Citation Nr: 20037520 Decision Date: 06/02/20 Archive Date: 06/02/20 DOCKET NO. 18-22 661 DATE: June 2, 2020 REMANDED The issue of entitlement to an initial disability rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is remanded. The issue of entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1966 to June 1969, during the Vietnam Era. This matter comes before the Board of Veteran’s Appeals (Board) on appeal of a November 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office. In June 2019, the Board remanded this matter for further development; namely, to afford the Veteran another VA examination. 1. The issue of entitlement to an initial disability rating in excess of 30 percent for PTSD is remanded. As noted above, in June 2019 the Board remanded this matter, in pertinent part, to afford the Veteran another VA examination with respect to this claim. Pursuant to the remand directives, he underwent an examination in December 2019. A review of the December 2019 PTSD VA Examination Report discloses it is not substantially compliant with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Specifically, in the June 2019 decision, the Board indicated the VA examiner must address “any conflicting medical evidence of record as well as: the onset of memory problems several years before being taken out of the workforce; the Veteran’s report that his supervisor was instrumental in his keeping his job as long as he did; his difficulty doing the testing during the 2015 neuropsychological evaluation; his reliance upon his wife for reporting history and giving perspective of symptoms; and the occurrence of extreme rage that lasts for a week or more at a time.” However, the VA examiner did not fully address the pertinent evidence of record identified by the Board. This was due in part to the VA examiner’s inability to fully evaluate his complaint of memory problems and indicated a referral to a neurologist for evaluation was warranted in this regard because it was out of their own clinical scope. See Jones v. Shinseki, 23 Vet. App. 382, 389-90 (2010). For this reason, a remand is necessary for a neurological VA examination and addendum medical opinion. 2. The issue of entitlement to TDIU is remanded. This claim is inextricably intertwined with the above remanded claim for an increased initial disability rating for PTSD as the adjudication of that claim will impact the Board’s assessment of the occupational impairment resulting therefrom. See Harris v. Derwinski, 1 Vet. App. 180 (1991). As such, a remand of this claim is also appropriate for further development, if necessary. The matters are REMANDED for the following action: 1. Schedule the Veteran for a neurological examination with an appropriate medical professional to determine the current nature and etiology of his cognitive impairment(s), if any. After reviewing the record, the examiner should: (a.) Determine whether the Veteran has any cognitive impairments. (b.) If so, the examiner should opine as to whether it is at least as likely as not (50 percent probability or greater) the Veteran’s cognitive impairment(s) is caused by or otherwise related to his service-connected PTSD and explain why. (c.) If the Veteran’s cognitive impairment(s) is caused by or is otherwise related to his service-connected PTSD, the examiner should assess its current severity. (d.) In rendering an opinion, the examiner should consider the relevant medical evidence of record, to include an August 2015 H.P.G. Neuropsychological Evaluation documenting an impression of “[o]rganic [b]rain [i]mpairment or [e]arly [d]ementia are [r]uled-[o]ut” and some mild cognitive “inefficiency”. (e.) In rendering an opinion, the examiner should consider the Veteran’s relevant lay statements of record. 2. Then, to the extent possible, obtain an addendum medical opinion from an appropriate medical professional regarding the current nature and severity of the Veteran’s PTSD. After reviewing the record, the examiner should: (a.) Discuss the current nature and severity of the Veteran’s PTSD in light of the neurological VA examination evaluating his cognitive impairment(s). (b.) Provide a retrospective opinion discussing the historical severity of the Veteran’s PTSD symptomatology prior to the most recent December 2019 examination. If his PTSD symptomatology underwent any change in severity at any time prior to the December 2019 examination, the examiner should identify when this change occurred and assess the severity of his PTSD during the relevant time period. In doing so, the examiner should discuss the Veteran’s report of the onset of memory problems several years before being taken out of the workforce; that his supervisor was instrumental in his keeping his job as a long as he did; difficulty during the August 2015 neuropsychological evaluation; reliance upon his wife for reporting history and providing perspective regarding his symptoms; and the occurrence of extreme rage that lasted for a week or more at a time. 3. After undertaking any additional development deemed appropriate and giving the Veteran a full opportunity to supplement the record, readjudicate the claims in light of any additional evidence associated with the claims file. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Suh, 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.