Citation Nr: 18147271 Decision Date: 11/02/18 Archive Date: 11/02/18 DOCKET NO. 16-32 014 DATE: November 2, 2018 REMANDED Entitlement to service connection for substance use disorder to include as secondary to service connected posttraumatic stress disorder (PTSD) is remanded. Entitlement to an initial disability rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1976 to May 1977. He served in the United States Marine Corps. 1. Entitlement to service connection for substance use disorder to include as secondary to service-connected PTSD Remand is required to obtain an adequate VA examination. Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Additionally, a medical opinion should address the appropriate theories of entitlement and must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). Service connection may be granted for disability that is proximately due to, the result, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310 (2018); Allen v. Brown, 7 Vet. App. 439 (1995). Compensation for primary alcohol abuse disorders and secondary disorders that result from primary alcohol abuse is precluded. 38 U.S.C. § 105 (West 2014); 38 C.F.R. § 1110 (2018); Allen v. Principi, 237 F.3d 1368, 1376 (Fed. Cir. 2001). However, service connection is warranted when drug or alcohol abuse results secondarily from a service-connected disability, but compensation should only result “where there is clear medical evidence establishing that the alcohol or drug abuse disability is indeed caused by the Veteran’s primary service-connected disability.” Allen, 237 F.3d at 1371, 1381. The Veteran claims he developed a substance use disorder as a result of his service-connected PTSD. The medical evidence of record supports a diagnosis of polysubstance abuse, cannabis dependence, and alcohol dependence, remission. See active problems/diagnosis list from VA Treatment Records, Mental Health Outpatient Note, Minneapolis, VA HCS, April 29, 2016. A June 2016 VA examination was conducted. The Veteran had diagnoses of PTSD, alcohol use disorder, in remission, and cannabis use disorder, in remission. The examiner opined that the Veteran’s substance abuse was neither caused nor aggravated by his service-connected PTSD. The examiner reasoned that the onset of substance abuse was in adolescence – years before military sexual trauma (MST). The examiner also noted that substance abuse was currently in remission and therefore had not been aggravated by the Veteran’s PTSD. In January 2017, the Veteran reported that although he no longer drank alcohol that much as it made him sick and would not stick a needle in his body, he continued to smoke marijuana. The examiner did not indicate why the evidence did not support a finding that the Veteran’s substance abuse was caused or aggravated by his service-connected PTSD. On remand, another opinion is thus warranted that addresses the fact that the Veteran’s cannabis use disorder may not be in remission.   2. Entitlement to an initial disability rating in excess of 50 percent for PTSD Remand is also required for a current examination. When a claimant asserts, or the evidence indicates, that the severity of a disability has increased since the most recent rating examination, an additional examination is appropriate. VAOPGCPREC 11-95 (April 7, 1995); Snuffer v. Gober, 10 Vet. App. 400 (1997). A June 2016 VA examination was conducted. The Veteran had a diagnosis of PTSD. It was noted that the Veteran was also diagnosed with antisocial personality disorder during an October 2015 VA examination. The examiner noted that the Veteran’s current symptoms were due to PTSD, and that the level of occupational and social impairment was best described as reduced reliability and productivity. At the time of the examination, the Veteran was working part-time, which he reported he was doing good and that the employer was happy with him. The Veteran exhibited symptoms of PTSD, including depressed mood (occasional); anxiety; mild memory loss, such as forgetting names, directions or recent events; difficulty in adapting to stressful circumstances, including work or a worklike setting; and feelings of hopelessness. The VA examiner further opined that the Veteran was capable of managing his own financial affairs. On a January 2017 hand-annotated copy of the June 2016 VA examination report, the Veteran alleged that his PTSD was worse than what the June 2016 examination report indicated. The Veteran alleged that his occupational and social impairment was best described as deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran also disagreed that the frequency and amount of cannabis and alcohol use was above and beyond what could be accounted for by anxiety/PTSD. The Veteran also reported that in addition to the symptoms identified by the June 2016 VA examiner, he also felt shame, guilt, and worthlessness, and also saw dead people. Because the Veteran has asserted that his disability had worsened since the June 2016 VA examination, an additional examination is appropriate.   3. Entitlement to TDIU As the matter of entitlement to a TDIU is inextricably intertwined with the above-discussed issues on appeal, adjudication of that matter will be deferred until further development of the inextricably intertwined issues is completed. See Gurley v. Peake, 528 F.3d 1322 (Fed. Cir. 2008) (remand of inextricably intertwined claims was warranted for reasons of judicial economy even in absence of administrative error); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two or more issues are inextricably intertwined if one claim could have significant impact on the other). The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified and this should be documented for the record. Required notice must be provided to the Veteran and his representative. 2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 3. After any additional records are associated with the claims file, arrange for a qualified medical professional to provide an opinion for the Veteran’s claim of entitlement to service connection for a substance use disorder. The entire claims file should be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. If an examination is deemed warranted, one must be provided. (a.) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the substance use disorder had onset in or was otherwise related to the Veteran’s active service. (b.) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the substance use disorder was caused by the Veteran’s service-connected PTSD. (c.) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the substance use disorder was aggravated by the Veteran’s service-connected PTSD. A complete and detailed explanation must be provided for any opinions expressed. The examiner must consider: 1) the Veteran’s lay statements, including the Veteran’s MST, 2) the June 2016 VA examination report, and 3) all relevant VA treatment records. 4. After any additional records are associated with the claims file, schedule the Veteran for a VA examination to assist in determining the current severity of the service-connected PTSD. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. The examiner must utilize the appropriate Disability Benefits Questionnaire. 5. Notify the Veteran that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claims, and that the consequences for failure to report for a VA examination without good cause may include denial of the claims. 38 C.F.R. §§ 3.158, 3.655 (2018). In the event that the Veteran does not report for any scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Nguyen, Associate Counsel