Citation Nr: 20023932 Decision Date: 04/07/20 Archive Date: 04/07/20 DOCKET NO. 19-16 607 DATE: April 7, 2020 REMANDED Entitlement to an initial disability rating in excess of 70 percent for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) and major depressive disorder, is remanded. Entitlement to an initial disability rating in excess of 10 percent for primary open-angle glaucoma is remanded. Entitlement to service connection for obstructive sleep apnea is remanded. Entitlement to service connection for diabetes mellitus, type II, is remanded. Entitlement to service connection for a thyroid disability is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1995 to March 2007. During his period of service, he earned the Army Commendation Medal (4th Award), Army Achievement Medal (6th Award), Army Good Conduct Medal (4th Award), National Defense Service Medal (2nd Award), Global War on Terrorism Expeditionary Medal, Global War on Terrorism Service Medal, Kosovo Campaign Medal, Korea Defense Service Medal, Iraq Campaign Medal, Noncommissioned Officer Professional Development Ribbon (2nd Award), Army Service Ribbon, Overseas Service Ribbon (4th Award), NATO Medal, Combat Action Badge, Driver and Mechanic with Driver – Wheeled Vehicle(s) Clasp, and Air Assault Badge. 1. Entitlement to a higher rating for PTSD Here, additional VA-obtained evidence that has not been considered by the Agency of Original Jurisdiction (AOJ), to include the Veteran’s most recent treatment records, has been added to the claims file following certification of this appeal to the Board. See March 2020 CAPRI. Specifically, November 2019 treatment notes indicate that the Veteran’s symptoms have worsened, to include in-patient treatment for PTSD symptoms. Id. Because the evidence of record not only shows that the Veteran’s symptoms have worsened, the Board finds that a remand is necessary to obtain a new VA examination to determine the current severity of the Veteran’s acquired psychiatric disability, to include PTSD and major depressive disorder. Snuffer v. Gober, 10 Vet. App. 400 (1997) (noting that a veteran is entitled to a new VA examination where there is evidence that the condition has worsened since the last examination); Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (determining that Board should have ordered 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). Moreover, the Veteran has not submitted a waiver of the AOJ’s consideration of the pertinent VA treatment records added to the file since the issuance of the SOC. See 38 U.S.C. § 7105(e)(1); 38 C.F.R. § 20.1304(c); Disabled Am. Veterans v. Sec’y of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). These records may not, therefore, be considered by the Board and such action would be prejudicial to the Veteran’s claim. However, as the issue is being remanded for VA examination, the AOJ will have the opportunity to readjudicate these issue in light of the new evidence.   2. Entitlement to a higher rating for primary open-angle glaucoma The Veteran is seeking a higher evaluation for his service-connected primary open-angle glaucoma. The Veteran last underwent a VA examination for his service-connected bilateral eye disability in October 2012. The Board notes that a private eye conditions disability benefits questionnaire was also associated with the Veteran’s claims file in April 2015. Considering it has been more than five years since his last VA eye examination, the Board finds that the medical evidence is not sufficient upon which to decide the higher evaluation claim. As such, a remand is warranted for a new VA eye examination to ensure that the record contains evidence showing the current severity of the Veteran’s service- primary open-angle glaucoma. Green v. Derwinski, 1 Vet. App. 121 (1991); Caffrey v. Brown, 6 Vet. App. 377 (1994); 38 C.F.R. § 3.326(a) (2019). 3. Entitlement to service connection for obstructive sleep apnea The Veteran most recently appeared for a VA sleep apnea examination in April 2019. The examiner opined that it was less likely than not that the Veteran’s sleep apnea was incurred in service. In support of the opinion, the examiner explained that the Veteran’s sleep complaints were inconsistent and associated with sinusitis, upper respiratory complaints, and primary insomnia. Therefore, after review of the available medical records, the examiner determined that the Veteran did not have a diagnosis of sleep apnea that was incurred in or caused by the documented sleep disorders treated on during service. Unfortunately, the Board finds that the April 2019 VA examination is inadequate for adjudication purposes, as the examiner failed to provide sufficient rationale to support the opinion. Moreover, clarification is warranted as to whether the Veteran’s sleep apnea is secondary to his service-connected allergic rhinitis. The Board acknowledges that once VA undertakes the effort to provide an examination or opinion when developing a service connection claim, an adequate examination or opinion must be provided. