Citation Nr: 18159901 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 15-19 032 DATE: December 20, 2018 REMANDED Entitlement to an initial disability rating in excess of 30 percent for posttraumatic stress disorder with depressive disorder, not otherwise specified (NOS), is remanded. REASONS FOR REMAND The Veteran had active service from November 1969 to April 1971. This matter is on appeal from a January 2014 rating decision. In July 2018, the Veteran withdrew his prior request for a Board hearing. 1. Entitlement to an initial disability rating in excess of 30 percent for posttraumatic stress disorder with depressive disorder, not otherwise specified (NOS), is remanded This matter is remanded for a new VA examination. The Veteran previously underwent VA examinations in December 2010 and May 2013. Most recently, a private (non-VA) provider conducted an examination in August 2018 and completed a corresponding Disability Benefits Questionnaire (DBQ). At present, the Board finds the August 2018 DBQ to be too incomplete to properly evaluate the severity of the Veteran’s disability. Specifically, the examiner found the Veteran to have a disability picture consistent with occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal. Although this assessment is consistent with the current 30 percent rating, the examiner identified some symptoms that would be consistent with a higher-level disability rating. For example, the examiner found near continuous depression affecting the ability to function independently, appropriately and effectively; speech intermittently illogical, obscure, or irrelevant; difficulty in adapting to stressful circumstances (including work or a worklike setting); impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Overall, however, a noticeable aspect of the examiner’s DBQ is his repeated references to the Veteran’s low IQ and illiteracy. The private examiner marked the box on the DBQ indicating that there were no other mental disorder diagnoses. But, this is not entirely accurate based on the remainder of the DBQ’s repeated references to the Veteran’s low IQ and illiteracy as complicating his functioning, including his ability to accurately report his symptomatology. The examiner expressly summarized that the Veteran “frequently gave incorrect information about various things.” Most importantly for purposes of this appeal, the examiner followed this by stating that it was “not clear [to the examiner] whether this is deliberately glossing over, behavioral acting or, or due to low IQ/illiteracy.” This statement illustrates that the examiner did not consider all procurable and assembled data, such as by obtaining all tests and records that might reasonably illuminate the medical analysis to identify the reason the Veteran frequently gave incorrect information. In fact, the DBQ shows that the examiner found the Veteran’s functioning to be impacted by his low IQ, but the examiner did not distinguish what symptoms were attributable to that condition and to what degree. When, as here, the record leaves this issue in doubt, it is the Board’s duty to remand for further development. See Jones v. Shinseki, 23 Vet. App. 382, 390 (2010). A higher disability rating cannot be assigned based on nonservice-connected symptomatology. See Mittleider v. West, 11 Vet. App. 181 (1998). This is especially true where “mental deficiency as such” is expressly defined as not a disease or injury “within the meaning of applicable legislation.” See 38 C.F.R. § 3.303(c). Notably, this is not a situation where the Veteran is diagnosed with two distinct psychiatric conditions with symptomatology that cannot be distinguished as demonstrated by the medical evidence. Rather, it is a situation where the evidence indicates two coexisting mental conditions, but provides no indication either way as to whether his symptomatology can be separated and, if so, what symptomatology is associated with which condition. The August 2018 examiner simply did not attempt to do so, nor did the examiner attempt to reconcile this inconsistency in the examination report. (The Board is aware that the examiner may not have considered the Veteran’s low IQ to be a “mental disorder” per se, as asked on the DBQ. But, if this were the case, the examiner did not state so. Therefore, the Board cannot make this assumption. Nor would such an assumption tend to rehabilitate the inconsistency in the DBQ, which still indicates some degree of symptomatology associated with the low IQ.) Under such a situation, the evidence is insufficient to properly evaluate the severity of the service-connected disability. The matter is REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected psychiatric disorder. 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. 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 his service-connected psychiatric disorder alone. The examiner should identify and distinguish the nature and degree of symptomatology associated with any non-psychiatric etiology, such as a low IQ and/or illiteracy. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Bosely, Counsel