Citation Nr: 19169596 Decision Date: 09/09/19 Archive Date: 09/09/19 DOCKET NO. 18-27 868 DATE: September 9, 2019 ORDER An effective date earlier than July 17, 2017 for the award of service connection for peripheral neuropathy of the left upper extremity is granted as of December 3, 2009, but not before that. An effective date earlier than July 17, 2017 for the award of service connection for peripheral neuropathy of the right upper extremity is denied. A disability rating in excess of 10 percent for peripheral neuropathy of the left upper extremity is denied. A disability rating in excess of 10 percent, for peripheral neuropathy of the right upper extremity, is denied. REMANDED The claim of entitlement to a disability rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is remanded. The claim of entitlement to a total disability rating based upon individual unemployability due to service-connected disability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s peripheral neuropathy of the left upper extremity was shown on December 3, 2009, but not before that. 2. The Veteran’s peripheral neuropathy of the right upper extremity was shown on July 17, 2017, but not before that. 3. Throughout the entire appeal period, the Veteran’s peripheral neuropathy of the left upper extremity has not manifested in worse than mild incomplete paralysis. 4. Throughout the entire appeal period, the Veteran’s peripheral neuropathy of the right upper extremity has not manifested in worse than mild incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than July 17, 2017, for the award of service connection for peripheral neuropathy of the left upper extremity were met on December 3, 2009, but not prior to that. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400. 2. The criteria for the award of service connection for peripheral neuropathy of the right upper extremity prior to July 18, 2017, have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400. 3. The criteria for a disability rating in excess of 10 percent for peripheral neuropathy of the left upper extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8515. 4. The criteria for a disability rating in excess of 10 percent for peripheral neuropathy of the right upper extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8515. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from November 1967 to June 1969. His decorations include the Purple Heart. These matters come to the Board of Veterans’ Appeals (Board) on appeal from March 2009 and December 2017 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The procedural history of the issues on appeal is lengthy and complex. In July 2008, the Veteran filed a claim, in part, for service-connected disability compensation for peripheral neuropathy of the upper extremities and PTSD. In March 2009, the RO granted service connection and a 50 percent rating for PTSD but denied service connection for peripheral neuropathy of the upper extremities. In October 2009, the RO continued the 50 percent rating for the Veteran’s PTSD and denied his claim for a TDIU. In October 2012, the RO issued a statement of the case regarding the Veteran’s claims related to his PTSD, peripheral neuropathy of the upper extremities, and a TDIU. The Veteran perfected his appeal and in January 2015, the Board, in part, denied service connection for peripheral neuropathy of the upper extremities and remanded his claims for an increased rating for PTSD and entitlement to a TDIU. In April 2016, the United States Court of Appeals for Veterans Claims (CAVC) vacated the January 2015 denial of service connection for peripheral neuropathy of the upper extremities and, in May 2017, the Board remanded this claim or further development. In December 2017, the RO granted service connection for peripheral neuropathy of both the left and right upper extremity, with an evaluation of 10 percent for each extremity, effective July 17, 2017. In April 2018, the RO issued a statement of the case denying the Veteran’s claims for an earlier effective date, and increased rating, for his claims for peripheral neuropathy of both the left and right upper extremity. The Veteran perfected an appeal of that decision. Because the Board has not previously ruled on the Veteran’s claims for an increased rating for PTSD and entitlement to a TDIU, these claims are properly before the Board. 1. An effective date earlier than July 17, 2017 for the award of service connection for peripheral neuropathy of the left upper extremity is granted as of December 3, 2009, but not before that. The Veteran seeks an effective date no later than August 29, 2008, for the award of service connection for peripheral neuropathy of the left upper extremity. Generally, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim for increase, or a claim reopened after final disallowance, will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. However, if the claim is received within one year after separation from service, the effective date of an award of disability compensation shall be the day following separation from active service. 