Citation NR: 9721324	
Decision Date: 06/18/97		Archive Date: 06/30/97
DOCKET NO.  95-26 573	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Medical and Regional Office 
Center in Fargo, North Dakota


THE ISSUES

1.  Entitlement to service connection for fibromyalgia on a 
secondary basis.

2.  Entitlement to an increased evaluation for post-traumatic 
stress disorder (PTSD), currently evaluated as 30 percent 
disabling.


REPRESENTATION

Appellant represented by:	Disabled American Veterans


WITNESS AT HEARING ON APPEAL

Appellant



ATTORNEY FOR THE BOARD

Christopher J. Gearin, Associate Counsel



INTRODUCTION

The veteran had active service from February 1968 to 
September 1969.  This matter comes before the Board of 
Veterans' Appeals (Board) on appeal from a decision of the 
Department of Veterans Affairs (VA) Medical and Regional 
Office Center (M&ROC) in Fargo, North Dakota.

The issue of entitlement to an evaluation in excess of 30 
percent for PTSD will be addressed in the remand portion of 
this action.


CONTENTIONS OF APPELLANT ON APPEAL

The veteran has contended, including at his M&ROC hearing in 
September 1995, that there is sufficient evidence on file of 
a causal connection between his post-service fibromyalgia and 
his service-connected PTSD to warrant a grant of service 
connection on a secondary basis.


DECISION OF THE BOARD

The Board, in accordance with the provisions of 38 U.S.C.A. 
§ 7104 (West 1991 & Supp. 1996), has reviewed and considered 
all of the evidence and material of record in the veteran's 
claims file.  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 preponderance of the 
evidence supports the veteran’s claim for service connection 
for fibromyalgia secondary to service-connected PTSD.


FINDINGS OF FACT

1.  All available evidence necessary for an equitable 
determination of the veteran’s claim for service connection 
for fibromyalgia secondary to service-connected PTSD has been 
obtained.

2.  The veteran’s fibromyalgia was caused by his service-
connected PTSD.


CONCLUSION OF LAW

The veteran’s fibromyalgia is proximately due to or the 
result of his service-connected PTSD.  38 U.S.C.A. § 5107(a) 
(West 1991); 38 C.F.R. § 3.310(a) (1996).


REASONS AND BASES FOR FINDINGS AND CONCLUSION

The veteran's claim for service connection for fibromyalgia 
is well grounded within the meaning of 38 U.S.C.A. § 5107(a).  
Additionally, the facts relevant to the claim have been 
properly developed and the statutory obligation of VA to 
assist the veteran in the development of this claim has been 
satisfied.  Id.

The veteran is service connected for PTSD.  Service 
connection may be granted for disability which is proximately 
due to or the result of service-connected disease or injury.  
38 C.F.R. § 3.310(a).

Treatment records from Gordon M. Dean, D.C., dated from June 
1977 to May 1994, and from Weber Chiropractic Clinic, dated 
from July 1980 to January 1984, reveal musculoskeletal 
complaints.

VA outpatient records from April 1990 to March 1992 and from 
March 1993 to April 1994 contain a diagnosis of fibromyalgia 
beginning in October 1990.  According to an August 1994 VA 
arthritis clinic record from a physician who had previously 
seen the veteran, the veteran had fibromyalgia tender points 
as before; his fibromyalgia was somewhat responsive to 
medication.  The assessment was fibromyalgia related to PTSD.

A September 1994 letter from Allen Crockett, L.P.C., a 
counselor with the Vet Center, reveals that the veteran had 
been a client for approximately 14 years and had symptoms 
that included sleep problems and muscle pain.  It was 
suggested that the veteran’s fibromyalgia could be due to his 
PTSD, and copies of articles received by VA in September 1994 
include articles on fibromyalgia.  One article refers to a 
relationship between fibromyalgia and PTSD based on a 
conclusion that fibromyalgia is related to the lack of a 
growth hormone important for muscle maintenance and repair 
that is produced during deep sleep.

A November 1994 report from James R. Carpenter, M.D., 
contains a diagnosis of spinal myalgias with epicondylitis 
and right shoulder periarthritis consistent with 
fibromyalgia.

A VA examiner concluded on VA psychiatric evaluation in 
November 1994 that there was no clear evidence for connecting 
the veteran’s psychiatric symptomatology with fibromyalgia, 
which might be more related to the veteran’s occupation 
and/or injury.

