Citation Nr: 1609134 Decision Date: 03/08/16 Archive Date: 03/15/16 DOCKET NO. 13-31 210 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office in Baltimore, Maryland THE ISSUE Entitlement to an initial disability evaluation in excess of 50 percent for the Veteran's posttraumatic stress disorder (PTSD). ATTORNEY FOR THE BOARD J. T. Hutcheson, Counsel INTRODUCTION The Veteran is the appellant in the instant appeal. He had active service from June 1968 to February 1970. The Veteran served in the Republic of Vietnam and was awarded the Combat Action Ribbon. This matter came before the Board of Veterans' Appeals (Board) on appeal from a September 2011 rating decision of the Baltimore, Maryland, Regional Office (RO) which established service connection for PTSD; assigned a 50 percent evaluation for that disability; and effectuated the award as of October 15, 2010. The Board has reviewed both the Veterans Benefit Management System (VBMS) and the "Virtual VA" files. This appeal was processed using the VBMS paperless claims processing system. Accordingly, any future consideration of the Veteran's appeal should take into consideration the existence of this electronic record. In his February 2009 Veteran's Application for Compensation and/or Pension (VA Form 21-526), the Veteran advanced that he "was knock[ed] down from a concussion by a tank." The Veteran's contentions may be reasonable construed as a claim of entitlement to service connection for traumatic brain injury (TBI) residuals. The issue has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it. The issue is referred to the AOJ for appropriate action. 38 C.F.R. § 19.9(b) (2015). The Veteran's appeal is REMANDED to the AOJ. VA will notify the Veteran if further action is required. REMAND The Veteran asserts that an initial 70 or 100 percent schedular evaluation is warranted for his PTSD as his disability has been found by his treating private psychologists to be productive of severe impairment. In his September 2011 notice of disagreement, the Veteran conveyed that L. Glogau, M.A., L.P.A., and A. Freeman, Ph.D., had treated his psychiatric disability "for one year and nine months, conducted therapy with the Veteran, [and] had a long and ongoing clinical relationship with the Veteran." Clinical documentation of the cited treatment is not of record. VA clinical documentation dated after October 2011 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran's claim. See Murphy v. Derwinski, 1 Vet. App. 78, 81-82 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). The Veteran was last afforded a VA psychiatric evaluation which addressed his PTSD in July 2011. VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). Therefore, the Board finds that further VA psychiatric evaluation is required to adequately assess the Veteran's current psychiatric disability picture. Accordingly, the case is REMANDED for the following action: 1. Contact the Veteran and request that he provide information as to all treatment of his PTSD after July 2011, including the names and addresses of all health care providers whose records have not already been provided to VA. Upon receipt of the requested information and the appropriate releases, the RO should contact L. Glogau, M.A., L.P.A., A. Freeman, Ph.D. , and all other identified health care providers and request that they forward copies of all available clinical documentation pertaining to treatment of the Veteran, not already of record, for incorporation into the record. If identified records are not ultimately obtained, the Veteran should be notified pursuant to 38 C.F.R. § 3.159(e) (2015). 2. Associate with the record any VA clinical documentation not already of record pertaining to treatment of the Veteran, including that provided after October 2011. 3. Schedule the Veteran for a VA psychiatric examination to assist in determining the current nature and severity of the Veteran's PTSD. The examiner should express an opinion as to the impact of the Veteran's PTSD upon his vocational pursuits. All relevant medical records must be made available to the examiner for review of pertinent documents therein. The examination report should specifically state that such a review was conducted. A rationale for all opinions should be provided. 4. Then readjudicate the issue on appeal. If the benefit sought on appeal remains denied, the Veteran should be provided a supplemental statement of the case (SSOC) which addresses all relevant actions taken on the Veteran's claim for benefits, to include a summary of the evidence considered, since the issuance of the statement of the case. An appropriate period of time should be allowed for response before the case is returned to the Board. The Veteran has the right to submit additional evidence and argument on the 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 or by the United States Court of Appeals for Veterans Claims (Court) for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West 2014). _________________________________________________ BRADLEY W. HENNINGS Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2014), only a decision of the Board is appealable to the Court. 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) (2015).