asks that he be accorded a more contemporaneous examination. The United States Court of Veterans Appeals held in Littke v. Derwinski, 1 Vet.App. 90 (1990), that VA's duty to assist a veteran in obtaining and developing available facts and evidence to support his claim includes obtaining an adequate and contemporaneous VA examination. We also note that the most recent medical evidence of record is dated in 1991. At the time of discharge from hospitalization at the Northampton VA Medical Center in November 1991, it was indicated that the veteran was in need of continued psychotherapy. Recommendation was made for individual counseling at a local Vet Center, as well as followup treatment in the substance abuse treatment program for alcohol dependence at the VA Medical Center, Manchester, New Hampshire. As noted above, most recently it has been indicated that the veteran has been scheduled for admission to the VA Medical Center, Northampton, Massachusetts, for evaluation for the post-traumatic stress disorder program from August 9 to August 11, 1993. Also, there is no medical evidence of record subsequent to January 1991 from Dr. Goldsberry pertaining to treatment and evaluation of the veteran's chemical dependency and post-traumatic stress disorder. In light of the foregoing and our duty to assist the veteran in the development of facts pertinent to his claims, as mandated by 38 U.S.C.A. § 5107(a) (West 1991), 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 his service-connected disabilities in the recent past and specify the approximate dates of treatment, if possible. Then, after any necessary authorization is obtained from the veteran, the RO should obtain copies of any treatment records identified by the veteran which have not been previously secured. Of particular interest are any records subsequent to January 1991 from John J. Goldsberry, Jr., M.D., at the Naukeag Hospital, 216 Lake Road, Ashburnham, Massachusetts 01430. The RO should also obtain and associate with the claims folder copies of any records pertaining to treatment and evaluation of the veteran by VA, particularly at the Northampton VA Medical Center and the Manchester VA Medical Center, since 1991. 2. The RO should contact the Cambridge Police Department, 5 Western Avenue, Cambridge, Massachusetts, and request a copy of any records pertaining to an award or denial of disability benefits to the veteran, including information as to the termination of the veteran's employment status in 1983 or 1986. 3. The veteran should complete an application for increased compensation based on unemployability (VA Form 21-8940). 4. Thereafter, the RO should arrange for VA psychiatric and dermatology examinations of the veteran to determine the current nature and extent of social and occupational impairment attributable to his service-connected psychiatric and skin disabilities. All indicated studies should be performed. The board-certified psychiatrist should provide an opinion, with a detailed rationale, as to whether the veteran's alcoholism is a manifestation of his post-traumatic stress disorder. Each examiner is also requested to provide an opinion as to the impact of the psychiatric and dermatologic symptomatology, respectively, on the veteran's ability to obtain and maintain substantially gainful employment. The claims folder should be made available for review by the examiners prior to their examinations. 5. Then, in light of the evidence obtained pursuant to the requested development, the RO should readjudicate the issues listed on the title page and adjudicate the claims for increased ratings for the veteran's skin disorder and a total compensation rating based on unemployability by reason of service- connected disabilities. If the veteran disagrees with any decision of the RO, and if otherwise appropriate, a supplemental statement of the case should be issued for all issues in appellate status, and the veteran and his representative should be provided an opportunity to respond. Thereafter, the case should 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. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 * JOHN J. CASTELLOT, SR., M.D. ROBERT E. SULLIVAN (CONTINUED ON NEXT PAGE) *38 U.S.C.A. § 7102(a)(2)(A) (West 1991) permits a Board of Veterans' Appeals Section, upon direction of the Chairman of the Board, to proceed with the transaction of business without awaiting assignment of an additional Member to the Section when the Section is composed of fewer than three Members due to absence of a Member, vacancy on the Board or inability of the Member assigned to the Section to serve on the panel. The Chairman has directed that the Section proceed with the transaction of business, including the issuance of decisions, without awaiting the assignment of a third Member. 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 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) (1992).