Citation Nr: 1320614 Decision Date: 06/26/13 Archive Date: 07/05/13 DOCKET NO. 06-39 405 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Des Moines, Iowa THE ISSUES 1. Entitlement to an evaluation in excess of 50 percent for service-connected dissociative disorder, multiple personality disorder with depression. 2. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU). REPRESENTATION Appellant represented by: Vietnam Veterans of America ATTORNEY FOR THE BOARD D. Cherry, Counsel INTRODUCTION The Veteran served as a member of the United States Navy, with active service from August 1990 to June 1993. This case comes before the Board of Veterans' Appeals (the Board) on appeal from a November 2006 rating decision rendered by the Department of Veterans Affairs (VA) Regional Office in Des Moines, Iowa (the RO). In April 2011, the Board remanded the claims for further development. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The Board remanded the claims for, among other reasons, to schedule the Veteran for VA examinations. The appellant failed to report for VA examinations scheduled in May 2011. A July 2011 VA e-mail reflects that the Veteran claimed that she did not receive the notice letter. The VA medical center in Des Moines, Iowa, determined that there was a discrepancy regarding the appellant's street address because CAPRI had listed her street address as "[redacted three-digit number] NW [redacted two-digit number] Street" whereas her actual address is "[redacted three-digit number] [redacted two-digit number] Street NW". That e-mail reflects that the street address was going to be updated and that a corrective letter scheduling her for another examination would be sent to the correctly stated street address. The Veteran failed to report for VA examinations scheduled in July and August 2011. The letter informing her of the examinations scheduled in July and August 2011 that was printed on August 1, 2011, for documentation of its mailing. The notice letter shows that VA did not correct her address before mailing the letter because the notice letter regarding the July and August 2011 examinations still had her street address incorrectly listed. A September 2011 e-mail shows that an employee of the AMC was informed by an employee of the relevant VA medical center that the letter, which to reiterate had an incorrect street address, was not returned as undeliverable. The employee of the AMC concluded that the case could therefore be decided. Put another way, the AMC concluded that the appellant must have received timely notice of the July and August 2011 VA examinations because the notice letter had not been returned as undeliverable as of September 7, 2011. In fact, a compensation and pension exam inquiry printed May 29, 2012, shows that her address had still not been updated. In light of the above, the Board finds that the fact that the letter with an incorrectly stated street address had not been returned as undeliverable as of September 7, 2011, is not persuasive evidence to show that the Veteran did indeed receive the letter, much less receive it in a timely manner as to the scheduled dates of the July and August 2011 VA examinations. Therefore, the Board finds that is good cause for her failure to report for those examinations and that she is entitled to another attempt to schedule her for an examination. In light of the above discussion, the Board finds that the AMC did not comply with the directives of the April 2011 Board remand. Stegall v. West, 11 Vet. App. 268 (1998). Accordingly, the case is REMANDED for the following action: 1. Contact the Veteran and request that she identify all VA and non-VA health care providers that have treated her for her service-connected dissociative disorder, multiple personality disorder with depression. 2. The Veteran should complete a release for any private treatment records identified by her prior to any attempts to obtain such. All records obtained should be associated with the Veteran's VA claims file. If any requested records are not available, or if the search for any such records otherwise yields negative results, that fact should clearly be documented in the claims file, and the Veteran should be informed in writing. 3. Obtain and associate with the claims file all identified outstanding records of VA treatment pertaining to the Veteran's service-connected dissociative disorder, multiple personality disorder with depression. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact should clearly be documented in the claims file. 4. The appropriate VA medical center should document prior to scheduling the Veteran for an examination that her street address (assumed that she has not moved in the interim) has been changed in CAPRI from "[redacted three-digit number] NW [redacted two-digit number] Street" to "[redacted three-digit number] [redacted two-digit number] Street NW". This documentation may be accomplished by putting a copy of the compensation and pension exam inquiry, which would show her correct address of record, in her claims file. 5. Thereafter, the AMC should schedule the Veteran for a VA psychiatric examination. The Veteran's complete VA claims file is to be provided to the examiner for review in conjunction with the examination. The VA examiner should expressly state which of the Veteran's psychiatric symptomatology are due to her service-connected dissociative disorder, multiple personality disorder with depression, without regard to any non service-connected psychiatric disorders which may be diagnosed. Furthermore, the VA examiner should provide an opinion as to the Veteran's GAF score due, solely, to her service-connected dissociative disorder, multiple personality disorder with depression, without regard to any non service-connected psychiatric disorders which are diagnosed. If it is not possible to make the above distinctions, the VA examiner should state so and indicate the reasons why such distinctions could not be made. The VA examiner should specifically opine as to whether the Veteran's dissociative disorder, multiple personality disorder with depression, symptomatology causes the following: (1) suicidal ideation; (2) obsessional rituals which interfere with routine activities; (3) speech intermittently illogical, obscure, or irrelevant; (4) near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; (5) impaired impulse control (such as unprovoked irritability with periods of violence); (6) spatial disorientation; (7) neglect of personal appearance and hygiene; (8) difficulty in adapting to stressful circumstances (including work or a worklike setting); (9) inability to establish and maintain effective relationships; (10) gross impairment in thought processes or communication; (11) persistent delusions or hallucinations; (12) grossly inappropriate behavior; (13) persistent danger of hurting self or others; (14) intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); (15) disorientation to time or place; and/or (16) memory loss for names of close relatives, own occupation or own name. The examiner should assign a Global Assessment of Functioning (GAF) score for the Veteran's service-connected dissociative disorder, multiple personality disorder with depression, (distinct from any other diagnosed psychiatric condition, to the extent possible) consistent with the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The examiner should also provide an opinion concerning the impact of the Veteran's service-connected dissociative disorder, multiple personality disorder with depression, on her ability to obtain and maintain gainful employment. The rationale for all opinions expressed must also be provided. If the examiner is unable to render any opinion requested above, the examiner should fully state the reasons for the inability to provide the requested opinion(s). 6. The AMC should then readjudicate the claims in light of all of the evidence of record on the merits. Even if the Veteran's increased evaluation claim is denied, and the Veteran fails to meet the schedular requirements for a TDIU claim as per 38 C.F.R. § 4.16(a), the AMC MUST consider whether submission of the Veteran's TDIU claim to the Director of the VA Compensation and Pension Service for extraschedular consideration, as per 38 C.F.R. § 4.16(b), is appropriate. If the claims are not granted to the fullest extent possible, the Veteran and her representative should be provided with a supplemental statement of the case (SSOC) as to the issues on appeal, and afforded a reasonable period of time within which to respond thereto. The Veteran 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). The Veteran is advised that failure to appear for VA examinations could result in the denial of her claims. 38 C.F.R. § 3.655 (2012). See Connolly v. Derwinski, 1 Vet. App. 566, 569 (1991). The Board intimates no opinion as to the ultimate outcome of this case. 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. 2012). _________________________________________________ J. K. BARONE Acting 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) (2012).