38 U.S.C. § 5110(b)(1); 38 C.F.R. § 3.400(b)(2)(i). Prior to March 24, 2015, a “claim” was defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p); Brannon v. West, 12 Vet. App. 32, 34-5 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). The Veteran initially filed a claim for service connection for peripheral neuropathy of the left upper extremity that was received on August 29, 2008. As above, in January 2015, the Board denied service connection of peripheral neuropathy of the left upper extremity and, in April 2016, the CAVC vacated the Board’s decision and remanded the case. In a December 2017 rating decision, service connection was awarded at 10 percent disabling, effective July 17, 2017. The question before the Board is how early is there medical evidence of peripheral neuropathy of the left upper extremity. A preponderance of the evidence shows that the Veteran is entitled to a compensable rating for peripheral neuropathy of the left upper extremity effective December 3, 2009, but no earlier. In September 2008, a VA neurologist noted that the sensory examination of the upper extremities was unremarkable and there was no wasting and no paralysis. In November 2008, a VA examiner noted that the numbness in the Veteran’s hands probably did not reflect a peripheral neuropathy because the symptoms were readily relieved by flexion and extension of his hands. In June 2009 the Veteran reported his hands fall asleep when he sleeps on his back. In December 2009, a VA neurologist noted that it may be possible that the Veteran might have some elements of neuropathy. Thus, the evidence shows limited report of symptoms related to peripheral neuropathy of the left upper extremity prior to December 3, 2009. The Veteran reported numbness in his hands when he fell asleep. Although the Veteran is competent to report symptoms he has personally experienced, the VA examiner was aware of the Veteran’s reports of numbness to his hands, but persuasively noted they were not reflective of peripheral neuropathy, because they were readily relieved by flexion and extension of the hands. Because the VA examiner addressed the Veteran’s reported symptoms while stating they were not reflective of peripheral neuropathy a preponderance of the evidence shows that the Veteran is not entitled to a compensable rating for peripheral neuropathy of the left upper extremity before December 3, 2009. Beginning December 3, 2009, peripheral neuropathy of the left upper extremity was shown. As noted above, the VA neurologist, in December 2009, indicated it may be possible that the Veteran has some elements of neuropathy. In January 2010, an electromyogram (EMG) showed left mild median sensory neuropathy. The evidence, including examinations by VA neurologists, after this date also demonstrates neuropathy of the left upper extremity. In October 2017, a VA examiner opined that he could not determine if the Veteran’s carpal tunnel syndrome on the left side was secondary to diabetes without resorting to mere speculation. It was noted it was possible that the Veteran’s diabetes led to the carpal tunnel syndrome. Because the VA examiner was not able to distinguish the Veteran’s symptoms of neuropathy from his service-connected diabetes versus carpal tunnel, the Board attributes his neuropathy symptoms to his service-connected diabetes. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). The presence of a neurologist suggesting possible neuropathy in 2009, and an EMG shortly thereafter showed evidence of neuropathy, demonstrates that beginning December 3, 2009, the Veteran is entitled to an earlier effective date for peripheral neuropathy of the left upper extremity. On balance, and taking into account the totality of the evidence, the Board is persuaded that the criteria for an earlier effective date for peripheral neuropathy of the left upper extremity have been met since December 3, 2009, but not before, because that is the earliest date that the facts establish the presence of a service connected disability. 