Citation Nr: 1237750 Decision Date: 11/05/12 Archive Date: 11/09/12 DOCKET NO. 10-12 359 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to an increased rating for posttraumatic stress disorder (PTSD), currently evaluated as 50 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J. Henriquez, Counsel INTRODUCTION The Veteran had active service from February 1943 to November 1945. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) that confirmed and continued a 50 percent evaluation in effect for PTSD. The record reflects that the Veteran requested a video-conference hearing, but in correspondence received in February 2012, he cancelled the hearing request. The Board also notes that, in addition to the paper claims file, there is a paperless, electronic claims file associated with the Veteran's claim. A review of the documents in such file reveals that they are potentially relevant to the issue on appeal. Thus, any future consideration of this appellant's case should take into account the existence of this electronic record. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND While further delay is regrettable, the Board finds that additional development is necessary. The Board notes that on VA examination on April 26, 2012, the Veteran was noted to have diagnoses of PTSD and dementia. In one portion of the examination, the examiner noted that it was not possible to differentiate what symptoms were attributable to each diagnosis. The examiner reasoned that the Veteran's PTSD symptoms were no longer prevalent or at least could not be adequately assessed due to hearing loss and cognitive decline. Later in the examination, however, the examiner stated that it was possible to differentiate what portion of the occupational and social impairment was caused by each mental disorder. The examiner opined that the Veteran's dementia and related physical problems are responsible for his total impairment. The examiner opined the Veteran had total occupational impairment but that his condition did not allow for any conclusion regarding employability due to PTSD as an interview for such is precluded due to other problems. The Board notes that where it is not possible to distinguish the effects of a nonservice-connected condition from those of a service-connected condition, the reasonable doubt doctrine dictates that all symptoms be attributed to the Veteran's service-connected disability. See Mittleider v. West, 11 Vet. App. 181 (1998). However, it appears that the examiner's statement that symptoms of dementia and PTSD could not be differentiated was not because he was unable to distinguish symptoms of PTSD from symptoms of dementia, but rather that no symptoms concerning PTSD could be elicited due to the Veteran's dementia and hearing loss. Thus, clarification of the opinion is needed. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. Return the claims file to the examiner who conducted the May 2012 VA PTSD examination, if available. The examiner is asked to review the claims file and provide a clarifying opinion concerning the effects of the Veteran's diagnosed dementia versus his PTSD. Specifically, the examiner is asked to respond to the following: a. Are the mental health symptoms identified on the examination attributable primarily to his dementia? b. Are there any mental health symptoms identified on the examination that can be attributed to the Veteran's PTSD? If so, please identify what symptoms, and the impact on his social and occupational functioning. c. A rationale for the opinions expressed should be provided. If a new examination is deemed necessary, one should be scheduled. If the original examiner is not available, then the claims file should be forwarded to another examiner of similar or greater qualifications to provide the opinions. 2. After the development requested above has been completed to the extent possible, the RO/AMC should again review the record. If the benefit sought on appeal remains denied, the appellant and representative, if any, should be furnished a supplemental statement of the case and given the opportunity to respond thereto. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ K. A. BANFIELD Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This 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) (2012).