Decision Date: 11/30/95 Archive Date: 12/01/95 DOCKET NO. 91-14 492 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Diego, California THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for post-traumatic stress disorder. 2. Entitlement to an increased (compensable) evaluation for chronic mild low back syndrome with strong functional overlay. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant, his wife, and June Craigwell ATTORNEY FOR THE BOARD Ronald R. Bosch, Counsel INTRODUCTION The veteran served on active duty from April 1969 to October 1970. In November 1987, the Board of Veterans' Appeals (Board) denied entitlement to service connection for a chronic psychiatric disorder to include post-traumatic stress disorder. The Board found, among other things; that no acquired psychiatric disorder was present during service and no psychosis was manifested within the presumptive period following the veteran's separation from service; the veteran had no acquired psychiatric disorder which was related to service-connected disability; the presence of a post- traumatic stress disorder had not been demonstrated; and the veteran's personality disorder or disorders were congenital or developmental abnormalities. The current appeal arose from a May 1990 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. The RO affirmed the previous denial of entitlement to service connection for post- traumatic stress disorder, and denied entitlement to an increased (compensable) evaluation for chronic mild low back syndrome with strong functional overlay. The RO continued the denial of entitlement to service connection for post-traumatic stress disorder when it issued a rating decision in February 1991. The Board REMANDED the case to the RO for further development in November 1991 and October 1993. In April 1994, the RO determined that new and material evidence had not been submitted to reopen a claim of entitlement to service connection for post-traumatic stress disorder, and affirmed the denial of entitlement to an increased (compensable) evaluation for chronic mild low back syndrome with strong functional overlay. The case has been returned to the Board for further appellate review. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that new and material evidence, particularly documentation of a diagnosis of post-traumatic stress disorder, has been submitted to warrant reopening of his claim for service connection for post-traumatic stress disorder. He argues that his low back disability is productive of disabling pain, thereby warranting entitlement to an increased (compensable) evaluation. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims files. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the veteran has presented new and material evidence warranting the reopening of his claim of entitlement to service connection for post-traumatic stress disorder, and that the record supports a grant of entitlement to an increased (compensable) evaluation for chronic mild low back syndrome with strong functional overlay. FINDINGS OF FACT 1. The Board denied entitlement to service connection for post-traumatic stress disorder in November 1987. 2. The evidence added to the record since the November 1987 Board decision consists of hearing testimony, correspondence from the United States Army and Joint Services Environmental Support Group (ESG), correspondence from the Vet Center pertaining to the veteran's treatment, VA special psychiatric examination and outpatient clinic reports, correspondence from the veteran's mother and a service comrade, and duplicates of lay statements previously associated with the claims file. 3. The additional evidence submitted since the November 1987 Board decision raises a reasonable possibility of changing the prior outcome. 4. Chronic mild low back syndrome with strong functional overlay is productive of characteristic pain on motion. CONCLUSIONS OF LAW 1. Evidence received since the November 1987 Board decision denying the veteran's claim of entitlement to service connection for post-traumatic stress disorder is new and material. 38 U.S.C.A. §§ 5107, 7104 (West 1991); 38 C.F.R. § 3.156(a) (1994). 2. The decision of the Board in November 1987 denying the veteran's claim of entitlement to service connection for post-traumatic stress disorder is not final and such claim is reopened. 38 U.S.C.A. §§ 1110, 5107, 5108, 7104 (West 1991); 38 C.F.R. §§ 3.104(a) (1994). 3. The criteria for an increased (compensable) evaluation of 10 percent for chronic mild low back syndrome with strong functional overlay have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.40, 4.71(a), Diagnostic Code 5295 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for post-traumatic stress disorder. Factual Background The evidence which was of record at the time of the Board's November 1987 decision will be summarized below. The veteran trained and served as a general warehouseman with the United States Marine Corps in Vietnam. His decorations include a Vietnam Service Medal and a Vietnam Campaign Medal with a 1960 device. A July 1972 VA general medical examination of the psychiatric and personality systems resulted in a notation of no apparent disturbance of orientation. In a July 1985 letter, Warren G. Gershwin, M.D., noted diagnostic impressions of affective syndrome and adjustment disorder. Schizophreniform disorder was diagnosed in connection with a VA hospitalization of the veteran during April and May, 1956. A September 1986 VA special psychiatric examination concluded in diagnoses of somatiform disorder-conversion disorder, generalized anxiety disorder, and mixed personality disorder. A February 1987 favorable decision for an award of Social Security disability benefits shows a psychiatrist, James F. Hooper, M.D., was of the opinion the veteran had post- traumatic stress