Citation Nr: 18152905 Decision Date: 11/27/18 Archive Date: 11/26/18 DOCKET NO. 12-04 437 DATE: November 27, 2018 REMANDED Entitlement to service connection for an acquired psychiatric disorder, claimed as posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for a vision defect, claimed as secondary to diabetes mellitus, type II is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for polyps, to include as secondary to herbicide exposure is remanded. Entitlement to service connection for gastritis, claimed as secondary to medication used to treat a service-connected disability is remanded. Entitlement to an effective date earlier than July 18, 2014 for the grant of a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1968 to April 1970. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. The Board remanded these issues in June 2017 for additional development. Unfortunately, additional development is necessary. 1. Acquired Psychiatric Disorder In June 2017, the Board remanded the claim for service connection for an acquired psychiatric disorder, claimed as PTSD, for the issuance of a supplemental statement of the case, which was completed in June 2018. However, additional development is necessary before the Board can adjudicate the claim. Specifically, the Veteran had a VA examination in May 2013. The examiner diagnosed major depressive disorder and indicated that psychiatric treatment notes identified his Axis IV stressors as medical conditions and poor compliance with treatment. Further, a March 2013 psychiatric progress note, which is quoted in the examination report, indicates that Axis IV stressors affecting the Veteran’s mental health included diabetes and postsurgical aortocoronary bypass status. The Veteran has service connection for coronary artery disease and diabetes mellitus. Thus, the record suggests a possible relationship between the Veteran’s service-connected disabilities and his major depressive disorder. On remand, an opinion must be obtained that addresses whether the Veteran has an acquired psychiatric disorder that is due to or has been aggravated by his service-connected disabilities. 2. All Other Service Connection Claims In June 2017, the Board remanded the claims for service connection for a vision defect, claimed as secondary to diabetes mellitus, type II; bilateral hearing loss; tinnitus; polyps, to include as secondary to herbicide exposure; and gastritis, claimed as secondary to medication used to treat a service-connected disability, to obtain opinions from examiners addressing the etiology of these disabilities. The Board ordered that physical examinations be scheduled if the examiners could not provide the requested opinions based solely on review of the evidence in the claims file. Rather than request the opinions, the RO scheduled examinations. The Veteran failed to report for the examinations. Generally, when a claimant, without good cause, fails to report for an examination or reexamination, “the claim shall be rated based on the evidence of record, or even denied.” However, in this case, since the RO did not ask examiners to provide opinions based on the record, the Board finds that the development ordered in the June 2017 remand has not been substantially completed. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Therefore, a remand is necessary to allow the RO the opportunity to request the opinions. 3. TDIU The Veteran’s claim for an earlier effective date for TDIU is inextricably intertwined with the claims on appeal. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to remand the claim on appeal pending adjudication. The matters are REMANDED for the following action: 1. Ask the Veteran to identify the names and addresses of all health care providers who have treated him for the issues on appeal. Notify him that he may submit evidence or treatment records to support his claims. The Board is particularly interested any outstanding records of VA medical treatment (generated after the last treatment notes of record) and attempts to obtain such records must be made. All efforts to obtain such records should be documented in the claims folder. All available records should be associated with the Veteran’s VA claims folder. 2. Arrange for an appropriate health care provider to review the Veteran’s claims file and provide an opinion as to whether it is at least as likely as not, (50 percent probability or greater), that any acquired psychiatric disorder was (A) caused or (B) aggravated (permanently worsened beyond normal progression) by any service-connected disability, to include diabetes and/or coronary artery disease. If the reviewing health care provider finds that an examination of the Veteran is necessary, such should be accomplished. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board 3. Arrange for an appropriate health care provider to review the Veteran’s claims file and provide an opinion as to whether it is at least as likely as not, (50 percent probability or greater), that any vision disorder was (A) caused or (B) aggravated (permanently worsened beyond normal progression) by the service-connected diabetes. If the reviewing health care provider finds that physical examination of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 4. Arrange for an appropriate health care provider to review the Veteran’s claims file and provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the diagnosed hearing loss and/or tinnitus is due to an event or incident of the Veteran’s period of active service. If the reviewing health care provider finds that physical examination of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 5. Arrange for an appropriate health care provider to review the Veteran’s claims file and provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the diagnosed polyps had their clinical onset during service or is due to an event or incident of the Veteran’s period of active service, to include the Veteran’s exposure to herbicides. In addition, in providing the opinion, the physician must consider the Veteran’s personal circumstances and how the recognized risk factor(s) apply in his case. The physician may not rely solely on the fact that the Veteran’s polyps are not on the presumptive list of diseases associated with herbicide exposure. If the reviewing health care provider finds that physical examination of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 6. Arrange for an appropriate health care provider to review the Veteran’s claims file and provide an opinion on whether it is at least as likely as not, (50 percent probability or greater), that the diagnosed gastritis was (A) caused or (B) aggravated (permanently worsened beyond its normal progression) by medications used to treat a service-connected disability. If the reviewing health care provider finds that physical examination of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 7. Ensure that the VA medical opinions obtained include a complete rationale for the conclusions reached. The medical opinions must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. (Continued on the next page)   8. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Amanda G. Alderman