92 Decision Citation: BVA 92-22545 Y92 BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 DOCKET NO. 90-05 933 ) DATE ) ) ) THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder. 2. Entitlement to service connection for alcoholism, secondary to claimed post-traumatic stress disorder. REPRESENTATION Appellant represented by: Michael K. Lehr, Attorney WITNESSES AT HEARING ON APPEAL Appellant, L. Haverkamp, M.S.W., and E. Huycke, M.D. ATTORNEY FOR THE BOARD Brian J. Milmoe, Counsel INTRODUCTION The veteran served on active duty from August 1967 to April 1970. By a decision of August 14, 1990, the Board of Veterans' Appeals (BVA) denied the veteran's entitlement to service connection for various disorders, to include post-traumatic stress disorder and alcoholism. The veteran thereafter appealed the aforementioned decision to the United States Court of Veterans Appeals (Court). The Secretary of Veterans Affairs subsequently moved the Court to remand the case to BVA so that sufficiently detailed reasons and bases could be set forth with respect to the denial of entitlement to service connection for post-traumatic stress disorder. A copy of the Secretary's motion for remand was mailed to the veteran in late September 1991, to which he failed to respond. The Court, in an order entered in October 1991, granted the Secretary's motion for remand and vacated the BVA's decision of August 14, 1990. The Court retained jurisdiction and remanded the matter to BVA for readjudication, including consideration of the relationship between the veteran's mental disorder and alcoholism, and the applicability of 38 U.S.C.A. § 1154(b) (West 1991) and the Department of Veterans Affairs (VA) Veterans Benefits Administration (VBA) Manual M21-1, paragraph 50.45. It was further noted that any BVA physician opinion relied upon must be accompanied by quotation from competent medical authority. [citation redacted]. REMAND In a telephone conversation with BVA personnel in June 1992, the veteran's attorney asked if there was a possibility that the veteran could be afforded another personal hearing. An attempt was made in August 1992 by BVA to clarify the veteran's desire to appear at another hearing, at which time BVA personnel contacted the veteran's attorney, who advised that further time would be required in order to review the record and ascertain whether a formal hearing request was to be made. Further review of the claims folder indicates that multiple psychiatric diagnoses have been entered with respect to the veteran's mental status and that those diagnoses include post-traumatic stress disorder. Evaluation of the veteran in June and September 1988 at the Vet Center in Wichita, Kansas, culminated in a diagnosis of post-traumatic stress disorder; psychiatric examination by VA in October 1988 disclosed findings which failed to identify the presence of post-traumatic stress disorder related to the veteran's period of military service. The VA examination did reveal alcohol abuse and dependency, a generalized anxiety disorder, and a severe mixed personality disorder. The presence or absence of a sustainable diagnosis of post-traumatic stress disorder is of primary importance in this matter, and in view of the noted conflict, we deem it advisable to secure clarifying data. For the reasons noted, we hereby REMAND this case to the Wichita, Kansas, regional office (RO) for completion of the following actions: 1. The veteran's attorney should be contacted in writing to determine the veteran's desire to appear at another hearing before RO or BVA personnel concerning his entitlement to service connection for post-traumatic stress disorder and alcoholism. In the event that another hearing is desired at the RO level, arrangements for that hearing should then be made and his attorney should be advised of the date and time of that proceeding. The RO should conduct any and all communications regarding the above matter, as well as the scheduling of necessary examinations, through the veteran's attorney. 2. Complete clinical records with respect to periods of hospitalization of the veteran at VA facilities in Leavenworth, Topeka, and/or Witchita, Kansas, in October 1973, June 1976, September 1978, and December 1983, should be obtained and made a part of the veteran's claims folder. A complete record of a VA agent orange examination performed in early 1980 should also be secured. Also, the RO should ascertain whether there are in existence recent reports of treatment, which were compiled at inpatient or outpatient VA facilities or the Vet Center in Witchita, Kansas, for management of the veteran's claimed post-traumatic stress disorder, and if so, those records should be obtained for inclusion in the claims folder. 3. Thereafter, the veteran should be afforded a VA psychiatric examination by a board of two psychiatrists, comprised of physicians who have not previously examined or treated him. The purpose of such evaluation is to determine whether the diagnostic criteria outlined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised for entry of a diagnosis of post-traumatic stress disorder related to the veteran's period of military service have been met. Also, it should be ascertained whether there is present any other mental disorder, including any personality disorder, aside from the claimed post-traumatic stress disorder. Such examination should be conducted in accordance with the provisions of Chapter 20 of the VA's Physician's Guide for Disability Evaluation Examinations. Prior to the psychiatric evaluation, the veteran should be afforded psychological testing, to include all post-traumatic stress disorder scales. Each examiner should be asked to provide his/her professional opinion, with supporting reasons, as to whether the diagnostic criteria for entry of a diagnosis of post-traumatic stress disorder have been met. The claims folder and a copy of this REMAND decision should be provided to all examiners for use in the study of this case. When this development has been completed, the RO should readjudicate the veteran's claim of entitlement to service connection for post-traumatic stress disorder, considering all relevant statutory and regulatory authority, including 38 U.S.C.A. § 1154(b), and the provisions of VBA Manual M21-1, paragraph 50.45. Also, the issue of the veteran's entitlement to secondary service connection for alcoholism should be readjudicated. If the benefits sought on appeal are not granted, the veteran and his attorney should be furnished a supplemental statement of the case with regard to the additional development and the subsequent determination. They should also be given the opportunity to respond. The records should then be returned to BVA for further appellate consideration. No action is required by the veteran until he receives further notice. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 NANCY R. ROBIN B. KANNEE ALBERT D. TUTERA 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. 57 Fed. Reg. 4126 (1992) (to be codified as 38 C.F.R. § 20.1100(b)).