disorder, that the possibility of depression could not be ruled out, and that true schizophrenia was a remote possibility. Lay statements dated in February 1987 were to the combined effect that the veteran's personality had changed after service. In a February 1987 letter, Bobby E. Hill, M.D., advised that he was treating the veteran for post-traumatic stress disorder. The veteran provided testimony before a section of the Board in September 1987, in support of his claim for service connection for post-traumatic stress disorder. The additional evidence which has been submitted since the November 1987 Board decision will be summarized below. The veteran submitted duplicates of lay statements dated in February 1987 which had been previously associated with the claims file. On file is a March 1989 letter from a service comrade noting his knowledge and observations of the veteran's nervousness. In a May 1989 letter the veteran's mother described the problems encountered by the veteran subsequent to his separation from service. In an August 1989 letter, Joan T. Craigwell, a readjustment counseling therapist from the Vet Center, advised that the veteran was experiencing many frustrations in his daily life and felt that the Vet Center and VA might make a difference in his life. A February 1990 VA special psychiatric examination concluded in diagnoses of possible post-traumatic stress disorder, possible affective syndrome, and possible adjustment disorder with mixed disturbance of emotions and conduct. In an August 1990 letter, Joan T. Craigwell, a readjustment counseling therapist from the Vet Center, advised the psychological testing of the veteran disclosed elevated scores for every post-traumatic stress disorder scale. A December 1990 VA behavioral medicine/post traumatic stress disorder program consultation evaluation concluded in a finding of post-traumatic stress disorder. A February 1991 VA special psychiatric examination concluded in diagnoses of post-traumatic stress disorder and adjustment disorder with mixed disturbances of emotions and conduct. The veteran, his wife, and Joan T. Craigwell, provided testimony before a travel section of the Board sitting at the RO in February 1991. In a December 1993 letter, the ESG advised that it no longer undertook research on behalf of United States Marine Corps veterans. Analysis The Board notes that in view of the previous remands of the case to the RO for further development, all relevant facts have been properly developed, that the evidence of record is sufficiently complete, and that no further assistance to the veteran is required in order to comply with the duty to assist him in the development of facts pertinent to his appeal. Murphy v. Derwinski, 1 Vet.App. 78 (1990). When a claim is disallowed by the Board, that claim may not thereafter be reopened absent the submission of new and material evidence. 38 U.S.C.A. § 5108, 7104. If new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. 38 U.S.C.A. § 5108. "New" evidence is that which is relevant to and probative of the issue at hand, and which must be of sufficient weight or significance (assuming its credibility, see generally, Justus v. Principi, 3 Vet.App. 510, 513 (1992)) that there is a reasonable possibility that the new evidence, when viewed in the context of all the evidence, both new and old, would change the prior outcome. Cox v. Brown, 5 Vet.App. 95, 98 (1993). After a review of the record, the Board concludes that the additional evidence is both "new" and "material." Accordingly, the veteran's claim for service connection for post-traumatic stress disorder is reopened and the Board's previous decision entered in November 1987 is not final. The additional evidence constituting hearing testimony, correspondence from a Vet Center therapist, VA clinical and examination reports, correspondence from the veteran's mother and a service comrade, and correspondence from the ESG is "new" in the sense that it is not cumulative of prior evidence of record. Of particular importance is the clinical evidence showing that post-traumatic stress disorder has been diagnosed. In the Board's November 1987 decision, the veteran's claim was denied because it was determined that post-traumatic stress disorder was not definitively shown. Since the Board's November 1987 decision, the veteran has been examined by VA and determined to have post-traumatic stress disorder. Psychological studies have supported such a diagnosis. This evidence is "material" in nature because it raises a reasonable possibility of changing the prior Board denial. Accordingly, because the Board must now assume that the statements presented in an attempt to reopen a claim are credible, the Board finds that the clinical reports of the veteran's having post-traumatic stress disorder represent new and material evidence warranting the reopening of the claim for service connection. II. Entitlement to an increased (compensable) evaluation for chronic mild low back syndrome with strong functional overlay. The Board finds that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a), in that he has presented a claim which is plausible. The Board is satisfied that as a result of the previous Board remands of the case to the RO for further development, all relevant facts have been properly developed, and that no further assistance to the veteran is required in order to comply with 38 U.S.C.A. § 5107(a). In accordance with 38 C.F.R. §§ 4.1, 4.2 (1994), and Schafrath v. Derwinski, 1 Vet.App. 589 (1991), the Board has reviewed the service medical records and all other evidence of record pertaining to the history of the veteran's low back disability. The Board has found nothing in the historical record which would lead to a conclusion that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations which would warrant a detailed exposition of the remote clinical histories and findings pertaining to the veteran's low back disability. Disability evaluations are based on the comparison of clinical findings to the relevant schedular criteria. 