**UNITED STATES COURT OF VETERANS APPEALS**

No. 91-1948

[Mary Lou Romeo, Appellant,]{.smallcaps}

[v.]{.smallcaps}

[Jesse Brown,]{.smallcaps}

[Secretary of Veterans Affairs, Appellee]{.smallcaps}.

On Appeal from the Board of Veterans\' Appeals

(Decided August 6, 1993 )

*Karl E. Osterhout* was on the brief for appellant.

*James A. Endicott, Jr.*, General Counsel, *Norman G. Cooper*, Acting
Assistant General Counsel, *Andrew J. Mullen*, Deputy Assistant General
Counsel, and *Ralph G. Davis* were on the brief for appellee.

Before NEBEKER, *Chief Judge*, and FARLEY and IVERS, *Judges*.

FARLEY, *Judge*: Appellant, the widow of World War II veteran Patsy A.
Romeo, appeals a July 19, 1991, decision of the Board of Veterans\'
Appeals (BVA or Board) which denied entitlement to (1) service
connection for the cause of the veteran\'s death and (2) an increased
evaluation for the veteran\'s post-traumatic stress disorder (PTSD), for
purposes of accrued benefits. A timely appeal to this Court followed.
The Court has jurisdiction pursuant to 38 U.S.C.A. § 7252(a) (West
1991). Because the Board failed to provide adequate reasons or bases for
its denial of service connection for the cause of the veteran\'s death
and for its conclusion that the veteran was entitled to no more than a
30% evaluation for his service-connected PTSD, and also failed to
consider whether the veteran was entitled to a total rating based on
individual unemployability, the decision will be vacated and the matter
remanded for readjudication consistent with this opinion.

**I. Background**

The veteran served on active duty in the United States Army from
September 1943 to February 1946, service that included combat duty
during World War II. During service, he was treated for a black widow
spider bite to the left upper arm, scabies, and an injury to his left
knee. Service medical records do not reveal any complaints of or
treatment for a psychiatric or liver disorder during service. After his
discharge, the veteran sought service connection for a psychiatric
disorder which he claimed was the result of the black widow spider bite
during service. In decisions dated June 1946, October 1947, and December
1947, the Veterans\' Administration (now Department of Veterans Affairs)
(VA) Regional Office (RO) denied service connection for a nervous or
psychiatric disorder.

In January 1950, the veteran was hospitalized in a VA medical center for
acute infectious hepatitis. In a decision dated March 1950, the RO
denied service connection for infectious hepatitis, finding that it was
neither incurred in nor aggravated by service, but granted service
connection for scabies, residuals of a spider bite, and a scar of the
left knee, rating each as 0% disabling, based on additional evidence of
record. In October 1978, the veteran sought to reopen his claim for
service connection for a psychiatric disorder. During a VA special
psychiatric examination, he claimed that he had become addicted to
heroin as a result of the black widow spider bite. The examining
psychiatrist diagnosed the veteran with heroin dependence, based on the
patient\'s history; personality disorder with what appeared to be
inadequate features; and some symptoms of anxiety. In a rating action
dated November 1978, the RO granted service connection for active
psychosis for treatment purposes only and denied entitlement to
non-service-connected pension. In November 1978, the veteran was
hospitalized in a private facility with alcoholic liver disease and
gastrointestinal bleeding. He underwent a gastric resection due to
peptic ulcer disease, as well as a liver biopsy which confirmed the
presence of chronic persistent hepatitis and Laennec\'s cirrhosis. In a
rating action dated August 1979, the RO granted appellant a 100%
non-service-connected evaluation for infectious hepatitis with
cirrhosis, ulcer disease necessitating surgery, and esophageal varices,
and awarded him a permanent and total evaluation for pension purposes.

