Citation NR: 9734673	
Decision Date: 10/14/97		Archive Date: 10/16/97
DOCKET NO.  96-16 130	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Denver, 
Colorado


THE ISSUES

1.  Whether new and material evidence has been submitted in 
order to reopen a claim for service connection for post-
traumatic stress disorder (PTSD).

2.  Entitlement to service connection for an acquired 
psychiatric disorder, characterized as dysthymic disorder. 


REPRESENTATION

Appellant represented by:	Disabled American Veterans


WITNESS AT HEARING ON APPEAL

Appellant


ATTORNEY FOR THE BOARD

Daniel G. Krasnegor, Associate Counsel



INTRODUCTION

The veteran served on active duty from July 1966 to January 
1970.

The claims file contains a October 1991 Regional Office (RO) 
decision wherein entitlement to service connection for PTSD 
was denied.

This matter comes before the Board of Veterans’ Appeals 
(Board) on appeal of a May 1992 rating determination by the 
Department of Veterans Affairs (VA) RO.  In addition to 
denying entitlement to service connection for dysthymia, the 
March 1992 decision again denied entitlement to service 
connection for PTSD.

In a recent decision, the United States Court of Appeals for 
the Federal Circuit held that the Board does not have 
jurisdiction to consider a claim which is previously 
adjudicated unless new and material evidence has been 
submitted.  The Federal Circuit determined that as a 
preliminary matter, the Board must therefore determine 
whether new and material evidence has been submitted before 
proceeding to decide a case on the merits.  Determinations 
made by the regional office as to newness and materiality are 
not deemed relevant. Barnett v. Brown 83 F.3d 1380 (Fed.Cir. 
1996).  

In this regard, the record shows clearly that the RO 
adjudicated the PTSD service connection claim for the first 
time in March 1991, and subsequently in October 1991, and the 
veteran's notice of disagreement was not received until March 
1993.  The filing of additional evidence after October 1991 
does not serve to extend the time for initiating or 
completing an appeal from that determination, 38 C.F.R. 
§ 20.304 (1996).  As such, and pursuant to Barnett, the Board 
must therefore adjudicate the question of whether new and 
material evidence has been submitted in order to reopen a 
claim for service connection for PTSD as a preliminary 
matter.  The issue on the title page has been adjusted 
accordingly.

These matters were previously before the Board in June 1995, 
and April 1996, at which time they were remanded for 
additional evidentiary development, and so as to afford the 
veteran a requested hearing.

In May 1997, the veteran completed an application for VA 
benefits, claiming entitlement to non-service-connected 
pension benefits. During a hearing before the undersigned 
Board member, the veteran's representative raised a claim for 
entitlement to service connection for dysthymic disorder as 
secondary to PTSD. These issues have been neither prepared 
nor certified for appellate review and are referred to the RO 
for appropriate action.

Entitlement to service connection for PTSD on a direct basis 
will be addressed in the remand portion of this decision.


CONTENTIONS OF APPELLANT ON APPEAL

The veteran maintains that he suffers from PTSD and dysthymic 
disorder as a result of service.

DECISION OF THE BOARD

The Board of Veterans’ Appeals (Board), in accordance with 
the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 
1997), 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 new and material evidence has been submitted to 
reopen a claim for PTSD. 

It is also the decision of the Board that the claim for 
service connection for a psychiatric disorder, claimed as 
dysthymic disorder, is not well grounded.


FINDINGS OF FACT

1. In a October 1991 decision, the RO denied entitlement to 
service connection for PTSD.

2.  Additional evidence submitted since the October 1991 RO 
decision shows a diagnosis of PTSD rendered during VA 
hospitalization.

3.  The additional evidence submitted since the October 1991 
RO decision, consisting of VA hospital records, is new, 
probative of the issue at hand, and when reviewed in light of 
all the evidence of record, both new and old, raises a 
reasonable possibility of changing the prior outcome.

4.  The claim for service connection for an acquired 
psychiatric disorder, characterized as dysthymic disorder, is 
not supported by cognizable evidence showing that the claim 
is plausible or capable of substantiation.