2. An effective date earlier than July 17, 2017, for the award of service connection for peripheral neuropathy of the right upper extremity is denied. The Veteran seeks an effective date no later than August 29, 2008, for the award of a compensable rating for his service-connected peripheral neuropathy of the right upper extremity. The Board finds that the earliest that which it is factually ascertainable that the Veteran met the criteria for service-connected peripheral neuropathy of the right upper extremity is July 17, 2017. As above, in September 2008, a VA neurologist noted that the sensory examination of the upper extremities was unremarkable and there was no wasting and no paralysis. In November 2008, a VA examiner noted that the numbness in the Veteran’s hands probably did not reflect a peripheral neuropathy because they are so readily relieved by flexion and extension of his hands. An EMG in January 2010 showed no ulnar or median sensorimotor neuropathy, and showed no generalized peripheral polyneuropathy affecting the right upper extremity. In June 2010, the Veteran reported bilateral wrist discomfort and was instructed to wear splints for two weeks. In October 2010, the Veteran reported chronic bilateral arm pain. In May 2012, the VA examiner noted that the Veteran did not have complications of diabetes mellitus such as peripheral neuropathy. In September 2015, the VA neurologist noted sensory issues in the Veteran’s lower extremities and left upper extremity, but nothing was noted regarding the Veteran’s right upper extremity despite the Veteran’s report of intermittent numbness in his hands. The impression included neuropathy for the Veteran’s lower extremities and left ulnar neuropathy, but nothing was noted regarding the Veteran’s right upper extremity. In August 2016, an EMG showed no evidence of neuropathy of the right upper extremity, even though the Veteran had positive Tinel and Phalen signs bilaterally. In July 2017, the VA examiner noted that the Veteran had diabetic peripheral neuropathy with incomplete paralysis, described as mild, in severity in his right upper extremity. The evidence shows that the Veteran had EMGs in January 2010 and August 2016, that did not show neuropathy of the right upper extremity. Although the Veteran reported symptoms of neuropathy of the left upper extremity, the EMGs were negative and the examinations prior to July 2017, did not identify neuropathy in the Veteran’s right upper extremity. Therefore, a preponderance of the evidence is against the Veteran’s claim for an earlier effective date for peripheral neuropathy of the right upper extremity. July 17, 2017 is the earliest date that it is factually determinable that the Veteran met the criteria for service-connected peripheral neuropathy of the right upper extremity. Accordingly, the claim for entitlement to an effective date earlier than July 17, 2017, for peripheral neuropathy of the right upper extremity, is denied. 3. A disability rating in excess of 10 percent, for peripheral neuropathy of the left upper extremity is denied. In a Notice of Disagreement received in February 2018, the Veteran requested the highest possible percentage evaluation for his peripheral neuropathy of the left upper extremity. The Veteran is currently rated at 10 percent for peripheral neuropathy of the left upper extremity under Diagnostic Code 8515. Paralysis of the median nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8515. Under these criteria, mild incomplete paralysis is rated as 10 percent for both the major and minor extremity. Moderate incomplete paralysis is rated as 30 percent for the major extremity and 20 percent for the minor extremity. Severe incomplete paralysis is rated as 50 percent for the major extremity and 40 percent for the minor extremity. 38 C.F.R. § 4.124a. The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). In December 2009, a VA neurologist examined the Veteran. The Veteran reported numbness and tingling in his upper extremities; and that his numbness and pain radiates from his shoulder to his hands, especially on the fingers. It was noted that his upper extremity strength is good, he had normal tone, his deep tendon reflex was 1+, sensory was negative, and F to N is normal. In January 2010, an EMG showed left median sensory neuropathy at the wrist. In February 2010, the Veteran reported a history of radiation of pain to both arms. On examination it was noted he had decreased sensation to the left C 5, positive Hawkins signs, negative Neer signs, positive Jobes, negative O’Brien, negative liftoff and bearhug, and negative Hornblower. In June 2010, the Veteran reported pain in both wrists. In October 2010, the Veteran reported chronic bilateral arm pain. The Veteran was afforded a VA examination in September 2015 and the VA examiner noted that the Veteran’s diagnoses included peripheral neuropathy. The Veteran reported numbness in both hands, and some pain in the upper arm. It was noted the Veteran had no constant pain in the left upper extremity, no intermittent pain in the left upper extremity, no paresthesias and/or dysesthesias in the left upper extremity, and mild numbness in the left upper extremity. The Veteran had 5/5 strength in all of the areas tested in the left upper extremity. He had 1+ reflexes in his biceps, triceps, and