Citation Nr: 9835435	
Decision Date: 12/01/98    Archive Date: 12/15/98

DOCKET NO.  94-29 108A	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in St. 
Petersburg, Florida


THE ISSUE

Whether new and material evidence has been submitted to 
reopen a claim for service connection for post-traumatic 
stress disorder (PTSD) and, if so, whether all the evidence 
both old and new warrants the grant of service connection.  

REPRESENTATION

Appellant represented by:	The American Legion


WITNESSES AT HEARING ON APPEAL

Appellant and the appellant's wife


ATTORNEY FOR THE BOARD

J. Fussell, Counsel

INTRODUCTION

The veteran had active military service from October 1958 to 
July 1970 and he had verified service in the Republic of 
Vietnam from February to November 1969.  

The veteran was notified in May 1991 of a rating action of 
the prior month which denied service connection for PTSD.  
The April 1991 rating action determined that there was no 
clinical diagnosis of PTSD and that there was no recognizable 
stressor which would warrant a diagnosis of PTSD.  

This matter comes before the Board of Veterans’ Appeals 
(Board) from an August 1993 decision of the Department of 
Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, 
Florida, which denied service connection for PTSD on a de 
novo basis.  

An April 1997 rating action denied entitlement to automobile 
and adaptive equipment or for adaptive equipment only and 
denied special monthly compensation based on aid and 
attendance or housebound benefits.  An increased rating for 
service-connected chronic obstructive pulmonary disease 
(COPD) was also denied and it was determined that a claim for 
an increased rating for service-connected headaches was not 
well grounded.  No appeal was taken from these denials.  


CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends that his PTSD is the result of stressors 
he was exposed to in Vietnam.  He states that he was exposed 
to mortar or artillery fire as well as gun fire.  He 
witnessed a number of deaths when a bus was blown up and saw 
a Vietnamese self-immolate.  Finally, the accredited 
representative contends that the veteran’s stressors should 
be verified by the U.S. Armed Services Center for Research of 
Unit Records (USASCRUR) (formerly U. S. Army and Joints 
Services Environmental Support Group (ESG) in light of the 
diagnosis of PTSD by a VA psychiatrist.  


DECISION OF THE BOARD

The Board, in accordance with the provisions of 38 U.S.C.A. 
§ 7104 (West 1991 & Supp. 1998), 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 the claim for service connection for 
PTSD.  


FINDINGS OFFACTS

1.  Service connection for PTSD was denied by an April 1991 
rating decision and the veteran was notified of that decision 
in May 1991 but did not submit a notice of disagreement 
within one year from the date of notification.  

2.  Evidence submitted since that decision with regard to 
PTSD includes a VA examination report showing a diagnosis of 
PTSD and a more detailed description of putative stressors in 
the Republic of Vietnam.  

3.  The evidence received since the April 1991 denial of 
PTSD, when considered together with the evidence previously 
on file, is such that the new evidence must be fairly 
considered for a merits adjudication and, thus, is sufficient 
to reopen the claim for service connection for PTSD.  




CONCLUSIONS OF LAW

1.  The unappealed April 1991 rating decision denying service 
connection for PTSD is final.  38 U.S.C.A. § 7105 (West 
1991); 38 C.F.R. §§ 3.104(a), 20.302, 20.1103 (1998).  

2.  Evidence submitted by the veteran with respect to service 
connection for PTSD since the April 1991 denial is new and 
material and reopens his claim for service connection for 
PTSD.  38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) 
(1998).  


REASONS AND BASES FOR FINDINGS AND CONCLUSION

The April 1991 denial of service connection for PTSD became 
final when it was not appealed within one year from the date 
the veteran was notified of it.  A rating action which is 
final may not be reopened unless new and material evidence is 
presented.  38 U.S.C.A. §§ 5108, 7105(c) (West 1991) and 38 
C.F.R. §§ 3.104, 20.302 (1998).  

Although the rating action appealed in 1993 appeared to deny 
service connection for PTSD on a de novo basis, it was not 
made clear whether the RO first determined that there was 
sufficient new and material evidence to reopen the claim.  
However, new and material evidence is jurisdictional and 
without it the Board may not adjudicate the merits of a 
previously denied claim.  Barnett v. Brown, 83 F.3d 1380 
(Fed. Cir. 1996).  

To reopen a previously finally denied claim, a two-step 
analysis must be executed.  Manio, 1 Vet. App. 140, 145 
(1991).  First, it must be determined whether the evidence 
submitted with the reopened claim is new and material.  

