Citation Nr: 18141013 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 13-11 651 DATE: October 9, 2018 REMANDED Entitlement to service connection for a head injury, to include a traumatic brain injury (TBI) is remanded. Entitlement to service connection for a seizure disorder, claimed as secondary to a head injury or TBI is remanded. Entitlement to service connection for a cognitive disorder, to include memory loss, and claimed as secondary to a head injury or TBI is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include depression, posttraumatic stress disorder (PTSD), and bipolar disorder, claimed as secondary to service connected disabilities and/or an assault in service is remanded. Entitlement to a compensable rating for residuals of a fracture of the left little finger is remanded. Entitlement to a rating in excess of 10 percent for rosacea is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1990 to May 1990, and from December 1990 to August 1991. These matters come before the Board of Veterans' Appeals (Board) on appeal from a November 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2013, the Veteran and his friend, K.B., testified before a Decision Review Officer. A transcript of the hearing is of record. These matters were last before the Board in October 2016, at which time they were remanded to afford the Veteran an examination as to all of the above-captioned claims. Entitlement to service connection for a head injury, seizure disorder, cognitive disorder, acquired psychiatric disorder, and an increased rating for residuals of a fracture of the left little finger and rosacea are remanded. Following the October 2016 remand, the Veteran was scheduled for VA examinations to determine the nature and severity of the above-captioned issues. Most recently, the Veteran was scheduled to undergo examinations at the VA Hospital in Little Rock, AK, in September 2017. In an October 2017 Correspondence, the Veteran informed the AOJ that the Little Rock VA Hospital was unable to perform the examinations on the scheduled date, and he requested that the examinations be rescheduled. See VA 21-0820 Report of General Information, submitted October 26, 2017. Additionally, the Veteran’s representative submitted correspondences in January and March 2018 requesting that the Veteran’s exams be rescheduled. To date, there is no indication in the claims file that the Veteran’s examinations were rescheduled or conducted. As such, the Board finds that the Veteran should be afforded an additional opportunity to undergo VA examinations in connection with his appeal. In this instance, the Veteran is reminded that he must aid in the development of his claim by attending the VA examination as requested. If the Veteran fails to attend his rescheduled examination without good cause, his claim will be decided based on the evidence of record. See 38 C.F.R. § 3.655 (2017). The matters are REMANDED for the following action: 1. Appropriate efforts should be made to obtain and associate with the case file any further treatment records (private and/or VA) identified and authorized for release by the Veteran. All actions to obtain the records should be documented. If the records cannot be located or do not exist, a memorandum of unavailability should be associated with the claims file, and the Veteran should be notified and given an opportunity to provide them. 2. After the above has been completed, the RO should schedule an appropriate VA examination to determine the current severity of the Veteran's service-connected rosacea. If possible, the examination should be conducted during a flare-up of his rosacea. The claims file must be made available to and reviewed by the examiner. Any indicated diagnostic tests and studies must be accomplished. All pertinent symptomatology and findings must be reported in detail. 3. After directive (1) has been completed, the RO should schedule an appropriate VA examination to determine the current severity of the Veteran's service-connected residuals of a fracture of the left little finger. The claims file should be made available to and reviewed by the examiner. All indicated studies and tests should be completed to include complete range of motion testing with an articulated assessment as to any additional loss of range of motion or other functional loss that may be caused by such factors as pain, weakness, or fatiguability; clinical findings should be reported in detail. The examiner should explain the rationale for all opinions expressed. 4. After directive (1) has been completed, the RO should schedule an appropriate VA examination schedule the Veteran for an examination by a VA psychiatric examination by a psychiatrist. The claims file and all pertinent electronic records must be made available to the examiner, and the examiner must specify in the examination report that these records have been reviewed. Upon review of the file, and following examination, the examiner is asked to render opinions as to the following: a.) Whether a diagnosis of PTSD is appropriate; and if so, whether it is at least as likely as not related to the Veteran's active service, to include his assault in-service (see August 1991 service treatment record), and/or his service in the Gulf War, Operation Desert Storm, and Operation Desert Shield. Specifically, the examiner should determine whether the Veteran currently suffers from PTSD related to his in-service personal assault and/or his experiences in the Gulf War, Operation Desert Storm, and Operation Desert Shield, and whether it is adequate to support a diagnosis of PTSD. The examiner is asked to provide an opinion as to whether there is evidence of behavior changes indicating that a personal assault occurred. The examiner's attention is directed to the August 2013 DRO hearing testimony as well as the Veteran's August 1991 service treatment records. b.) For any non-PTSD psychiatric disability or disabilities diagnosed, including depression and bipolar disorder, whether it is at least as likely as not (50 percent probability or greater) that the disability is related to the Veteran's active service, to include his in-service personal assault and/or his experiences in the Gulf War, Operation Desert Storm, and Operation Desert Shield. c.) Also for any non-PTSD psychiatric disability or disabilities diagnosed, including depression and bipolar disorder, whether it at least as likely as not (a fifty percent probability or greater) that the Veteran's psychiatric disability or disabilities are proximately due to, the result of or aggravated by a service-connected disorder, to include rosacea and/or residuals of a fracture of the left little finger. If the examiner determines that an opinion cannot be made without resort to mere speculation, then it should be clear in the examiner's remarks whether it cannot be determined from current medical knowledge that a specific in-service injury or disease can possibly cause the claimed disorder, or whether the actual cause is due to multiple potential causes. In other words, simply stating that an opinion cannot be made without resort to mere speculation is not acceptable without a detailed explanation as to why this is so. 5. After directive (1) has been completed, schedule the Veteran for a TBI examination to be conducted by one of the four designated specialists (physiatrist, psychiatrist, neurologist, or neurosurgeon). Arrange for the Veteran's electronic claims file, including a copy of this remand, to be reviewed by the VA examiner. Following review of the claims file, the examiner should render opinions as to: a.) Whether it is at least as likely as not (i.e. 50 percent or greater probability) that the Veteran's head injury, to include any diagnosed TBI, is etiologically related to his military service, to include the assault in service. See August 1991 service treatment record. b.) Whether it is at least as likely as not (i.e. 50 percent or greater probability) that the Veteran's currently diagnosed cognitive disorder (claimed as memory loss) is related to his military service, to include the assault in service, or secondary to any diagnosed TBI. See August 1991 service treatment record. c.) Whether it at least as likely as not (a fifty percent probability or greater) that the Veteran's currently diagnosed cognitive disorder (claimed as memory loss) is due to, the result of, or aggravated by a service-connected disability, to include any service-connected seizure disorders and/or psychiatric disorders. d.) Whether it is at least as likely as not (i.e. 50 percent or greater probability) that the Veteran's currently diagnosed seizure disorder is related to his military service, to include the assault in service, or secondary to any diagnosed TBI. See August 1991 service treatment record. The examiner should provide detailed rationale for the opinions. The examiner is asked to explain the reasons behind any opinion expressed and conclusion reached. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Marsh II, Associate Counsel