A July 1995 psychiatric evaluation report from James H. 
Bland, M.D., in which the August 1994 VA physican’s opinion 
of a connection between the veteran’s PTSD and fibromyalgia 
was referred to, diagnosed fibromyalgia secondary to PTSD.  
An April 1996 Memorandum from Allen Crockett reiterates his 
belief that the veteran’s PTSD is causally related to 
fibromyalgia.  A May 1996 report from Dr. Bland reiterates 
his belief, based on his understanding of the current 
literature and the veteran’s case history, that the veteran’s 
fibromyalgia is causally related to his service-connected 
PTSD, because the veteran’s PTSD has resulted in the sleep 
deprivation that causes fibromyalgia.

According to a November 1996 medical report from James H. 
Lampman, M.D., who examined the veteran earlier in November 
1996, the veteran had a persistent soft tissue pain disorder 
that could possibly be classified as post-traumatic 
fibromyalgia.  Dr. Lampman also indicated that the disorder 
was plausibly linked to the veteran’s PTSD.

Fibromyalgia has been consistently diagnosed since 1990.  
Although the file contains a November 1994 VA examination 
report in which the examiner concluded that there was no 
clear evidence of a causal connection between the veteran’s 
service-connected PTSD and his fibromyalgia, the 
preponderance of the evidence supports a causal connection 
between them.  A causal connection was found on VA arthritis 
clinic evaluation in August 1994, by a physician who had seen 
the veteran on several occasions, and by Dr. Bland, in 
statements dated in July 1995 and May 1996.  According to the 
November 1996 statement from Dr. Lampman, a causal connection 
between the veteran’s fibromyalgia and his PTSD is plausible.  
Additionally, medical literature received by VA explains what 
fibromyalgia involves and why there is a connection with 
PTSD.  Therefore, the Board finds that, based on the evidence 
as a whole, service connection for fibromyalgia secondary to 
service-connected PTSD is warranted.  Id.


ORDER

Service connection for fibromyalgia is granted.


REMAND

The Board notes that, effective November 7, 1996, VA has 
revised the criteria for evaluating mental disabilities, to 
include PTSD.  The veteran has not been provided a VA 
examination which addresses the new rating criteria, nor has 
the M&ROC had an opportunity to consider the claim under both 
the old and the new rating criteria.  The Board also notes 
that the most recent July 1996 VA examination report does not 
include a Global Assessment of Functioning (GAF) score.

In light of the foregoing, the case is REMANDED to the M&ROC 
for the following actions:

1.  The M&ROC should contact the veteran 
and request that he provide the names, 
addresses and approximate dates of 
treatment for all VA and non-VA health 
care providers who have treated him for 
PTSD since July 1996.  With any necessary 
authorization from the veteran, the M&ROC 
should attempt to obtain pertinent 
treatment records identified by the 
veteran which are not currently of 
record.

2.  Then, the M&ROC should schedule the 
veteran for a comprehensive VA 
examination by a board certified 
psychiatrist, if available, to determine 
the current severity of his PTSD.  The 
claims file must be made available to the 
examiner prior to the examination.  The 
examiner should indicate with respect to 
each of the psychiatric symptoms 
identified under the new schedular 
criteria for rating mental disorders 
whether such symptom is a symptom of the 
veteran’s service-connected psychiatric 
disability.  The examiner should provide 
a complete multiaxial assessment, to 
include a GAF score with an explanation 
of the significance of the score 
assigned.  The examiner should also 
provide an opinion concerning the degree 
of social and industrial impairment 
resulting from the veteran’s service-
connected psychiatric disability, to 
include whether it renders the veteran 
unemployable.  All indicated studies 
should be performed, and the rationale 
for all opinions expressed should be 
provided.

3.  Thereafter, the M&ROC should review 
the claims file and ensure that all 
developmental actions, including the 
medical examination and requested 
opinions, have been conducted and 
completed in full.  The M&ROC should then 
undertake any other indicated development 
and should readjudicate the issue of 
entitlement to increased rating for PTSD, 
considering the criteria in effect prior 
to November 7, 1996, as well as the new 
criteria and the provisions of 
38 U.S.C.A. § 5107(b) and 38 C.F.R. 
§§ 3.321(b)(1) and 4.7.  

4.  If the benefit sought on appeal is 
not granted to the veteran’s 
satisfaction, a Supplemental Statement of 
the Case should be issued and the veteran 
and his representative should be afforded 
an appropriate opportunity to respond.

Thereafter, the case should be returned to the Board for 
further appellate action, if otherwise in order.  No action 
on the part of the veteran is required until he receives 
further notice.  By this remand, the Board intimates no 
opinion, either legal or factual, as to any ultimate outcome 
warranted.



		
	JAMES W. LOEB
	Acting Member, Board of Veterans' Appeals

38 U.S.C.A. § 7102 (West Supp. 1996) 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 
1991 & Supp. 1996), 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, 102 Stat. 4105, 4122 (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 the issue 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) 
(1996).


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