Citation Nr: 1012811 Decision Date: 04/05/10 Archive Date: 04/14/10 DOCKET NO. 06-33 598 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to an increased evaluation for generalized anxiety disorder with depression, currently evaluated as 30 percent disabling. 2. Entitlement to service connection for a heart disorder. 3. Whether new and material evidence has been received to reopen a claim for service connection for residuals of bilateral frozen feet. REPRESENTATION Appellant represented by: Virginia A. Girard-Brady, Attorney at Law ATTORNEY FOR THE BOARD A. C. Mackenzie, Counsel INTRODUCTION The Veteran served on active duty from February 1943 to October 1952. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2006 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The Board denied the Veteran's claims in an August 2008 decision. These denials, however, have since been vacated pursuant to an October 2009 Joint Motion for Partial Remand of the Veteran's representative and the VA General Counsel (herein "the parties") and an October 2009 order of the United States Court of Appeals for Veterans Claims. The Board notes that, in the Joint Motion, the parties let stand a denial of service connection for residuals of frozen ears from the August 2008 Board decision. Additionally, in separate August 2008 and October 2009 Board actions, a claim for service connection for glaucoma was remanded for additional development. There is no indication of subsequent action on this claim, and it will accordingly not be addressed at this time. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2009). 38 U.S.C.A. § 7107(a)(2) (West 2002). The appeal is REMANDED to the RO. VA will notify the Veteran if further action is required. REMAND As to the claim for an increased evaluation for generalized anxiety disorder with depression, the parties have called into question whether further consideration of findings of a Global Assessment of Functioning (GAF) score of 35, suicidal ideation, and memory loss from a March 2006 VA examination report is warranted. The Board observes that this examination report is now more than four years old and finds that, given the representative's request for an additional VA examination in a March 2010 brief, a further VA examination is needed. 38 U.S.C.A. § 5103A(d) (West 2002). With regard to the claim for service connection for a heart disorder, the parties found that the record raised a question of whether there exists a basis for service connection for this disorder as secondary to the service- connected generalized anxiety disorder. The parties noted a September 1952 Clinical Board report which links the Veteran's complaints, including chest pains, to "a psychogenic basis" and contains a diagnosis of psychogenic cardiovascular reaction. Further consideration under 38 C.F.R. § 3.310 (2009) is therefore warranted, and additional action should include a notification letter as to the secondary service connection theory of the case and a VA cardiovascular examination to ascertain the etiology of the claimed heart disorder. Finally, with regard to the issue of whether new and material evidence has been received to reopen a claim for service connection for residuals of bilateral frozen feet, the parties asserted that it was unclear whether all of the service treatment records relating to the Veteran's claimed frostbite residuals were requested or obtained in this case. Of concern to the parties was the fact that an April 1971 Request for Information referred only to the Veteran's "heart trouble" as the alleged disease or injury. Given this and the fact that the Veteran has asserted that he was treated for his bilateral foot disorder numerous times during service, further efforts to retrieve all service treatment records are warranted. 38 C.F.R. § 3.159(c)(2) (2009). Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2009). Expedited handling is requested.) 1. A letter should be sent to the Veteran explaining, in terms of 38 U.S.C.A. §§ 5103 and 5103A, the need for additional evidence regarding the claims on appeal. This letter must inform the Veteran about the information and evidence that is necessary to substantiate the claims and provide notification of both the type of evidence that VA will seek to obtain and the type of evidence that is expected to be furnished by him. With regard to the claim for service connection for a heart disorder, to include as secondary to the service-connected generalized anxiety disorder with depression, it is essential that the provisions of 38 C.F.R. § 3.310 be described in detail. 2. All necessary efforts to obtain the Veteran's complete service treatment records, to include contacting the National Personnel Records Center, should be made. All records obtained pursuant to this request must be included in the Veteran's claims file. If the search for such records has negative results, documentation to that effect should be included in the claims file. 3. The Veteran should then be afforded a VA psychiatric examination to determine the symptoms and severity of the service-connected generalized anxiety disorder with depression. The Veteran's claims file, particularly the report of the March 2006 VA examination, must be reviewed in conjunction with this examination. In this report, the examiner should describe all subjective complaints and objective findings in detail. An assessment of whether the Veteran currently has suicidal ideation is particularly important in this regard. The examiner should then render a multi- axial diagnosis, with a GAF score, and must provide an explanation of the GAF score in terms of the effect of the Veteran's disability on his occupational and social functioning. A complete rationale should be given for all opinions and conclusions expressed in a typewritten report. 4. The Veteran should also be afforded a VA cardiovascular examination, with an appropriate examiner, to determine the nature and etiology of the claimed heart disorder. The Veteran's claims file, especially the September 1952 Clinical Board report, must be reviewed in conjunction with this examination. All tests and studies deemed necessary by the examiner should be performed. Based on a review of the claims file and the clinical findings of the examination, the examiner is requested to provide a diagnosis corresponding to the claimed heart disorder. The examiner is also requested to offer an opinion as to whether it is at least as likely as not (e.g., a 50 percent or greater probability) that the diagnosed disorder: (1) is etiologically related to the Veteran's period of service, or (2) was caused or permanently worsened by his service-connected generalized anxiety disorder with depression. A complete rationale should be given for all opinions and conclusions expressed in a typewritten report. 5. After completion of the above development, the Veteran's claims should be readjudicated, with 38 C.F.R. § 3.310 considered in conjunction with the claim for service connection for a heart disorder. If the determination of any of these claims remains less than fully favorable to the Veteran, he and his representative should be furnished with a Supplemental Statement of the Case and given an opportunity to respond. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim 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. 2009). _________________________________________________ MARY GALLAGHER 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) (2009).