In Evans v. Brown, 9 Vet. App. 273 (1996) it was held that in 
the first step of the Manio analysis, three questions must be 
addressed.  First, is the newly presented evidence “new” 
(not of record at the time of the final disallowance of the 
claim and not merely cumulative of other evidence that was 
then of record)?  Second, is it probative of each issue which 
was a specified basis for the last final disallowance?  
Third, if the answer to the first two questions is in the 
affirmative, is there a reasonable possibility that, when 
considered in light of all the evidence of record, the 
outcome of the claim on the merits would be different?  If 
the evidence passes these three tests, then the second step 
of the Manio analysis is applied, and the new evidence must 
be reviewed in the context of the old to determine whether 
the prior disposition should be altered.  Manio, 1 Vet. 
App. at 145.  

However, it was recently held by the United States Court of 
Appeals for the Federal Circuit that the third step, 
requiring that evidence be not only new and probative but 
also demonstrate a reasonable possibility of allowance of the 
claim, is not required under 38 C.F.R. § 3.156(a) (1998).  38 
C.F.R. § 3.156(a) only requires that the new and material 
evidence, either by itself or together with other evidence on 
file, is so significant that it must be considered to fairly 
decide the merits of the claim.  Hodge v. West, No. 98-7017 
(Fed. Cir. Sept. 16, 1998).  

Under 38 U.S.C.A. §§ 5108, 7104(b), and 7105(c) in order to 
reopen a previously and finally disallowed claim (by the BVA 
or RO) there must be new and material evidence presented 
since the last disallowed on any basis (including not 
reopening), not only since the denial on the merits.  Evans 
v. Brown, 9 Vet. App. 273, 285 (1996).  Here, the last 
disallowance was the April 1991 original de novo denial of 
PTSD.  

Old Evidence

A January 1957 examination for enlistment revealed the 
veteran was psychiatrically normal.  On examinations in 
October 1958 and June 1964 he was psychiatrically normal and 
in adjunct medical history questionnaires there were no 
pertinent complaints.  In a medical history questionnaire in 
March 1967 he complained of depression or excessive worry and 
nervous trouble of some sort.  It was noted that he took 
Librium for his nerves.  On examination for service discharge 
in May 1970 he was psychiatrically normal and in an adjunct 
medical history questionnaire there was no pertinent 
complaint.  

On VA neuropsychiatric examination in September 1970 the 
veteran complained of headaches due to inservice head trauma 
in a vehicular accident in 1961.  After a mental status 
examination, the diagnoses included no evidence on 
examination of neuropsychiatric disease.  

On VA neuropsychiatric examination in September 1975 the 
veteran again complained of headaches and he reported having 
spent about 2 years in Vietnam.  He related having had 
pneumonia and an appendectomy while in Vietnam.  He also 
mentioned that he had been experiencing nervousness and 
irritability for the last 4 months because of not having a 
job.  He had been prescribed Valium.  After neurological and 
psychiatric examinations it was commented that there were no 
particular positive findings.  

During VA hospitalization in January 1987 it was reported 
that the veteran had a history of depression.  

On VA general medical examination in 1987 the veteran 
complained of depression and nervousness.  

The veteran’s original claim for service connection for PTSD 
was received in September 1990 and he reported having been 
treated by a private physician for this for the last 3 years.  
In January 1991, after the veteran executed and returned the 
necessary authorization form, the RO requested the records of 
that physician but there was no response.  

In October 1990 the RO requested the veteran to provide 
detailed information as to his alleged inservice stressors 
but there was no response.  



New Evidence

The evidence received since the April 1991 denial of service 
connection for PTSD includes VA outpatient treatment (VAOPT) 
records of 1990 to 1993 which reflect complaints of anxiety 
and depression.  In December 1992 it was noted that he 
described nightmares of combat-related events.  The 
impressions included PTSD.  

In April 1993 the RO requested the veteran to provided 
detailed information as to his alleged inservice stressors 
but there was no response.  

On VA respiratory examination in April 1993 it was reported 
that the veteran had a history of PTSD.  

