Citation Nr: 1305698 Decision Date: 02/19/13 Archive Date: 02/27/13 DOCKET NO. 09-37 605 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Baltimore, Maryland THE ISSUE Entitlement to an initial rating greater than 50 percent for posttraumatic stress disorder. REPRESENTATION Appellant represented by: American Red Cross ATTORNEY FOR THE BOARD S.K.C. Boyce, Associate Counsel INTRODUCTION The Veteran served on active duty from July 1967 to September 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Baltimore, Maryland, which granted service connection for PTSD and assigned a 50 percent disability rating, effective January 26, 2006. 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 Unfortunately, a remand is required in order to ensure that all necessary development is completed before the Board renders a decision on the Veteran's appeal. Although the additional delay is sincerely regretted, further action is needed in order to satisfy VA's duty to assist the Veteran in the development of this claim. The Veteran contends that he is entitled to a higher initial rating for his service-connected PTSD due to the severity of his PTSD symptoms, particularly the degree of social isolation he experiences as a result of his PTSD. When the evidence indicates that there has been a material change in the Veteran's disability or the current rating may be incorrect, VA has a duty to assist a claimant by providing a thorough and contemporaneous medical examination. Hart v. Mansfield, 21 Vet. App. 505, 508 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); Caffrey v. Brown, 6 Vet. App. 377, 381 (1994)); 38 C.F.R. § 3.327(a) (2012); see also 38 U.S.C.A. § 5103A(d)(1) (West 2002 & Supp. 2012). Mere passage of time alone does not render a previous VA medical examination inadequate. Palczewski v. Nicholson, 21 Vet. App. 174, 180 (2007). However, a new examination is appropriate when evidence added to the record, including the Veteran's own statements, suggests that the condition has worsened since the last examination. Caffrey, 6 Vet. App. at 381; VAOPGCPREC 11-95 (1995). Here, the Veteran's last VA examination was in February 2009, nearly four years ago, and the examiner noted that the Veteran experienced periods of remission lasting from three to six months. The Veteran also stated that his work was the main source of stability in his life and that his symptoms increase when he is forced to remember the events in service during group therapy. These environmental variables suggest a significant possibility of changes to the severity of the Veteran's PTSD symptoms over the last four years as the Board is not aware of the Veteran's current occupational status or status of any mental health treatment, and it is not clear from the February 2009 VA examination report if the Veteran was in a period of remission at that time. Thus, the Board finds that a more contemporaneous VA examination report is needed in order to assess the current severity of the Veteran's service-connected PTSD. On remand, appropriate efforts should also be made to obtain any outstanding relevant treatment records, including any additional records of VA mental health treatment dated since December 2005. See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). The Veteran should be contacted and asked to submit any additional relevant private treatment records that he has in his possession, or to identify any private sources of records of his mental health treatment and to furnish signed authorizations for release of these identified records if he would like VA to obtain them on his behalf. Id. Accordingly, the case is REMANDED for the following action: 1. Obtain all of the Veteran's outstanding VA mental health treatment records from the VA Medical Center in Washington, DC, or any other location where the Veteran is determined to have received such treatment, dated since December 2005. All information which is not duplicative of evidence already received should be associated with the claims file or the Veteran's electronic claims folder. 2. Ask the Veteran to submit any additional relevant private treatment records that he has in his possession, or to identify (i.e., provide the names, addresses, and approximate dates of treatment) his private mental health care providers and to furnish signed authorizations for release of any records identified. Make arrangements to obtain all records that are adequately identified and for which signed authorizations have been obtained. Specifically, the RO should make two attempts to obtain these records or make a formal findings that a second request for such records would be futile. All development efforts should be associated with the claims file. 3. Then, schedule the Veteran for a VA psychiatric examination. The claims file and a copy of this Remand must be made available to and reviewed by the examiner in conjunction with the examination. Any indicated tests and studies are to be conducted. Following a detailed mental status examination of the Veteran, the examiner is asked to make the following determinations: (a) Identify what symptoms, if any, the Veteran currently manifests, or has manifested during the appellate period, that are specifically attributable to his service-connected PTSD. (b) Specifically, determine whether depression is a manifestation of PTSD or a separate unrelated diagnosis. If depression is a separate diagnosis, the examiner should determine whether there are any symptoms attributable to the Veteran's depression that are not attributable to his PTSD. Lastly, if there are symptoms only attributable to depression, and not PTSD, the examiner should state whether the Veteran's depression is at least as likely as not related to service or a result of or aggravated by his service-connected PTSD. (c) Discuss the effect, if any, of the Veteran's service-connected psychiatric disorder on his social and occupational adaptability. (d) Assign a Global Assessment of Functioning (GAF) score for the Veteran's PTSD consistent with the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM- IV) and explain the significance of the score. The examiner should determine whether the Veteran is in a period of remission at the time of the examination and, if possible, provide an estimate of the expected changes to the Veteran's GAF score that would be seen were he not in remission at the time of the examination. If this information, or any other requested information, cannot be provided without resort to speculation, indicate whether the inability to provide a definitive opinion is due to a need for further information, because the limits of medical knowledge have been exhausted, or for some other reason. Lastly, the examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. 4. Review the medical examination report obtained to ensure that the remand directives have been accomplished, and return the case to the examiner if all questions posed are not answered. 5. Finally, readjudicate the claim on appeal. If the claim remains denied, provide the Veteran and his representative with a supplemental statement of the case and allow an appropriate time for response. 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). _________________________________________________ KELLI A. KORDICH Acting 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).