Citation Nr: 1323535 Decision Date: 07/24/13 Archive Date: 08/01/13 DOCKET NO. 10-37 937 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to service connection for a psychiatric disability. REPRESENTATION Appellant represented by: Gregory D. Keenum, Attorney WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD T. Hal Smith, Counsel INTRODUCTION The Veteran served on active duty from October 1973 to November 1982. This matter is before the Board of Veterans' Appeals (Board) on appeal of a September 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. A videoconference hearing was held in February 2011 before the undersigned Veterans Law Judge. A copy of the transcript of that hearing is of record. The Board has reviewed the claims file and the Virtual VA electronic claims file. The appeal is REMANDED to the RO via the Appeals Management Center in Washington, D.C. REMAND The Veteran contends that he currently suffers from a psychiatric disability, to include paranoid schizophrenia, due to service. Review of the Veteran's service medical records shows that the Veteran was assaulted and stabbed multiple times in the back legs, left arm, and left hand in May 1975. His open wounds were sutured. In January 1977, it was noted that the Veteran was attempting to cross-train into an air traffic control career. Initial evaluation revealed that he might "not have the emotional stability required for this duty." That was based on an exam which did not find a psychotic or neurotic individual, but an unstable, somewhat immature individual. In April 1982, the Veteran was admitted for alcohol detoxification. Following evaluation, the diagnoses included alcohol abuse, and mixed personality disorder. He was separated from service in October 1982. Notation was made at that time of his previous treatment for detoxification. After service, private records dated from 2007 to 2009 show treatment for various conditions, to include paranoid schizophrenia and depression. An August 2009 VA psychiatric examination shows that the examiner reviewed the claims file and diagnosed paranoid schizophrenia by history. The examiner also discussed how personality disorders did not give rise to schizophrenia in that while both are mental disorders, they were not in the same "continuum" and therefore not related. While those conditions can exist at the same time in an individual, one does not result from the other. The examiner also noted that while the Veteran said that he experienced hallucinations during service, there was no evidence in the file to support that. The examiner did not discuss the inservice assault. At the February 2011 videoconference hearing, the Veteran presented testimony in support of his claim. As noted by his private attorney representative, the Veteran was assaulted during service and received multiple stab wounds. His service medical records show inservice treatment for psychiatric symptoms which were diagnosed as alcohol abuse and personality disorders. The representative argued that the Veteran currently has psychiatric disabilities which had their onset during service. The representative asserted that the Veteran's alcohol abuse started in the 1970s and that he entered service without any diagnosis of mental problems. The Veteran testified that he did not leave service on a voluntary basis. He was pushed out because of his psychiatric problems. He said that his time in service was stressful. Since service, he had not held a job for any length of time. He preferred to be alone and had problems with relationships. He continued to be seen for his psychiatric symptoms. Subsequent private and VA records dated through 2010 show continued treatment for psychiatric complaints, to include the use of medication to control his symptoms. Current review of the file by the Board results in a conclusion that the VA psychiatric examination in 2009 is inadequate to address the medical questions on appeal. While the examiner gave a detailed rationale for why personality disorders do not cause acquired psychiatric conditions, the examiner did not discuss whether the inservice assault on the Veteran might have resulted in a psychiatric disability or aggravated any preexisting psychiatric disability. When the medical evidence of record is insufficient, the Board must supplement the record by seeking an advisory opinion, ordering a medical examination, or citing recognized medical treatises that clearly support its ultimate conclusions. Colvin v. Derwinski, 1 Vet. App. 171 (1991); 38 C.F.R. § 3.159(c)(4) (2012); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, the case is REMANDED for the following action: 1. Contact the veteran and request that he identify the names, addresses, and approximate dates of treatment for all medical care providers, VA and non-VA, who may possess additional records of treatment of a psychiatric disability. After obtaining any necessary authorization or medical releases, request and associate with the claims file copies of the veteran's complete treatment reports from all sources identified whose records have not previously been secured. Regardless of the veteran's response, obtain all outstanding VA treatment records. 2. After any outstanding records have been obtained and associated with the claims file, schedule the Veteran for a VA examination to determine the nature and likely etiology of the Veteran's claimed psychopathology, variously diagnosed as paranoid schizophrenia, mixed personality disorder, anxiety, and depression. The examiner must review the claims file and must note that review in the report. All indicated tests and studies are to be performed. All clinical findings should be reported in detail, and rendered in accordance with the diagnostic criteria for the condition set forth in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). A complete rationale must be provided for all opinions rendered. Specifically, the examiner should: a) Provide a full multi-axial diagnosis pursuant to the criteria of DSM-IV and list all psychiatric diagnoses applicable to the Veteran. b) Take into account all relevant service records, such as those showing an inservice assault and treatment for various psychiatric complaints, diagnosed as a personality disorder and alcohol abuse, and provide an opinion as to whether it is clear and unmistakable that the Veteran had any psychiatric disability at the time of his entrance into active service, and if so, describe the nature of the disability. c) If the Veteran entered service with a psychiatric disability, provide an opinion as to whether or not that disability permanently increased in severity during service, and if so, opine as to whether or not the increase in severity represented a worsening of the underlying condition beyond the natural progress of the disorder. d) For any psychiatric disability not found to have existed prior to service, offer an opinion, consistent with sound medical principles and in consideration of the Veteran's specific contentions and review of pertinent records, as to whether it is at least as likely as not (50 percent or greater probability) that any psychiatric disability had its onset during active service. An opinion should be rendered for each psychiatric disability with which the Veteran is diagnosed. 3. Then readjudicate the claim. If the decision is adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the claim to the Board. 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). The Veteran is advised that failure to report for a scheduled VA examination without good cause shown may have adverse effects on his claim. 38 C.F.R. § 3.655 (2012). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ HARVEY P. ROBERTS Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002 & Supp. 2012), 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).