On VA examination in April 1993, to determine if the veteran 
had PTSD, he related having served 2 tours in Vietnam, for a 
total of less than 2 years.  The first time he was attached 
to the 8th Field Hospital and the 28th Medical Lab.  During 
his second tour he was stationed at Cam Rahn Bay in a mess 
hall.  He reportedly had very limited combat experience while 
in Vietnam and was mostly in the back of other units, in a 
field hospital.  He stated that while at Cam Rahn Bay his 
battalion had been under attack from shells and gas.  During 
the second tour, Vietnamese girls riding a bicycle blew up a 
bus which was in front of the bus in which he was traveling.  
This was the only time he came close to having been in a 
traumatic experience of imminent danger but he also related 
having served in a hospital which took care of wounded and 
dying patients.  

The veteran related having had flashbacks about the bus 
incident since his service in Vietnam.  He often dreamed of 
times when he saw wounded and dying people.  On mental status 
examination he had obvious difficulty when talking and his 
mood was depressed but his affect was appropriate.  He was 
oriented and his memory was intact.  The impression was PTSD.  
It was noted that although he had never had a life-
threatening experience, he had had a lot of experience with 
dead and dying people and had symptoms of PTSD.  His primary 
problem, however, was that his physical problems had resulted 
in depression which was not a result of his Vietnam 
experiences.  In June 1993 the examiner reported that the 
veteran had symptoms of the criteria for PTSD in Categories 
A, B, and C.  It was again stated that the diagnosis was 
PTSD.  

In VA Form 9 of August 1994 the veteran reported that the 
self-immolation he had witnessed had occurred in January or 
February 1963 and while with the 8th Field Hospital he had 
seen dead and mutilated bodies and dying people.  The bombing 
of a bus near Long Binh in Vietnam had occurred in February 
1969.  He had been awarded Social Security benefits in 1986 
due to PTSD.  Attached to VA Form 9 was a copy of a request 
to the U.S. Army and Joint Services Environmental Support 
Group, dated June 1994, requesting verification of (1) the 
self immolation of a Vietnamese in January or February 1963 
near one of the hotels in Saigon which housed American 
troops; (2) the bombing of a bus transporting troops in 
February 1969 from the Long Binh airport; (3) gunfire from a 
hillside into a recreational area from American troops in 
April or May 1969 at Na Trang; (4) and Agent Orange having 
been sprayed from February to October 1969.  He reported 
having been assigned to the 20th Medical Lab attached to the 
8th Field Hospital from January 1962 to January 1963 at Nha 
Trang and from February to October 1969 having been assigned 
to the mess hall of the Signal Battalion at Cam Rahn Bay.  

At an RO hearing in October 1996 the veteran testified that 
he had served in Vietnam in 1962 and 1963 and a second time 
in 1967 or 1968.  During his first tour his military 
occupational specialty had been a hospital mess steward and 
he had seen casualties with missing limbs (page 1).  He had 
seen dead and mutilated bodies.  During one tour a bus ahead 
of the one in which he was riding was blown up by a couple of 
Vietnamese girls on a motor bike.  He relived and dreamed of 
this experience.  He had seen the self-immolation of a 
Vietnamese.  His condition had gone down hill after the death 
of his father (page 2).  He had not been given a medal or 
citation indicating participation in combat.  During his 
second tour in Vietnam he had been assigned to an Ordnance 
outfit stationed in Cam Rahn Bay as a regular mess sergeant 
and firefights had occurred on the other side of a river and 
his unit had been subjected to shelling and gassing.  Once 
during this tour he had gone across a few rivers in search of 
old mess gear and had been involved in a small firefight 
(page 3).  On the occasion when the bus had been blown up he 
had lost some friends, although he did not know their names 
(page 4).  The veteran’s wife testified that after he 
returned from Vietnam he was changed (page 4).  

Analysis

Service connection for PTSD requires the presence of three 
elements: (1) a current, clear diagnosis of PTSD (presumed to 
include the adequacy of the PTSD symptomatology and the 
sufficiency of a claimed in-service stressor); (2) credible 
supporting evidence that the claimed in-service stressor 
actually occurred; and (3) medical evidence of a causal nexus 
between current symptoms and the specific claimed in-service 
stressor.  Moreau v. Brown, 9 Vet. App. 389, 394-95 (1996).  

At to the first element for service connection for PTSD, a 
“clear diagnosis” should be an “unequivocal” one under the 
appropriate DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL 
DISORDERS (DSM).  DSM-III was revised in 1987 (DSM-III-R) and 
the fourth edition was issued in 1994 (DSM-IV). Cohen v. 
Brown, 10 Vet. App. 128 (1997).  

