Citation Nr: 18152617 Decision Date: 11/27/18 Archive Date: 11/23/18 DOCKET NO. 11-33 041 DATE: November 27, 2018 REMANDED Entitlement to service connection for substance abuse secondary to the service-connected anxiety disorder is remanded. Entitlement to an evaluation in excess of 30 percent prior to January 29, 2018, and in excess of 70% thereafter for the service-connected anxiety disorder is remanded. Entitlement to a TDIU is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Army from September 1986 to November 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from February 2010 and February 2013 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in July 2013. 1. Entitlement to an evaluation in excess of 30 percent prior to January 29, 2018, and in excess of 70% thereafter for the service-connected anxiety disorder is remanded. Unfortunately, another remand is necessary in this case. In February 2018, the Veteran submitted a psychiatric evaluation completed by a private psychologist. While this evaluation indicates worsened psychiatric symptoms, the private psychologist attributed these to posttraumatic stress disorder (PTSD) and unspecified depressive disorder, and noted no other psychiatric disorders. The Veteran is service-connected for anxiety disorder, and past VA examinations have called older diagnoses of PTSD into question. Because it appears that the disability has worsened since the last evaluation, a new VA examination is necessary to determine the current severity of the Veteran’s service-connected disability. See Palczewski v. Nicholson, 21 Vet. App. 174, 181-82 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). The new examination should address the various diagnoses of record, and indicate to the extent possible which symptoms are attributable to which psychiatric diagnosis. 2. Entitlement to service connection for substance abuse secondary to the service-connected anxiety disorder is remanded. There is conflicting evidence in the VA examinations of record regarding whether the Veteran’s substance abuse disorder is caused by an acquired psychiatric disorder, or whether any of the diagnosed acquired psychiatric disorders contributed to the substance abuse disorder. On remand, the examiner should specifically address these past examinations, as well as the private medical evidence the Veteran has submitted, and provide an opinion on the relationship between the acquired psychiatric disorders and the substance abuse disorder. 3. Entitlement to a TDIU is remanded. The TDIU issue is intertwined with the above remanded issue and is also remanded at this time. See Henderson v. West, 12 Vet. App. 11, 20 (1998); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991).   The matters are REMANDED for the following action: Schedule the Veteran for an examination with an appropriate clinician to determine the current severity of the Veteran’s service-connected anxiety disorder (previously rated as PTSD). The examiner should provide a full description of the anxiety disorder and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms. To the extent possible, the examiner should identify any symptoms and social and occupational impairment due to the service-connected anxiety disorder alone. The examiner should identify any other current psychiatric disorders, and attempt to distinguish the symptoms of these from those of the service-connected anxiety disorder. The examiner must specifically identify the symptoms related to each separate psychiatric diagnosis. If the examiner cannot distinguish the symptoms of the service-connected disability from any non-service-connected psychiatric disability, this must be clearly stated. Finally, the examiner must also opine whether it is at least as likely as not (50 percent or greater probability) that any current substance abuse disorder, whether active or in remission, is (a) caused by; or (b) aggravated (i.e., worsened beyond the normal progression of the disease) by the Veteran’s service-connected anxiety disorder. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the substance abuse disorder prior to aggravation by the service-connected disorder. Please note, causation and aggravation are separate concepts and must be addressed independently. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Josey, Associate Counsel