Citation Nr: 18146006 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 16-24 622 DATE: October 30, 2018 REMANDED Entitlement to a rating in excess of 50 percent for major depressive disorder is remanded. Entitlement to service connection for hypertension, to include as secondary to major depressive disorder is remanded. Entitlement to a total disability rating due to individual unemployability by reason of service-connected disability (TDIU) is remanded. REASONS FOR REMAND 1. Entitlement to a rating in excess of 50 percent for major depressive disorder. The Veteran contends that major depressive disorder is worse than currently rated. The Veteran was last provided an examination of major depressive disorder in September 2012. The Veteran contends that the disability has worsened since that examination. VA has a duty to assist Veterans to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. This duty to assist includes providing a thorough and contemporaneous medical examination. Green v. Derwinski, 1 Vet. App. 121 (1991). VA must schedule a more current examination when the available evidence is too old to adequately evaluate the current state of the disability. Olson v. Principi, 3 Vet. App. 480 (1992); Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The most recent VA examination of record is over six years old. Therefore, it is necessary to obtain a more current examination to assess the current effects of major depressive disorder. 2. Entitlement to service connection for hypertension, to include as secondary to or aggravated by major depressive disorder. The Veteran contends that he is entitled to service connection for hypertension as secondary to or aggravated by service connected major depressive disorder. According to a September 2012 VA examination report, the examiner found that the Veteran’s hypertension was less likely than not due to major depressive disorder because major depressive disorder was not a medically recognized cause of sustained hypertension. A March 2016 VA addendum opinion found that hypertension had not been permanently aggravated by major depressive disorder is adequate as it considered the evidence in the record, which showed that the Veteran’s hypertension had been stable since it was initially diagnosed in 2003. However, subsequent to the September 2012 examination, the Veteran submitted an April 2013 notice of disagreement where he cited to medical research relating mental disorders to hypertension. The Board finds that another VA examination is needed which considers that medical research. 3. Entitlement to TDIU. The issue of entitlement to TDIU is inextricably intertwined with the increased rating claim for major depressive disorder also being remanded. Harris v. Derwinski, 2 Vet. App. 180 (1991). The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to remand the claim on appeal pending the adjudication of the inextricably intertwined claim. Harris v. Derwinski, 2 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Obtain, with any necessary authorization from the Veteran, all outstanding medical treatment records. All attempts to obtain records must be documented in the claims folder. 2. Schedule the Veteran for an examination with a psychologist or psychiatrist to evaluate the severity of major depressive disorder. The examiner must review the claims file and should note that review in the report. The examiner should opine as to the levels of social and occupational impairment and should describe the frequency and severity of the symptoms resulting in those levels of impairment. The examiner should opine whether the mental disorder causes total occupational and/or total social impairment. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran is unable to secure or follow a substantially gainful occupation due to the combined effects of the service-connected disabilities. If the Veteran is felt capable of work despite the service-connected disabilities, the examiner should state what type of work and what accommodations would be needed due to the service-connected disabilities. 3. Schedule the Veteran for a VA examination with a medical doctor examiner who has not previously examined him in conjunction with the claim for service-connected for hypertension. The examiner must review the claims file and should note that review in the report. The examiner should specifically review the medical literature cited by the Veteran in the April 2013 notice of disagreement, and any related medical research. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that hypertension manifested in active service or within one year following separation from active service, or is related to any event, injury, or disease during service. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that hypertension is due to or the result of a service-connected mental disorder, or any other service-connected disability. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that hypertension has been aggravated by a service-connected mental disorder, or any other service-connected disability. The examiner should cite to medical research to support the opinion and should provide a rationale for all opinions provided. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Gillian A. Flynn, Associate Counsel