CONCLUSIONS OF LAW

1.  Evidence received since the RO denied entitlement to 
service connection for PTSD in July 1991, is new and 
material, and the veteran's claim for that benefit has been 
reopened.  38 U.S.C.A. §§ 5107, 5108 (West 1991 & Supp. 
1997);  38 C.F.R. §§ 3.156(a) (1996), 19.192 (1991).

2.  The claim for service connection for an acquired 
psychiatric disorder, claimed as dysthymic disorder, is not 
well grounded. 38 U.S.C.A. § 5107(a).





REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

Factual Background

a.  PTSD New and Material

The evidence of record at the time of the October 1991 RO 
decision will be summarized below.

Service medical records showed no treatment for or diagnosis 
of PTSD.  At separation in January 1970, the veteran's 
psychiatric condition was evaluated as normal.

Of record was a January 1991 VA examination report, 
indicating that there was insufficient clinical evidence to 
warrant a diagnosis of acute, delayed, or chronic PTSD.

VA out-patient treatment records and hospital records were 
received in April 1991.  Those records show that the veteran 
was seen for a PTSD evaluation in September 1990, at a VA 
medical facility, to determine the usefulness of treatment 
for that disorder.  It was concluded that he might benefit 
from PTSD treatment.

In a July 1991 statement, the veteran reported events which 
he claimed were stressors leading to PTSD.

The additional evidence which has been submitted since the 
October 1991 RO decision will be summarized below.

March 1992 VA hospital records show that the veteran was 
diagnosed with cocaine abuse, in remission, and dysthymic 
disorder.  The hospital summary indicated that it was felt 
that a stress disorder of the kind needing specific trauma 
therapy was not present.

Received in April 1995 was a report of treatment from the 
National Center for Posttraumatic Stress Disorder at the Palo 
Alto, California VA Medical Center (MC) covering the period 
from January 1992 to February 1992.  That report contains a 
diagnosis of PTSD.

In August 1995, additional VA out-patient treatment records 
were received, including an October 1990 report in which the 
veteran was described as having had a long history of PTSD, 
and a July 1991 report in which he was diagnosed with PTSD.

In June 1997, the veteran presented testimony at a personal 
hearing before the undersigned Board member.  


b.  Psychiatric disorder characterized as dysthymic disorder 

Service medical records demonstrate that at entry into 
service, in January 1966, the veteran reported a history of 
depression or excessive worry, and of nervous trouble.  His 
psychiatric condition was evaluated as normal.

In August 1967, records show that the veteran requested to 
speak with a psychiatrist about his personal problems.  It 
was noted that he had asked to see a psychiatrist because his 
aunt told him to since she thought he worried too much.  At 
examination, the veteran reported that he had a difficult 
time thinking and concentrating, and that he was nervous and 
lacked confidence, mainly because he wasn’t doing what he had 
come to the service for, namely learning a trade and going to 
school.  The veteran was described as immature and 
narcissistic, and was diagnosed with an immature personality 
with passive aggressive personality.

The veteran's psychiatric condition was evaluated as normal 
at his separation examination in January 1970.

In January 1991, the veteran was afforded a VA psychiatric 
examination.  On examination, the veteran was noted to have a 
somewhat depressed affect.  He also appeared to be angry at 
times.  He was diagnosed with a personality disorder, not 
otherwise specified alcohol abuse and cocaine abuse and 
dependence.

The veteran was diagnosed with recurrent moderate major 
depression on during VA hospitalization in January and 
February 1992.

Of record are VA hospitalization records from March 1992, 
evidencing a diagnosis of dysthymic disorder. 

Additional VA records received in August 1995, and covering 
the period from 1990 to 1991 evidence treatment for substance 
abuse and PTSD.

At a personal hearing in June 1997 before the undersigned 
Board member, the veteran indicated that he was then in 
treatment for depression and anxiety.


Analysis

a.  PTSD New and Material

The United States Court of Veterans Appeals (Court) has held 
that there is a statutory duty to assist the veteran applying 
to reopen a claim where the evidence before the Board raises 
sufficient notice of pertinent records which may constitute 
new and material evidence sufficient to justify reopening.  
Ivey v. Derwinski, 2 Vet. App. 320 (1992).  The Board is 
satisfied that VA has met its duty to assist the veteran in 
the development of evidence pertinent to his claim pursuant 
to 38 U.S.C.A. § 5107.