From May 1980 to February 1983, the veteran attempted to reopen his
claim for service connection for a psychiatric disorder through the
submission of numerous personal statements. In these statements, the
veteran, referring to himself as \"the Black Widow\" or \"Merlin,\"
contended that his current psychiatric condition, liver disorder, and
substance abuse were directly related to his service-connected spider
bite. In December 1982, he was hospitalized at a VA medical facility
after complaining of an inability to sleep. The report listed the final
diagnosis as major depressive disorder with psychotic features. In a
rating action dated March 1983, the RO confirmed the previous denial of
service connection for a psychiatric disorder. In a subsequent rating
action dated June 1983, the RO determined that no clear and unmistakable
error had taken place in the rating decisions made in June 1946 and
October 1947. In a decision dated November 1983, the BVA denied
appellant\'s claim for service connection for a psychiatric disorder and
a liver disorder on the grounds that there had been no manifestations of
either disorder during service or within one year after separation from
service; that there was no evidence of an etiological relationship
between his current liver disorder and the spider bite during service;
and that there was no clinical evidence establishing a relationship
between his cirrhosis of the liver and his period of service.

In August 1984, the veteran\'s service representative requested that the
RO review the veteran\'s case to determine whether he was suffering from
PTSD. The veteran underwent a VA compensation and pension examination
and a social and industrial survey in September 1985. The compensation
and pension examination report revealed that, although the veteran had
presented a complicated case with a variety of psychiatric symptoms, his
symptoms were consistent with PTSD. The report noted that the veteran
had indicated that he was involved in the D-Day invasion at Omaha Beach
and the Battle of the Bulge and that \"he \[had been\] exposed to many
very gruesome scenes during his wartime experience, including seeing
young men screaming as parts of their bodies were blown off.\" R. at
236. The veteran also had recalled mortar shells landing very close to
him and having suffered concussions from such mortar fire. The VA
psychiatrists diagnosed the veteran with PTSD, chronic; schizophrenia,
chronic, paranoid, mild to moderate severity; opiate dependence, in
remission; barbiturate dependence, in remission; alcohol dependence, in
remission. The results of the social and industrial survey also
indicated that the veteran exhibited behavior patterns usually
associated with PTSD. The VA social worker noted that although the
veteran had been able to work at times, for the most part he had not had
any established work history, a problem which, according to the social
worker, might have been related to his psychiatric problems. The social
worker determined that the veteran should be considered to have an
industrial handicap \"at least to a partial degree.\" R. at 243. In a
rating action dated April 1986, the RO denied service connection for
PTSD, finding that the veteran did not suffer from PTSD related to his
military service, but instead from \"pre-morbid personality disturbance,
schizophrenia, and multiple substance abuse.\" R. at 248. In a decision
dated October 30, 1988, the BVA denied service connection for PTSD,
finding that the veteran\'s psychiatric symptoms were general in nature
and were more closely akin to schizophrenia. R. at 255-56. The veteran
filed a Notice of Disagreement (NOD) on August 3, 1988, received a
Statement of the Case (SOC) in September 1988, and perfected an appeal
to the BVA in November 1988.

On December 16, 1988, the veteran died. His death certificate listed the
cause of death as intra-abdominal hemorrhage due to or as a consequence
of carcinoma of the liver. In January 1989, appellant filed a VA Form
21-534 ([Application for Dependency and Indemnity Compensation or Death
Pension by Surviving Spouse or Child]{.smallcaps} \[DIC\]). In a rating
decision dated May 1989, the RO confirmed and continued the denial of
service connection for a psychiatric disorder, to include PTSD. The RO
issued a Supplemental SOC to appellant in May 1989. In a decision dated
April 1990, the Board granted the veteran service connection for PTSD
for purposes of appellant\'s claim for accrued benefits. In May 1990,
the RO assigned the veteran a noncompensable service-connected rating
for PTSD, noting that there \"were neurotic symptoms which may somewhat
adversely affect relationships with others but which did not cause
impairment of working ability.\" R. at 285. Appellant filed an NOD with
the May 1990 RO decision in September 1990. In the NOD, appellant
claimed entitlement to a 100% evaluation for the veteran\'s PTSD and
requested service connection for the cause of the veteran\'s death. The
RO issued an SOC to appellant in January 1990. In October 1990, the RO
denied service connection for the cause of the veteran\'s death, finding
that there were no complaints of or treatment for carcinoma or other
related disability while on active duty or within any applicable
presumptive period following discharge from service and that there was
no evidence that the veteran\'s service-connected disabilities
contributed materially to his demise. R. at 294.

