93 Decision Citation: BVA 93-12830 Y93 BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 DOCKET NO. 90-45 993 ) DATE ) ) ) THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder. 2. Entitlement to service connection for a cardiovascular disorder as secondary to post-traumatic stress disorder. 3. Entitlement to service connection for skin disorders as secondary to post-traumatic stress disorder. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD T. H. Tousley, Associate Counsel INTRODUCTION The veteran had active military service from July 1969 to February 1971. This case originally came before the Board of Veterans' Appeals (Board) on an appeal of a December 1988 rating decision by the Department of Veterans Affairs (VA) regional office (RO) in Waco, Texas, that denied entitlement to a nonservice-connected pension and entitlement to service connection for post-traumatic stress disorder, residuals of an injury to the right great toe, and jungle rot. The veteran submitted a notice of disagreement in March 1989. He stated that he disagreed with the RO's denial of entitlement to service connection for post-traumatic stress disorder which he also claimed contributed to heart problems, back pain, etc. The RO in May 1989 issued a statement of the case regarding the issues of entitlement to a nonservice-connected pension and entitlement to service connection for post-traumatic stress disorder. The veteran stated in his substantive appeal received in September 1989 that he was not requesting entitlement to a nonservice-connected pension, but rather entitlement to service connection for post-traumatic stress disorder and "adjunct disabilities." By a rating decision in March 1990, the RO denied service connection for a psychiatric disorder, to include post-traumatic stress disorder, a heart disorder, a skin disorder, and residuals of neck, back and left knee injuries. The RO issued supplemental statements of the case concerning these issues in April 1990 and July 1990. The Board denied entitlement to service connection for these disorders by a decision dated March 8, 1991. By a Memorandum Decision, dated December 3, 1992, the United States Court of Veterans Appeals (Court) affirmed the Board's denial of entitlement to direct service connection for a cardiovascular disorder, a skin disorder and residuals of back, neck and left knee injuries. The Court vacated the Board's decision as to the issues of entitlement to service connection for post-traumatic stress disorder and entitlement to service connection for a cardiovascular disorder and skin disorders as secondary to post-traumatic stress disorder. The case was remanded to the Board for further action consistent with the decision. [citation redacted]. The veteran's representative, the Disabled American Veterans submitted additional written argument in March 1993. REMAND The veteran served for approximately 10 months in Vietnam, from 1969 to 1970. His military occupational speciality was "wheeled vehicle mechanic." He submitted a copy of a letter he wrote to his mother from Vietnam that recounted his experiencing incoming mortar and rocket fire the evening before. He also submitted a September 1988 statement detailing other stressful experiences such as the hearing of the death at different times of several other soldiers he knew, receiving sniper fire while driving a truck or pulling guard duty, and accidentally striking and killing civilians with his truck. The veteran has received treatment from a psychologist who is of the opinion that the veteran has post-traumatic stress disorder. An examining VA psychiatrist in June 1988 diagnosed a dysthymic disorder and post-traumatic stress disorder. A second examining VA psychiatrist in September 1989 recommended the veteran be hospitalized for observation and evaluation to determine whether the veteran had post-traumatic stress disorder, depression, or a personality disorder. During the subsequent hospitalization for observation and evaluation from October 1989 to November 1989, results from psychological testing and evaluation indicated the criteria for a diagnosis of post-traumatic stress disorder have been met. The VA treatment team considered the results, but diagnosed a personality disorder instead. Concerning the issue of service connection for post-traumatic stress disorder, the Court determined the record before the Board was inadequate for the Board to make a fully informed decision. The Court further determined the VA failed to assist the veteran in development of facts pertinent to his claim when the VA did not seek further clarification of the conflicting psychiatric diagnoses and did not obtain the veteran's military records to corroborate his alleged post-traumatic stress disorder stressors as well as to trigger the evidentiary provisions contained in 38 U.S.C.A. § 1154(b) (West 1991) concerning a veteran who engaged in combat. The veteran was hospitalized by the VA in 1982 and 1988 for evaluation and treatment of atrial fibrillation. The veteran has received treatment by the VA for a skin rash that he reported he had experienced ever since his return from Vietnam. Three distinctive skin disorders were diagnosed by an examining VA dermatologist in June 1988. The veteran contends these disorders have been caused by his post-traumatic stress disorder. The Court directed that these intertwined service connection issues be addressed upon further development of the evidence. In consideration of the Court's remand, the case is REMANDED to the RO for the following action: 1. The RO should obtain from the Shreveport, Louisiana, Veterans Affairs Medical Center, copies of the veteran's treatment notes from the hospitalization for observation and evaluation from October 1989 to November 1989. 2. The RO should obtain the veteran's pertinent service personnel records as instructed in M21-1, Part VI, paragraph 7.46(f)(2)(b). The RO should also contact the Joint Services Environmental Support Group (ESG) in accordance with M21-1, Part VI, paragraph 7.46(f)(2)(c)(1) for possible verification of any of the incidents described by the veteran in his statement received in September 1988. However, before contacting ESG, the veteran should be requested to provide more details concerning the incidents he specifically described in his statement so that the ESG may effectively search its available records. In particular, he should, as much as possible in regard to each incident, provide the date within 7 days, the place, and the full names and units of friends killed or wounded by hostile action. The RO may want to provide the veteran with a copy of his handwritten September 1988 statement. In any event, after the veteran has been allowed sufficient time to respond, a request should be made to the ESG in accordance with M21-1. 3. After the action directed in the above paragraphs has been completed, the additional evidence should be associated with the claims folder which must be made available to a board of two VA psychiatrists who have not treated or examined the veteran before. The VA psychiatrists are requested to review the claims folder and to offer an opinion as to whether or not the veteran has post-traumatic stress disorder. The basis of the opinion should be articulated. 4. After the action in the first three paragraphs has been completed, the veteran should undergo cardiovascular and dermatological examinations. The claims folders must be made available to each examiner prior to the examinations. The examiners are requested to offer an opinion as to whether or not any diagnosed disorder is of psychogenic origin. 5. Once all requested actions have been taken, the RO should evaluate the claims in light of the additional evidence. If applicable, the RO should consider the provisions of 38 U.S.C.A. § 1154(b) (West 1991), and 38 C.F.R. § 3.304(d) (1992) in evaluating the veteran's claim for service connection for post-traumatic stress disorder. If the benefits sought on appeal are not granted, the veteran and his representative should be furnished a supplemental statement of the case and they should be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. The purpose of this REMAND is to comply with the decision of the Court, and the Board does not intimate any opinion as to the merits of this case, either favorable or unfavorable at this time. No action is required of the veteran until he is notified. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 * WARREN W. RICE, JR. (Member temporarily absent) FRANCIS F. TALBOT *38 U.S.C.A. § 7102(a)(2)(A) (West 1991) permits a Board of Veterans' Appeals Section, upon direction of the Chairman of the Board, to proceed with the transaction of business without awaiting assignment of an additional Member to the Section when the Section is composed of fewer than three Members due to absence of a Member, vacancy on the Board or inability of the Member assigned to the Section to serve on the panel. The Chairman has directed that the Section proceed with the transaction of business, including the issuance of decisions, without awaiting the assignment of a third Member. 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. 38 C.F.R. § 20.1100(b) (1992).