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As such, a remand is required to obtain new opinions on direct and secondary causation. 4. Entitlement to service connection for diabetes mellitus, type II 5. Entitlement to service connection for a thyroid disability Private thyroid and parathyroid conditions and diabetes mellitus DBQs were associated with the Veteran’s claims file in April 2015, at which time hypothyroidism and diabetes mellitus, type II, was diagnosed. However, this examiner unfortunately failed to provide nexus opinions as to the etiology for the Veteran’s diagnosed disabilities. To date, no VA medical opinion has been obtained regarding the Veteran’s diabetes mellitus or thyroid disabilities. As such, the Board finds that the Veteran should be afforded VA examinations to address the nature and etiology of his current diabetes mellitus and thyroid disabilities. McLendon v. Nicholson, 20 Vet. App. 79 (2006). 6. Entitlement to a TDIU Finally, the Veteran’s claim of entitlement to a TDIU is inextricably intertwined with the issues addressed above and will be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that issues are inextricably intertwined and must be considered together when a decision concerning one could have a significant impact on the other). The matters are REMANDED for the following action: 1. Schedule the Veteran for VA examinations with the appropriate examiners to determine the current nature and severity of his service-connected acquired psychiatric disability and primary open-angle glaucoma. The claims folder must be made available to the examiners for review in connection with the examinations. The examination reports must reflect that such a review was conducted. Any and all studies, tests, and evaluations deemed necessary by the examiners should be performed. (a.) With regard to the acquired psychiatric disability claim, the examiner should identify any symptoms that the Veteran currently manifests or has manifested that are attributable to his service-connected acquired psychiatric disability. S/he must also distinguish, to the extent possible, between psychiatric symptoms attributable to the Veteran’s service-connected acquired psychiatric disability and those attributable to nonservice-connected disorder(s). (b.) With regard to the bilateral glaucoma claim, the examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s primary open-angle glaucoma. The examiner should consider all applicable rating criteria (including the versions effective prior to and since May 13, 2018) in light of all pertinent diagnoses rendered at the examination, to include information regarding incapacitating episodes. 2. Schedule the Veteran for VA examinations with the appropriate examiner(s) to determine the nature and etiology of his current obstructive sleep apnea, diabetes mellitus, and thyroid disabilities. The examiner(s) must review pertinent documents in the Veteran’s claims file in conjunction with the examinations. This must be noted in the examination reports. (a.) With regard to the sleep apnea claim, the examiner must state whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s sleep apnea (i) had its onset in service or is otherwise etiologically related to active service, (ii) is caused by his service-connected allergic rhinitis; and (iii) was aggravated (i.e., permanently worsened beyond the natural progression) by his service-connected allergic rhinitis. (b.) With regard to the diabetes mellitus, type II, claim, the examiner must state whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s diabetes mellitus, type II, had its onset in service or is otherwise etiologically related to active service, to include service in Southwest Asia. (c.) With regard to the thyroid disability claim, the examiner must state whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s thyroid disability had its onset in service or is otherwise etiologically related to active service, to include service in Southwest Asia. Rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. Issue an SSOC for the issue of entitlement to an initial disability rating in excess of 70 percent for an acquired psychiatric disability, to include PTSD and major depressive disorder, to include consideration of medical evidence received since the May 2019 SOC. 4. After completing the above actions and any other necessary development, the inextricably intertwined issue of the Veteran’s entitlement to TDIU also must be adjudicated. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Joseph, 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.