Citation Nr: 18156378 Decision Date: 12/07/18 Archive Date: 12/07/18 DOCKET NO. 13-30 913 DATE: December 7, 2018 REMANDED Entitlement to an initial rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1970 to January 1971. Entitlement to an initial rating in excess of 50 percent for PTSD is remanded. Pursuant to the June 2018 Board remand, the Veteran was afforded a VA examination in October 2018. The examiner’s discussion on the Veteran’s functional and occupational impact discussed that he stopped working because of his non-service connected disabilities, but did not identify any functional or occupational impact related to the service-connected PTSD. Thus, there has not been substantial compliance with the Board’s previous remand directives regarding the effect the Veteran’s PTSD alone had on any occupational functioning and activities of daily living. The examiner also noted that only psychiatric diagnosis was PTSD; however, the Veteran’s VA treatment records include diagnoses of major depressive disorder and anxiety. Another medical opinion, with an examination if deemded necessary, is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). TDIU Adjudication of the claim for TDIU must be deferred because that issue is inextricably intertwined with the remanded issue. Additionally, the October 2018 examiner discusses that up until one year prior, the Veteran’s suffered from a prescription drug addiction. Although the pain medications were precribed for non-service connected disabilities, the examiner does not discuss or consider whether the Veteran’s drug addiction may have been aggravated or worsened by the Veteran’s PTSD symptoms of anxiety and panic attacks; thus, possibly further impacting the Veteran’s functional occupational and social impairment. The matters are REMANDED for the following action: Obtain a supplemental opinion from the October 2018 VA examiner (with another examiner if that examiner is unavailable or it is otherwise determined that an opinion cannot be provided without another examination). The claims file, including this remand and copies of all pertinent records, should be made available to the examiner for review. After reviewing the record, the examiner should answer the following: (a) Please list all psychiatric disorders the Veteran has or has had during the appeal period. The examiner is asked to discuss as necessary the various diagnoses of PTSD, major depressive disorder and anxiety found in the Veteran’s treatment records. (b) For any of the diagnosis identified by the examiner above in (a), the examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria and whether symptoms from different psychiatric impairments found, if any, can be differentiated for each mental disorder. (c) The examiner should identify any symptoms and functional impairments due to the Veteran’s PTSD only (and any other diagnosed psychiatric disabilities if the examiner is unable to differentiate the symptoms) and discuss the effect of the Veteran’s PTSD on any occupational functioning and activities of daily living. (d) Did the Veteran’s PTSD cause or aggravate his dependence on prescription pain medications and if so, did this dependence on prescriptions further impact the Veteran’s occupational functioning? The examiner should elicit a complete history from the Veteran pertaining to his contentions that his service-connected PTSD has worsened. The examiner is advised that the Veteran is competent to provide evidence of symptomatology apparent to him, regardless of whether the symptoms are noted in the treatment records or on the date of examination. The examiner should discuss and address the detailed history taken from the Veteran in the opinion. If there is any clinical or medical basis for corroborating or discounting the reliability of the history provided by the Veteran, the examiner should so state, with a complete explanation in support of that finding. The examiner should complete any necessary testing necessary to that will assist the examiner reaching this conclusion A complete rationale must be provided for all opinions, to include the opinion that the Veteran does not have a psychiatric diagnosis. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Perkins, Michael