The Board has reviewed the evidence submitted since the 
October 1991 decision by the RO and has determined that this 
additional evidence is both new and material.  Accordingly, 
the veteran's claim is reopened.

Following notification of an initial review and determination 
by the RO, a notice of disagreement must be filed within one 
year from the date of mailing of notification, followed by a 
timely substantive appeal; otherwise, the determination 
becomes final and is not subject to revision absent new and 
material evidence.  38 U.S.C. § 4005(c) (1988); 38 C.F.R. 
§ 19.192 (1990).

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 and material evidence means evidence not previously 
submitted to agency decision makers which bears directly and 
substantially upon the specific matter under consideration, 
which is neither cumulative nor redundant, and which by 
itself or in connection with evidence previously assembled is 
so significant that it must be considered in order to fairly 
decide the merits of the claim. 38 C.F.R. § 3.156(a).

“New” evidence is that which is not merely cumulative of 
other evidence of record.  “Material” 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) 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 (1993).  

The evidence submitted since October 1991 includes VA medical 
records showing that the veteran has been diagnosed with 
PTSD.  No such diagnosis was of record at the time of the 
October 1991 denial.  As the evidence of record at the time 
of the October 1991 denial did not contain a diagnosis of 
PTSD, the Board concludes that the recently submitted 
evidence is clearly “new.”  Further, as the diagnosis of PTSD 
as a result of service raises a reasonable possibility of 
changing the outcome of the prior denial, the evidence is 
also material, Marcoux v. Brown, 10 Vet. App. 3 (1996).  

The newly submitted evidence is therefore found to be 
probative of the issue at hand, and is both “new” and 
“material.”  Evans v. Brown, 9 Vet. App. 273 (1996).

As the Board found above, new and material evidence has been 
submitted to reopen the previously denied claim of 
entitlement to service connection for PTSD; accordingly, the 
claimant’s appeal must be reopened.  38 C.F.R. § 3.156(a).


b.  Psychiatric disorder characterized as dysthymic disorder 

Section 5107 of Title 38, United States Code unequivocally 
places an initial burden upon the claimant to produce 
evidence that his claim is well grounded; that is, that his 
claim is plausible.  See Grivois v. Brown, 6 Vet. App. 136, 
139 (1994); see Grottveit v. Brown , 5 Vet. App. 91, 92 
(1993).  Because the veteran has failed to meet this burden, 
the Board finds that his claim for service connection for an 
acquired psychiatric disorder, characterized as dysthymic 
disorder, is not well grounded and should be denied.

Where the determinative issue involves a question of medical 
diagnosis or medical causation, competent medical evidence to 
the effect that the claim is plausible or possible is 
required.  See Murphy v. Derwinski, 1 Vet. App. 78, 81 
(1990).  The claimant does not meet this burden by merely 
presenting his lay opinion because he is not a medical health 
professional and does not constitute competent medical 
authority.  See Espiritu v. Derwinski, 2 Vet. App. 492 
(1992).  Consequently, his lay assertions cannot constitute 
cognizable evidence, and as cognizable evidence is necessary 
for a well grounded claim, see Tirpak v. Derwinski, 2 Vet. 
App. 609, 611 (1992), the absence of cognizable evidence 
renders a veteran's claim not well grounded.

In order for a claim to be well grounded, there must be 
competent evidence of current disability (a medical 
diagnosis), of incurrence or aggravation of a disease or 
injury in service (lay or medical evidence), and of a nexus 
between the in-service injury or disease and the current 
disability (medical evidence.) Caluza v. Brown, 7 Vet. App. 
498, 506 (1995).  

The evidence above shows that the veteran was found to have a 
personality disorder in service, and has been diagnosed with 
psychiatric disorders other than PTSD since at least 1991.

In this case, however, there is no competent medical evidence 
of record linking an acquired psychiatric disorder, including 
dysthymic disorder to a disease or injury of service origin.  
In other words, the veteran's claim that his current disorder 
is related to service is predicated on his own opinion.