A clear (unequivocal) PTSD diagnosis by a mental-health 
professional will, unless shown by evidence to the contrary, 
be presumed to be in accord with DSM criteria as to 
sufficiency of stressor(s) and adequacy of symptomatology.  
Cohen v. Brown, 10 Vet. App. 128 (1997).  

Since the 1991 denial, 38 C.F.R. § 3.304(f) became effective 
on May 19, 1993.  See 58 Fed. Reg. 29, 109, 29, 110.  38 
C.F.R. § 3.304(f) provides that:

Service connection for [PTSD] requires medical 
evidence establishing a clear diagnosis of the 
condition, credible supporting evidence that the 
claimed inservice 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, Combat Infantryman 
Badge, or similar combat citation will be 
accepted, in the absence of evidence to the 
contrary, as conclusive evidence of the claimed 
inservice stressor.  

38 C.F.R. § 3.304(f).  

Additionally, “VA's Manual M21-1 contains specific 
procedures for the VA to follow in evaluating claims for 
service connection based on PTSD.”  Zarycki v. Brown, 6 Vet. 
App. 91, 197 (1993).  The Manual now also provides that 
“[o]ther supportive evidence includes, but is not limited 
to, plane crash, ship sinking, explosion, rape or assault, 
duty on a burn ward or in graves registration unit.”  None 
of these situations specifically apply here, although the 
veteran was attached at one time to a medical unit and 
relates having seen the self-immolation of a Vietnamese.  

Also, since the 1991 denial, the criteria for a diagnosis of 
PTSD under the Diagnostic and Statistical Manual of Mental 
Disorders (DSM) was changed from DSM-III- Revised to DSM IV 
eliminating the requirement that the stressor be an event 
outside the range of usual human experiences and would be 
markedly distressing to almost anyone but, rather only that 
the response be one of intense fear, helplessness or horror.  
Thus the criteria are no longer based solely on usual 
experiences but are individualized.  Cohen v. Brown, 10 Vet. 
App. 128, 141 (1997).  

Moreover, since the 1991 denial the veteran has described in 
greater detail his stressful events in Vietnam and there has 
been a confirmed diagnosis of PTSD.  While that diagnosis, on 
VA psychiatric examination, apparently assumed the 
credibility of the stressors, i.e., assumed that they 
actually occurred, the Board need not at this time determine 
whether the veteran actually participated in combat for the 
purpose of determining whether the provisions of 38 U.S.C.A. 
§ 1154(b) (West 1991) and 38 C.F.R. § 3.304(d) (1998) apply.  

This is because in a reopening context, the credibility of 
the evidence is to be presumed.  This presumption is made 
only for the purpose of determining whether the case should 
be reopened.  Once reopened, the presumption of credibility 
and full weight no longer applies and there must be a 
determination, as a question of fact, of both the weight and 
credibility of the new evidence in the context of all the 
evidence, new and old.  Justus v. Principi, 3 Vet. App. 510, 
513 (1992).   

Further, M21-1 provides that “[a] stressor is not to be 
limited to just one single episode.  A group of experiences 
also may affect an individual, leading to a diagnosis of 
PTSD.  M21-1, Part VI, para. 7.46(b)(2) (1995) and M21-1, 
Subch. XII, para. 50.45(f)(2) (1989). Cohen v. Brown, 10 Vet. 
App. 128 (1997).  Thus, in light of the subjective nature of 
the DSM-IV criteria as to the sufficiency of a PTSD stressor 
and adequacy of symptoms, these questions (of the two DSM-IV 
criteria) are medical questions requiring examination and 
assessment by a mental-health professional.  Thus, VA can 
reject favorable medical evidence as to stressor sufficiency 
and symptom adequacy only on the basis of independent medical 
evidence, and if necessary only after first seeking 
clarification of an incomplete examination report.  Cohen v. 
Brown, 10 Vet. App. 128 (1997).  

As to the second element required for PTSD (occurrence of in-
service stressor) § 3.304(f) requires credible supporting 
evidence that the stressor occurred.  If the claimed stressor 
is not combat related, lay testimony regarding in-service 
stressor is not sufficient to establish occurrence and must 
be corroborated by “credible supporting evidence.”  Moreau 
v. Brown, 9 Vet. App. 389, 395 (1996).  If the claimed 
stressor is combat related, a medical opinion based on a 
postservice examination of a veteran may not be the 
“credible supporting evidence” necessary to corroborate in-
service occurrence.  Moreau v. Brown, 9 Vet. App. at 395-96.  

