Citation Nr: 18147628 Decision Date: 11/06/18 Archive Date: 11/05/18 DOCKET NO. 17-26 376 DATE: November 6, 2018 REMANDED Entitlement to service connection for a back disorder (claimed as chronic condition to account for back pain and spasm) is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. Entitlement to total disability rating based upon individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 2003 to March 2007 and from February 2009 to March 2010. This case comes before the Board of Veterans' Appeals (Board) on appeal from November 2015 and December 2017 decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. The Board recognizes that in an August 2016 rating decision, the RO proposed to reduce the disability rating for PTSD from 70 percent to a 50 percent rating. The Veteran filed a notice of disagreement (NOD) in November 2016 requesting an increased disability evaluation of “70-100%.”. However, this NOD was premature as the reduction was not final. Rather, the reduction was affected by a December 14, 2017 rating decision, and the Veteran's rating was reduced to a 50 percent rating, effective March 1, 2018. The Veteran was notified of the reduction in a December 21, 2017 letter. By way of a May 2018 appellate brief and supporting medical documentation, the Veteran's representative disagreed with the rating decision effecting the reduction. However, the statement was not on the standardized VA Notice of Disagreement form. As explained in the December 2017 notification letter, in order to initiate an appeal of the December 2017 rating decision reducing the PTSD disability rating, the Veteran must submit a VA Form 21-0958, Notice of Disagreement. When the AOJ provides the Veteran with a standardized form for initiating appeals, which in this case is VA Form 21-0958, a valid notice of disagreement consists only of a completed and timely-submitted copy of that form, and no expression of disagreement in any other form constitutes a valid notice of disagreement. See 38 C.F.R. § 20.201. Thus, the May 2018 correspondence does not constitute a valid notice of disagreement with the December 2017 rating decision. The Board reminds the Veteran and his representative that he still has until December 2018, to submit a completed VA Form 21-0958 in order to initiate an appeal of the December 2017 rating decision. Entitlement to service connection for a back disorder (claimed as chronic condition to account for back pain and spasm), is remanded Records from the Social Security Administration indicate that the Veteran received treatment from Brown Chiropractic. While the initial visit has been associated with the file, it appears that additional records may be available as chriroprcator care was to be for two months. A remand is required to allow VA to obtain authorization and request these records. Moreover, the Veteran reported injurying his back in service. However, he has not been afforded a VA examination. In light of the Veteran’s contention, the Board finds that a VA examination with etiologal opinion is necessary.   Entitlement to service connection for hypertension, to include as secondary to service-connected PTSD, is remanded. The Veteran was afforded a VA examination in October 2015. The examiner opined that the Veteran’s hypertension was less likely as not proximately due to or the result of the Veteran’s PTSD. However, the examiner failed to offer a rationale for this opinion, but rather just stated there was no causal relation, which essentially is just a restatement of the opinion. Moreover, the examiner failed to opine whether the Veteran’s hypertension was aggravated by his service-connected PTSD. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). The examiner also did not proffer an opinion as to whether the Veteran’s hypertension is directly related to service. As such, a new VA examination with opinion is necessary. Entitlement to a TDIU is remanded Finally, the Board must defer consideration of the issue of entitlement to a TDIU, as it is inextricably intertwined with the remaining issues on appeal. See Smith (Daniel) v. Gober, 236 F.3d 1370, 1373 (Fed. Cir. 2001) (Where the facts underlying separately claims are “intimately connected,” the interests of judicial economy and avoidance of piecemeal litigation require that the claims be adjudicated together); see also Harris v. Derwinski, 1 Vet. App. 180 (1991) (issues are inextricably intertwined if one claim could have significant impact on the other). The matters are REMANDED for the following actions: 1. Obtain the Veteran’s VA treatment records for the period from September 2017 to the present. 2. Ask the Veteran to complete a VA Form 21-4142 for Brown Chiropractic and any additional relevant private records. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any back disorder. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his hypertension. The examiner must opine whether it is at least as likely as not (1) related to an in-service injury, event, or disease; (2) proximately due to service-connected PTSD; or (3) aggravated beyond its natural progression by service-connected PTSD. J.N. MOATS Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Marcus Colicelli