As it is the province of trained health care providers to 
enter conclusions which require medical opinions as to 
causation, see Grivois, the veteran's lay opinion is an 
insufficient basis upon which to find this claim well 
grounded.  See Espiritu.  Accordingly, as a well grounded 
claim must be supported by competent medical evidence, not 
merely allegations, see Tirpak, the veteran's claim for 
service connection for an acquired psychiatric disorder, 
characterized as dysthymic disorder must be denied as not 
well grounded.

In reaching this determination, the Board recognizes that 
this issue is being disposed of in a manner that differs from 
that used by the RO.  The Board therefore considered whether 
the veteran has been given adequate notice to respond, and if 
not whether he has been prejudiced thereby.  See Bernard v. 
Brown, 4 Vet. App. 384, 394 (1993).

In light of the veteran’s failure to meet his initial burden 
in the adjudication process, the Board concludes that he has 
not been prejudiced by the decision to deny his appeal.  In 
such a situation, the Board is not denying service connection 
on the merits, but rather is finding that the veteran has 
failed to meet his obligation of presenting a claim that is 
plausible, or capable of substantiation, at this time.

If the veteran or his representative can secure competent 
medical evidence that his acquired psychiatric disorder, 
characterized as dysthymic disorder, is linked to service, 
such evidence may be used in the filing of another claim.

In reaching its decision, the Board notes that the Court has 
held that there was some duty to assist the veteran in the 
completion of his application for benefits under 38 U.S.C.A. 
§ 5103(a) (West 1991 and Supp. 1997), depending on the 
particular facts in each case.  Robinette v. Brown, 8 Vet. 
App. 69 (1995); Beausoleil v. Brown, 8 Vet. App. 459 (1996); 
as modified by Epps v. Brown, 9 Vet. App. 341, 344 (1996), 
wherein the Court found there was a duty to further assist in 
the development of the evidence only when the veteran has 
reported the existence of evidence which could serve to 
render a claim well grounded.  The facts and circumstances of 
this case are such that no further action is warranted.

ORDER

New and material evidence having been submitted to reopen a 
claim of entitlement to service connection for PTSD, the 
claim is reopened.

The veteran not having submitted a well grounded claim of 
entitlement to service connection for an acquired psychiatric 
disorder, characterized as dysthymic disorder, the appeal is 
denied.


REMAND

This claim must be afforded expeditious treatment by the RO.  
The law requires that all claims that are remanded by the 
Board of Veterans’ Appeals or by the United States Court of 
Veterans Appeals for additional development or other 
appropriate action must be handled in an expeditious manner.  
See The Veterans’ Benefits Improvements Act of 1994, Pub. L. 
No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. 
§ 5101 (West Supp. 1997) (Historical and Statutory Notes).  
In addition, VBA’s ADJUDICATION PROCEDURE MANUAL, M21-1, Part 
IV, directs the ROs to provide expeditious handling of all 
cases that have been remanded by the Board and the Court.  
See M21-1, Part IV, paras. 8.44-8.45 and 38.02-38.03.

Service connection may be granted for PTSD if the evidence 
establishes that PTSD was incurred in service or as the 
result of events experienced during service.  38 U.S.C.A. 
§ 1110; 38 C.F.R. § 3.303.  Notwithstanding the lack of a 
diagnosis of PTSD during service, service connection may be 
granted if all of the evidence including that pertinent to 
service, establishes that the disease was incurred in 
service.  38 U.S.C.A. § 1113(b) (West 1991 & Supp. 1997); 38 
C.F.R. § 3.303(d).

Service connection for PTSD requires medical evidence 
establishing a clear diagnosis of the condition, credible 
supporting evidence that the claimed in-service stressor(s) 
actually occurred, and a link, established by medical 
evidence, between current symptomatology and the claimed in-
service stressor.  38 C.F.R. § 3.304(f) (1996).  

The VA Adjudication Procedure Manual M21-1 (Manual M21-1) 
pertaining to the adjudication of PTSD claims provide that, 
“where records available to the rating board do not provide 
objective or supportive evidence of the alleged in service 
traumatic stressor, it is necessary to develop this 
evidence.”  Manual M21-1, Part VI, 7.46(f)(2) (emphasis 
added).  

In this case, the veteran's service administrative records do 
not show that he was awarded the purple heart or other awards 
denoting combat experience.  Nor is there evidence of his 
claimed stressors.

