Citation Nr: 0812737 Decision Date: 04/17/08 Archive Date: 05/01/08 DOCKET NO. 05-30 571 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to an initial disability rating higher than 30 percent for post-traumatic stress disorder (PTSD). 2. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU). REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD B. Adams, Associate Counsel INTRODUCTION The veteran served on active duty from March 1968 to October 1969. This case comes before the Board of Veterans' Appeals (Board) on appeal from January 2005 and June 2005 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. REMAND In an April 2008 statement, the veteran's representative argued that the symptomatology associated with the veteran's service-connected PTSD had worsened. The record reflects that the veteran's most recent VA psychiatric examination was conducted in October 2004 and that he was assigned a Global Assessment of Functioning (GAF) score of 50 at that time. However, in an August 2004 VA outpatient treatment record, the veteran was assigned a GAF score of 37. In light of the discrepancy in GAF scores and the reported subsequent worsening of the veteran's symptoms, the Board finds that a new examination is necessary in order to decide his claim. See 38 U.S.C.A. § 5103A(d) (West 2002 & Supp. 2007); 38 C.F.R. § 3.159(c)(4) (2007). See also Snuffer v. Gober, 10 Vet. App. 400 (1997); Green v. Derwinski, 1 Vet. App. 121 (1991). With respect to the veteran's claim of entitlement to a TDIU, the Board finds that this issue is inextricably intertwined with the issue being remanded. See Babchak v. Principi, 3 Vet. App. 466 (1992). Moreover, further development of the record, to include a current VA examination, is in order before the Board decides this claim. In addition, the Board notes that the most recent VA outpatient treatment records associated with the claims file are dated in August 2005. The August 2005 record indicates that the veteran was receiving treatment regularly for his PTSD, and the Board finds it likely that more recent records exist. These records should be obtained since they likely contain information pertinent to the current severity of the veteran's PTSD and his employability. 38 C.F.R. § 3.159(c)(2). Finally, the Board notes that the veteran is appealing the initial rating of a disability following an award of service connection. He has not been provided with the notice required under 38 U.S.C.A. § 5103(a) (West 2002) and 38 C.F.R. § 3.159(b) (2007) with respect to this downstream element of his original service connection claim. Therefore, while this case is in remand status, the RO or the Appeals Management Center (AMC), in Washington, D.C., should ensure that all notice required under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) is provided. Accordingly, this case is REMANDED to the RO or the AMC for the following actions: 1. The veteran should be provided all notice required under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), to include notice in accordance with Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006) and notice that he should submit any pertinent evidence in his possession. 2. The AMC or RO should undertake appropriate development to obtain any pertinent evidence identified but not provided by the veteran, including any VA outpatient treatment records for the period since August 2005. If it is unable to obtain any such evidence, it should so inform the veteran and his representative and request them to provide the outstanding evidence. 3. Then, the veteran should be afforded a VA examination by a physician with appropriate expertise to determine the current severity of his PTSD. The claims folder must be made available to and be reviewed by the examiner, and any indicated studies should be performed. The examiner should identify all current manifestations of the veteran's PTSD and should provide an opinion concerning the current degree of social and occupational impairment resulting from the PTSD. In addition, the examiner should provide a global assessment of functioning (GAF) score and explain the significance of the score assigned. The examiner should state whether the veteran's PTSD is sufficient by itself or in combination with his other service-connected disabilities to preclude him from obtaining or maintaining any form of substantially gainful employment consistent with his education and occupational background. The rationale for all opinions expressed must be provided. 4. The RO or the AMC also should undertake any other development it determines to be warranted. 5. Then, the RO or the AMC should readjudicate the claim for a higher initial rating for PTSD. If it has not been rendered moot, the claim for a total rating based on unemployability due to service-connected disabilities should also be adjudicated. If the benefits sought on appeal are not granted to the veteran's satisfaction, the veteran and his representative should be furnished a supplemental statement of the case and provided an appropriate opportunity to respond before the claims folder is returned to the Board for further appellate action. By this remand, the Board intimates no opinion as to any final outcome warranted. No action is required of the appellant until he is otherwise notified, but he has the right to submit additional evidence and argument on the matters the Board has remanded. See Kutscherousky v. West, 12 Vet. App. 369 (1999). This case must be afforded expeditious treatment. 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 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). _________________________________________________ Shane A. Durkin Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), 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) (2007).