Citation Nr: 18146136 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 16-23 268 DATE: October 30, 2018 REMANDED The claim of entitlement to an initial compensable evaluation for an anxiety disorder is remanded. The claim of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Navy from March 1986 to April 1986 and with the United States Army from April 1990 to April 1994. 1. The claim of entitlement to an initial compensable evaluation for an anxiety disorder is remanded. The Board cannot make a fully informed decision regarding the issue of entitlement to an initial compensable evaluation for an anxiety disorder as the evidence of record regarding its severity is insufficient. The Veteran attended an initial consultation with a VA psychiatrist in July 2011 to assess his anxiety. The Veteran reported anxiety episodes beginning around 2002 that involved shortness of breath, anxiousness and irritability. He would also experience tachycardia and sharp chest pain, frequently with a headache. The Veteran stated that he could not drive a forklift during episodes, and would stop working during these attacks. The episodes occurred twice per week and were triggered by stress. He also experienced frequent intrusive recollections of events that occurred during his service in Iraq, and dreams of violence. The Veteran had an exaggerated startle response and was hypervigilant. On examination, the Veteran presented as neatly groomed and appropriately dressed. He was cooperative, pleasant and polite to the clinician. He was alert and oriented in all spheres with normal speech and psychomotor activity. There were no delusions, obsessions, compulsions or hallucinations noted. Memory, judgment and insight were also good. The psychiatrist diagnosed the Veteran with anxiety disorder not otherwise specified. In January 2012, the Veteran reported that he was diagnosed with posttraumatic stress disorder (PTSD), and he lost time from work due to his mental health. In March 2013, the Veteran underwent a VA examination to assess the nature and etiology of his mental health disorder. He was diagnosed with anxiety disorder not otherwise specified, but the examiner determined that the symptoms were not severe enough to interfere with occupational and social functioning. The examiner reported that the Veteran did not undergo treatment for his anxiety disorder, and did not appear to have considered the July 2011 psychiatrist consultation. Additionally, the only symptom noted was anxiety, which contrasts with the number of symptoms discussed in his July 2011 consultation. Accordingly, clarification is necessary to determine the severity of the totality of the Veteran’s symptoms, particularly as considered with contemporaneous treatment records. Furthermore, in April 2013, the Veteran reported a worsening of his psychiatric symptoms. The duty to conduct a contemporaneous examination is triggered when the evidence indicates that there has been a material change in disability or that the currently assigned disability rating may be incorrect. See Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (holding that a Veteran is entitled to a new examination after a two-year period between the last VA examination and the Veteran’s contention that the pertinent disability had increased in severity). In the present case, it has been over 5 years since the Veteran was last afforded a VA examination to determine the current severity of his anxiety disorder, and he has specifically asserted that his condition has worsened since this examination. As such, a new VA examination is warranted to more accurately assess the severity of the Veteran’s anxiety disorder. 2. The claim of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. The Veteran has also asserted entitlement to TDIU benefits. The Board finds that this issue is inextricably intertwined with the resolution of the remanded issue. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to defer the claim on appeal pending the adjudication of the inextricably intertwined claim. See Harris v. Derwinski, 1 Vet. App. 180 (1991). Accordingly, this issue is remanded for readjudication following evidentiary development. The matters are REMANDED for the following action: 1. Obtain any relevant, outstanding VA treatment records that are not already associated with the claims file. If no records are available, the claims folder must indicate this fact and the Veteran should be notified in accordance with 38 C.F.R. § 3.159 (e). All attempts to contact the Veteran should be documented in the record. 2. After the aforementioned evidentiary development is complete, schedule the Veteran for a VA examination to assess the present nature and severity of his anxiety disorder. A complete copy of the claims file must be made available to the examiner. After a thorough review of the medical and lay evidence of record, the examiner should discuss the following: (a.) Discuss any and all present diagnoses pertaining to the Veteran’s mental health. Note if diagnoses have changed, or are a progression of the service-connected anxiety disorder. If the Veteran is not diagnosed with PTSD, explain why. (b.) For each diagnosis, discuss its the present severity, including any occupational impairment caused by the condition. (c.) If possible, provide a retrospective opinion of its severity since August 2011. The examiner should also provide an assessment of the Veteran’s occupational impairment in this period of time. Consider the Veteran’s reports of specific symptomatology in subsequent lay statements of record. The examination report should specifically state that a review of the record was conducted. The examiner should provide a complete rationale for all opinions provided. If an opinion cannot be provided without to resorting to mere speculation, the examiner should identify all medical and lay evidence considered in this conclusion, fully explain why this is the case and identify what additional evidence (if any) would allow for a more definitive opinion. 3. Following completion of the foregoing, the AOJ should review the record and readjudicate the claims on appeal. If any remain denied, the AOJ should issue an appropriate supplemental SOC, afford the Veteran and his representative an opportunity to respond, and return the case to the Board. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Fisher, Associate Counsel