brachioradialis areas of his left upper extremity. Light touch/monofilament testing of his left upper extremity was normal in the shoulder area and the inner/outer forearm. It was decreased in the hand/finger of his left upper extremity. His position sense in the left upper extremity was normal. His vibration sensation of the left upper extremity was decreased. His cold sensation was normal in the left upper extremity. It was noted the Veteran did not have muscle atrophy. His radial nerve and median nerve, of the left upper extremity were normal, but the ulnar nerve had incomplete paralysis described as mild. The VA examiner specifically opined of mild incomplete paralysis, and the examination showed normal strength, diminished reflexes, and some sensory disturbance. The opinion directly supports a 10 percent rating and the clinical examination is supportive of the opinion as it showed normal strength and other findings consistent with mild incomplete paralysis. In October 2015, a VA neurologist noted the Veteran had normal bulk, tone, and strength in the proximal and distal upper extremity muscles. His reflexes were normal in his biceps, triceps, brachioradialis. The Tinel signs were negative at the wrists, and elbows, bilaterally. The sensory exam was normal for soft touch, temperature, vibration, pin prick, and proprioception in the upper extremity dermatomes bilaterally. He had diminished sensation to pin prick in his ulnar innervated skin of the left fourth/fifth fingers. It was noted he had left ulnar neuropathy, which might simply be due to position. An EMG in August 2016 showed electrodiagnostic evidence of mild carpal tunnel syndrome in the left upper extremity, and the Veteran had positive Tinel and Phalen signs bilaterally. Although neuropathy was demonstrated by the EMG it was described as mild. In July 2017, the Veteran was afforded a VA examination and was diagnosed with diabetic neuropathy and left carpal tunnel syndrome. The Veteran reported his hands and arms hurt 90 percent of the time, he had numbness in fingers 3-5 bilaterally on an intermittent basis, that he dropped a lot of things, and had weakness in his arms. Muscle strength testing showed grade 5 for shoulder abductors, biceps, triceps, wrist flexors, extensors, finger flexors and intrinsic in the left upper extremity. There was no muscle atrophy. He had 1+ reflexes to the biceps, triceps and brachioradialis bilaterally. His sensory examination showed diminished sensation but present to light touch at finger 4 and 5 bilaterally; and otherwise was normal light touch to the upper extremities. He had negative Tinel sings on the left and positive Phalen signs at the wrists. At the elbows he had positive Tinel signs bilaterally. The examiner noted that the nerves affected in the upper extremity were the median nerve on the left, mild in severity. It was noted the Veteran occasionally used a carpal tunnel splint on the left side. The VA examiner description of mild more nearly approximates a 10 percent rating, as mild in severity is consistent with mild incomplete paralysis. Further the examination showed grade 5 strength, and although some sensation was altered a 10 percent rating nevertheless considers some loss of functioning. The evidence more nearly approximates a rating for 10 percent for the Veteran’s peripheral neuropathy of the left upper extremity. VA examiners, in September 2015 and July 2017, both described the Veteran’s neuropathy as “mild.” This directly supports a 10 percent rating as the criteria identify mild incomplete paralysis. The clinical examinations of the VA examiners are also supportive of a 10 percent rating as they show some sensory loss consistent with a 10 percent rating, no atrophy, and motor function that more nearly approximates a 10 percent rating. The EMGs, in January 2010 and August 2016, showed mild neuropathy. There is evidence of sensory and reflex loss however that evidence more nearly approximates a 10 percent rating. At worst the reflexes were 1+. Other times, the reflexes were normal. At worst his strength was 5-/5, and other times it was 5/5, such as in July 2017. The evidence shows sensory loss, however not at a level that would support a higher rating. For example, in July 2017, it was noted as diminished but present in fingers 4 and 5, otherwise normal to light touch. Atrophy has also not been noted in the record. This evidence of multiple examiners opining of mild incomplete paralysis, EMGs showing mild neuropathy, at worst 5- strength, and diminished sensation more nearly approximates a rating of 10 percent. The Board thus finds that the level of impairment is most analogous to mild incomplete paralysis, which corresponds to a 10 percent rating. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 10 percent for peripheral neuropathy of the left upper extremity. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 4. A disability rating in excess of 10 percent, for peripheral neuropathy of the right upper extremity is denied. In a Notice of Disagreement received in February 2018, the Veteran requested the highest possible percentage evaluation for his peripheral neuropathy of the right upper extremity. The Veteran is currently rated at 10 percent for peripheral neuropathy of the right upper extremity under Diagnostic Code 8515. In December 2009, a VA neurologist examined the Veteran. The Veteran reported numbness and tingling in his upper extremities; and that his numbness and pain radiates from his shoulder to his hands, especially on the fingers. It was noted that his upper extremity strength is good, he had normal tone, his deep tendon reflex was 1+, sensory was negative, and F to N is normal. In January 2010, an EMG showed left mild median sensory neuropathy at the wrist, but no bilateral ulnar sensomotor, or radial sensory, neuropathy. In February 2010, the Veteran reported a history of radiation of pain to both arms. On examination it was noted he had decreased sensation to the left C 5, positive Hawkins signs, negative Neer signs, positive Jobes, negative O’Brien, negative liftoff and bearhug, and negative Hornblower. In June 2010, the Veteran reported pain in both wrists. In October 2010, the Veteran reported chronic bilateral arm pain. In May 2012, it was noted the Veteran did not have diabetic peripheral neuropathy. In September 2015, the VA examiner noted that the Veteran’s diagnoses included peripheral neuropathy. The Veteran reported numbness in both hands, and some pain in the upper arm. It was noted he had no constant pain in the right upper extremity, no intermittent pain in the right upper extremity, no paresthesias and/or dysesthesias in the right upper extremity, and no numbness in the right upper extremity. The Veteran had 5/5 strength in all of the areas tested in the right upper extremity. He had 1+ reflexes in his biceps, triceps, and brachioradialis areas of his right upper extremity. Light touch/monofilament testing of his right upper extremity was normal in the shoulder area, the inner/outer forearm and in the hand/finger of his right upper extremity. His position sense in the right upper extremity was normal. His vibration sensation of the right upper extremity was decreased. His cold sensation was normal in the right upper extremity. It was noted the Veteran did not have muscle atrophy. It was noted he did not have upper extremity diabetic peripheral neuropathy. It was noted that his radial nerve, median nerve, and ulnar nerve of the right upper extremity were normal, and the examiner did not indicate incomplete paralysis. In October 2015, a VA neurologist noted the Veteran had normal bulk, tone, and strength in the proximal and distal upper extremity muscles. The reflexes were normal in biceps, triceps, brachioradialis. The Tinel signs were negative at the wrists and elbows bilaterally. The sensory exam was normal for soft touch, temperature, vibration, pin prick, and proprioception in the upper extremity dermatomes bilaterally. An EMG in August 2016, showed no evidence of neuropathy in the right upper extremity. The Veteran had positive Tinel and Phalen signs bilaterally. In July 2017, the Veteran was afforded a VA examination. He was diagnosed with diabetic neuropathy. The Veteran reported his hands and arms hurt 90 percent of the time, he has numbness in fingers 3-5 bilaterally on an intermittent basis, that he drops a lot of things, and has weakness in his arms. Muscle strength testing showed grade 5- for right shoulder abductors and biceps with shoulder pain. Grade 5- for right wrist flexors and extensors with wrist pain. Grade 5 for triceps on the right. Grade 5 for finger flexors and intrinsics on the right. It was noted there was no muscle atrophy. It was noted he had 1+ reflexes to the biceps, triceps and brachioradialis bilaterally. His sensory examination showed diminished, but present, sensation to light touch at finger 4 and 5, bilaterally; and otherwise was normal light touch to the upper extremities. He had negative Tinel sings on the right and positive Phalen signs at the wrists. He had positive Tinel signs, at the wrists, bilaterally. The examiner opined it was possible the Veteran had bilateral ulnar neuropathy. The examiner noted that nerves effected of the upper extremity were the median nerve on the left, normal strength, mild in severity, and did not include any nerves affected on the right. This evidence more nearly approximates a rating for 10 percent for the Veteran’s peripheral neuropathy of the right upper extremity. The VA examiner in September 2015, did not indicate any paralysis of the right upper extremity. In July 2017, the