The RO issued an SOC to appellant in December 1990 on the issue of a
surviving spouse\'s entitlement to accrued benefits by virtue of
entitlement of the veteran to service connection for a psychiatric
disorder. Appellant perfected an appeal to the BVA in January 1991. In
support of her appeal, appellant submitted additional evidence,
including (1) a letter from the veteran\'s attending physician, Dr.
Edward L. Bamonte, attached to a copy of the veteran\'s death summary,
which noted that the veteran had expired following surgery for a
malignant hepatoma, \"most certainly related to his chronic liver
disease\" (R. at 302); and (2) private and VA treatment records for the
period June 1987 to April 1988. In March 1991, appellant\'s service
representative filed a VA Form 1-646 ([Statement of Accredited
Representative in Appealed Case]{.smallcaps}) which cited to various
medical textbooks to establish that alcohol and drug abuse are forms of
self-help for PTSD; that hepatitis and cirrhosis are causally related to
alcohol abuse; and that liver carcinoma is related to hepatitis and
cirrhosis of the liver.

In a decision dated July 19, 1991, the Board denied service connection
for the cause of the veteran\'s death and granted the veteran a 30%
evaluation for PTSD for accrued benefits purposes. *Mary Lou Romeo*, BVA
\_\_\_\_\_ (July 19, 1991). A timely appeal to this Court followed.

**II. Analysis**

The controlling statutory and regulatory law provides that upon the
death of a veteran, periodic monetary benefits to which he or she was
entitled on the basis of evidence in the claims file at the time of
death, and due and unpaid for a period of one year prior to the
veteran\'s death, may be paid to the veteran\'s spouse. *See* 38
U.S.C.A. § 5121(a)(2)(A) (West 1991); 38 C.F.R. § 3.1000(a)(1)(i)
(1992). The application for such accrued benefits must be made within
one year of the date of the veteran\'s death. *See* 38 U.S.C.A. §
5121(c) (West 1991); 38 C.F.R. § 3.1000(c) (1992). A widow\'s claim for
DIC is deemed to include a claim for any accrued benefits. *See*
38 C.F.R. § 3.1000(c). Based on these statutory and regulatory
requirements, the Court finds that appellant filed a timely application
for DIC to include a claim for accrued death pension benefits.
Accordingly, the Court must now determine whether the BVA erred in
denying appellant\'s claims for service connection for the cause of the
veteran\'s death and for a higher evaluation for the veteran\'s PTSD,
for accrued benefits purposes.

A. Service Connection for Cause of Veteran\'s Death

Appellant contends that the veteran\'s death was service connected; she
argues that the veteran died from liver carcinoma, associated with
hepatitis and/or cirrhosis; that these conditions were related to his
long history of drug and alcohol abuse; and that the substance abuse, in
turn, was an attempt to self-medicate his service-connected PTSD. As
support for this contention, appellant points, first, to the medical
opinion of the veteran\'s treating physician, Dr. Bamonte, who stated
that the veteran\'s malignant hepatoma was \"most certainly related to
his chronic liver disease,\" R. at 234; Appellant\'s Br. at 15.
Appellant notes that the Secretary of Veterans Affairs (Secretary) has
never solicited or produced an opinion contrary to Dr. Bamonte\'s. *Id.*
Next, appellant contends here, as she did before the BVA, that Dr.
Bamonte\'s opinion is bolstered by several medical texts, including
[Merck\'s Manual of Medical Diagnosis]{.smallcaps}; [Harrison\'s
Principles of Internal Medicine]{.smallcaps}; [Cecil\'s Textbook of
Medicine]{.smallcaps}; and [Tom Williams, Post-traumatic Stress Disorder
\-- A Handbook for Clinicians]{.smallcaps}. Appellant\'s Br. at 15.
Appellant contends that the medical textbooks show that (1) alcohol and
post-necrotic cirrhosis are the most common forms of underlying liver
disease in patients with liver carcinoma in the United States; (2) liver
carcinoma is predominantly a disease of males and usually arises from a
cirrhotic liver; and (3) alcohol and drug abuse are common attempts at
self-medication for people with PTSD. *Id.* at 15-16. Finally, appellant
states that the lay testimony of record of the veteran and herself
corroborate the fact that the veteran\'s PTSD was causally related to
his alcohol and drug abuse, which was causally related to his liver
disorder which, in turn, was causally related to his ultimate liver
carcinoma, which resulted in his death. *Id*. at 17.

