Citation Nr: 18140154 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 16-23 841 DATE: October 2, 2018 REMANDED Entitlement to an increased rating in excess of 60 percent for service-connected hiatal hernia, gastroesophageal reflux disease (GERD), gastritis/gastroduodenitis with mild colitis and history of dumping syndrome and status post cholecystectomy claimed as irritable bowel syndrome (IBS) is remanded. Entitlement to an increased rating in excess of 70 percent for an acquired psychiatric disorder, to include bipolar disorder and post-traumatic stress disorder (PTSD) is remanded. Entitlement to a rating of total disability based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from October 2000 to September 2004. This case comes on appeal of October 2011 and March 2016 rating decisions. The Board notes that in the October 2011 rating decision, the RO, in pertinent part, granted service connection for IBS and included its symptoms as part of the overall rating for the Veteran’s other service-connected gastrointestinal disorders, in accordance with 38 C.F.R. § 4.114. 1. Entitlement to an increased rating in excess of 60 percent for service-connected hiatal hernia, gastroesophageal reflux disease (GERD), gastritis/gastroduodenitis with mild colitis and history of dumping syndrome and status post cholecystectomy claimed as irritable bowel syndrome (IBS) is remanded. 2. Entitlement to an increased rating in excess of 70 percent for an acquired psychiatric disorder, to include bipolar disorder and post-traumatic stress disorder (PTSD) is remanded. 3. Entitlement to a rating of total disability based on individual unemployability (TDIU) is remanded. The Board first notes that the Veteran’s claims file only contains medical records through December 2015. As the Veteran had been receiving consistent, ongoing treatment as of that time, additional medical records dated past December 2015 should be obtained, as they may be relevant in evaluating the current conditions of the Veteran’s service-connected disabilities, as well as in providing insight into the Veteran’s occupational history. On remand, any additional VA medical records should be obtained. The Board also notes that the claim of entitlement to TDIU is inextricably intertwined with the Veteran’s other claims on appeal, as the Veteran claims that her psychiatric and gastrointestinal symptoms prevent her from securing or following substantially gainful employment. The Veteran last underwent VA examinations for the conditions on appeal in March and September 2011. Although the passage of time alone does not warrant a new examination, when prior examinations are not adequate for adjudicating the present level of disability, new examinations are necessary. Palczewski v. Nicholson, 21 Vet. App. 174 (2007). Here, the Veteran was scheduled to undergo a new VA psychiatric examination in November 2016, but did not appear. Upon learning of the missed examination, the Veteran called VA to report that she had not been notified of the examination and requested to reschedule. To date, there is no rescheduled examination of record. Accordingly, on remand, the Veteran should be afforded that examination. Additionally, the Veteran has maintained that her inability to secure or follow substantially gainful employment is caused, in part, by her frequent need to use the bathroom, related to her service-connected gastrointestinal disabilities. The Veteran most recently underwent a VA intestinal conditions examination in March 2011. Based upon that examination, the RO granted entitlement to service connection for IBS, in addition to the Veteran’s other service-connected gastrointestinal disabilities. At the March 2011 examination, the examiner did not address the effects that the Veteran’s combined gastrointestinal disabilities would have on her employability and that issue has not since been addressed in the record. Accordingly, on remand, the Veteran should be afforded a new examination that addresses the current severity of all service-connected gastrointestinal issues and their effects on the Veteran’s ability to secure or follow substantially gainful employment. The matters are REMANDED for the following action: 1. Provide the Veteran with a new VA Form 21-8940 in connection with the claim of entitlement to TDIU and request that she supply updated employment information. 2. Obtain all of the Veteran’s VA treatment records for the period from December 2015 to the present. 3. Schedule the Veteran for updated VA examinations of each of her service-connected psychiatric and gastrological disabilities. In each case, the claims file should be made available to and reviewed by the examiner. All appropriate tests and studies should be conducted. The examiners should review both medical and lay evidence. The examiners should evaluate the current severity of each of the Veteran’s service-connected psychiatric and gastrological disabilities. In doing so, the examiners should comment on each disability’s impact on the Veteran’s ability to work. The examiner should describe the functional limitations imposed by the service-connected disabilities under evaluation. A written copy of the report should be associated with the claims folder. 4. Once the above development has been achieved, as well as any other development deemed necessary thereafter, readjudicate the issues on appeal. If any benefits sought remain denied, issue a supplemental statement of the case and return the case to the Board. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Giaquinto, Associate Counsel