VA examiner indicated that there was mild incomplete paralysis on both upper extremities. This directly supports a 10 percent rating. The clinical examinations of the VA examiners are also supportive of a 10 percent rating. The EMGs, in January 2010 and August 2016, showed no neuropathy. There is evidence of sensory and reflex loss, however that evidence more nearly approximates a 10 percent rating. At worst the reflexes were 1+. At worst his strength was 5-, and other times it was 5/5, such as in September 2015. The evidence shows sensory loss, however not at a level that would support a higher rating. For example, in July 2017 it was noted as diminished but present in fingers 4 and 5, otherwise normal to light touch. Atrophy has also not been noted in the record. This evidence of one examiner opining of mild incomplete paralysis, another examiner not noting any paralysis, EMGs showing no neuropathy, at worst 5- strength, and diminished sensation more nearly approximates a rating of 10 percent. The Board thus finds that the level of impairment is most analogous to mild incomplete paralysis, which corresponds to a 10 percent rating. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 10 percent for peripheral neuropathy of the right upper extremity. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 5. The claim of entitlement to a rating in excess of 50 percent for PTSD is remanded. VA’s duty to assist includes the conduct of a thorough and comprehensive medical examination. Robinette v. Brown, 8 Vet. App. 69, 76 (1995). This includes providing a new medical examination when a veteran asserts or provides evidence that a disability has worsened and the available evidence is too old for an adequate evaluation of the current condition. Weggenmann v. Brown, 5 Vet. App. 281, 284 (1993); see also Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (finding that VA should have ordered a contemporaneous examination of veteran because a 23-month old exam was too remote in time to adequately support the decision in an appeal for an increased rating). In the present case the Veteran has presented evidence that his PTSD may have worsened. The Veteran was afforded a VA examination in June 2015. At that time, the Veteran denied suicidal ideation. However, records after that date suggest the Veteran experiences suicidal ideation. For example, in March 2018, the Veteran reported he had thoughts about taking his own life once a week. In April 2017, a vocational rehabilitation counselor noted that the Veteran had exhibited consistent and worsening symptoms and limitations related to his service-connected PTSD. The most recent VA examination was approximately four years ago, and since then there is evidence of worsening including suicidal ideation, and an opinion that the Veteran’s symptoms have worsened. This warrants an updated VA examination. Accordingly, a more contemporaneous VA examination is required to provide a current picture of the Veteran’s service-connected disabilities, at issue on appeal. 38 C.F.R. §§ 3.326, 3.327; see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). 6. The claim of entitlement to a TDIU is remanded. The issue of the Veteran’s entitlement to a TDIU is inextricably intertwined with the resolution of the remanded PTSD issue. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to defer the claim on appeal pending the adjudication of the inextricably intertwined claim. See Harris v. Derwinski, 1 Vet. App. 180 (1991). Accordingly, the TDIU issue is remanded for readjudication following evidentiary development. The matters are REMANDED for the following action: 1. Ask the Veteran to identify, and provide appropriate releases for, any care providers who may possess new or additional evidence pertinent to the issue on appeal. If he provides the necessary release(s), assist him in obtaining the records identified, following the procedures set forth in 38 C.F.R. § 3.159. Any new or additional (i.e., non-duplicative) evidence received should be associated with the record. If any of the records sought are not available, the record should be annotated to reflect that fact, and the Veteran and his representative should be notified. 2. Obtain copies of records pertaining to any relevant VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 3. After completing the foregoing development to the extent possible, arrange to have the Veteran scheduled for a VA mental disorders examination to assess the current severity of his PTSD. The examiner should provide a full description of the Veteran’s associated functional impairments as they relate to the relevant rating criteria. 4. Consider whether the Veteran is entitled to a TDIU. APRIL MADDOX Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Smith, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.