Of record is a July 1991 statement in which the veteran set 
forth combat related events which he claimed led to PTSD.  
During his personal hearing in June 1997, the veteran 
restated his claimed stressors.

In a January 1995 letter, an attorney writing on behalf of 
the veteran stated that a Dr. Rangell had informed the Denver 
Department of Social Services that the veteran was diagnosed 
with, in pertinent part, PTSD.  Records from Dr. Rangell are 
not present in the claims file, nor does it appear that an 
attempt has been made to locate them.  As such a remand is in 
order.

The Board notes that the criteria for rating psychiatric 
disabilities was changed effective November 7, 1996.  Under 
the new criteria, mental disorders are to be consistent with 
the Diagnostic and Statistical Manual of Mental Disorders 
(DSM) IV.  38 C.F.R. § 4.125 (1996).  Previously, mental 
disorders were evaluated pursuant to DSM III, 38 C.F.R. 
§ 4.125 (1995).  At the time VA adjudication of this case 
began, DSM-III-R criteria for PTSD had been incorporated by 
the VA Adjudication Procedure Manual, M21-1.  

DSM-III-R provides that an essential feature of a diagnosis 
of PTSD is the development of characteristic symptoms 
following an “event that is outside the range of usual human 
experience and that would be markedly distressing to almost 
anyone, e.g., serious threat to one’s life or physical 
integrity; . . . or seeing another person seriously injured 
or killed as the result of an accident or physical violence.”  
DSM-III-R at 247-48.  However, the diagnostic criteria for a 
stressor now in effect for VA adjudication under DSM-IV 
differ substantially from those in DSM-III-R.

DSM IV defines stressors as a traumatic event in which both 
of the following were present:

(1) the person experienced, 
witnessed, or was confronted with an 
event or events that involved actual 
or threatened death or serious 
injury, or a threat to the physical 
integrity of self or others.

(2) the person’s response involved 
intense fear, helplessness, or 
horror.  

Quick Reference to the Diagnostic Criteria from DSM IV 
(Michael B. First, M.D., editor, 1994).  The Court has 
recently addressed the effect of the change to DSM IV on 
claims for PTSD in Cohen v. Brown, No. 94-661 (March 7, 
1997).  In that case, the Court pointed out that the 
requirement that a stressor be outside the range of usual 
human experience that would evoke significant symptoms of 
distress in almost anyone had been dropped in DSM IV.  The 
Court made the following holding:

. . . the Court takes judicial notice of the 
effect of this shift in diagnostic criteria.  
The major effect is this:  the criteria have 
changed from an objective (“would evoke. . . 
in almost anyone”) standard in assessing 
whether a stressor is sufficient to trigger 
PTSD, to a subjective standard.  The criteria 
now require exposure to a traumatic event and 
a response involving intense fear, 
helplessness, or horror.  A more susceptible 
individual may have PTSD based on exposure to 
a stressor that would not necessarily have 
the same effect on “almost anyone.”  The 
sufficiency of a stressor is, accordingly, 
now a clinical determination for the 
examining mental health professional.

Cohen, slip. op. at 38-39.

Where the law or regulation changes after a claim has been 
filed or reopened but before the administrative or judicial 
appeal process has been concluded, the version more favorable 
to the veteran applies unless congress provides otherwise.  
Karnas v. Derwinski, 1 Vet. App. 308 (1991).  Thus, the Board 
is of the opinion that the claim must be returned for 
consideration by the RO under the new criteria.

Therefore, pursuant to VA’s duty to assist the appellant in 
the development of facts pertinent to his claim under 
38 U.S.C.A. § 5107(a); 38 C.F.R. § 3.103(a) (1996), the Board 
is deferring adjudication of the issue of entitlement to 
service connection for PTSD pending a remand of the case to 
the RO for further development as follows:

1.  The RO should request the veteran to 
identify all physicians who have treated 
him for psychiatric disorders in the 
recent past.  The RO should then obtain 
medical records from all sources 
identified by the appellant which are not 
already of record, to include treatment 
reports from Dr. Rangell.