38 U.S.C.A. § 1155. In determining the rating warranted, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet.App. 55, 58 (1994); therefore, the Board will briefly summarize the remote clinical evidence and concentrate on current clinical findings. A review of the service medical records discloses the veteran was treated on numerous occasions for low back symptomatology attributed to traumatic injury sustained during basic training. A December 1969 radiographic study disclosed minimal narrowing at L5-S1 and spina bifida. A July 1972 VA general medical examination concluded in a diagnosis of mild low back syndrome with strong functional overlay. The RO granted entitlement to service connection for chronic mild low back syndrome with strong functional overlay with assignment of a noncompensable evaluation when it issued a rating decision in August 1972. A January 1990 VA special orthopedic examination report shows the veteran carried a cane in his right hand. He stood erect with normal alignment of the entire spine. There was no pelvic tilt or scoliosis. He walked with a wide gait but was able to walk on heels or tiptoes. Forward flexion of the lumbosacral spine was to 60 degrees, extension to 40 degrees, and lateral bending to 40 degrees in each direction. On recumbency leg length was equal and straight leg raising was to 30 degrees on each side. The examination diagnosis was recurrent low back pain with evidence of "bulging discs" at L4-5 and L5-S1 levels on computerized axial tomographic scan. Pertinent clinical findings obtained during a January 1990 VA special neurological examination disclosed the spine showed diffuse spinal, paraspinal tenderness extending out to the hip area. There was no sciatic notch tenderness. Straight leg raising was positive for some discomfort at about 100 degrees sitting down. The veteran refused to lie down for the straight leg raising test. On gait testing he showed mild unsteadiness with a mild ectasia basa gait sometimes leaning on alternate walls. This phenomena was increased with tandem gait. On standing with his feet together and his eyes open the veteran was terribly unsteady; however, after having him close his eyes and distracting him, writing words on his forehead, he was completely normal. Sensory examination showed no extension to double stimulative stimulation and diffusely decreased sensations over the entirety of both arms and legs with no particular distribution in any particular limb. The relevant diagnosis was chronic low back pain. The veteran provided testimony as to the disabling manifestations of his low back disability before a travel section of the Board sitting at the RO in February 1991. He discussed how pain adversely affected him in his daily life situation. The veteran's chronic mild low back syndrome with strong functional overlay is evaluated as noncompensable under diagnostic code 5295 of the VA Schedule for Rating Disabilities. The noncompensable evaluation contemplates lumbosacral strain with slight subjective symptoms only. The next higher evaluation of 10 percent requires lumbosacral strain with characteristic pain on motion. The next higher evaluation of 20 percent requires lumbosacral strain with muscle spasm on extreme forwarding bending with loss of lateral spine motion. 38 C.F.R. § 4.71(a). The Board's evaluation of the evidence of record permits the conclusion that compensable disablement is demonstrated by the evidence of record. In this regard, the Board observes that the veteran does experience pain on motion of the lumbosacral spine, a fact demonstrated when he was examined by VA in January 1990, and elaborated upon in testimony presented on appeal. The Board is of the opinion that current clinical disabling manifestations of the veteran's low back disability more closely approximate the level of impairment contemplated in the next higher evaluation of 10 percent. 38 C.F.R. § 4.7. Muscle spasm on extreme forward bending with loss of lateral spine motion has not been shown by the evidence of record. Accordingly, a 20 percent evaluation under diagnostic code 5295 is not warranted. As moderate limitation of motion of the lumbar spine was not shown when the veteran was examined by VA in January 1990, a 20 percent evaluation under diagnostic code 5292 of the VA Schedule for Rating Disabilities is not warranted. The veteran's back disability has not been shown to be productive of moderate intervertebral disc syndrome with recurring attacks; consequently, a 20 percent evaluation under diagnostic code 5293 of the VA Schedule for Rating Disabilities is not warranted. The Board has considered application of the criteria under 38 C.F.R. § 4.40; however, any functional loss due to pain is considered in the 10 percent evaluation granted by the Board for the veteran's low back disability. The veteran's low back disability has not rendered his disability picture unusual or exceptional in nature and has not been shown to have adversely affected his employment. It has not resulted in frequent inpatient care as to render impractical the application of regular schedular standards, thereby precluding a grant of entitlement to an increased evaluation on an extraschedular basis. 38 C.F.R. § 3.321(b)(1). It is the judgment of the Board that the record supports a grant of entitlement to an increased (compensable) evaluation of not more than 10 percent for chronic mild low back syndrome with strong functional overlay with application of pertinent governing criteria. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.40, 4.71(a), Diagnostic Code 5295. ORDER New and material evidence having been submitted to reopen a claim of entitlement to service connection for post- traumatic stress disorder, the claim is reopened. Entitlement to an increased (compensable) evaluation of 10 percent for chronic mild low back syndrome with strong functional overlay is granted, subject to governing criteria applicable to the payment of monetary benefits. REMAND In light of the decision to reopen the review of the veteran's claim for service connection for post-traumatic stress disorder, such review must be conducted on a de novo basis. Significantly, however, the question of whether or not service connection is warranted on the merits is a question of fact. The Board may challenge or inquire into the credibility or probative value of any evidence presented. Hadsell v. Brown, 4 Vet.App. 208, 209 (1993). A review of the record discloses that VA psychiatrists have diagnosed the veteran with post-traumatic stress disorder. However, his psychiatric symptomatology over all has been variously diagnosed. The veteran has never been afforded the benefit of a comprehensive examination by a Board of VA psychiatrists to determine the nature, extent of severity, and etiology of any psychiatric disorder(s) which may be present. Significantly, verification of the veteran's claimed stressors has never been obtained by the RO. Under 38 C.F.R. § 3.304(f) (1994), service connection for post-traumatic stress disorder requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed inservice stressor. If the claimed stressor is related to combat, service department evidence that the veteran engaged in combat or that the veteran was awarded the Purple Heart Medal, Combat Action Ribbon, or similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor. In addition, VA's Manual M21-1 contains specific procedures for VA to follow in evaluating claims for service connection for post-traumatic stress disorder. Manual 21-1, Part VI, Para 7.46(e), (f) (Dec. 21, 1992). In Zarycki v. Brown, 6 Vet.App. 91 (1991), the United States Court of Veterans Appeals (Court) set forth procedures for VA to follow in adjudicating claims for service connection for post-traumatic stress disorder. The Court concluded that the statutory and regulatory criteria provided a framework in which the evidence necessary to establish the occurrence of a recognizable stressor during service to support a claim of entitlement to service connection for post-traumatic stress disorder will vary depending on whether or not the veteran was "engaged in combat with the enemy." Where it is determined, through recognized military citations, or other supportive evidence, that the veteran was engaged in combat with the enemy and the claimed stressors are related to such combat, the veteran's lay testimony regarding claimed stressors must be accepted as conclusive as to their actual occurrence and no further development for corroborative evidence will be required, provided that the veteran's testimony is found to be credible and "consistent with the circumstances, conditions, or hardships of such service" (emphasis added)". 38 U.S.C.A. § 1154(b) (West 1991); 38 C.F.R. § 3.304(d), (f) (1994); Manual M21-1, Part VI, Para. 7.46(e), (f). If VA determines that the veteran did not engage in combat with the enemy but the claimed stressor is not related to such combat, the veteran's lay testimony, by itself, will not be enough to establish the occurrence of the alleged stressor, unless it is substantiated by service records. Id. The Court further held that even if it is found that there was a stressful event in service, it must still be determined whether that stressful event was of sufficient gravity to support a diagnosis of post-traumatic stress disorder as required in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. The essential feature of post-traumatic stress disorder is "a psychologically distressing event that is outside the range of usual human experience." The most common traumata involve a threat to one's life, a threat to the lives of one's friends, or seeing another person who has recently been seriously injured or killed as the result of an accident or physical violence. Id at 247, 248. The Court emphasized, however, that mere service in a combat zone, in and of itself, was insufficient to support a diagnosis of post-traumatic stress disorder. In West v. Brown, 7 Vet.App. 70 (1994), the Court commented that a "significant feature of post-traumatic stress disorder requires that the sufficiency of the stressor be clinically established. It must be determined whether the claimed events are sufficient stressors to support a diagnosis of post-traumatic stress disorder. The current posture of the record does not establish that the appellant "engaged in combat with the enemy." The veteran is not shown to have received one of the citations specified in 38 C.F.R. § 3.304(f). As noted above, even if the record contained evidence that the appellant "engaged in combat with the enemy," his accounts would still have to be reviewed to determine if they were credible and consistent with the circumstances, conditions and hardships of service. While the record shows that post-traumatic stress disorder has been diagnosed by VA psychiatrists, the question of whether a specific event claimed by the veteran as a stressor actually occurred is a question of fact for the Board to decide, involving as it does factors that are as much historical as psychological. In this regard, the Court has observed that just because a physician or other health care professional accepted the appellant's description of his Vietnam experiences as credible and diagnosed post- traumatic stress disorder does not mean that the Board was required to grant service connection for post-traumatic stress disorder. Wilson v. Derwinski, 2 Vet.App. 614, 618 (1992). In the veteran's case, VA and other health care professionals have