In order to establish service connection for the cause of a veteran\'s
death, the evidence must show that a disability incurred in or
aggravated by service was either the principal cause of death or a
contributory cause of death. 38 C.F.R. § 3.312(a) (1992). A service
connected disability will be considered to be the principal cause of
death when it, either singly or jointly with some other condition, was
the immediate or underlying cause of death or was etiologically related
to the cause of death. 38 C.F.R. § 3.312(b) (1992). In defining what
constitutes a \"contributory cause of death,\" VA regulations provide:

> Contributory cause of death is inherently one not related to the
> principal cause. In determining whether the service-connected
> disability contributed to death, it must be shown that it contributed
> substantially or materially; that it combined to cause death, that it
> aided or lent assistance to the production of death. It is not
> sufficient to show that it casually shared in producing death, but
> rather it must be shown that there was a causal connection.

38 C.F.R. § 3.312(c)(1) (1992). Further, the governing VA regulations
provide:

> There are primary causes of death which by their very nature are so
> overwhelming that eventual death can be anticipated irrespective of
> coexisting conditions, but, even in such cases, there is for
> consideration whether there may be a reasonable basis for holding that
> a service-connected condition was of such severity as to have a
> material influence in accelerating death. In this situation, however,
> it would not generally be reasonable to hold that a service-connected
> condition accelerated death unless such condition affected a vital
> organ and was of itself of a progressive or debilitating nature.

38 C.F.R. § 3.312(c)(4) (1992).

In denying service connection for the cause of the veteran\'s death, the
Board found as fact that \"\[t\]he veteran\'s death on December 16,
1988, was the overwhelming result of carcinoma of the liver\"; that
\"\[c\]arcinoma of the liver was not shown in active service, but
initially manifested many years thereafter and was not causally related
to a service-connected disability\"; and that \"\[t\]he service
connected disabilities did not contribute materially in producing the
veteran\'s death.\" *Romeo*, BVA \_\_\_\_\_, at 6. As its reasons or
bases for its findings and conclusions, the Board noted:

> . . . \[T\]he medical evidence of record does not show that the
> veteran\'s service-connected disabilities; particularly, his
> post-traumatic stress disorder, contributed materially to his demise.
> It is clear that carcinoma of the liver, which resulted in an
> intra-abdominal hemorrhage, was so overwhelming in nature that it
> would have produced death regardless of the effects of disabilities
> for which service connection had been established during the
> veteran\'s lifetime. It is the judgment of this Board, that the
> veteran\'s death was not the result of disability which was incurred
> in or aggravated by service.

*Id*.

This Court has held in numerous opinions that the BVA may not refute the
expert medical conclusions in the record with its own unsubstantiated
medical conclusions. *Colvin v. Derwinski*, 1 Vet.App. 171, 175 (1991).
*See also* *Cosman v. Principi*, 3 Vet.App. 503, 506 (1992); *Hatlestad
v. Derwinski*, 3 Vet.App. 213, 217 (1992) (*Hatlestad II*); *Budnik v.
Derwinski*, 3 Vet.App. 185, 187 (1992); *Quarles v. Derwinski*, 3
Vet.App. 129, 139 (1992); *Tobin v. Derwinski*, 2 Vet.App. 34, 39
(1991). In *Colvin*, this Court noted:

> BVA panels may consider only independent medical evidence to support
> their findings. If the medical evidence of record is insufficient, or,
> in the opinion of the BVA, of doubtful weight or credibility, the BVA
> is always free to supplement the record by seeking an advisory
> opinion, ordering a medical examination or citing recognized medical
> treatises in its decisions that clearly support its ultimate
> conclusions. *See* 38 U.S.C. § 4009 (1988); *Murphy v. Derwinski*, 1
> Vet.App. 78, 81 (1990). This procedure ensures that all medical
> evidence contrary to the veteran\'s claim will be made known to him
> and be a part of the record before this Court.

