Citation Nr: 18152824 Decision Date: 11/26/18 Archive Date: 11/26/18 DOCKET NO. 17-21 365 DATE: November 26, 2018 REMANDED Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1967 to July 1974. He is the recipient of numerous awards and decorations, to include the Combat Action Ribbon. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in August 2016 by a Department of Veterans Affairs (VA) Regional Office. In this regard, the August 2016 rating decision denied increased ratings for PTSD and diabetes mellitus, type II. Thereafter, the Veteran entered a notice of disagreement as to the denial of both claims and a statement of the case was subsequently issued; however, he limited his substantive appeal to the issue of entitlement to an increased rating for PTSD. Consequently, such issue is the only matter before the Board. Entitlement to a rating in excess of 50 percent for PTSD. The Board finds that a remand is necessary in order to afford the Veteran a contemporaneous VA examination so as to determine the current nature and severity of his PTSD. In this regard, the Board observes that he was last examined by VA in July 2016. At such time, the Veteran reported a good relationship with his current spouse and children, but indicated that he had no desire to establish or maintain friendships. He further indicated that he had worked as a paralegal for a law firm specializing in criminal defense for approximately 30 years, but he started working part-time a year ago due to increased irritability with occasional verbal outbursts towards clients and sat in an office in the back to avoid people. The Veteran endorsed PTSD symptoms of depressed mood, anxiety, chronic sleep impairment, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a worklike setting. The examiner concluded that the Veteran’s PTSD resulted in occupational and social impairment with reduced reliability and productivity. However, since such examination, the Veteran has reported a worsening of PTSD symptoms. In his August 2016 notice of disagreement and a September 2016 statement, he reiterated the change in his working conditions, and also reported increased difficulty with sleep due to nightmares, flashbacks that have become more real, increased anger, and a decrease in activities outside of the house due to anxiety and paranoia. Additionally, in an April 2017 statement, the Veteran’s spouse reported that his PTSD symptomatology had worsened over the past several years. Specifically, she indicated that, due to his attitude, mood, and outlook on life, his hours at work were decreased, he cannot be around people or noises, has no patience, and has road rage to the point where he yells, curses, and loses control. His spouse further reported that he did not sleep, would walk around the house and look out windows, and had increased anxiety. Similarly, in an April 2017 statement, the Veteran’s employer reported that he had decreased the Veteran’s hours and moved his office due to an increase in his temper. He further indicated that the Veteran reported difficulty sleeping that led to his irritability, and stated that he had witnessed a change in his personality over the last three to four years. Finally, the Veteran’s employer indicated that, if his behavior continued, he would be forced to let him go. Therefore, as the evidence suggests that the Veteran’s PTSD symptomatology may have increased in severity since the July 2016 VA examination, a remand is necessary in order to schedule him for an appropriate VA examination in order to assess the current nature and severity of such service-connected disability. See Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994); VAOPGCPREC 11-95 (1995). The Board further notes that, in his September 2016 and April 2017 statements, the Veteran reported that he was unable to open up to the July 2016 VA examiner due to embarrassment and felt he was able to express himself better in writing. As such, while the Board encourages the Veteran to be open and honest with the examiner who conducts the examination on remand, the examiner will also be encouraged to review the written submissions by the Veteran, his spouse, and his employer in assessing the nature and severity of his PTSD. The matter is REMANDED for the following action: Afford the Veteran an appropriate VA examination so as to determine the nature and severity of his PTSD. The record, including a complete copy of this remand, must be made available for review in connection with the examination, and all indicated tests and studies should be accomplished. The examiner should describe the nature and severity of all manifestations of the Veteran’s PTSD, to include the resulting impact on his social and occupational functioning. In this regard, while the Veteran is encouraged to be open and honest with the examiner, he or she is also encouraged to review the written submissions by the Veteran, his spouse, and his employer in assessing the nature and severity of his PTSD. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD V. Woehlke, Associate Counsel