Citation Nr: 18114530 Decision Date: 06/27/18 Archive Date: 06/27/18 DOCKET NO. 10-27 645 DATE: June 27, 2018 REMANDED The issue of entitlement to an increased disability rating in excess of 50 percent for service-connected schizophrenia is remanded. REASONS FOR REMAND The Veteran has active duty service in the United States Army from February 1970 to September 1977. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2008 rating decision by the Department of Veterans Affairs (VA) Regional Office. The Board previously remanded this issue in March 2014 and in September 2016. In March 2017 the Board denied the issue; the Veteran appealed to the United States Court of Appeals for Veterans Claims and the case was subject to a Joint Motion for Remand. It has returned to the Board for review. By way of history, the Veteran was granted entitlement to service connection for a nervous condition in a February 1978 rating decision. Her disability rating has been 50 percent as of August 1, 1986. In November 2007, she instituted the present claim for an increased disability rating. The Veteran has carried a 50 percent disability rating throughout the course of the appeal. This disability rating has remained static based in part on VA examinations in March 2008, May 2014, and September 2014, all of which have designated the Veteran’s schizophrenia as causing occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation, all of which is consistent with a 50 percent disability rating. Nonetheless, it is evident that these VA examinations have not adequately considered some of the Veteran’s mental health characteristics that may entitle her to a higher disability rating, namely her tendency to isolate, her hallucinations, and her reported sleep issues. There is evidence that the Veteran preferred to isolate herself from others. In a June 2008 Social Security Administration appeal form, she reported that she did not feel like leaving her apartment. Moreover, in January 2009 she asserted to a VA treatment provider that she preferred to isolate herself from being with others rather than being active. The Board notes that there is also some evidence that the Veteran had hallucinations, which would be consistent with a higher disability rating. In April 2011, the Veteran told her VA treatment provider that she had some visual experiences where she thought she saw her partner or ghosts, but found there was nobody there. The following month, the Veteran indicated that she had some ongoing visual experiences of being watched by her partner while exercising or bathing, or being watched by others when she was in her bedroom watching television; she asserted that this had occurred five or six times since her last visit. Lastly, there is evidence that the Veteran had sleep disturbances that may not have been considered by the VA examiners. She asserted having some sleep difficulties in her increased rating claim in November 2007. An August 2008 Social Security Administration mental health questionnaire also denoted that the Veteran had a sleep disturbance. Given these inconsistencies between the VA examinations and the record, the Board finds that remand is necessary to provide the Veteran with a supplemental VA examination. Incidentally, the Board notes that the Veteran has not had a VA mental health examination since September 2014, nearly four years ago. Thus, a current VA examination would be helpful in determining the Veteran’s current mental functioning. The Veteran receives continuous treatment through VA, and the Board finds that the AOJ should obtain and associate with the file VA treatment records dated from September 2016 to present. See Bell v. Derwinski, 2 Vet. App. 611 (1992). The matter is REMANDED for the following actions: 1. Ask the Veteran to identify all outstanding treatment records relevant to her mental health claim. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability of the records. 2. After records development is completed, schedule the Veteran for a VA mental health examination to determine the current symptoms, level of severity, and functional impairment associated with her service-connected schizophrenic disorder. The claims file should be reviewed by the examiner. All necessary tests should be performed and the results reported. The examiner should specifically comment on the Veteran’s tendency to isolate, as denoted in the June 2008 Social Security Appeal form and January 13, 2009 VA treatment note; her reported hallucinations, as denoted in her April 15, 2011 and May 15, 2011 treatment notes; and her sleep disturbances, as denoted in her November 2007 increased rating claim, and August 2008 Social Security Administration Mental Health Questionnaire. 3. Then, the record should again be reviewed. If the benefit sought on appeal remains denied, the Veteran and her representative should be furnished with a supplemental statement of the case and be given the opportunity to respond. LANA K. JENG Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. F. Brandau, Associate Counsel