Citation Nr: 18146036 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 07-31 006 DATE: October 30, 2018 REMANDED An initial disability rating greater than 30 percent for chronic adjustment disorder with anxiety, depression, and paranoia is remanded. A total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1960 to February 1963. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision of the Regional Office (RO) of the Department of Veterans Affairs (VA) in North Little Rock, Arkansas which granted service connection for chronic adjustment disorder with anxiety, depression, and paranoia, assigning an initial 30 percent disability rating effective January 6, 2006, the date of the Veteran’s claim. With regard to the TDIU claim, the Veteran’s attorney submitted a formal claim for a TDIU in May 2015 but indicated that this was not a separate claim for benefits, rather it involved an attempt to obtain an appropriate rating for the Veteran’s service-connected psychiatric disability as part of the initial claim for a higher rating pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). Therefore, in considering the increased rating issue on appeal, the Board finds that the issue of entitlement to a TDIU is also currently before the Board, as reflected on the cover page. 1. An initial disability rating greater than 30 percent for chronic adjustment disorder with anxiety, depression, and paranoia is remanded. With regard to the psychiatric disorder issue, the Veteran was last afforded a VA psychiatric examination in July 2015. At that time, it was noted that the Veteran had been married to his third wife for the past 22 years and maintained some contact with his five grown children. It was also noted that the Veteran was prescribed Mirtazapine and Temazepam for his psychiatric symptoms and that he had previous psychiatric hospitalizations in the 1960s and 1970s. While the Veteran had not worked for the past several years due to his hearing loss, he was active in his church and was in the process of becoming a deacon. The July 2015 VA examiner found that the Veteran’s psychiatric disability resulted in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. Significantly, the July 2015 VA examiner wrote that the Veteran’s psychiatric symptoms were “mild” and that the Veteran may have difficulty working in environments in which he has to interact much with the military given that this is a catalyst for his symptoms. In contrast to the July 2015 VA examiner’s findings of “mild” psychiatric symptoms, a December 2014 private psychiatric evaluation report from Dr. R.B.N. shows much more severe psychiatric symptoms. Significantly, Dr. R.B.N. noted the Veteran’s long history of psychiatric problems. Dr. R.B.N. reported that the Veteran described himself as suspicious and kept to himself as being around people increased his anxiety. Significantly, Dr. R.B.N. wrote that, because of the Veteran’s service-connected psychiatric disability, the Veteran was completely unable to establish working relationships and maintain effective personal relationships with anyone other than his current wife and that he had not worked effectively since 2005. In a May 2017 statement, Dr. R.B.N. wrote that the July 2015 VA examination report is inadequate as the report gives very little history and lacks documentation of current and/or past symptoms. Significantly, there is no mention of the Veteran’s lengthy history of a paranoid disorder to include the Veteran’s previous treatment with potent antipsychotic medications such as Mellaril, Stelazine, and Respiradone. Dr. R.B.N. wrote that the potent antipsychotic medications that have been prescribed to the Veteran over the years are not the medications that would be appropriately given to a man with a “mild” mental illness. In view of the discrepancy between the private psychiatric findings in December 2014 as compared to the VA psychiatric findings in July 2015, the Board finds that a new VA examination along with a retrospective opinion addressing the severity of the Veteran’s chronic adjustment disorder throughout the pendency of this appeal beginning January 6, 2006 would be helpful in resolving this claim. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Also, the Board notes that the most recent VA treatment records in the claims file are dated in October 2017. Given the necessity to remand this issue for other reasons, VA treatment records dated since October 2017 should be obtained prior to readjudication of the remanded issue. 2. A TDIU is remanded. With regard to the TDIU issue, the Board notes that the Veteran does not presently meet the schedular criteria for an award of TDIU benefits. Where the schedular rating is less than total, a total disability rating for compensation purposes may be assigned when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). However, depending on the outcome of the remanded issues above, this could change. As such, the claim of entitlement to TDIU benefits is inextricably intertwined with the increased rating issue currently on appeal. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both issues have been considered). As such, the Board defers ruling on this matter until after the mandates of the Remand have been completed. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records dated since October 2017. 2. After completing the above and any other appropriate development, arrange for the Veteran to undergo VA psychiatric examination, by an appropriate medical professional, at a VA medical facility. The claims file should be made available to the examiner. The examiner should identify the nature and severity of all current manifestations of the Veteran’s service-connected chronic adjustment disorder with anxiety, depression, and paranoia, to include whether the Veteran’s psychiatric disability renders him unemployable. The examiner should also comment on the severity of the Veteran’s psychiatric disability during the period from January 6, 2006 through the present. Based on review of the claims file, the examiner should render an opinion addressing whether, at any point from the January 6, 2006 initial claim to the present the record reflects any change(s) in the severity of the Veteran’s chronic adjustment disorder, and, if so, the approximate date(s) of any such changes(s), and the extent of severity of the disability on each date. In addressing the above, the examiner should specifically consider and discuss the Veteran’s lengthy history of a paranoid disorder to include the Veteran’s previous treatment with potent antipsychotic medications such as Mellaril, Stelazine, and Respiradone as noted in the December 2014 report from Dr. R.B.N. Complete, clearly-stated rationale for the conclusions reached must be provided. 3. Readjudicate the claim. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD April Maddox, Counsel