1 Vet.App. at 175. Thus, while the Board is not required to accept the
medical authority supporting a claim, it must provide its reasons for
rejecting such evidence and, more importantly, must provide a medical
basis other than its own unsubstantiated conclusions to support its
ultimate decision. *Id*.; *see also* *Simon v. Derwinski*, 2 Vet.App.
621, 622 (1992); *Hatlestad v. Derwinski*, 1 Vet.App. 164, 169 (1991)
(*Haltestad I*); *Gilbert v. Derwinski*, 1 Vet.App. 49, 47 (1990);
*Murphy v. Derwinski*, 1 Vet.App. 78, 81 (1990). It is not the function
of this Court to speculate on the relationship between a veteran\'s
service-connected disabilities and his or her cause of death; rather, it
is the function of this Court to decide whether the Board\'s factual
determinations on the issue constitute clear error. *See Shoemaker v.
Derwinski*, 3 Vet.App. 248, 254 (1992); *Gilbert*, 1 Vet.App. at 53. In
order for the Court to determine whether the BVA\'s factual findings
related to cause of death are clearly erroneous, the Board must ensure
that its findings are adequately explained and sufficiently supported by
the evidence of record. *See Shoemaker*, 3 Vet.App. at 254.

Here, the Court finds that appellant, by means of the medical opinion
and medical treatises of record, has provided competent medical
evidence, i.e., evidence which may justify a belief in a fair and
impartial individual that the claim is \"plausible\" or \"possible,\" to
meet the threshold well-grounded claim requirement with respect to her
claim for service connection for the cause of the veteran\'s death.
*See* 38 U.S.C.A. § 5107(a) (West 1991); *Grottveit v. Brown*, 5
Vet.App. 91, 93 (1993) (where the issue involves medical causation,
competent medical evidence which indicates that the claim is plausible
or possible is required to set forth a well-grounded claim); *see also
Tirpak v. Derwinski*, 2 Vet.App. 609, 611 (1992) (for purposes of
well-grounded claim requirement, claimant must submit supporting
evidence which justifies a belief by a fair and impartial individual
that the claim is plausible). The BVA has rejected this medical evidence
based on its own unsubstantiated medical conclusions and without citing
to independent medical evidence to support such conclusions. The Board
has not cited to any medical authority, such as a medical examination, a
medical advisory opinion, or a medical text or treatise, to support its
factual determination that there is no etiological relationship between
the cause of the veteran\'s death and his service-connected
disabilities. Furthermore, the Board has not provided an analysis of the
probative value of the evidence submitted in support of appellant\'s
claim. Accordingly, under *Colvin* and the related case law cited above,
the BVA decision as to appellant\'s claim for entitlement to service
connection for the veteran\'s cause of death must be vacated and the
matter remanded for further development.

B. Increased Rating for PTSD/Total Rating Based On Individual
Unemployability

Under the VA\'s Schedule for Rating Disabilities, a 30% evaluation is
warranted for PTSD when there is a definite impairment in the ability to
establish or maintain effective and wholesome relationships with people
and when psychoneurotic symptoms result in such reductions in
initiative, flexibility, efficiency, and reliability levels as to
produce definite industrial impairment. 38 C.F.R. § 4.132, diagnostic
code 9411 (1992). A 50% evaluation is warranted for PTSD when there is a
considerable impairment in the ability to establish or maintain
effective and wholesome relationships with people and when
psychoneurotic symptoms result in such reductions in initiative,
efficiency, and reliability levels as to produce considerable industrial
impairment. *Id*. A 70% evaluation for PTSD requires a severe impairment
in the ability to maintain effective and wholesome relationships with
people and psychoneurotic symptoms resulting in such reductions in
initiative, flexibility, efficiency, and reliability as to produce
severe industrial impairment. *Id.* A 100% evaluation for PTSD is
mandated when the attitudes of all contacts except the most intimate are
so adversely affected as to result in virtual isolation in the
community, when there are totally incapacitating psychoneurotic symptoms
bordering on gross repudiation of reality with disturbed thought or
behavioral processes associated with almost all daily activities such as
fantasy, confusion, panic, and explosions of aggressive energy,
resulting in profound retreat from mature behavior, and where there is a
demonstrable inability to obtain or retain employment. *Id.* In its July
1991 decision, the Board found as fact that the veteran\'s PTSD was
productive of *definite* social and industrial impairment during the
one-year period prior to the veteran\'s death, warranting a 30%
evaluation. *Romeo*, BVA \_\_\_\_\_, at 7.

