Citation Nr: 18156057 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 15-12 525 DATE: December 6, 2018 REMANDED Entitlement to more than a 70 percent rating for service-connected posttraumatic stress disorder (PTSD) with Panic Disorder without Agoraphobia (psychiatric disability) is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from January 1989 to January 1993. These matters are before the Board of Veterans’ Appeals (Board) on appeal from April 2011 and January 2012 rating decisions. Although the Veteran initially requested a hearing before the Board in this matter, he withdrew that request by October 2017 correspondence. 1. Entitlement to more than a 70 percent rating for service-connected posttraumatic stress disorder (PTSD) with Panic Disorder without Agoraphobia (psychiatric disability) is remanded. A review of the record shows the Veteran has been historically diagnosed with several psychiatric disabilities (e.g., panic disorder, PTSD, unspecified depressive disorder, substance-induced mood disorders, generalized anxiety disorder, major depressive disorder, and multiple polysubstance dependence or abuse disorders). However, the evidence remains unclear as to (1) what diagnoses are currently active or applicable and (2) whether the symptoms and pathology attributable to diagnoses that are not explicitly service-connected (i.e., anything other than PTSD and Panic Disorder) can be meaningfully differentiated from those that are service-connected. In so finding, the Board notes that, until the most recent VA examination of record, all prior VA examiners diagnosed several psychiatric problems but either offered conflicting findings (i.e., finding the various diagnoses identified on examination could be distinguished from one another in terms of symptoms or impairment, but then also suggesting that “symptom[s] overlap” or non-PTSD diagnoses were “PTSD-driven” and “must be considered additional (additive) challenges”), as in the case of August 2011 or April 2016 VA examination reports, or failing to provide any explanation at all as to why the examiner felt such a distinction was possible and instead noting only the symptoms attributable to the service-connected PTSD and Panic Disorder in their report, as in the case of a March 2015 and the same April 2016 VA examination report noted above. Furthermore, the most recent November 2017 VA examination report only diagnosed PTSD, which the examiner later recharacterized as “PTSD with Panic Disorder without Agoraphobia,” without acknowledging the several other diagnoses of record or explaining why they were apparently no longer applicable. As these questions go directly to defining the scope of the Board’s inquiry in this matter, a remand is necessary. 2. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. This matter is inextricably intertwined with the increased rating claim concomitantly on appeal, and therefore a final adjudication thereof must be deferred at this time. The matters are REMANDED for the following action: 1. Obtain all updated records (i.e., those not already of record) of VA and adequately identified private treatment the Veteran has received for the disabilities remaining on appeal. 2. Then, arrange for the Veteran to be examined by a psychiatrist or psychologist to determine the current severity of his service-connected psychiatric disability. Based on an examination, review of the record, and any tests or studies deemed necessary, the examiner should describe all pertinent symptoms, pathology, and impairment associated with such disability in sufficient detail to allow for application of the pertinent rating criteria. Specifically, the examiner MUST identify the degree of occupational and social impairment found on examination. The examiner must also identify, by diagnosis, all psychiatric disability entities found. All diagnostic findings (or lack thereof) must be reconciled with conflicting evidence in the record and, if any documented diagnoses are either not or no longer felt to apply, the examiner must explain why, citing to the pertinent diagnostic criteria. If the Veteran is found to have other psychiatric diagnoses IN ADDITION TO his service-connected disability, the examiner must also indicate whether there is clear evidence allowing for differentiation of the symptoms, pathology, or impairment attributable to service-connected and nonservice-connected diagnoses, and explain why. If so, the examiner must clearly identify all symptoms and impairment found and attribute them to their appropriate underlying diagnoses. The examiner is asked to also comment on the impact the Veteran’s psychiatric disability would be expected to have on his ability to function in various occupational environments, identifying the types of work or tasks that would be precluded and those that would remain feasible. The examiner must provide a detailed explanation (rationale) for all opinions. (By law, the Board may not rely on any conclusion not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may require clarification). 3. Then, conduct any additional development deemed necessary or otherwise indicated by the fruits of the above-ordered development before readjudicating the matters on appeal. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Yuan, Associate Counsel