The critical element of a diagnosis of PTSD is the existence 
of a stressor or stressors.  The question of whether a 
veteran was exposed to a stressor or stressors during service 
is a factual determination and VA adjudicators are not bound 
to accept such statements simply because treating medical 
providers or examiners have done so.  Wood v. Derwinski, 1 
Vet. App. 190 (1991) [Wood I] (affirmed on reconsideration, 1 
Vet. App. 406 (1991) [Wood II]; Wilson v. Derwinski, 2 Vet. 
App. 614 (1992).  

In this case, since the 1991 denial, the veteran has provided 
more details concerning his stressors, there is a diagnosis 
of PTSD, and there are more liberal evidentiary standards for 
application.  

Accordingly, it is the determination of the Board that the 
claim for service connection for PTSD is reopened since the 
new evidence is such that, in all fairness, it should be 
considered on de novo adjudication.  Hodge v. West, No. 98-
7017 (Fed. Cir. Sept. 16, 1998).  

Accordingly, as new and material evidence has been presented, 
the veteran’s claim for service connection for PTSD is 
reopened and must be considered in light of all the evidence, 
both old and new, with evaluation of the probative value of 
the evidence.  However, in view of the reopening of the claim 
for service connection for PTSD, this issue is further 
addressed in the REMAND section of this decision.  


ORDER

New and material evidence has been submitted to reopen a 
claim of entitlement to service connection for PTSD, and to 
this extent the appeal is granted.  


REMAND

A claim reopened with new and material evidence is by its 
nature well-grounded.  The VA has the duty to assist in 
developing all facts pertinent to a well-grounded claim.  38 
U.S.C.A. § 5107(a) (West 1991).  

The service medical records suggest, in light of his 
testimony, the veteran’s presence in Vietnam in 1962 and 
1963, as he testified.  There is otherwise no corroboration 
of service in Vietnam in 1962 and 1963.  Moreover, under 
38 C.F.R. § 3.2(f) (1998) the Vietnam era is “[t]he period 
beginning on February 28, 1961, and ending on May 7, 1975, 
inclusive, in the case of a veteran who served in the 
Republic of Vietnam during that period.  The period beginning 
on August 5, 1964, and ending on May 7, 1975, inclusive, in 
all other cases.”  See 38 U.S.C.A. § 101(29)(B) (West 1991).  

Much of the matters under consideration in this case center 
upon whether the veteran actually engaged in combat.  The 
evidence necessary to establish the occurrence of a 
recognizable stressor during service to support a claim of 
entitlement to service connection for PTSD will vary 
depending on whether or not the veteran was "engaged in 
combat with the enemy."  If recognized military citations or 
other supportive evidence shows that he was engaged in combat 
with the enemy, which is not the case here, and the claimed 
stressors are related to such combat, his lay testimony 
regarding claimed stressors must be accepted as true and no 
further development or corroborative evidence will be 
required, provided that the veteran's testimony is found to 
be "satisfactory," e.g., credible, and "consistent with the 
circumstances, conditions, or hardships of such service.  If 
the evidence does not show that he was engaged in combat with 
the enemy or the claimed stressors are related to such 
combat, there must be corroborative evidence.  Zarycki v. 
Brown, 6 Vet. App. 91 (1993).  However, the mere absence of 
combat citations or combat MOS is not enough to conclude that 
the veteran never engaged in combat.  See West v. Brown, 7 
Vet. App. 70, 76 (1994).  

Here, verification of the veteran’s service in 1962 and 1963 
as well as his MOS during that time should be undertaken and 
an attempt should be made to obtain records from the USASCRUR 
and Social Security Administration.  

Accordingly, further appellate consideration will be deferred 
and the case is REMANDED to the RO for the following 
development:  

1.  The RO should take the appropriate 
steps to obtain records of the veteran’s 
award of Social Security disability 
benefits, to include not only the 
underlying medical evidence but also a 
copy of an administrative determination 
by an Administrative Law Judge, if any.  
If obtained, these records should be 
associated with the claim file.  

2.  The RO should obtain the veteran’s 
service personnel records of his entire 
period of service, to include the years 
1962 and 1963, as well as 1969.  If 
obtained, these records should be 
associated with the claim file.

3.  The RO should contact the veteran and 
request that he provide any and all 
documents he received in response to his 
request from the USASCRUR.   