Where the Board rejects a request for a rating increase for a
psychiatric impairment, it is required to provide adequate reasons or
bases for denying entitlement to a higher rating; these reasons or bases
should include (1) an analysis of the probative value of the evidence
submitted by or on behalf of the veteran and (2) citations to
independent medical authority to support the Board\'s conclusion on the
level of impairment. *See Shoemaker*, 3 Vet.App. at 253-54 (1992); *see
also* *Hood v. Brown*, 4 Vet.App. 301, 303-04 (1993) (Board must
explain, in the context of the facts presented, the criteria used in
determining the rating category into which the veteran\'s symptoms
fall). The reasons or bases requirement is heightened where the BVA\'s
determination of the level of impairment appears to be inconsistent with
its own conclusions and the medical evidence of record. *See Shoemaker*,
3 Vet.App. at 253.

Here, the BVA decision fails to provide adequate reasons or bases for
its conclusion that the veteran was entitled to a 30% rating for PTSD,
but not to a higher evaluation. In support of the 30% rating, the Board
noted:

> A review of the VA social worker and the psychotherapy reports, dated
> during the one-year period prior to the veteran\'s death, discloses
> that \[PTSD\] symptomatology included the veteran\'s extreme fear of
> thunder and lightning because they reminded him of exploding guns from
> his combat service in Vietnam \[sic\], flashbacks, social avoidance,
> startle response, and nightmares. The veteran required periodic
> psychotherapy and medication to alleviate his symptomatology. He led a
> socially isolative existence and there was no prospect of his engaging
> in gainful employment. He was also reported to suffer from periodic
> depression. The above clinical description of the disabling
> manifestations of \[PTSD\] during the one-year period prior to the
> veteran\'s death allows the Board to conclude that the veteran
> experienced definite social and industrial inadaptability, thereby,
> warranting the assignment of a 30 percent evaluation for accrued
> benefits purposes.

*Romeo*, BVA \_\_\_\_\_\_, at 7. (The Court notes that appellant served
in World War II, rather than Vietnam as incorrectly stated in the BVA
decision.) Since the BVA, itself, determined that the veteran led a
socially isolated existence and had no prospect of engaging in gainful
employment, and several of the medical opinions of record corroborate
this finding, it is at least open to question whether the veteran was
entitled to a rating in excess of 30% for his PTSD.

Just as it is not this Court\'s function to speculate on whether a
veteran\'s service-connected disability was related to his cause of
death, it is not this Court\'s role to determine the level of a
veteran\'s psychiatric impairment. Instead, the Court must decide
whether the factual determinations by the BVA regarding the veteran\'s
level of impairment constituted clear error. *Archer v. Principi*, 3
Vet.App. 434, 436 (1992); *Lovelace v. Derwinski*, 1 Vet.App. 73, 74
(1990); *Gilbert*, 1 Vet.App. at 52-53. Before the Court may make such