accepted the veteran's account of his Vietnam experiences in both outpatient and compensation examination settings. Significantly, however, not one scintilla of the veteran's stressor accounts is verified. Hence, each examination which diagnosed post-traumatic stress disorder is inadequate for rating purposes. West, 7 Vet.App. at 78; Wood v. Derwinski, 1 Vet.App. 190 (1991). The evidence of record pertaining to the veteran's stressors has been provided by the appellant on VA examinations and in hearing testimony. The veteran never responded to the RO's previous request that he provide written information as to his claimed stressors for purpose of verification of such stressors. The ESG, as noted above, referred the RO's request for verification of the veteran's stressors gleaned from information of record, to the Marine Corps Historical Center. A response from this agency is not of record. It is not known whether such agency actually verified any of the veteran's accounts. In light of the above discussion, the Board finds that the appellant should be provided the opportunity to submit additional evidence in light of Zarycki, West, 38 C.F.R. § 3.304(f) and the considerations discussed above, and for the RO to review the record in light of these same concerns. 1. The RO should contact the veteran and request that he provide the names and addresses of any health care providers, other than VA and the Vet Center, who have treated him for psychiatric disability, to include post- traumatic stress disorder and specify the dates of treatment, if possible. Then, after any necessary authorization is obtained from the veteran, the RO should obtain copies of all treatment records for the veteran from the health care providers identified. 2. The RO should request from the veteran a statement containing as much detail as possible regarding the alleged stressful events to which he was exposed in service. The veteran should be asked to provide specific details of the claimed stressful events during service, such as dates, places, detailed description of the events, his service units in Vietnam, duty assignments and the names, ranks, unit of assignment and any other identifying information concerning any other individuals involved in the events. He should be told that the information is necessary to obtain supportive evidence of the stressful events and that failure to respond may result in adverse action. 3. The information provided by the claimant concerning the specific circumstances of the claimed stressors and a copy of the veteran's service records and DD 214 should be sent to the Commandant of the Marine Corps, Headquarters, U.S.M.C. (Code MMRB), Quantico, Virginia 22134-0530; and the Marine Corps Historical Center, Building 58, Washington, Navy Yard, Washington, D.C. 20374-0530, for verification of the stressors claimed by the veteran. 4. The veteran should then be afforded an examination by a panel of two VA psychiatrists, if available, who have not previously examined him to determine the nature, extent of severity, and etiology of all psychiatric disorders which may be present. It is imperative that each examiner actually review the veteran's entire claims file and this remand prior to conducting their examinations. If there are psychiatric disorders other than post-traumatic stress disorder, the examiners should reconcile the diagnoses and should specify which symptoms are associated with each of the disorders. If certain symptomatology cannot be dissociated from one disorder or another, it should be specified. The psychiatrists should specifically confirm or rule out a diagnosis of post-traumatic stress disorder based on the accurate history of the veteran's service in Vietnam as documented in the claims folder by the veteran's service records and the anticipated report from the United States Marine verification agency discussed earlier. If it is concluded that a diagnosis of post-traumatic stress disorder is warranted, the examiners should specify the stressor(s) believed to have brought on the disorder and it should be specified what evidence was relied upon to determine that the veteran was exposed to such stressor(s). Any opinions expressed must be accompanied by a detailed rationale. Again, the claims file must be made available to and reviewed by the psychiatrists prior to the examinations. 5. The RO should then review the record and assure that all of the above requested Board development directives are fully complied with and if not, the RO should undertake corrective action. The RO must also make a determination as to whether the existence of an adequate stressor or stressors has been established consistent with Zarycki. 6. After undertaking any development deemed appropriate in addition to that specified above, the RO should adjudicate the issue of entitlement to service connection for post- traumatic stress disorder on a de novo basis. If the benefit sought on appeal is not granted to the veteran's satisfaction, the RO should issue a supplemental statement of the case. The applicable period of time for a response should be afforded. Thereafter, the case should be returned to the Board for final appellate review, if otherwise in order. By this REMAND, the Board intimates no opinion as to any final outcome warranted. No action is required of the veteran until he is notified by the RO. WARREN W. RICE, JR. Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West Supp. 1995), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date that appears on the face of this decision constitutes the date of mailing and the copy of this decision that you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals. Appellate rights do not attach to those issues addressed in the remand portion of the Board's decision, because a 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) (1994). - 2 -