Citation Nr: 20032011 Decision Date: 05/06/20 Archive Date: 05/06/20 DOCKET NO. 16-41 536 DATE: May 6, 2020 REMANDED Entitlement to a rating higher than 10 percent for service-connected traumatic brain injury (TBI) is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1992 to March 1996, October 1998 to June 1999, and from August 1999 to July 2009, with an additional 3 years of Reserve service. This matter comes before the Board of Veteran’s Appeals (Board) from a March 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In the February 2020 appellate brief, the representative argued that a new examination should be provided, given that the Veteran was last examined in February 2015 and that the examination was inadequate (per the Veteran’s contention, the method of the examination seemed questionable as the examiner did not seem to take into consideration the symptoms that he reported as related to the accident he incurred in Iraq/related to his current TBI and he claims that he continues to experience various symptoms). However, the Board points out that the Veteran was, in fact, last examined in February 2017. That examination report is not, however, entirely adequate for rating the Veteran’s condition. The Board is not stating the doctor who conducted that examination was not competent, but there are certain requirements for a TBI examiner. The 2017 examiner identified his specialty as family medicine. While initial diagnosis of TBI must be provided by a physiatrist, psychiatrist, neurologist, or neurosurgeon, review examinations can be conducted by other clinicians who have successfully completed the Disability Examination Management Office TBI training module. See page 1 of the TBI DBQ from 2017, which follows the guidance set forth in VA's Adjudication Procedures Manual at M21-1, III.iv.3.D.2.j. It is not known whether the 2017 examiner had completed such training, but he was unable to provide one of the opinions asked in the DBQ. See page 7 of the TBI DBQ from 2017. Here, it is important, if medically possible, to separate the Veteran’s symptoms and impairment from his TBI from his co-existing posttraumatic stress disorder and persistent depressive disorder, which is separately evaluated as 70 percent disabling. Although neither the Veteran nor his VSO has explicitly raised worsening of his TBI symptoms since the last examination, it has been more than three years since the examination was conducted and it is not known whether that examination was performed by the correct specialist. Therefore, in the circumstances of this case, the Board finds a new examination is necessary to determine the current severity of his TBI symptoms. The matter is REMANDED for the following action: 1. Obtain VA treatment records from April 2020 to present. 2. Schedule the Veteran for a VA TBI examination with a neurologist, psychiatrist, physiatrist, or neurosurgeon, or with a clinician who is certified by C&P to perform TBI examinations. If the examination is with such a certified clinician, that individual must indicate in the report that he/she is so certified to conduct TBI evaluations. The examiner should provide an opinion, to the extent possible, which emotional/behavioral signs and symptoms are part of the co-existing mental health disorder (posttraumatic stress disorder and persistent depressive disorder) and which represent residuals of TBI. If it is impossible to make such a determination without speculation, please state so. The examiner should also, to the extent possible, review the 2015 and 2017 VA examination reports and provide a retrospective opinion as to which emotional/behavioral signs and symptoms shown at the time of those examinations were part of the co-existing mental health disorder (posttraumatic stress disorder and persistent depressive disorder) and which represented residuals of TBI. If it is impossible to make such a determination without speculation, please state so. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Lee 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.