a decision, the Board must present the Court with an adequate
explanation of its reasoning with respect to its findings on the degree
of impairment. *See Hood*, *supra*; *Shoemaker*, *supra*. In this case,
the Board did not provide an analysis of the probative value of the
evidence submitted in support of appellant\'s claim and did not cite to
medical evidence of record, advisory opinions, or medical texts or
treatises to support its findings concerning the veteran\'s level of
psychiatric impairment. Accordingly, the BVA\'s decision on this claim
must be vacated and the matter remanded for readjudication consistent
with this decision. In *Hood*, this Court noted the confusion created by
the VA Schedule of Rating\'s use of the term \"definite,\" which is
qualitative in nature, as a level of impairment for PTSD, along with the
terms \"considerable,\" \"severe,\" and \"total,\" which are
quantitative in nature. 4 Vet.App. at 303-04. On remand, the Board is
reminded that the general policy of the VA rating schedule is to
determine the average impairment in earning capacity resulting from a
specific disability in question. *Id*. at 303; *see also* 38 C.F.R. §
4.1 (1992). Accordingly, under *Hood*, the Board is directed to quantify
the veteran\'s degree of social and industrial impairment resulting from
his service-connected PTSD, and not merely to refer to the level of
impairment as \"definite\" merely to indicate that such PTSD actually
existed. *See Hood*, 4 Vet.App. at 303-04.

The Court also finds error in the Board\'s failure to consider whether
the veteran was entitled to a total disability rating based on
individual unemployability, given the evidence in the record suggesting
that \"there was no prospect of him engaging in gainful employment.\"
*Romeo*, BVA \_\_\_\_\_\_, at 7; *see also* R. at 239; *Hood*, 4
Vet.App. at 304 (citing *EF v. Derwinski*, 1 Vet.App. 324, 326 (1991)
(duty to assist extends liberal reading to include issues raised in all
documents submitted prior to BVA decision)); *see also* 38 C.F.R. §
4.16(b) (1992) (requiring rating boards to submit to the Director of the
Compensation and Pension Service, for extra-schedular consideration,
those cases of veterans who are unemployable due to service-connected
disabilities, but who otherwise fail to meet the percentage requirements
of 38 C.F.R. § 4.16(a) (1992)). Further, in the event that the Board
determines, upon readjudication, that the veteran was entitled to a 70%
rating for PTSD, the Board also must consider whether he was entitled to
a total rating based on unemployability under 38 C.F.R. § 4.16(c). *See
Tripp v. Derwinski*, 3 Vet.App. 173, 176 (1992). On remand, the Board
will have the opportunity to address these issues.

C. Clear and Unmistakable Error in Prior RO and BVA Decisions

In her brief, appellant argues that the RO\'s denial, in 1946 and 1947,
of the veteran\'s claim for service connection for a psychiatric
disorder should be set aside because of clear and unmistakable error.
Appellant\'s Br. at 10-13. Additionally, appellant contends that even if
the Court does not find clear and unmistakable error in the 1946 and
1947 RO determinations, the RO and BVA decisions of the late 1970\'s and
early 1980\'s, which denied appellant\'s claim for service connection
for PTSD, must be set aside as clearly and unmistakably erroneous. *Id.*
at 13-15. The Secretary, in turn, argues that because these issues were
not previously raised before the Board, they are not properly before
this Court for review. Appellee\'s Mot. at 9.

Upon reviewing the record, the Court agrees with the Secretary; the
issue of clear and unmistakable error in the earlier RO and BVA
decisions was not raised before the Board and, therefore, is not
properly before this Court for review. *See Villalobos v. Principi*, 3
Vet.App. 450, 452 (1992); *Russell v. Principi*, 3 Vet.App. 310, 315
(1992) (en banc). However, since the appeal is being remanded on related
matters, the Board will have an opportunity on remand to address
appellant\'s contentions regarding the errors in the earlier decisions.

**III. Conclusion**

For the reasons articulated above, the Secretary\'s motion for summary
affirmance is DENIED, and the Board\'s July 19, 1991, decision is
VACATED and REMANDED for disposition in accordance with this opinion.
\"A remand is meant to entail a critical examination of the
justification for the decision. The Court expects that the BVA will
reexamine the evidence of record, seek any other evidence the Board
feels is necessary, and issue a timely, well-supported decision in this
case.\" *Fletcher v. Derwinski*, 1 Vet.App. 394, 397 (1991). Moreover,
if the circumstances warrant, the BVA is authorized and obligated to
remand the claim to the RO for further development. *See* 38 C.F.R.
§ 19.182(a); *Littke v. Derwinski*, 1 Vet.App. 90 (1990).