Citation Nr: 18147326 Decision Date: 11/05/18 Archive Date: 11/02/18 DOCKET NO. 16-34 404 DATE: November 5, 2018 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. Entitlement to a rating in excess of 10 percent for coronary artery disease (CAD), status post stent placement, is remanded. Entitlement to a rating in excess of 30 percent prior to June 18, 2016, and a rating in excess of 70 percent thereafter for PTSD is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) for the period prior to June 18, 2016 is remanded. REASONS FOR REMAND The Veteran had active duty in the Army from October 1967 to October 1969. This matter is on appeal to the Board of Veterans’ Appeals (Board) from a February 2013 rating decision of a regional office of the Department of Veterans Affairs (VA). Hypertension The Veteran seeks service connection for hypertension, to include as secondary to his service-connected PTSD. A VA examination of October 2012 reflects a finding that the Veteran’s hypertension was not caused by or related to his service-connected PTSD. In the rationale, the examiner stated that “there is no anatomic or physiologic nexus by which to connect the conditions.” The Board finds the October 2012 opinion inadequate as it is unclear what medical literature, research or evidence was relied upon by the examiner in rendering the opinion. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Further, although the VA examiner addressed the secondary service connection theory of entitlement, no opinion was provided for direct service connection. The Board also notes there is no etiological opinion of record that reflects consideration of the Veteran’s lay statements and reported history. Given the foregoing reasons, the Board finds that remand is necessary to afford the Veteran a new examination and to obtain an adequate medical opinion. CAD The Veteran seeks an increase in evaluation for his service-connected CAD, status post stent placement, as his condition has changed in severity and requires continuous medical treatment. In this regard, the Board observes that the October 2012 VA examination is too remote in time to ascertain the current severity and manifestations of the Veteran’s condition. In Snuffer v. Gober, the Court of Appeals for Veterans Claims held that a veteran was entitled to a new examination after a two-year period between the last VA examination and the veteran’s contention that his disability had increased in severity. Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Caffrey v. Brown, 6 Vet. App. 377, 381 (1994), further held that an examination too remote for rating purposes cannot be considered “contemporaneous.” The situation in this case is analogous to those cited above. Accordingly, to ensure that the Veteran’s claim is afforded full consideration, the Board concludes that a reexamination is necessary. PTSD and TDIU As for the Veteran’s increased rating claim for PTSD, the Board notes that by rating action of July 2016, his PTSD evaluation was increased from 30 percent to 70 percent, effective July 18, 2016, the date of the most recent private examination. The Veteran continues to disagree with the ratings assigned and seeks higher ratings for the entire appeal period. AB v. Brown, 6 Vet. App. 35 (1993). The record reflects a June 2016 medical opinion from a private psychologist, J.M., Ph.D, opining that “the veteran’s service connected PTSD has imposed very severe limitations of social and occupational functioning since at least as early as 2011” and “have clearly resulted in deficiencies in most areas, such as family relations, thinking and mood, due to such symptoms as intrusion, avoidance, isolation an arousal.” See Statement of J.M., Ph.D., dated June 18, 2016 and accompanying PTSD Disability Benefits Questionnaire. The private psychologist also disagreed with the October 2012 VA psychiatrist’s assessment that the “veteran’s PTSD appears to be having a mild impact on social and occupational functioning as reflected by his GAF score of 75.” See VA PTSD examination dated October 2012. The private psychologist noted that the record is very clear for evidence of severe symptoms reflected in very low GAF scores. Given the above, the Board finds that remand is necessary to reconcile the conflicting medical evidence of record regarding the severity of the Veteran’s PTSD symptoms for the period from June 2011 to June 2016. Further, the opinion should acknowledge and address the private psychologist’s assessment and clinical findings. Lastly, the Board finds the issue of entitlement to TDIU for the period prior to July 2016 is inextricably intertwined with the development ordered above for the increased rating claim, and therefore must also be remanded. 38 C.F.R. § 4.16; Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain any outstanding pertinent VA treatment records not evidenced by the current record and associate with the claims file. 2. Hypertension Schedule the Veteran for an appropriate VA examination with an appropriate medical professional to determine the nature and etiology of his claimed hypertension. The Veteran’s claims file, to include a copy of the remand, must be made available to the examiner in conjunction with the examination along with any other information the medical professional deems pertinent. This review should include the Veteran’s service treatment records, post-service medical treatment records and the assertions of the Veteran and his representative, along with any other information the medical professional deems pertinent. A note that it was reviewed should be included in the opinion. The examiner is asked to provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s hypertension had onset in service or is directly linked to his time on active duty. The provided examination opinion must reflect consideration of both the medical and lay evidence of record setting forth a complete rationale for all findings and conclusions. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. 3. CAD Schedule the Veteran for a VA examination to determine the current nature, extent and severity of his coronary artery disease. All required tests should be performed. The claims file, including this remand, should be reviewed by the examiner to become familiar with the Veteran’s pertinent medical history and such review should be noted in the examination report. The examiner must consider all signs and symptoms necessary for evaluating the disability under the rating criteria as indicated by the relevant Disability Benefits Questionnaire. An explanation for all opinions expressed must be provided 4. PTSD Obtain an opinion from an appropriate VA medical professional to determine the severity of the Veteran’s PTSD for the period of June 2011 to June 2016. The Veteran’s claims file, to include a copy of the remand, along with any other information the medical professional deems pertinent must be made available. A note that it was reviewed should be included in the opinion. The provided examination opinion must specifically acknowledge and address the conflicting medical opinion of record (private opinion from J.M., Ph.D. dated June 18, 2016). The examiner must consider all signs and symptoms necessary for evaluating the disability under the rating criteria as indicated by the relevant Disability Benefits Questionnaire. 5. After completing the above actions and any other development deemed necessary, the claims must be readjudicated. If the claims remain denied, a supplemental statement of the case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. K.A. KENNERLY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. An, Associate Counsel