If he received no response or if the 
response was unsatisfactory, the RO 
should review the entire claims file and 
prepare a summary of all the claimed 
stressors based on review of all 
pertinent documents.  This summary, and 
all associated documents, should then be 
sent to the USASCRUR, 7798 Cissna Road, 
Springfield, Virginia 22150.  USASCRUR 
should then be requested to provide any 
information which might corroborate the 
veteran's reported stressful events.  

4.  Any information received from 
USASCRUR should be reviewed and the RO 
should determine whether the veteran's 
reported stressful event(s) have been 
confirmed.  

5.  The RO must adjudicate whether the 
veteran participated in combat, thus 
making the provisions of 38 U.S.C.A. 
§ 1154(b) and 38 C.F.R. § 3.304(d) 
applicable.  

6.  The RO should arrange for the veteran 
to be accorded an examination by a board 
of two VA psychiatrists, if available, 
who have not previously examined him to 
determine the diagnosis of all 
psychiatric disorders that are present.  

The RO must specify for the examiners the 
stressor or stressors which the RO 
determine are established by the record.  

The examiners must be instructed that 
only those events may be considered for 
the purpose of determining whether 
exposure to a stressor in service has 
resulted in current psychiatric symptoms 
and, whether the diagnostic criteria to 
support the diagnosis of PTSD have been 
satisfied.  

The examination report should reflect 
review of pertinent material in the 
claims folder.  If the diagnosis of PTSD 
is deemed appropriate, the examiners 
should comment upon the link between the 
current symptomatology and one or more of 
the inservice stressors found to be 
established by the RO and state whether 
it was sufficient to cause PTSD.  The 
examination report should include the 
complete rationale for all opinions 
expressed.  All necessary special studies 
or tests, to include psychological 
testing and evaluation should be 
accomplished.  The claims folder must be 
made available to the examiners for 
review prior to, and during, the 
examination.

7.  Following completion of the above 
actions, the RO must review the claims 
folder and ensure that all of the 
foregoing development have been conducted 
and completed in full.  If any 
development is incomplete, appropriate 
corrective action is to be implemented.  
Specific attention is directed to the 
examination report.  If the examination 
report does not include fully detailed 
descriptions of pathology and all test 
reports, special studies or adequate 
responses to the specific opinions 
requested, the report must be returned 
for corrective action.  38 C.F.R. § 4.2 
(1998) ("if the [examination] report does 
not contain sufficient detail, it is 
incumbent upon the rating board to return 
the report as inadequate for evaluation 
purposes.").  Green v. Derwinski, 1 Vet. 
App. 121, 124 (1991); Abernathy v. 
Principi, 3Vet. App. 461, 464 (1992); and 
Ardison v. Brown, 6 Vet. App. 405, 407 
(1994).

8.  After the above development has been 
completed, the RO should readjudicate the 
veteran’s claim for entitlement to 
service connection for PTSD in light of 
Cohen, supra.  If the action is adverse 
to the veteran, he and his representative 
should be furnished a supplemental 
statement of the case which summarizes 
the pertinent evidence, fully cites the 
applicable legal provisions and reflects 
detailed reasons and bases for the 
decision reached. 

9.  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. 1998) (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.  

This is to put the veteran on notice, and in keeping with the 
VA’s duty to assist, as announced in Connolly v. Derwinski, 1 
Vet. App. 566, 569 (1991), that at least in part the purpose 
of the examination requested in this remand is to obtain 
information or evidence (or both) which may be dispositive of 
the claim.  Therefore, the veteran is hereby placed on notice 
that pursuant to 38 C.F.R. § 3.655 (1998) failure to 
cooperate by attending the requested VA examination may 
result in denial of the claim.  

While this case is in remand status, the veteran and 
representative are free to submit additional evidence and 
argument on the questions at issue.  Quarles v. Derwinski, 3 
Vet. App. 129, 141 (1992).  

Thereafter, the veteran and his representative should be 
afforded the opportunity to respond thereto.  The case should 
then be returned to the Board for further appellate 
consideration, if otherwise in order.  By this REMAND the 
Board intimates no opinion, either factual or legal, as to 
the ultimate determination warranted in this case.  No action 
is required of the veteran until he receives further notice.  



		
	A. BRYANT 
	Member, Board of Veterans' Appeals

NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. § 7266 (West 
1991 & Supp. 1998), 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) 
(1997).
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