Citation Nr: 20009723 Decision Date: 02/05/20 Archive Date: 02/05/20 DOCKET NO. 12-33 922A DATE: February 5, 2020 REMANDED The issue of entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depression, is remanded. The issue of entitlement to service connection for a total disability rating based on individual unemployability (TDIU) is remanded. The issue of entitlement to service connection for an ear condition, to include as secondary to service-connected pilonidal cyst with sinus opening and perirectal fistula, is remanded. The issue of entitlement to service connection for a low back condition, to include as secondary to a service-connected bilateral ankle sprain, left knee sprain, right leg peripheral neuropathy, and right anterior tibial area muscle hernia, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1972 to October 1974. These matters come to the Board of Veteran's Appeals (Board) on appeal from April 2011 and March 2013 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. The appeal was previously before the Board in November 2015 and August 2017 and was remanded for further development. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder and depression; entitlement to service connection for an ear condition, to include as secondary to service-connected pilonidal cyst with sinus opening and perirectal fistula; and entitlement to service connection for a low back condition, to include as secondary to a service-connected bilateral ankle sprain, left knee sprain, right leg peripheral neuropathy, and right anterior tibial area muscle hernia; is remanded. Pursuant to the Board's prior remand, the Veteran was scheduled for VA examinations in August 2018. However, the record shows that the Veteran did not report, and the examinations were cancelled. The Veteran explained in October 2019 correspondence that he missed the examinations due to a "several deaths in his family" and requested new examinations. Having shown good cause for his failure to appear for the examinations, the Board finds that remand is warranted to provide the Veteran with VA examinations to address his acquired psychiatric disorder, ear condition, and low back condition. The Veteran is advised to cooperate in the development of his claim, and that it is his responsibility to report for any scheduled examination. He is further advised that the future consequences of failure to report for any scheduled VA examination without good cause may include denial of his claim. 38 C.F.R. §§ 3.158, 3.655. Entitlement to service connection for a TDIU is remanded. As the decision on the service connection claims remanded herein will impact the decision on the TDIU claim, they are inextricably intertwined. Therefore, the TDIU claim must also be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a claim is inextricably intertwined with another claim, the claims must be adjudicated together in order to enter a final decision on the matter). The matters are REMANDED for the following action: 1. Request that the Veteran provide or authorize VA to obtain records of his relevant treatment that have not yet been associated with the claims file, and associate with the claims file any outstanding VA treatment records. 2. Schedule the Veteran for a VA psychiatric examination to determine the nature, etiology, and date of onset of any diagnosed acquired psychiatric disorder. If the Veteran fails to report for the examination, please provide an opinion based on file review. The claims file should be made available to the examiner and review of the file should be noted in the requested report. The examiner is to answer the following questions: (a.) Please identify all current psychiatric disorders. (b.) For each diagnosed psychiatric disorder, is it at least as likely as not (50 percent probability or more) that it had its onset in service, or within one year of his separation from service, is related to the Veteran's reported in-service stressors, or is otherwise related to service? Please explain why or why not. The examiner is asked to specifically address the Veteran’s contention that he has an acquired psychiatric disorder related to the following in-service incidents: (1) a June 1973 motor vehicle accident in which he witnessed the injury of a fellow soldier who blamed him and threatened him regarding the injury; (2) an October 1973 incident in which he was physically attacked by a Supply Sargent because he had a profile for his right leg and the Supply Sargent was attempting to make him perform guard duty even though his profile said he was not supposed to; (3) a January 1974 incident in which he was injured when he was blown off of a howitzer gun; (4) a March 1973 incident in which he witnessed/was involved in a bar fight in which a German citizen might have been killed. (c.) If the criteria for a diagnosis of PTSD are met, please specify the stressors supporting the diagnosis. (d.) In formulating the requested opinions, please specifically acknowledge and discuss the psychiatric diagnoses of record, including PTSD and depression. Please also acknowledge and discuss the May 2014 correspondence from a VA clinician stating that the Veteran has PTSD due to non-combat traumatic events that occurred during the course of his military service. (e.) In determining whether the Veteran meets the criteria for a current psychiatric diagnosis, please consider medical and lay evidence dated both prior to and since the filing of the July 2010 claim for service connection. Please note that although the Veteran may not meet the criteria for a psychiatric diagnosis at the present time, diagnoses made prior to and since the date of claim filing meet the criteria for a "current" diagnosis. Please also note that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions. 3. Return the file to the July 2012 VA examiner for an addendum opinion regarding the claimed ear condition. If that examiner is unavailable, the opinion should be provided by another examiner. If a clinical evaluation is deemed necessary to answer the questions presented, one should be scheduled. If the Veteran fails to report for the examination, please provide an opinion based on file review. The claims file, and a copy of the remand, must be reviewed by the examiner. Following review of the file, and the remand, the examiner is to address the following: (a.) Is it at least as likely as not (50 percent probability or more) that the claimed ear condition it had its onset in service, or within one year of his separation from service, or is otherwise related to service? Please explain why or why not. The examiner is asked to specifically address the Veteran’s contention that he has had chronic ear infections since service. (b.) Is it at least as likely as not that the ear condition has been permanently worsened beyond normal progression (as opposed to temporary exacerbations of symptoms) by his service-connected pilonidal cyst with sinus opening and perirectal fistula? Please explain why or why not. (c.) If the examiner finds that the ear condition has been permanently worsened beyond normal progression (aggravated) by his service-connected pilonidal cyst with sinus opening and perirectal fistula, the examiner should attempt to quantify the degree of aggravation beyond the baseline level that is attributed to the pilonidal cyst with sinus opening and perirectal fistula. 4. Return the file to the July 2012 VA examiner for an addendum opinion regarding the claimed low back condition. If that examiner is unavailable, the opinion should be provided by another examiner. If a clinical evaluation is deemed necessary to answer the questions presented, one should be scheduled. If the Veteran fails to report for the examination, please provide an opinion based on file review. The claims file, and a copy of the remand, must be reviewed by the examiner. Following review of the file, and the remand, the examiner is to address the following: (a.) Is it at least as likely as not that the low back condition has been worsened beyond normal progression by his service-connected bilateral ankle sprain, left knee sprain, right leg peripheral neuropathy, and/or right anterior tibial area muscle hernia? Please explain why or why not. The examiner is asked to specifically address the Veteran’s contention that a VA physician told him that the leg injury resulted in his back problem. (b.) If the examiner finds that the low back condition has been worsened beyond normal progression (aggravated) by his service-connected bilateral ankle sprain, left knee sprain, right leg peripheral neuropathy, and/or right anterior tibial area muscle hernia, the examiner should attempt to quantify the degree of aggravation beyond the baseline level that is attributed to bilateral ankle sprain, left knee sprain, right leg peripheral neuropathy, and/or right anterior tibial area muscle hernia. All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. S.C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Smith-Jennings, 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.