2.  The RO should request from the 
veteran a statement containing as much 
detail as possible regarding any and all 
stressful events to which he was exposed 
in service.  He should be asked to 
provide specific details of the claimed 
stressful events to the best of his 
ability.  The veteran's statement should 
include dates, places, detailed 
descriptions, units of service, duty 
assignments, as well as the names, units 
of assignment and any other identifying 
information concerning other individuals 
involved in the events.  

In this respect, the Board takes this 
opportunity to inform the veteran that 
the United States Court of Veterans 
Appeals (Court) has held that asking the 
veteran to provide the underlying facts, 
i.e., the names of individuals involved, 
the dates, and the places where the 
claimed events occurred, does not 
constitute an impossible or an onerous 
task.  Wood v. Derwinski, 1 Vet. App. 
190, 193 (1991).

3. After obtaining the foregoing 
requested information from the veteran, 
the RO should forward it together with a 
copy of the veteran's July 1991 statement 
and June 1997 personal hearing 
transcript, copies of the veteran's 
medical records (on file), and a copy of 
his record of service (DD Form 214) to 
the USASCRUR, 7789 Cissna Road, Suite 1, 
Springfield, Virginia 22150, in an 
attempt to verify any claimed stressor.  
Any information obtained is to be 
associated with the claims file.

4.  Following the above, the RO must make 
a specific determination, based on the 
complete record, with respect to whether 
the veteran was exposed to a stressor or 
stressors in service, and if so, the 
nature of the specific stressor or 
stressors.  In rendering this 
determination, the attention of the RO is 
directed to the law cited in the 
discussion above.  If the RO determines 
that the record establishes the existence 
of a stressor or stressors, the RO must 
specify what stressor or stressors in 
service or prior to service it has 
determined are established by the record.  
In reaching this determination, the RO 
should address any credibility questions 
raised by the record.

5.  If and only if the RO determines that 
the veteran was exposed to a valid 
stressor or stressors, action should be 
taken to schedule the veteran for a 
psychiatric examination by a board of two 
VA psychiatrists who have not previously 
seen or treated him.  Any appropriate 
studies, including PTSD sub scales are to 
be performed.  The claims file and a copy 
of this remand must be made available to 
and reviewed by the examiners prior to 
completing their examinations.  Prior to 
the examinations, the RO is to inform the 
examiners of the results of its 
determination in paragraph (4) above as 
to the existence of a stressor or 
stressors.  

The examiners must be requested to 
express an opinion as to the correct 
diagnosis to account for the veteran’s 
psychiatric symptomatology reported in 
service, and whether any psychiatric 
disorder currently found on examination 
is related thereto.  With regard to PTSD, 
the RO must specify for the examiners the 
stressor or stressors that it has 
determined are established by the record 
and the examiners must be instructed that 
only those events may be considered for 
the purpose of determining whether the 
veteran was exposed to a stressor in 
service.  If the examiners believe that 
PTSD is the appropriate diagnosis they 
should specify (1) whether the alleged 
stressor was sufficient to produce PTSD; 
(2) whether the remaining diagnostic 
criteria to support the diagnosis of PTSD 
have been satisfied; and (3) whether 
there is a link between the current 
symptomatology and one or more of the in-
service alleged stressors found to be 
established by the record by the RO, and 
found to be sufficient to produce PTSD by 
the examiner.  

Any and all opinions expressed must be 
accompanied by a complete rationale.  The 
examiners must assign a Global Assessment 
of Functioning (GAF) Score which is 
consistent with the American Psychiatric 
Association’s Diagnostic and Statistical 
Manual of Mental Disorders and explain 
what the assigned score means.

6.  Thereafter, the RO should review the 
claims file to ensure that all of the 
above requested development has been 
completed.  In particular, the RO should 
review the requested examination reports 
and required opinions to ensure that they 
are responsive to and in complete 
compliance with the directives of this 
remand and if they are not, the RO should 
implement corrective procedures.

7.  After undertaking any development 
deemed appropriate in addition to that 
specified above, the RO should 
readjudicate the issue of entitlement to 
service connection for PTSD.

If the benefit sought on appeal is not granted to the 
veteran’s satisfaction, the RO should issue a supplemental 
statement of the case.  A reasonable 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.  



		
	RONALD R. BOSCH
	Member, Board of Veterans’ Appeals

NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. § 7266 (West 
1991 & Supp. 1997), 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 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) 
(1996).
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